It’s Valentine’s Day, but you won’t find any cupids, candy hearts or saccharine sweet messages here. WYSK is devoting February 14th to truly important matters of the heart… women’s heart health and disease. Heart disease is the #1 killer of women and it can affect WOMEN OF ANY AGE.
While many women are aware of these forbidding statistics, lots of us also have an “it’s not going to happen to me” attitude. Well, none of us should be too quick to brush these facts off, as a staggering 90% of women have at least one risk factor for cardiovascular disease.
We had the very rare privilege to speak with one of the country’s leading cardiologists – an expert in cardiovascular disease in women and a nationally recognized pioneer in women’s health. We’re grateful for the in-depth education she gave us. Dr. Nieca Goldberg is a Woman You Should Know.
As February is American Heart Health Month, we encourage each of you to pass this Q/A with Dr. Goldberg on to at least one woman you know. We need to inspire and encourage each other to be the very best we can be, which includes taking better care of ourselves and living heart-healthy lives.
When it comes to matters of the heart, specifically health & disease, are women and men different?
Dr. Goldberg: The symptoms of heart attack in men and women can be different. Although pressure in the center of the chest radiating to the arm, neck or jaw is still the most common symptom. For women specifically, many explain having similar symptoms such as shortness of breath, unexplained fatigue, upper back pressure and pressure lower down in the chest, which is easily mistaken for a stomach ailment. It is important to remind everyone that heart symptoms are not only limited to the left side of the chest. The symptoms of chest discomfort can occur at any location in the chest.
We read a startling statistic that heart disease kills more women in the U.S. than all forms of cancer. Is this true and why don’t more women know the facts?
Dr. Goldberg: This is true. Although many women know that heart disease is the leading killer of women, the same women do not think that it will happen to them. The good news is that over the last 10 years we see the death rate due to cardiovascular disease dropping in women, overall. Unfortunately, at the same time this is happening, we are seeing an increase in cardiovascular disease deaths, specifically in women age 35-50 years old. It is estimated that 90% of women have at least one cardiovascular risk factor.
What are the risk factors for heart disease in women?
High blood pressure
High cholesterol-more specifically high levels of LDL or bad cholesterol, low levels of HDL cholesterol and elevated triglycerides.
Other risk factors to look for in women are conditions such as lupus, preeclampsia, gestational diabetes, hypertension or pregnancy and toxemia of pregnancy. Studies have been showing that pregnancy related outcomes may increase risk for cardiovascular disease in later life. Lupus is an autoimmune disease and the leading killer of women with lupus is cardiovascular disease so it is very important that these women continue to be monitored for their cardiovascular risk factors.
What about stress? How does that affect the heart?
Dr. Goldberg: Although stress is not an official cardiovascular risk factor but more of a cardiovascular risk marker, we still do not have proof that treatment for stress reduces risk for cardiovascular disease. Stress increases levels of hormones such as cortisol and norepinephrine and epinephrine. Cortisol raises blood pressure and blood sugar. Norepinephrine and epinephrine raise blood pressure.
How much of a role do genetics play in heart disease?
Dr. Goldberg: We believe genetics play an important role in heart disease. Family history alone, particularly if it’s a close family member such as mother, father, sister or brother, can increase risk for heart disease anywhere from 25-50%. At the present time there may be genetic factors that are yet undiscovered.
Are there specific questions women should ask their doctor about heart disease?
Dr. Goldberg: When women go to the doctor they need to be prepared to ask and answer questions. The visit should be a conversation. The women should ask the doctor about checking further risk factors such as high blood pressure, diabetes, methods to quit smoking and to exercise. Women should also be prepared to give the doctor information about their family history so the doctor can make a complete assessment about their cardiovascular risk.
Some other important points about the medical visit that I see need improvement are: the patient should also be honest about all of their medications, their supplements, and any other cardiac testing that has been done in the past. If a woman has been to another cardiologist and is going for a second opinion, it is important to bring your medical records in order to get a complete evaluation by the second opinion doctor.
Is it possible to have a heart attack and not actually know it?
Dr. Goldberg: Yes. Sometimes the subtle symptoms of heart attack in women are not recognized. There are statistics from the American Heart Association that state nearly 2/3 of women die before getting to the hospital. Sometimes this is due to delays in getting to the emergency room. I have seen patients in my office who didn’t recognize that some of the less common symptoms they were experiencing were those of a heart attack. That is why it is so important for everyone to learn all the possible symptoms.
How do women fare in regard to recovery and survival following a heart attack compared to men?
Dr. Goldberg: Once a woman has a heart attack, in the first month she has a higher death rate compared to men. This is because many of the women who come to the hospital have more risk factors such as high blood pressure, diabetes and come to the hospital in heart failure.
It is important for women who have heart attacks to make sure that they are discharged from the hospital on the medications that we know prevent second heart attacks such as aspirin, cholesterol-lowering medicine and beta blockers. Another important therapy is cardiac rehabilitation and an organized program of exercise, nutritional counseling and stress management. Cardiac rehabilitation is covered by many insurance plans. Past studies have shown that women are under-referred to cardiac rehabilitation, so another conversation to have with the doctor, particularly if you are a woman who has had heart surgery or a heart attack, is about getting referred to cardiac rehabilitation.
What should women do to maintain a healthy heart?
Dr. Goldberg: It depends upon whether or not you’re talking about women who have already had a heart attack or trying to prevent a first heart attack. For both groups, modify your diet to one that is low in saturated fats, free of trans fats, simple sugars and starches. Instead include complex carbohydrates such as those found in grains like oatmeal and quinoa; fruits and vegetables should be incorporated into the diet as well. It is recommended that men and women should eat at least 5 servings of fruits and vegetables daily. The benefit of fruits and vegetables is that they contain minerals and antioxidants and there has been no study to prove that antioxidant vitamins reduce risk for cardiovascular disease.
Reduce salt intake to no more than 2300 mg or a teaspoon a day. It is clear from these recommendations that reading food labels is important. Avoid greasy foods, ask for sauces and salad dressing on the side and avoid shiny food options at the salad bar because the shiny food options mean that the food option is greasy.
Everyone should participate in at least 30 minutes of aerobic exercise daily. This is as simple as taking a moderate pace walk. Moderate pace means that you are short of breath and can speak to the person next to you, but you probably cannot sing a song.
Aspirin therapy is recommended for all women who have had previous heart attacks provided that they are not allergic to the aspirin. Aspirin therapy is strongest in preventing a first heart attack in healthy women over the age of 65. My recommendation for younger women, who may have multiple risk factors, is to discuss taking aspirin with their doctors.
Cholesterol-lowering medications, known as statins, are recommended to women who have had a heart attack. It is also recommended in women who were at high risk and have elevated cholesterol.
It’s also important to get at least 7-9 hours of sleep daily and reduce stress.
Is it ever too late to make changes?
Dr. Goldberg: It’s NEVER too late to take a healthy step in the right direction.
Meet Woman You Should Know, Nieca Goldberg, M.D.
Dr. Nieca Goldberg is a cardiologist and a nationally recognized pioneer in women’s heart health. She is Medical Director of the Women’s Heart Program at NYU Langone Medical Center and Clinical Associate Professor of Medicine, in the Division of Cardiology, at the NYU School of Medicine. Dr. Goldberg is the Co-Medical Director of the 92nd Street Y’s Cardiac Rehabilitation Program and a national spokesperson for the American Heart Association’s Go Red For Women campaign – an association where she has volunteered for over 15 years and has been a board member.
Dr. Goldberg is Medical Director of the new Joan H. Tisch Center for Women’s Health at NYU Langone Medical Center. The 18,000-square-foot, state-of-the-art facility is a premier destination for women’s health care in New York, NY. The medical anchor of the Center is its cardiovascular services provided by Dr. Goldberg and the NYU Women’s Heart Program. The Center is powered by an elite staff of physicians and nurses from NYU Langone embracing the concept that women’s health and medical needs must be addressed in a manner that considers the whole woman.
A graduate of Barnard College and SUNY Downstate Medical Center, Brooklyn, she completed her medical residency at St. Luke’s-Roosevelt Hospital Center and a cardiology fellowship at SUNY Downstate. She was formerly the Chief of Women’s Cardiac Care at Lenox Hill Hospital in New York City.
Dr. Goldberg’s research and medical publications focus on cardiovascular disease in women, exercise imaging and exercise. She is often asked by the media for her expert interpretation of current studies and medical news. Dr. Goldberg has made numerous appearances on programs such as The Today Show, The View, Good Morning America, The Early Show, and CBS Evening News. In addition, she has been featured and interviewed by reporters from The Wall Street Journal, The New York Times, The New York Post, The New York Daily News, Fitness Magazine, More, Glamour, Good Housekeeping and many others discussing woman’s health and heart disease. She serves on Woman’s Day magazine’s Editorial Advisory Board.
In 2010 Dr. Goldberg was celebrated, yet again, on New York Magazine’s “Best Doctors” list, a recognition she also received in 2009, 2008, 2007, 2006, 2005, 2004, 2001, and 2000. In 1999, she was the only woman in their top ten “Hall of Fame of Physicians”. The recipient of numerous awards for her advocacy for women’s heart health, she received the American Heart Association’s “Dr. With Heart” award, Woman’s Day magazine’s “Red Dress” award, Jewish Women International’s “Women to Watch” award and The Women at Heart 2006 Honoree Award from the Links Greater New York Chapter.
Editor’s Note: This interview was originally published by Women You Should Know on February 14, 2012