Heart Health for Women at Every Age

[00:00:00] I’m Yvonne Commodore-Mensah, Board President for PCNA. I’d like to welcome you to Heart to Heart Nurses. PCNA supports your professional journey with accessible continuing education, practical patient resources and a vibrant community that understands the unique challenges and rewards of cardiovascular nursing. Together, we’re advancing the knowledge that defines excellence in cardiac care while celebrating the difference you make every day.

Geralyn Warfield (host): (00:19)

I’d like to welcome our audience today to a conversation with Dr. Lundberg. I’m let her introduce herself to you.

Gina Lundberg (guest): (00:26)

Hi, Geralyn, I’m Dr. Gina Lundberg. I’m a Preventive Cardiologist at Emory University School of Medicine. I’m a full Professor of Medicine and I’m the Director of the Emory Women’s Heart Center.

I’m very active with women in heart disease, but the ACC and AHA, and I’m also very interested in women in medicine, and I’m the chair of the Women in Cardiology section for the American College of Cardiologists.

Geralyn Warfield (host): (00:52)

Well, we’re so excited to have you here speaking with us today. Could you talk a little bit about women and cardiovascular disease and whether or not we’re doing a good job?

Gina Lundberg (guest): (01:02)

Well, that’s a really good question. And unfortunately, the answer is no, we’re not doing a very good job.

scular disease is, and remains, the number one killer of women in the United States since about the 1970s. There was a time period when the deaths from cardiovascular disease in women and men were declining. But since about 2015, we’ve seen them on the rise. And again, this year’s statistical update from the American Heart Association showed another increase in men and women, more men of dying of heart disease now than women, which was the reverse in the 1970s and 80s, but it’s a very worrisome trend.

The other thing is we have had several studies, one from the Women Heart Alliance, that showed women are now less aware of their cardiovascular risk. In 2004, after the Go Red for Women campaign came out, women were much more aware of the risk of heart disease and the signs and symptoms. It was up around 50% for white women and about 40% for African American women, and now it’s less than 25% again.

Geralyn Warfield (host): (02:07)

Gosh, that’s an incredibly low number for one of the top killers of people on the planet. That’s amazing. So, what is it that we can do to help improve that awareness in clinical practice or maybe in our daily lives?

Gina Lundberg (guest): (02:21)

Well, I think the main thing is to start an awareness campaign again. I think we did a very good job in the early 2000s, and now we’re back to women worrying about breast cancer, uterine cancer. They get their mammogram every year, no problem, but when you ask a woman, well, what are your cholesterol levels? Maybe they haven’t been checked in five years.

Do you check your blood pressure routinely? ‘No, I only get it at the doctor.’ So, we really need to promote health and wellness within the OB-GYN area, as well as primary care, family practice, internal medicine.

Geralyn Warfield (host): (02:56)

So, we know that cardiovascular disease can affect anyone at any age, but particularly as women go through pregnancy, that can be, as some of our guests have talked about, it’s a stress test. And often causes some issues that were underlying and unnoticed before to come to fruition and become an issue that the woman and her providers have to deal with.

But we also know as we age and we hit menopausal times that things can really cause changes in our metabolism and other things that really can affect our cardiovascular risk. Could you talk a little bit about that progression, particularly as we age, and how we’re impacted?

Gina Lundberg (guest): (03:32)

Yeah, so pregnancy is the first stress test on the heart.

And that’s when we really find…well, one could find underlying congenital heart defects that you didn’t know were there. Also, underlying cardiomyopathies that weren’t appreciated.

But very commonly, we see these hypertensive disorders of pregnancy, with the worst being pre-eclampsia and eclampsia. Gestational diabetes, also. And if a woman has had pre-eclampsia, eclampsia, or gestational diabetes, she’s at a lifelong higher risk of cardiovascular disease, but also diabetes and high blood pressure.

So, when they’re happening in the young woman, we want them to get in with a preventive cardiologist or primary care within six months of the delivery. When I’m assessing a perimenopausal woman, which the average age in America right now is 52, we go back to what happened in your pregnancies. And if they had any of these adverse outcomes of pregnancy, they’re automatically at higher risk and need more aggressive risk reduction.

And at the time of menopause, it’s sort of like everything goes in the wrong direction.

So, the bad cholesterol, LDL gets higher, the triglycerides get higher. The HDL, which had a beneficial impact, is now reduced. The elasticity of the arteries isn’t there. The high blood pressure starts to go up. The weight gain, particularly around the midsection, it’s very real, it’s very metabolic.

Of course, women are having bone density loss. Skin is changing, hair is changing. Sometimes vision is changing. There are cognitive and mental changes, mood swings. Some women experience everything from anxiety to rage.

So, it’s a head-to-toe impact on our bodies when we go through menopause. And many of those things adversely affect the cardiovascular profile.

Geralyn Warfield (host): (05:21)

So, how would hormone replacement therapy impact my overall health, or my cardiovascular health, if that was something that was right for me?

Gina Lundberg (guest): (05:30)

Well, that’s where it gets a little tricky. So, the large endocrine societies as well as ACOG, the American College of Obstetrics and Gynecology, in addition to the American College of Cardiology, still do not recommend hormone replacement therapy or menopause hormone therapy for cardiovascular benefits.

But having said that, quality of life and other health issues are very important. And nothing treats those vasomotor symptoms, the hot flashes, the sweat, the mood swings, like estrogen. Nothing is as good as estrogen, but more estrogen. And so, we really started to look at, well, is there harm? Are we really hurting these women? And what about some of the newer methods? Some of the transdermal patches in very low doses, the vaginal creams, the inserts, even IUD, what are these things doing health-wise?

And most of the newer studies are really showing minimal harm. A slight increase in risk in myocardial infarction, stroke, but incredible benefit in the vasomotor symptoms and the genitourinary symptoms.

And so, it’s really one of those shared decision-making situations. A woman needs to know her risk, know what’s out there, options for treatments, and then she and her provider decide what’s going to be best for her.

We have thought the lowest dose for the least amount of time was sort of the mantra. But a newer study that came out of Denmark shows that maybe the timing isn’t as important. Maybe you have just the same risk whether it’s less than a year or more than four years. But you still want the lowest dose that’s needed to achieve a good night’s sleep, not having hot flashes, not wanting to kill people. Those mood-swings are real.

 

Geralyn Warfield (host): (07:18)

We’re going to take a quick break and we will be right back.

Geralyn Warfield (host):

We’re back with Dr. Lumberg talking about the subtle [CV] symptoms that our women patients might be having. Could you talk a little bit more about what that looks like in practice and what we should be looking for?

Gina Lundberg (guest): (07:32)

Yeah. So, you know, women don’t always follow the rules. And in our male patients, we see more of this traditional, you know, sub-sternal chest pain, diaphoresis, maybe nausea and vomiting, but more intense chest pain.

In women, we see a lot more variety of symptoms and they tend to be more subtle. Sometimes it’s just feeling sweaty, clammy. Sometimes it’s nausea. Sometimes it’s lightheaded, dizziness, shortness of breath. Not having the energy that they had, let’s say, decreased exercise tolerance. “I used to walk up the stairs and now I get short of breath.”

The chest discomfort or angina symptom can literally be from the jaw to the abdomen, left or right, front or back. So, a lot of women present with jaw pain, neck pain, shoulder pain, often get sent to a doctor, to the dentist, or an ENT, or an orthopedist, and its cardiac.

So, these more comprehensive but subtle symptoms are things we also need to look for in women. And sometimes men have them too, but it’s a little more commo in women.

Geralyn Warfield (host): (08:39)

I suspect, too, as women are going through menopause that some of these symptoms are masking cardiovascular symptoms. When you’re talking about the vasomotor symptoms and the hot flashes and feeling clammy, you start to perhaps get accustomed to that and you don’t recognize that it’s really indicative of something else that’s happening in your body.

Gina Lundberg (guest): (08:55)

Yes, that is true. You can’t go to the doctor every time you have a hot flash, but it’s more of a profuse, sweating, diaphoresis, maybe associated with nausea, lightheaded, dizziness, maybe with chest heaviness, tightness, pressure. Women are very keen to say, “I’m not having pain, it’s just a pressure or a heaviness or a tightness.” Those words all matter.

Geralyn Warfield (host): (09:19)

Obviously, we have talked a little bit about hormone replacement therapy, but there are lifestyle things that women can be doing to help assuage these symptoms and make themselves feel better. I’m hoping you can help us address that so that we know what to talk about with women in clinical practice.

Gina Lundberg (guest): (09:34)

Absolutely. I think lifestyle is important at every age. When you start in your teens and 20s, then you have these healthy habits for life. But if a woman doesn’t have a routine exercise program by 40, she needs to get one.

And from a cardiovascular standpoint, the ideal exercise routine is about 30 minutes of cardio at least five times a week. And that can be walking. Patients say, “I just walk.” Well, that’s great. Walking is cardio. But it also can be rowing machine, elliptical, treadmill, if you have access to swimming. Those are all great cardio.

But what a lot of women neglect is you need at least two days a week of weight training. You want to keep the muscles strong, That’s also great for the bones.

And then about two days of the core exercises, which I think are the fun things, the yoga, the Pilates, that type of thing. So, it needs to be a well-rounded exercise routine.

And most women, as they get closer to menopause, they need to start cutting back on the portion size. You usually have to cut back about 100 calories per decade. So I teasingly tell my patients by the time you’re 70, you’re going to exercise three hours a day and you’re going to eat three grapes a day.

It’s not that bad, but we do need to focus more on a plant-based diet.

You want more protein, and that is not, you’re okay to start eating more beef and chicken. We want you to have more seafood. Poultry’s okay, but there’s a lot of good plant-based protein. In beans, in the low-fat dairy, particularly light Greek yogurt, cottage cheese, and in some of the whole grains. So, we like the plant-based protein or the low-fat dairy protein.

And then a good night’s sleep is so underestimated. So many women have sleep apnea, which not only has  dementia. And so those are very important.

And then women don’t drink enough water or water-based drinks. We start to see chronic kidney disease, a drop in eGFR, which is also a cardiovascular risk factor as women age.

So, you just really need this well-rounded, healthy lifestyle. Things you learned in your high school PE class, they’re still very important today.

Geralyn Warfield (host): (11:47)

I think you may have already hit on it, but what one key takeaway would you have for our audience?

Gina Lundberg (guest): (11:53)

I’d love to end on an optimistic note and I think menopause, as I pointed out on my talk [at the 2025 PCNA Cardiovascular Nursing Symposium], women can choose to have children and reproduce, but 100% of women will go through menopause. If you live long enough, you’ll go through menopause.

And it doesn’t have to be this, you know, death mark or this horrible time of life. It’s actually a great time of life to focus on you, your health, your food intake, your career, your family, your children, your grandchildren, whatever.

Menopause doesn’t have to be miserable. It can be a very productive and good time of your life. But it’s a time to really start to think about your heart health and do more for yourself.

Geralyn Warfield (host): (12:38)

Dr. Lundberg, thank you so very much for being with us today. I’m Geralyn Warfield, your host, and we will see you next time.

Thank you for joining us for this episode of Heart to Heart Nurses. We invite you to visit pcna.net for education and resources that will empower you to provide preventive cardiovascular care with confidence and expertise