A Woman’s Heart Is Special: Risk Factors for Heart Disease You Didn’t Know You Had

As February focuses on women's heart health and the anniversary of our Women's Heart Center, we wanted to highlight uniquely female cardiovascular (CV) risks. Heart disease is still the number one killer of women. As women, we face conventional risk factors for heart disease, such as high cholesterol, high blood pressure, tobacco and nicotine use (including vaping!), diabetes, sleep apnea, and obesity. Unfortunately, we have secondary risk factors that you need to be aware of — which are entirely gender specific.

Polycystic Ovary Syndrome (PCOS)

PCOS affects approximately 10% of women, and is often associated with obesity, high cholesterol, high blood pressure, and insulin resistance. Typically, PCOS women have higher coronary artery calcium scores and elevated levels of inflammatory/clotting markers, such as CRP and homocystine. Women with PCOS are three times more likely to develop gestational diabetes and preeclampsia, which are known to increase CV risk as well. Typical treatment options for PCOS have been spironolactone for hormone regulation and metformin to treat insulin resistance. GLP-1 drugs such as Wegovy, Ozempic, Mounjaro, and Zepbound markedly reduce abdominal fat and are emerging as tools for reducing inflammation and improving insulin resistance.

“Improving insulin resistance has a tremendous hormonal benefit and the possibility of delaying menopause by several years.”

I have a patient that I have been following for quite some time who is in her mid-40s and has PCOS. She was having irregular menstrual cycles. Her obstetrician tested her female hormones and determined she was starting to go through menopause. Several months after starting on Wegovy, she started having regular menstrual cycles again, in addition to getting benefits of weight loss and seeing improvement in her blood sugar levels. Improving insulin resistance has a tremendous hormonal benefit and the possibility of delaying menopause by several years.

Diabetes During Pregnancy (Gestational Diabetes)

Gestational diabetes is defined as any degree of glucose intolerance with onset or first recognition during pregnancy. Increasing rates of obesity and often undiagnosed type 2 diabetes have led to rising rates of gestational diabetes. Individuals who suffer from gestational diabetes have a seven times greater risk of developing type 2 diabetes over the course of their lifetime, which is of course a risk factor for CV disease.If you had gestational diabetes during your pregnancy, you should talk to your primary care provider and make sure you are having annual labs drawn to check for diabetes and prediabetes.

Hypertensive Disorders of Pregnancy

Hypertensive disorders of pregnancy include pre-pregnancy chronic high blood pressure, gestational hypertension, and preeclampsia and eclampsia. These disorders can cause placental ischemia, meaning that blood flow through the placenta is dangerously reduced. This can be a risk factor for long-term blood vessel damage to the mother and make it much more likely for future development of high blood pressure, dyslipidemia, and diabetes. If you had blood pressure issues during your pregnancy, it is very important that you get a blood pressure cuff and monitor this regularly at home. If you have readings consistently greater than 130/80, please talk to your primary care provider about getting treatment.

Autoimmune Diseases

Autoimmune diseases such as lupus, rheumatoid arthritis, Addison's disease, inflammatory bowel disease, psoriasis, scleroderma, and type 1 diabetes increase a person’s risk of developing CV disease by 150%.The mechanism behind this is thought to be underlying inflammation.The risks seem to be greatest in women under 55 years of age.

Radiation and Chemotherapy for Breast Cancer

Anyone who has undergone chest radiation or has been exposed to certain chemotherapy agents can be at increased risk for developing heart disease. As our cancer treatments improve, so does the subsequent life expectancy, and we are now seeing cardiotoxicity (heart damage) as much as 30 years after treatment. If you have had chest radiation or chemotherapy, you should ask to be evaluated with an echocardiogram every five to ten years for surveillance.

“Radiation exposure, while successful in treating cancer, can contribute to both small and large blood vessel damage and valve problems like aortic stenosis and mitral stenosis.”

This is due to increased inflammation in the coronary arteries and the cardiac valves. The risk of developing coronary artery disease from radiation is entirely dose-dependent. Getting a CardioScan to screen for coronary artery disease is a simple, inexpensive, and valuable screening tool.

Mental Health: Sexual Assault, Domestic Violence, Depression, and Anxiety

Violence against women is widely underreported but can impact women of all ages. This has been well documented to have an adverse effect on psychological health. Without mental health treatment and development of positive coping strategies, women who have experienced violence are at higher risk for depression, hypertension, anxiety, eating disorders, PTSD, and substance abuse.

Have an honest conversation with your primary care provider about your risk. If you are not comfortable discussing a history of violence or abuse, find a mental health care provider that you can discuss this comfortably with. As women, we twist ourselves into knots taking care of everyone else, but we need to also make time to take care of ourselves — both mentally and physically.

“I have been teaching my three-year-old daughter yoga... My goal is to teach her a simple stress reduction technique that she can use throughout her life.”

Seek out positive coping strategies to deal with stress and anxiety. I have been teaching my three-year-old daughter yoga, and this has come to be our nighttime routine after bath time. While I am certainly no yogi, we do basic poses and, most importantly, deep breathing exercises. My goal is to teach her a simple stress reduction technique that she can use throughout her life to help manage all the very big feelings she already has.

In addition to mindfulness techniques, there are many options for medications to treat depression and anxiety that can greatly improve your quality of life. Do not be afraid to ask for help from your healthcare team.

Prevention and Daily Habits

We can all do better with nutrition. We know highly processed foods and foods high in sugar are not the best choices for our bodies, and being mindful of our intake can be a powerful step in taking control of your health. Dr. James O'Keefe has written prolifically about nutrition in previous newsletters, and there are many free online resources about a heart-healthy diet.

If you have no exercise regimen, start with a daily walk — with a dog ideally. Most people can tolerate at least five minutes a day and then build from there.The goal is to get to 20 minutes of regular physical activity daily, in addition to strength training twice per week.

Seek out proactive preventive care, such as our Saint Luke's CardioWellness Clinic. This is a great way to assess your personal risk for heart disease and start working on the things you can control. We have a wonderful team here in our CWC clinic, and we are always eager to take new patients.