Ask the expert: Dr. Saltzman on women’s heart disease

Did you know that women have unique and specific risk factors for heart disease?  Or that approximately 44% of women in the U.S. are currently living with some form of heart disease?

Heart disease is the leading cause of death for both women and men in the U.S., claiming roughly one in five female lives each year.  Despite its prevalence, many women remain unaware of the seriousness of this often silent condition.  Research shows only about half of U.S. women recognize heart disease as their biggest health threat.

We chatted with Dr. Leslie Saltzman, chief medical officer at Ovia Health, a Labcorp company. Dr. Saltzman is a board-certified internal medicine physician with extensive experience in women's health. She began her career by founding a primary care practice exclusively for women that combined internal medicine, gynecology, psychology and nutrition.

What are the unique risk factors for women?

High cholesterol, high blood pressure, diabetes, smoking and obesity are some of the risk factors you typically hear about for heart disease. “Yet there are some unique risk factors specific to women that may play an important role in the development of heart disease,” says Dr. Leslie Saltzman.

They include:

• Preeclampsia and pregnancy-associated hypertension (high blood pressure)
• Gestational diabetes, a type of diabetes that develops during pregnancy
• Polycystic ovary syndrome, which can cause hormonal imbalances and irregular periods
• Menopause, particularly those with premature menopause (before age 40) or those with severe, untreated night sweats and hot flashes

For example, a preeclampsia diagnosis during or after pregnancy makes a woman 75% more likely to die of cardiovascular disease, according to Dr. Saltzman. In addition, about 50% of women with gestational diabetes go on to develop Type 2 diabetes.

Top heart problems in women

Coronary artery disease, the most common form of heart disease, is caused by the buildup of plaque in the walls of the arteries that supply blood to your heart. Should a coronary artery become completely blocked, a heart attack will occur, leading to a life-threatening situation in which your heart can’t get enough oxygen.

Other types of heart disease include arrhythmia—which includes atrial fibrillation—and heart failure. Arrhythmia occurs when your heart beats too fast, too slow or at an irregular pace, while heart failure is when your heart becomes weakened to the point where it can’t pump enough blood to meet your body’s needs, leading to fatigue, shortness of breath and other symptoms.

Did you know: Women are at a higher risk of coronary artery disease following menopause because of hormonal changes? This is primarily due to a decline in estrogen, a hormone found to have a protective effect on the coronary arteries. Accordingly, women who experience menopause before age 40 are particularly at risk for coronary artery disease.

Misconceptions about women’s heart health

“Even though heart disease is the number one killer of both women and men, there is a general idea that heart disease predominantly affects men,” says Dr. Saltzman. “Women are often more concerned with screening for breast cancer, even though they are much more likely to die from heart disease.”

In addition, Dr. Saltzman finds there is a lack of understanding about the broader group of disorders that fall under the umbrella of atherosclerotic cardiovascular disease. They include:

• Heart disease – A disease of the blood vessels supplying the heart muscles
• Cerebrovascular disease – A disease of the blood vessels supplying the brain, which causes strokes
• Peripheral arterial disease – A disease of the blood vessels supplying the arms and legs

What can you do to protect your heart?

Perhaps the single most important thing you can do for your heart is to quit smoking, according to Dr. Saltzman. That’s because women who smoke are more likely to develop heart disease than men who smoke.

There are also dietary changes you can make to help regulate cholesterol levels and blood pressure. Such dietary changes can include eating more heart-healthy foods like fruits, vegetables, beans and nuts. Plus, you can incorporate healthy lifestyle habits, such as getting regular exercise and adequate sleep, minimizing  alcohol consumption and doing stress-lowering activities like meditation or journaling. 

Finally, don’t forget about annual checkups. “See your primary care doctor regularly so that you can have your blood pressure checked and discuss screening for other risk factors,” says Dr. Saltzman.

The importance of testing in heart disease

“Everyone should be getting periodic screening in terms of a fasting lipid panel,” says Dr. Saltzman. “High LDL cholesterol and high triglycerides are both risk factors for cardiovascular disease. In addition, it’s important to screen for diabetes. Your doctor can then calculate your risk score which determines the need for treatment and possibly the need for other test such as a coronary calcium score.”

The Labcorp OnDemand Heart Health Test includes the lipid panel that Dr. Saltzman mentions. It looks at LDL cholesterol (“bad cholesterol”), HDL cholesterol (“good cholesterol”) and triglycerides, and it includes an inflammation test. The inflammation test measures your level of C-reactive protein (hs-CRP), which is made by the liver in response to inflammation and can be elevated in those with heart disease.

How can you self-advocate with your healthcare provider?

“It is really helpful when patients come prepared for a visit,” says Dr. Saltzman. This can include notes about your family history of heart disease—including any parent who had a heart attack or stroke and at what age—and previous lab results, including lipid panels.

For women, Dr. Saltzman also recommends bringing up these additional details:

• The age you were when you had your first period
• The age you were when you entered menopause
• Any history of infertility or polycystic ovary syndrome
• Any history of pregnancy complications, including:
  • Hypertensive disorders during pregnancy
  • Gestational diabetes
  • Preterm delivery
  • Intrauterine growth restriction

These sex-specific factors impact your risk of developing heart disease and are key details to be shared and discussed with your healthcare provider. So don’t be shy; a major component of self-advocacy is making sure that any risk factors you have are on the table and part of your health record.