Dr. Lynette Weeman (Guest): Thanks, Melanie. I think that heart disease in women and the risk factors both for women and men are very similar but one of the things that has happened over time is that women don’t have the same degree of exposure to research and don’t have the same knowledge base. A lot of people, just like you alluded to, have thought over the years that breast cancer was the number one cause of death in women. I think that’s largely due to advertising and to just exposure. Now, we realize that heart disease is not only the number one but a lot more people die of heart disease than they do the next three causes of death combined. It’s a huge deal and there are a lot of things that we can do to reduce the risk. As you said, one of the things is knowing the risk factors. I think the big things are certainly age but also a history of high cholesterol, high blood pressure, diabetes and being overweight or obese and, certainly, smoking.
Melanie: If women have these risk factors, how do they know if they have heart disease? Would there be some symptoms, some red flags? We’re not talking about a heart attack – just heart disease. What would they know?
Dr. Weeman: That’s a good question. The one thing about being a woman is that we do have a fair amount of exposure to the healthcare system just because we start at an early age to see physicians for general female health. I think we should optimize that opportunity and get your blood pressure checked with your doctor, have your weight and height checked, have things like a cholesterol screening to know your risks for heart disease. I think the other thing is also to be aware of your family history and understand if that’s something that is significant. Although you can’t change it, you can certainly be aware and more able to understand if that applies to you or not.
Melanie: If you do have some risk factors, some symptoms, then what do you do about it? What is your first line of defense if you determine that a woman has some sort of heart disease?
Dr. Weeman: I think the first line of defense is starting with the primary care provider and having a discussion with them about your symptoms and also about the risks. They are our first line of defense when it comes to heart problems. I think that one of the issues is that women often ignore their problems, perhaps longer than men. I think that if there are symptoms that are concerning, even if they sound like they might be a bit different, it’s really important to share those with your primary care provider and let them help you understand if it’s something to be concerned about.
Melanie: That’s certainly true. Women we tend to put ourselves last even though we’re the caregivers for society. So, it’s so important that we put our own masks on before we help those others of us. Speak about, for women, what you do for them that could help them if they do have some issue. Is medication what you look to? Are their treatments that you would like them to do? Exercise? Where does diet fit in?
Dr. Weeman: These are good questions. I’ll try to attack some of them. The first thing that I do is try to understand what kind of symptoms a woman is having and it is also helpful to know that women can present differently from men. A lot of our cardiovascular experience comes from looking at men in large groups and the women were less likely to be tested, partly because it’s just easier not to enroll women because they become pregnant and that becomes a complicated problem when you are talking about research and looking at their risks for being in a study. I think also, now that we have started to do more research on women, we are starting to find out that there are differences. Although the most common symptom that you will have when you are having a heart attack for a partially blocked artery is chest pain. Women are less likely to potentially have that. About 25-30% of women might present with shortness of breath. One of the things that I have to do is try to elicit “are these symptoms something that is concerning”. One of the things that I talk to women about is not just what they have for symptoms but when they happen. Often, heart disease symptoms don’t bother you when you are just sitting at rest but if you try to exert yourself or if you are under a lot of mental stress, that’s when they can come on and that’s helpful to understand those triggers. The next thing we would do, if a woman is having symptoms is start think about doing some tests to understand if they have significant cardiovascular disease. One of the first tests is doing some sort of stress test to see if we can elicit the symptoms and find out if significant cardiovascular disease is present. Once we’ve identified that, we can then explore talking about medications or other treatments and therapies.
Melanie: One of the difficult things for women, Dr. Weeman, is that so many of these symptoms you are discussing mimic other things: stress, anxiety, exhaustion, menopause. I mean, all these different things can have so many of these symptoms. How do we know when we take those symptoms seriously?
Dr. Weeman: I think that’s a very good point. It’s very difficult, sometimes, to know. One of the things I tell patients is that, again, if they happen consistently each time you are under stress or consistently each time you’re putting your body under physical stress, which just might be just doing the laundry or vacuuming or walking across the parking lot. If something starts to happen, you stop and it goes away – that’s something you need to get checked out. Opposed to that is, if you have five seconds of discomfort while you’re sitting at your computer and it doesn’t come back or it’s a sharp pain that is only there for seconds and it’s gone,, it’s much less likely to be coming from your heart. I often say that these are the kinds of things that you can bring up to your primary care provider and should, without hesitation. It’s our job to help you understand if it’s something to be concerned about or something that possibly you can just ignore. I also think if the symptoms don’t go away, that’s when it’s time to take action. A lot of women, and one of the major initiatives that has come up before the large cardiovascular societies recently, is how do we get people to come to the hospital sooner when they are having symptoms of a heart attack? Women tend to wait a little bit longer although they do often tend to call 9-1-1. I think we really need to emphasize that if a symptom is persistent, it’s not going away, then you really need to go ahead and call 9-1-1 and activate emergency services.
Melanie: Absolutely. Where do you see diet fitting in for women because, again, we’re so busy, we do so many things but healthy eating plays such a role? Tell us what you want women to do and your best advice about diet for heart disease prevention.
Dr. Weeman: I think diet for heart disease prevention has been a moving target. Probably everyone remembers that years ago, they said don’t eat any fat because that was bad for you. Then, there was the idea that you shouldn’t eat any meat. There is a lot of conflicting data out there. The one thing I find that is very consistent is that adding at least 5-6 servings of fruits and vegetables to your diet each day is a good goal and a very health-oriented goal that’s going to help you in the long run. I think we all know what foods are not so good for us and trying to avoid those or have those in moderation is definitely a way to go. I also try to help people on a daily basis, if you’re overweight or obese, trying to work towards decreasing portion sizes and starting to move more because both of those things ,no matter now simple they are, have to be daily tasks and they are something that can certainly reduce your cardiovascular risk over time.
Melanie: Thank you so much and it’s such great information. In just the last minute here, why should patients come to Maine Medical Center for their care?
Dr. Weeman: I think patients should come to Maine Medical Center for their care because they are number one in treating cardiovascular disease in the area of New England. They have a lot of experience. It’s good to go to a hospital where the kind of disease that you’re working through is seen all the time.
Melanie: That’s great. Thank you so much for being with us. You’re listening to MMC Radio and for more information you can go to MaineMedicalCenter.org. That’s MMC.org. This is Melanie Cole. Thanks so much for listening.