Empowering Health: Breast Cancer Awareness

As we step into October, it's essential to recognize that this month is not just about embracing the autumnal hues and cozy sweaters; it's also Breast Cancer Awareness Month. Breast cancer remains a formidable adversary, accounting for 30 percent of new female cancer cases yearly. According to the American Cancer Society, by the end of 2023, it's estimated that there will be approximately 297,790 new cases of invasive breast cancer diagnosed in the United States.

Breast cancer is the second-leading cause of cancer-related deaths among women. However, the silver lining is that rates have steadily declined since 1989. There has been an overall decrease of 43 percent in breast cancer cases through 2020. This is a testament to our progress but underscores the importance of continued efforts to drive these numbers even lower.

According to the American Cancer Society, one proactive way to reduce your risk of breast cancer is to stay physically active. It's not just a simple recommendation; it's a potentially life-saving practice.

Maintain a Healthy Weight

To start, it's crucial to get to and stay at a healthy weight. Both increased body weight and weight gain during adulthood are linked to a higher risk of breast cancer after menopause. The American Cancer Society advises maintaining a healthy weight and avoiding excessive weight gain by balancing your food intake with physical activity.

Weight gain is, unfortunately, one of the biggest challenges we hear from midlife women. You can revisit prior blog posts for a refresher on various approaches and understanding fads for weight loss and maintenance in midlife.  

Awareness of what and how much you eat is a first step to long-term weight management. The Food Counter's Pocket Companion can help make healthy eating easier. 

Embrace Physical Activity

Being physically active is another vital component in reducing breast cancer risk. Numerous studies have highlighted the link between moderate to vigorous physical activity and lower breast cancer risk. This emphasizes the significance of regular physical exercise in our lives and how critically important it is as we age. The American Cancer Society recommends that adults aim for at least 150 to 300 minutes of moderate-intensity activity or 75 to 150 minutes of vigorous-intensity activity each week, preferably spread across the week. Reaching or exceeding the upper limit of 300 minutes is ideal. Physical activity and exercise are also critical components to help manage weight. It’s never too late to get fit. 

High-Intensity Exercise and Cancer Prevention

Recent research published in Cancer Research in 2022 uncovered a compelling connection between high-intensity exercise and cancer prevention. The study indicated that high-intensity exercise could reduce the risk of metastatic cancer by up to 72 percent. The analysis emphasized that exercise is associated with a lower risk of developing cancer in both men and women, with a stronger correlation with highly metastatic cancers. In particular, high-intensity exercise significantly reduced the incidence of highly metastatic cancers, suggesting that it may help prevent cancer from spreading to distant sites. Incorporating high-intensity exercise as part of a functional training program is one of the hidden secrets of aging well. It improves overall health, strength, and functional ability and reduces the risk of all causes of mortality. 

The Benefits of Yoga

Physical activity doesn't solely mean high-intensity workouts. Yoga, for instance, offers a different but equally beneficial approach. According to the American Cancer Society, evidence demonstrates that yoga can help lower stress, increase strength, and reduce lower back pain while providing valuable exercise. While yoga does not cure cancer, the National Institutes of Health suggests it may alleviate some cancer-related symptoms when used alongside conventional medical treatment. Going inward to find calm during chaos tremendously benefits overall health.

Combat Stress

Chronic stress is linked to cancer progression and spread. Coping with stress is a critical aspect of maintaining good health. As the National Cancer Institute reported, one effective way to manage stress is through yoga and meditation. It's an approach that helps reduce the risk of certain cancers and chronic diseases and promotes overall well-being.

Early Detection

Mammograms are your very best chance of finding cancer in the early stages. According to the American Cancer Society, when breast cancer is detected early and hasn't spread, the 5-year relative survival rate is 99%. Don’t delay - if you’ve not had your mammogram yet, make your appointment today!

Breast Cancer Awareness Month reminds us to take proactive health measures and the important role our lifestyle choices have in reducing cancer risk. Maintaining a healthy weight, embracing regular exercise, including high-intensity workouts, and incorporating yoga and meditation into our routines can empower us to take charge of our well-being. Doing so contributes to the fight against breast cancer and enhances our overall quality of life. Remember, your health is your greatest wealth.

Embracing the Unpredictable: Navigating Health Scares and Prioritizing Wellness in Midlife

By the time we've reached midlife, we've most likely experienced a health crisis, either ours or someone’s very close to us, and lost people we’ve known well and loved.

Yet, no matter where we are on the health continuum, a crisis is always a shock, especially if it’s our own

The reality is modifiable risk factors are largely responsible for the leading causes of death. And many of the risk factors are preventable years and even decades before a diagnosis. There is a LOT of research (and a lot of speculation) about how to delay the onset of disease by engaging in healthy habits. However, many people feel their risk is more due to aging than how they choose to live.

The common perception of an inevitable decline and marginal health towards the end of life is evolving and, in our opinion, is outdated! We talk about the 'how tos' for living longer and better as we age at Rumblings.  

As a registered and licensed dietitian and an exercise physiologist, we practice what we recommend to others. We're on this aging journey too. Our aim has always been to distill the science into understandable and actionable recommendations to help you improve your aging journey. We want to help women differentiate between personal health recommendations (e.g., I lost weight; therefore, I am an expert), beliefs of self-professed wellness experts (e.g., I took a 30-hour class to get a coaching certificate), and true research-based recommendations to cut through the confusion, improve health, and prevent risk factors for disease.

We're not perfect. I (Karyn) secretly love salty chips and crackers and love cheese. But I enjoy them in moderation. We're focused on creating a strategy and plan for our health and prioritizing behaviors necessary to increase our health span. 

Our intent is not only to delay death but to push off disease from the so-called four Horsemen (cancer, cardiovascular disease, metabolic dysfunction, neurodegenerative declines) and improve the quality of our lives as we age. Who doesn’t want to feel great, move pain-free, and engage fully in life until we die?

I was recently reminded, however, that all the awareness, diligence, and healthy habits in the world don't make us immune to experiencing health scares. A few months ago, I was flagged for having an abnormality in my blood via a screening done to donate plasma. It was a fluke because this serum protein electrophoresis (SPEP) is not typically done as part of a routine exam in the United States.

I felt great, and all my typical wellness checks – and a few additional tests I requested – had been at optimal levels for health. Although I'm not thin, I require no regular medications. After completing several other tests, including a CT scan and bone marrow biopsy (sedation during the procedure made it pain-free), I was determined to have monoclonal gammopathy of undetermined significance (MGUS for short), a precursor for multiple myeloma. 

Multiple myeloma is terminal cancer with no treatment, and the standard treatment is to treat the effects of cancer. These effects are often the first indication an individual might have this type of cancer. Multiple myeloma is one of the rarer cancers, with no modifiable risk factors other than possibly obesity, but the number of individuals with the diagnosis is increasing worldwide.

As someone who is a “worried well” individual, there is a processing and reckoning required to accept that, occasionally, our health is out of our control. There is no lifestyle behavior to be modified, no treatment or pharmacological intervention to improve the situation, and nothing that could have prevented this from happening to me. It wasn't easy to grapple with.  

Confirmation that I have MGUS, a precursor, and not cancer, was a huge relief. I may never progress into multiple myeloma, but thankfully, I now have the baseline of all of my measures from my test results and can monitor any progression along the continuum of conditions that are precursors to multiple myeloma.

It was also a good reminder that as pristine as we may be with our health, there are some things over which we have no control. Rather than let it all go and live la vida loca, I have re-evaluated my approach to my health and wellness. I want to share it; in case it might be helpful for anyone else who finds themselves in a similar situation.

I have changed my mindset to think about my lifestyle behaviors as self-care. Good health is not only the absence and prevention of disease but also about building a 'reserve' of good health in case I get sick. 

Here is what that means for me and links to previous blog posts if you want to understand a topic further.

- I engage in exercise and physical fitness that feels like play, but I also choose activities that allow me to spend time in nature. I've always found joy in moving my body because I can – no matter what that looks like at any given moment. 

- I eat healthfully, including choosing plants, hitting protein targets, monitoring calorie intake, and focusing on whole foods.

- I limit alcohol consumption. Research suggests there may be no healthy intake levels for some individuals, and consuming too much may increase cancer risk.

- I am  extra vigilant with scheduling and staying current with my preventive exams and screenings

- I'm encouraging all my midlife friends (especially all of you) to ask their providers to include a SPEP or CBC test as part of their routine blood work at their next preventive exam.

- I got a bone density exam. The results provide information beyond just understanding the risk for osteoporosis. One of the initial signs of multiple myeloma for many people is vertebral compression fractures. This situation is exacerbated if your bone density is less than optimal.

This is my list based on my current health status. I encourage you to renew your focus on joy and vitality, whatever that looks like for you. Health is more than your test results and screening numbers. It's about creating memories with those you love and experiencing the joy of being healthy to live it as fully as possible.

Too often, as we age, we look to the past without recognizing that the best way to stay young is to look toward the future. 

A wise friend once told me that time is short and the world is big. There are dreams I've yet to finish, and many I still need to start living. My spirit is young, and I want to put in the effort to make sure my body stays young, even as I age.

Here's to life! Such a gift I will not waste.

You can find out more about multiple myeloma and its precursors here.

What Women Can Do to Care for Heart Health After 50

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.

5 Actions to Improve Women’s Heart Disease Risk After 50

This is part one of a two part series of a conversation with Courtney Jordan Baechler MD, MS, a preventive cardiologist and a Medical Director at the Minneapolis Heart Institute Foundation.

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.