What do you believe to be the biggest threat to a woman’s health? When polled, many women suspect their greatest enemy is likely breast cancer. However, where one in 30-40 women may die from breast cancer, according to the American Cancer Society, one in three women die from heart disease, per the American Heart Association.
Rachel Bond, M.D., a board-certified cardiologist with Dignity Health and one of Az Business magazine’s Most Influential Women of 2022, says this statistic fuels one of her greatest concerns in her clinical practice: when women underestimate the dangers of poor cardiac health. Although, according to the CDC, nearly 80% of heart diseases are preventable, cardiovascular disease continues to pose a problem for women, especially those in vulnerable populations or members of minority groups.
Most Influential Women: Rachel M. Bond, MD, Dignity Health
What’s the damage?
The circulatory system has two key roles:
1. To circulate oxygen, nutrients, and hormones
2. To remove waste products and toxins. When the heart or its vessels are damaged and they are unable to perform these roles, it may lead to further complications, including:
• Heart attack
• Abnormal heart rhythms
• Postpartum cardiovascular complications
Most cardiovascular damage is due to what medical providers call “modifiable risk factors,” which are lifestyle choices that individuals make that impact their health. Risk factors that are not lifestyle choices, like genetics, acute injury, or injection, make up only about 20% of heart disease cases.
Some major lifestyle factors that impact cardiovascular disease include:
• Smoking or vaping
• Sedentary lifestyle and obesity
• Poor diet
These lifestyle choices can also lead to other health conditions, like diabetes, high cholesterol and high blood pressure, which subsequently damage the vessel walls and lead to further cardiac complications.
When to enlist a cardiologist
You probably aren’t seeing a cardiologist if you don’t have any current cardiac disease or significant family history of cardiac disease. Primary care providers (PCPs) are usually the first line of defense and are essential in encouraging their patients to have healthy habits and lessen their modifiable risk factors.
A PCP usually refers someone to a cardiologist in the following circumstances:
• After an acute cardiac event or cardiac- related hospital admission
• Chronic or non-emergent chest pain (also called angina)
• Concerns of a non-urgent abnormal heart rhythm
• Need for additional cardiac monitoring or testing
• Ongoing monitoring after a procedure, like a pacemaker placement
When seeing a cardiologist for the first time, try to have your questions and concerns at the forefront of your mind so your specialist can help to address them.
Bond recommends that you take five actions to prepare:
1. Provide your relevant medical records. If you have a medical provider or PCP outside your cardiologist’s health system or network, have that office fax your medical records to your cardiologist.
2. Present any cardiac testing or labs you have had done. Previous testing and labs help your cardiologist better understand what could be going on. Medical providers correlate symptoms with labs, tests and imaging to determine an official diagnosis.
3. Bring a detailed medication list. This includes medication names, doses, scheduling, and why that medication
4. Know your medical history. Letting your cardiologist in on your medical history is also helpful for them to create a care plan. Bond suggests you provide a family history to your third-generation relatives. If your family member had a rare clotting disorder or died from a stroke in their 40s, that would be imperative for your cardiologist to know.
5. Notify your cardiologist about your risk factors. This includes a diagnosis of diabetes, high cholesterol, high blood pressure, gestational hypertension, preeclampsia, or a history of delivering small for gestational-age newborns. It also helps your cardiologist if they know the first and last date of your menstrual cycle and any psychological stressors or mental health conditions. Be prepared to discuss modifiable risk factors, including obesity, smoking/vaping, sedentary lifestyle and diet.
Recognize the signs of heart disease in women
Cardiovascular disease is the number one cause of death globally, according to the World Health Organization, which puts everyone at risk.
Although chest pain is a common sign of an acute cardiac event, women may experience heart attack symptoms differently than men. Some of these less common symptoms include:
• Pain in the jaw, shoulder, back, or neck
• Pain, weakness, or tingling in the arm
• Unusual fatigue
• Shortness of breath
Bond says that women are especially vulnerable to complications from heart disease because their diagnosis is often delayed. There is an “unconscious bias of healthcare clinicians who dismiss several cardiac symptoms in women to be non-urgent… frequently told to be as a result of ‘anxiety,’” she adds. This is confirmed by a 2022 study by the Journal of the American Heart Association, which found that women and people of color who presented to the emergency department with chest pain waited longer to see medical providers and were less likely to be admitted than their male or Caucasian counterparts.
When your provider isn’t listening
You may feel your provider isn’t taking you seriously or making you feel safe. If you are seeing an outpatient cardiology provider, go with your gut. “Typically, right off the bat, you can determine if someone is just not listening to your concerns,” Bond says, although it may take a few appointments to build up a high level of trust. If you are in a hospital setting and don’t feel your condition is being taken seriously, go up the chain of command or ask to speak with a patient advocate.
Bond explains that the delay in cardiac diagnoses in women is a concern. Dignity Health has created Women’s Heart Health Programs to improve the self-awareness of unconscious bias in healthcare. Another aim of the program is to include females, especially women of color, in clinical trials so providers have more inclusive data for medical decision-making.
Nationally, Bond says that the American Heart Association, American College of Cardiology, and Association of Black Cardiologists are three major cardiac bodies working to improve health outcomes in women and minority groups. They are also working on expanding education on sex-specific risk factors.
The biggest threat of cardiovascular disease is underestimating its severity. Knowledge is power; knowing your risk for cardiovascular disease will allow you to recognize and prevent the signs of heart disease.
“Women know their body better than anyone else,” Bond says. “If something doesn’t feel right, don’t hesitate to speak to your healthcare provider and find someone who takes your concerns seriously.”
Author: Payton Sy is an Arizona-based registered nurse and health writer. She currently holds nursing licensure in over 40 states and has worked in home health, hospitals, outpatient clinics, and insurance.