Turning 50 is a wake-up call for many of us.

During our 30s and 40s, we may not have prioritized our health while raising kids and building careers. The good news is it’s not too late.  

It’s our mission at Rumblings to ensure you have the science-based facts and education you need to understand your health risks and be your own best health advocate while also providing you with tools to put knowledge into action.  

 

This month, we’re focusing on heart health—the number one killer of women.

 

After menopause, heart disease risk in women increases, yet, only 56 percent of women identify cardiovascular disease as the most significant health problem facing them today.

 

Preventive cardiologist Dr. Courtney Jordan Baechler*, spoke to a group of Rumblings women about heart health, prevention, treatment, and what midlife women can do to improve overall health.

 

Not all of you could attend the in-person event, so we took what we learned and provided additional information to ensure you have the facts, resources, and tools to live well, flourish, and take great care of your heart as you age. The information below summarizes our 60-minute discussion. It is not a comprehensive list of everything you can do as it only covers the conversation and questions asked during the evening.

 

No matter where you’re at in your health journey, there is never a more critical time to take care of yourself.

 

Understand that current heart health recommendations for prevention and treatment are based primarily on men's research. 

 

It wasn’t until 1993 that women were mandated to be included in medical research reversing a restriction since 1977 that prevented women of childbearing potential from participating in clinical research. It created a two-decade gap in new medical knowledge on women. Women, as a result, may be misdiagnosed and mistreated more often than men, partly because scientists know far less about the female body.

 

Today women still only represent about 25 to 35 percent of subjects in clinical trials. We have a long way to go to ensure women are equally represented in research and that the knowledge used to create prevention and treatment recommendations represent us. This is critical to understand so you can have conversations with your medical providers and advocate for your health.

 

Today's underlying assumption in medical research is that not every trial will have 50 percent women subjects. We need to expect that women are 50 percent of all National Institutes of Health (NIH) funded trials. If not, we need to understand why participating doesn’t work for women and work to solve this systemic issue. Health care has been traditionally designed for families with a stay-at-home spouse with well-covered insurance, and that doesn’t work for most US families today.  

We need all women to advocate for greater inclusivity of women in medical research, as research informs the care women receive.

 

What can you do?

• Arm yourself with knowledge. Watch Ms. Diagnosed — an award-winning film following the stories of real women whose lives and families have been disastrously affected by this basic inequity in medical care that women receive.

• Stay up-to-date on women’s research. Read patient stories and sign-up for electronic communications from trusted research institutions like the Penny Anderson’s Cardiovascular Center at the Minneapolis Heart Institute Foundation, where Dr. Jordan Baechler works.    

•  Support research with women through financial contributions as you’re able.

 

Know your heart disease risk.

 

After menopause women’s risk for developing heart disease is similar to men's risk. The most significant risk factor for developing heart disease is age.

 

As we age, several risk factors to monitor and discuss regularly with your care provider include:

• High blood pressure which has no symptoms, and many people don’t know they have it, can lead to heart disease and stroke. 

• Being overweight or having obesity raises your risk of heart disease. Women often complain about weight gain during and after menopause.

• Arrhythmias, like atrial fibrillation, are fluttering feelings in your chest (palpitations).

• High cholesterol increases with age. Cholesterol is a waxy, fat-like substance made by the liver or found in certain foods. Your liver makes enough cholesterol to meet your body’s needs, but we may eat foods that increase cholesterol in our blood.

• High LDL (low-density lipoprotein) cholesterol is considered the “bad” cholesterol because it can cause plaque buildup in your arteries, reducing blood flow to the heart.

• Having diabetes causes sugar to build up in the blood. The risk for heart disease for adults with diabetes is higher than for adults without diabetes.

• Eating a poor diet.

• Physical inactivity.

• Drinking too much alcohol.

• Using tobacco. No amount is considered healthy. 

 

It’s imperative you know your risk and what to do about it.

 

What can you do?

• Know your blood pressure. Have it checked regularly. Ask for your numbers and understand the levels healthy for you.  Keep track of them or get a blood pressure monitor to check it yourself between visits to your doctor.  

• Calculate your BMI ( body mass index), which is a measure of fat based on height and weight. It’s a measurement used to calculate risk. However, it’s not a perfect measurement because it does not consider muscle mass, bone density, overall body composition, and racial and sex differences. If your BMI is outside the normal weight range, talk to your health care provider to determine if you should be concerned.  

• Use a risk calculator to determine your risk and talk to your medical provider or other health professionals about managing your risk.

 

Be aware of signs and symptoms of a heart attack that may differ from the symptoms men experience.  

 

A heart attack may not feel the same in women as in men. Dr. Jordan Baechler stated women might experience an overwhelming sense of depression, nausea, shoulder pain, teeth pain, anxiety, or jaw pain. However, the most common symptoms are similar to what men experience: chest pressure, tight chest, neck or jaw pain, feeling like an elephant sitting on the chest, or numbness, usually on the left side. The critical thing to realize is that whatever you’re experiencing if it is significantly disproportionate to anything you’ve ever experienced before, you need to get evaluated.

 

What can you do?

• Familiarize yourself with the common symptoms of a heart attack.

 

 

Talk to your primary care physician to ensure close attention is paid to your heart health as you get older.

 

You are an equal partner with your primary care providers. Make sure you know everything they are doing to manage your overall health and health risks.  Ask questions about tests and procedures to ensure you understand what they’re for, what you’ll learn from them, and how the outcomes will inform future recommendations and care.

 

What can you do?

• Restate! If you feel you are not getting the answers you deserve or feel dismissed, the best thing you can do is restate what your providers are saying back to them. Doing so may stop bias or dismissiveness from happening. For example, say, ”So you’re confident I am not having a heart attack or blood clot or (insert any symptom).”

 

Discuss the following lab tests with your primary care providers to better understand your heart health and disease risk.

The lipid panel includes total cholesterol, LDL cholesterol, HDL cholesterol, and triglycerides. The goal is to have total cholesterol of less than 200, but it does not automatically mean you need treatment. Today providers are looking at LDL cholesterol (most associated with coronary artery disease and blockages in your arteries), with less than 130 considered healthy. However, lower is better, and if you have disease most providers want it below 70. Having an LDL less than 70 is difficult to do without medication, no matter how clean you’re eating. HDL is the good cholesterol, and a desirable level is greater than 50. Triglycerides are an indicator of how well you eat and your genetics. If your triglycerides are high, it could indicate your simple or processed carbohydrate intake is too high. A triglyceride level less than 150 is considered healthy.

Know your fasting blood sugar. A healthy level of fasting blood sugar is 99 mg/dL or lower. Anything between 100 to 125 mg/dL indicates you have pre-diabetes and could benefit from lifestyle changes starting with eating and physical activity.

Hemoglobin A1c is a simple blood test that measures your average blood sugar levels over the past three months. It’s one of the most commonly used tests to diagnose prediabetes and diabetes and manage diabetes if you have it.

You can consider advanced testing such as a calcium score which is an x-ray of your coronary arteries that tells you if you have plaque or not. A calcium score does not tell us whether there is a narrowing of the arteries; that is what an angiogram does. More doctors are recommending a calcium score test to quantify risk as a way to determine if a medication like a statin may be beneficial. If you’re healthy and post-menopausal, should you get a calcium score? It’s a personal decision on how informed you like to be and whether or not you would take action, such as taking a statin if one is recommended. It’s an earlier way to detect plaque and disease and a new tool in the toolbox. For some people, it’s helpful. The results compare you to other people of the same gender and age. You get a percentage on how you rank 0-100.

If you have palpitations, you want to mention this to your doctor to potentially get a monitor to assess the cause and any underlying concerns.

Consider a stress test if you have symptoms. No data indicates you need to have one without symptoms. 

 

What can you do?

• Have a conversation with your primary care provider to determine what tests are right for you.

• When contemplating a test like a calcium score, good questions to ask yourself are:

  •  Do you want to know your risk? 

  • Will the results change your personal decision?

  • Do you want that information or not? Knowledge is power, but if knowing the facts will keep you up at night, it may not be worth it. It may be better for you to focus on lifestyle behaviors to reduce your risk. 

  • If you have no symptoms, a calcium score may be unnecessary as it most like won’t change the recommendations from your provider other than medication recommendations. If you are someone who may feel stressed or anxious from knowing your score or has no desire to take a statin, you may not want to know your calcium score.

• Talk to your provider about your numbers.

 

Understand how inflammation impacts heart health.

 

Inflammation is not a good thing. Understanding the impact of inflammation on disease is changing the future of how we think about and treat diseases like cardiovascular disease.  Cholesterol is one inflammatory marker. It will be interesting to see how much emphasis is put on cholesterol in the future. Dr. Jordan Baechler predicts that more emphasis will be placed on inflammation and less on cholesterol levels over the next 20 years. 

The best way to detect and measure inflammation is with a high sensitivity C-reactive protein blood test (hs-CRP).  This test is becoming more common, and Dr. Jordan Baechler orders it frequently for her patients. It’s another way to help quantify the risk for heart disease. The results will indicate your risk for developing blockages in your arteries. inflammatory conditions increase your risk of developing coronary artery disease, so the better the inflammation is managed, the less likely you will develop future heart blockages.

 

What can you do?

 

• Focus on the food you eat. People can see inflammation improvements by changing the foods they eat. Dr. Jordan Baechler has seen patients make food modifications and seen significant changes in inflammation. Start by getting a minimum of 5-11 servings of fruits and vegetables every day. If you’re looking for more guidance on what and how much to eat, Dr. Jordan Baechler recommends the following eating patterns which vary in how strict the recommendations are:

o   The Mediterranean Diet is a good style of eating and an excellent place to start.

o   The Anti-inflammatory Diet is plant-based with fish and one to two items of other nonplant protein portions a week. The recommendations are a little stricter than a Mediterranean diet, yet has more options than a vegan diet.

o   The Vegan Diet includes no animal products. Work with a registered dietitian nutritionist to ensure you’re getting adequate nutrition for good health and energy..

 

 

Get off the fad diet craze roller coaster.

 

Food recommendations overlap between diseases. Everyone is unique and there is not a one size fits all heart-healthy eating pattern recommendation.

Unfortunately, there is a lot of conflicting information online about the best way to eat. For example, some recommendations given for heart health do not always work for weight loss and obesity which are risk factors for developing cardiovascular disease.

Dr. Jordan Baechler gets asked frequently about ketogenic diets and advises her patients that the American version of the diet is often too high in processed fats and can be hard on your heart. She believes a ketogenic diet when followed strictly for long periods can raise the risk of heart disease.

 

What can you do?

• See a registered dietitian nutritionist to tailor recommendations for you, your lifestyle and your health risks. Dietitians are trained in medical nutrition therapy and behavior change. They can help you modify your eating patterns for life.  

• Consider following one of the three eating patterns listed above that have research behind them and show heart health benefits.

• To manage your weight as you age, you may need to consider increasing the good fat and reducing refined carbohydrates you eat in order to be successful in the long term.  A registered dietitian can help you make these modifications successfully.

 

 

Eat well, move more, don’t smoke, drink moderately, manage stress, sleep and be kind to yourself.

 

Changing habits can be challenging. Ask yourself the following questions:

• Where are you at?

• How can you do a little better?  

The goal is to start small. Quality of life is very important. Dr. Jordan Baechler recommends practicing the 80/20 rule (she does this too)— 80% of the time try to adhere to a healthful way of living. Find a balance that works for you. Every day is another day.

 

Evidence suggests making four critical changes—move 30 minutes a day, eat a minimum of five servings of fruits and vegetables, don’t use tobacco, and drink alcohol in moderation — you may get an extra decade of high-quality life. Only five percent of Americans do these four things. How are you doing with these behaviors?

 

It’s also important to manage stress by practicing calm. Most of us don’t do this, we’re constantly in a flight or fight state which takes a toll on our overall health and well-being. 

More and more research is emphasizing the critical importance of sleep to overall health. Ensure you wake up feeling rested. Usually, this means getting six to eight hours of sleep for most people. If you’re struggling to sleep or sleep well seek help earlier. You don’t want to suffer for two years before you get help. There are options that can help such as supplements, acupuncture, movement, food, etc.

 

Although not directly related to heart health, strength training with weights is important for building lean body mass which is especially important in midlife to prevent muscle loss. Lean body mass is also important for losing and maintaining weight as women age.  

 

The message is that we can all do a little better, one small change at a time. Don’t beat yourself up if you aren’t perfect today. Tomorrow is a new day.

 

What can you do?

• Move a minimum of 30 minutes a day. You can do It all at one time, or spread movement breaks throughout the day.  Join the Rumblings Move in May Challenge by downloading 40 ways to be active and follow us on social media for support and encouragement as we add more movement in our days throughout the month.

• Consider strength training with weights to build lean muscle and help manage weight as you age.

• Eat a minimum of five fruits and vegetables a day. Although our March Fruit and Veggie Challenge is over, you can still download 40 creative tips for eating more fruit and veggies in your day.

• Don’t use tobacco products.

• Limit alcohol to one drink a day for women and two drinks a day for men.  

• Practice calm— meditation, yoga, staring at a candle, prayer, etc.— in whatever way works for you for a minimum of 10-minutes a day.

• Sleep a minimum of six to eight hours a night. Wake up rested.

 

Chose foods key to a heart-healthy diet.

 

Research from Tufts University found that ten foods are estimated to cause nearly half of all US deaths from heart disease each year: eating too few nuts/seeds, seafood Omega-3, vegetables, fruit, whole grains, and polyunsaturated fats, and too much sodium, processed meat, sugary beverages, and processed red meat. This research also suggests that whole-fat dairy consumption can be part of a healthy diet, especially those with probiotic-containing unsweetened and fermented dairy products such as yogurt and certain aged and unpasteurized cheeses.  

If you’re trying to manage your blood cholesterol, natural compounds can be found in certain plant-based foods like fruits, vegetables, whole grains, legumes, nuts, seeds, and some vegetable oils have a valuable role.  Eating them helps limit the amount of cholesterol your body can absorb. These natural compounds in plants are called sterols, stanols, or phytosterols.  They can also be found in foods like margarine, cheeses, milk, cereals, and snacks that have been fortified with them. Check the labels for sterols, stanols, or phytosterols, and aim for 2 grams a day.

 

What can you do?

• Reach for nuts/seeds as snacks and toppings

• Aim for two Omega-3-containing seafood servings a week like salmon, sardines, Atlantic mackerel, cod, herring, lake trout, or canned tuna.

• Eat a minimum of five servings of fruits and vegetables a day

• Substitute whole grains for processed grains

• When eating dairy, choose unsweetened probiotic-containing yogurt and aged, unpasteurized cheeses like Swiss, provolone, gouda, cheddar, Edam, Gruyere, feta, caciocavallo, Emmental, and parmesan. Eat them sparingly.

 

 

Before taking dietary vitamins or supplements, work with a registered dietitian nutritionist and your medical providers to determine which ones can benefit you.

 

Supplement recommendations require an individualized approach based on deficiencies, medications, activity levels, and food consumed. Dr. Jordan Baechler prefers you get nutrients from your food first. 

In terms of heart health, there are no supplements that have been shown in studies to help clinically reduce heart disease risk. However, she is a fan of supplements when indicated. Supplements should be used as a complement to your food and medication regimen, not as a replacement. This is especially critical once the disease has developed.

 

There was a question about coenzyme Q10 (CoQ10) and statin use. CoQ10 is an antioxidant that your body produces naturally. Your cells use CoQ10 for growth and maintenance. Levels naturally decline as you age and are found to be lower in those who take certain medications, like statins. Statins are metabolized in your mitochondria and can deplete natural CoQ10 in your body. A supplement can help replace what is lost and there are minimal side effects to taking it. CoQ10 has also been seen to be helpful for those with heart failure. Dr. Jordan Baechler recommends starting with 200 mg a day if you’re on a statin or if your blood systolic blood pressure is over 130.

 

What can you do?

• Talk to your medical providers about the dietary supplement, vitamin needs, or medications specifically for you as you age This could include statins, CoQ10, and other vitamins and minerals. It can be helpful for your provider to analyze your blood levels and determine together with you what combination of supplements is right for you. 

 

Know what to consider if you’re advised to take a statin or aspirin.

 

Statins are the number one drug prescribed to lower cholesterol. Statins are intended to be used to stabilize plaque so you don’t have a heart attack or stroke, and that requires you to be on them for the rest of your life. There are no long-term effects of statin use that we know of today. Dr. Jordan Baechler feels safe having people on them, including her family members.

Before prescribing a statin, your doctor will consider all your risk factors for heart attacks and strokes. Eighty percent of people do great on statins and have no adverse effects. However, about 20 percent of people complain about side effects such as headaches, nausea, or muscle aches. If you experience side effects, talk to your doctor to review your risk factors for heart attack and stroke to see if it is recommended to discontinue the medication. Most patients’ complaints disappear as a result of stopping medications.

If you feel strongly you don’t want to be on a statin, you shouldn’t be on a statin. The mind is extremely powerful.  There was a trial done at the Minneapolis Heart Institute Foundation where people were blinded between statin and placebo and had equal side effects. At the end of the day, it doesn’t matter. If you don’t want to be on it, you don’t want to be on it.

  

It’s your body so you can decide when and if you want to be on or off a statin. There are other non-statin cholesterol-lowering medications you can discuss with your physician if statins don’t feel like the right choice for you.  

The use of aspirin in preventing heart disease as we age is common. However, aspirin recommendations have changed, and it is no longer recommended unless you have a diagnosis of heart disease. If you have established heart disease, your doctor may recommend 81 mg of aspirin daily. Aspirin use is a good topic to discuss with your doctor.    

What can you do?

• Discuss cholesterol-lowering medication options with your medical provider.

• If you have side effects from statins, talk to your physician about alternative types of cholesterol-lowering medications.

• If you have established heart disease, discuss the benefits and risks of daily low-dose aspirin

 

Discuss hormone replacement therapy (HRT) to manage menopausal symptoms with your provider.

 

There is an increased heart disease risk with hormone replacement therapy. However, not sleeping — a common occurrence during and after menopause — also increases your risk for heart disease. Work with your physician to decide the right option for you individually. If using HRT, Dr. Jordan Baechler recommends using the lowest dose possible to manage symptoms rather than using it to get hormone levels back to premenopausal levels.

Bioidentical hormone replacement therapy is one option to discuss with your provider. These hormones are from plant estrogens that are chemically identical to human-produced hormones may be slightly better than traditional hormone replacement therapy.  They are however more expensive.

What can you do?

• If you have menopausal symptoms, discuss low-dose hormone replacement therapy or bioidentical hormone replacement therapy with your medical providers.

 

There are many things you can do to prevent disease and reduce risks. Knowledge is power, and small changes add up. Take it one step at a time, and soon you’ll find yourself flourishing in midlife.

 

If you are facing other midlife challenges, we want to hear from you so that we can provide the expertise and answers to your questions through similar events, online webinars, newsletters, and future books.

 

If you want to read more about heart health, check out 5 Actions to Improve Heart Disease Risk and How to Care for Your Heart After 50.

* Dr. Jordan Baechler serves as medical director of health equity and health promotion at the Minneapolis Heart Institute Foundation.   Her previous roles included an appointment as assistant commissioner for the Minnesota Department of Health.  Before that, she served as Vice President of the Penny George Institute for Health and Healing, Allina Health’s prevention, wellness, and clinical service line.  She served as a consultant to the Statewide Health Improvement Plan for the clinical workgroup in Minneapolis.  She has been one of the authors of the Healthy Lifestyle Guideline for the Institute for Clinical Systems Improvement. She serves on the MN Department of Health Prevention of Cardiovascular and Stroke Committee.  Her leadership roles have included general board member for the YMCA of the Greater Twin Cities, MDH Maternal mortality and Review Committee member, and a policy advocate for the American Heart Association of MN and co-chair of the Twin Cities Go Red campaign 2020-2021.  She is passionate about helping individuals, families, and communities to find their highest state of well-being—body, mind, and spirit.