Heart conditions can present themselves in unique ways
Heart disease is the leading cause of death for women, despite the perception that it is primarily a men’s disease.
In a Community Conversation on March 31, Atlantic Medical Group cardiologists Colleen Coughlin, MD, and Claire Boccia, MD, discussed how women can reduce their risk of heart disease and how Atlantic Health System helps patients of all ages protect their heart health.
What is unique about Atlantic Health System’s heart health program for women?
“We really are trying to serve women’s heart health needs throughout their lifetime,” said Dr. Boccia.
Atlantic Health System's nationally-recognized cardiology program tailors prevention and treatment of heart disease to the needs of women of all ages – from their youngest patient at 18 to their oldest at 102.
“Our program was created almost 10 years ago to fill a void in how clinicians approach cardiology for women,” Dr. Coughlin said.
It focuses on aspects of heart health that are unique to women, such as heart conditions that affect pregnancy and the ways coronary artery disease impacts men and women differently. The intersection of different hormones, autoimmune diseases and heart conditions impact women in unique ways that require a gender-focused approach to care.
What role does age play in heart health for women?
“Women are a diverse group and the Women’s Heart program is attuned to the needs of individuals at any stage of life,” Dr. Boccia said. For example, some women have irregular heart rhythms, a condition that is more likely to occur during pregnancy or menopause.
Heart failure in women over the age of 65 is often attributed to diastolic heart failure, or a stiff heart that has a hard time relaxing. It is a particularly challenging type of heart failure to treat and requires cardiologists with experience in women’s health.
Are there typical signs women exhibit when suffering from a heart attack? Are they different from men?
Dr. Boccia said there are no gender-specific indicators of a heart attack, although women may exhibit some signs more frequently or more intensely than men. Symptoms may include chest pressure, jaw pain, nausea, pain between the shoulder blades, sweating and, for older women, generalized fatigue that is out of proportion to the daily activities that that older individual is accustomed to.
To what extent is heart health determined by genetic factors?
Some aspects of heart health can be controlled by behaviors: eating healthy, exercising, maintaining a healthy weight and not smoking.
Despite these healthy habits, there are factors that are not determined by behavior, Dr. Coughlin said.
A coronary calcium score can be used to build an individualized risk assessment and tailor a prevention strategy for each patient. For example, if a woman had a preeclamptic pregnancy or has gestational diabetes, an individualized health plan would help them to reduce her risk of heart disease.
How important is it for women to discuss genetic factors that would impact heart health with their children?
A proactive approach to heart health empowers young people to develop healthy habits early in life, Dr. Boccia said.
“We think of coronary artery disease or heart attacks as happening to older people, but it’s actually a slow-growing process, and a culmination of our lifestyle that starts in our teens. It’s a pediatric issue, not an elderly issue,” Dr. Boccia explained.
She said that mothers can lead by example and introduce a healthy diet full of vegetables and fruits. Dr. Boccia urged people to avoid simple sugars and trans fats.
Dr. Coughlin added that people have control of many risk factors. “If you live a healthy lifestyle, maintain a healthy weight, don’t smoke, are active, and eat well – you reduce your risk of coronary artery disease by 50%.”
Conversely, she said, patients who had low genetic cardiovascular risk, but did not maintain a healthy lifestyle, doubled their risk of heart disease.
How is heart disease defined?
Dr. Boccia explained there are many factors that contribute to heart disease:
- Coronary artery disease, also known as hardening of the arteries, accounts for almost 50% of all heart conditions
- Electrical problems of the heart, such as atrial fibrillation or irregular rhythms
- Valvular heart disease, where the disease impacts the arteries
- Heart disease caused by the heart not pumping correctly
How important is nutrition to maintain heart health?
Nutrition is a key part of maintaining heart health. A diet that is high in vegetables, fruits, fish and fiber is ideal. People should avoid foods high in salt and sugar, simple carbohydrates (e.g., processed grains) and food with saturated fats (e.g., animal protein).
Dr. Coughlin suggested that people be mindful of their food intake and find a balance in their nutrition. “If you have a hankering for a sweet, it’s probably better to turn to an apple or an orange than to your local cookie stand.”
How has the treatment of heart disease in women evolved over time?
Dr. Boccia emphasized that education, awareness, and advanced treatment options have begun to drive down mortality rates for women. She noted a growing understanding of Takotsubo cardiomyopathy, also known as broken heart syndrome.
“(The condition) is a sudden weakening of the heart muscle, we think from stunning of the heart, where ... the tiny, tiny areas of the blood vessels of the heart constrict. For reasons that are not fully understood, that happens nine times or more, more frequently in women than in men.”
She said that cardiologists and training fellows are now taught to look for the condition in women who arrive in the emergency department.
Dr. Coughlin also credited Dr. Boccia with improving the lives of patients with congenital heart disease. “Decades ago, children born with holes in their heart didn’t live to adulthood,” she explained.
“Surgical techniques have improved so much that these young people are now living to adulthood and thriving. Some young women who’ve had significant congenital surgery have been able to have babies of their own. It’s a very gratifying thing to see people not only survive, but to thrive.”
How has the COVID-19 pandemic changed the way heart care is delivered?
First, the Women’s Heart program was moved from the Gagnon Cardiovascular Institute to a nearby location to better accommodate patients outside of the emergency department, where many COVID-19 patients were being treated. All safety protocols were followed, including temperature checks, mask wearing and social distancing.
Many heart patients experienced elevated levels of stress, anxiety and isolation due to the pandemic. These factors can have a negative impact on heart health, Dr. Boccia said. In addition, Dr. Boccia and others have been treating patients with COVID-19 long haul syndrome, which has cardiac components, including dysregulated heart rates, a condition that causes “skyrocketing heart rates.”
Atlantic Health System has taken a multidisciplinary approach to treating patients with COVID-19 long haul syndrome.
Dr. Boccia credited the pulmonologists at the Atlantic COVID Recovery Center for bringing experts together from many medical disciplines to help combat the varied issues that COVID-19 can cause.
What should women over the age of 60, with no known heart conditions, do to stay on top of their heart health?
Dr. Coughlin recommended that everyone should have a primary care provider who looks after their general health. Your primary care doctor will screen for conditions that could indicate the onset of heart disease, including traditional risk factors such as a history of smoking, diabetes, high blood pressure, obesity and family history. She said exercise, or lack thereof, can unmask potential risks. If there are significant risk factors, a doctor may measure a patient’s coronary calcium score.
Does heart disease impact women in communities of color differently?
Dr. Coughlin made a link between heart health and pregnancy and said New Jersey has higher than average rates of maternal mortality. One cause is preeclampsia, a pregnancy complication characterized by high blood pressure.
“African American women are four to five times more likely to die in childbirth than white women. We’re trying to target programs to educate about the signs and symptoms of preeclampsia and to make sure (patients) get adequate care through our OB/GYN colleagues.”
She also noted that Atlantic Health System has outreach programs targeted to underserved communities to educate women about hypertension and prevention strategies for heart disease.
Where can I find more information?
In addition, the Women’s Heart program is a national sponsor of womenheart.org, a coalition of women with heart disease.