Women know that preventing breast cancer is a big health issue. While that is very important, and much has been done to shed a light on the value of early detection and treatment, it remains true that heart disease is still the leading cause of death in women. We don’t talk enough about how research on women’s heart health is decades behind that of men, how our symptoms are often not taken seriously, what we can do to prevent heart disease and cardiovascular events, and how we should treat it. We want to help change the narrative around women and heart disease. It all starts with having more conversations about this topic.  

As part of the Minneapolis Heart Institute Foundation’s (MHIF) women’s health event called Hope, Health, and Humor: At-Home Edition, we had Courtney Jordan Baechler MD, MS join us for a small outdoor gathering of women and a conversation about women’s heart health. This conversation is critical for women over 50 because many women think that heart and vascular disease only impact men at this age. However, once women reach menopause the level of risk, number of events, the severity of heart disease, and even death rates are the same. Yet, our symptoms may be different, are often not taken seriously, and we’re not researched as much as men. 

This gathering took place a few days after Rebecca’s husband had a stroke. Because of how healthy and young he was, it drove home that we need to start having conversations about heart health, cardiovascular events, and doing everything we can to take care of ourselves as we age.

Karyn: Dr. Baechler, tell us about yourself.

I’m a preventive cardiologist. I did the National Institutes of Health (NIH) scientist track, and added extra time onto my fellowship in cardiology to study the primary and secondary prevention of heart disease. I hit a wall during my intern year and thought the [healthcare] system was totally broken. How was I going to practice for the rest of my life in a sick-based system? There was no focus on nutrition, stress, exercise, ability to fill your prescriptions - nothing. It led me to pursue my interest in preventive medicine. I obtained a Master’s degree in Epidemiology and Public Policy to learn more about population health. I spent years running the Penny George Institute for Health and Healing. I’m a huge believer in the mind, body, spirit approach of Eastern medicine meets Western medicine. I currently run the Women’s Science Center at the Minneapolis Heart Institute Foundation and I see patients part-time through the Minneapolis Heart Institute. 

Karyn: What are the age-related changes that women go through that begin to increase our risk for heart disease?

Until menopause, women have a much lower risk of developing heart disease. After menopause, our risk increases to be the equivalent to the risk men experience for having a heart attack or stroke. 

I’m sure many women have heard of the Women’s Health Initiative and the research on hormone replacement therapy. There was an idea that if we put women on hormones so that menopause wouldn’t happen, that would fix things. It turns out the risk of having a heart attack and the risk of having a stroke was higher. It was back in 2004 when we first started getting this information. 

Here are some of the reasons our risk increases after menopause:

When we age, our blood vessels start to stiffen and we can develop high blood pressure. Our metabolism starts to slow and we tend to develop more central obesity and fat in our bellies. These things happen as we age, and there are things that we can do to counteract them. From a perspective of our metabolism slowing down, we can also be at higher risk for developing Type 2 diabetes because of the way our body responds to insulin and sugar in general. 

Our sleep changes. Sleep is the cornerstone of everything, and it helps to clear our brains. There is lots of data on the importance of sleep and our overall immune system and helping us to be well.

Most of these things appear to be true for men too, there just is a protective effect for women prior to menopause. We’re 35 years behind in doing research on women. We don’t know why that is, but can speculate that society has cared about keeping women healthy while we’re reproducing and then we have less perceived ‘value’ after we’re done with being able to reproduce. 

Karyn: You know, it’s really interesting that even Rebecca and I have found that there is so much information out there for women who are in childbearing years and for fertility. When you look for resources on health for women who are over 50 there is nothing. Everything that you Google is almost entirely about how to dress, how to be more attractive, or is about anti-aging. It’s fascinating, and not in a good way. We have work to do to change that!

Karyn: What symptoms should women be aware of, and when should they seek immediate care? What symptoms are different for women than for men?

Women are much more likely to have atypical symptoms. They are more likely to get jaw pain, arm numbness, nausea, vomiting, and also depression. They do get shortness of breath, and chest pain is still the most common symptom in women. However, women are much more likely to have all of the symptoms compared to men. I always tell women that you know your body best. Hands down, patient-wise, women are more in tune with their bodies. If you are experiencing something that is different and is not going away, you should get it checked out. Physicians should be grateful that you are proactive and focused on prevention. If everything turns out fine, then that is great!

Karyn: When we see our doctors, our primary care providers, what kinds of things should we ask them about to make certain we’re paying close attention to our heart health as we get older? 

One of the things that is critical for women to be aware of when seeing your physician is that you should have information about anything being done. As a patient, you should be told what your blood pressure is. You should be told what your heart rate is. And, you should understand what your medical providers are doing. Are they listening to your respiratory rate? Are they taking your temperature? All of those things are critical pieces of information that you want to be personally tracking. 

Blood pressure and heart rate are things that change over time. For example, if you’ve always had a heart rate in the 60s and now your rate is consistently in the 80s or 90s, you need to know about it. And, they should tell you that it’s better to be a little bit lower consistently. 

Body Mass Index (BMI), which is one way to look at weight, is another indicator that doesn’t get talked about much with your physician. Is your weight or BMI contributing to your level of risk and what is a healthy BMI? How do you compare to your peers? Physicians will usually tell you if there is something wrong, but they should also tell what they are looking for and why.

You should definitely get your cholesterol checked. There are advanced cholesterol profiles that we can do to tell whether the cholesterol is ‘sticky’ which can increase your risk. A cardiologist would also look at inflammation and other things. Most importantly, have a conversation with your primary care doctor about your family history and your lifestyle. Ask them about your risk of having a heart attack or stroke in the next 10 years. 

These are basic things that let you know where you fall in terms of risk and then based on these measures, does your doctor recommend that you see a cardiologist to do further testing and why or why not? Ask them what other specific things you could be doing to optimize your health. These are the conversations you want to have with the person taking care of you. 

Karyn: It is so important to have a relationship with a care provider that knows you and is willing to be a partner in your care. 

It is unfortunate but very common to be put on medication without ever being evaluated for all of these other things. It is important in those situations to ask why you are being prescribed something so you can be informed. 

Part two of the conversation with Courtney Baechler MD, MS discusses how to take care of your heart.