Women’s Heart Health Across the Lifecourse

[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): (00:31)

We are welcoming our audience to today’s episode where we have the great pleasure of speaking with Rachel Bond. Rachel, could you introduce yourself to our audience, please?

Rachel Bond (guest): (00:38)

Yes. Hi, I’m Dr. Rachel Bond. I am currently the director of a large women’s cardiovascular program locally in Arizona. I am an expert in women’s heart health and prevention, and I volunteer with many of our medical societies where I’m on the board of directors, and also several leadership committees that are focused on women’s health and prevention.

Geralyn Warfield (host): (00:59)

We often hear that pregnancy is a stress test. And I’m wondering if you could define for us or delineate a little bit more about what that means for women’s heart health.

Rachel Bond (guest): (01:08)

Absolutely. I always tell my patients that pregnancy is often their first but unequivocally will be their most important cardiac stress test. And the main major reason we say that is because think about what happens during pregnancy. So, all those hormonal changes actually can increase one’s cardiac output, which means that their heart is working at a much higher rate, higher pressure. It increases their heart rate, their blood pressure. It increases the volume because instead of the mother having to sort of compensate for herself, she has another human growing inside of her that also has to be compensated for.

So, with those hemodynamic changes or with those hormonal changes, a lot of time that does put a lot of strain and stress on the heart. Our hope is that the majority of women will pass that stress test with flying colors, but oftentimes if they have underlying cardiac disease, or cardiac risk factors they may not. And that’s where we in the cardiology world have to get involved. The best part of us getting involved or the best time to get involved often is before the pregnancy.That way we can figure out what their risk looks like, help to get them through the pregnancy and come up with a good game plan.

Geralyn Warfield (host): (02:20)

So, in addition to that stress test of pregnancy, what are we getting wrong about women’s heart health across the life course?

Rachel Bond (guest): (02:27)

We’re getting so many things wrong. The main things we’re getting wrong is that we’re caring for women very episodically. And that’s a big, big, big issue. We have to think about all of these different life courses as inflection points in a woman’s life. The reproductive years: if one goes into menarche earlier, later, if they go into menopause earlier, later. We have to think about pregnancy and any of the risk factors that come with that.

But then we also have to think about the lived experiences of women, particularly in that midlife, where oftentimes they’re called the sandwich generation because they’re caring for their children and their ailing parents.

What we do know is that if we think about women in that holistic way, where we’re again not just doing episodic care, but again, framing what their past history looked like and predicting that for their future history, we actually are going to do a much better job in caring for these female populations.

What I usually do when I see a patient for the first time is I take a very detailed clinical history. In that I ask about their reproductive history, their obstetric history. Of course, I ask about the traditional risk factors as well, but I also take it a step further and think about their stress.

We do PhQ-10s in my clinic, we also look at chronic stress scale, because all of those lived experiences are impacting, in a negative way sometimes, women’s cardiovascular health. And if we’re not doing that, we’re doing a disservice to our patient population.

Geralyn Warfield (host): (04:00)

I think one of the other things that we forget is sometimes women’s health care is fragmented, meaning that they may go to a primary care physician as a child, they might go to another practitioner when they are, let’s say, going to college, then perhaps during the reproductive years, their focus turns to their OBGYN, who may or may not be thinking holistically as we’ve just described, unless there’s an issue. After the child is born, sometimes they totally neglect their own health, because their focus is on their offspring and then maybe are not getting high quality care.

So, in addition to all these other inflection points that you’ve just described, there’s really not necessarily someone who is following them along that trajectory. So, I appreciate your long-term kind of looking at family history and those kinds of things. Is there a way that we could make that better for our patients?

Rachel Bond (guest): (04:50)

Yeah, I wish that there was a simple answer. What I will say is that we as women are good at advocating. Oftentimes it’s for others versus ourselves. But I am encouraging our new generation of women out there to do a better job in self-advocating. And I think they’re doing it for the most part.

I think what we as clinicians have to do a better job at is telling them what their risks are. That way at every visit, they’re telling the next person that’s caring for them. “Well, hey, I know that this is a risk factor for cardiovascular disease. I want to make sure you know that. I want to also understand what my risk looks like today because of what my past risk looked like.”

And I think that as we educate the patient population, they’re going to help us as clinicians also, of course, in the end, to just serve them so much better than what how we’re currently serving them.

Geralyn Warfield (host): (05:42)

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

Geralyn Warfield (host):

We are back speaking with Rachel about cardiovascular care across the life course, and I’m wondering if you could please address for us kind of risk stratification and what that might look like.

Rachel Bond (guest): (05:55)

Absolutely. So, with the risk stratification, I’m thinking about what are the traditional risk factors that this patient may have. That could include high blood pressure, diabetes, obesity, family history.

One thing I will say that many of those traditional risk factors do disproportionately affect women much greater than men. So, I’ll use even tobacco use as an example. Of course, we should be encouraging all of our patients to abstain from it. However, if someone is smoking and they’re smoking the same number of cigarettes for the same duration as their male counterpart, they’re at about a 25% greater risk of having a cardiac event.

This is where we have to also not just look at those traditional risk factors, but realize the sex of that individual can sometimes negatively impact them greater than the sex of another individual.

But then, I’m looking at female-predominant risk factors. So, do they have evidence of inflammatory conditions like lupus, rheumatoid arthritis, conditions which we know disproportionally affect women, but also can increase their risk of cardiac disease. The same way migraines can do that, the same way conditions that just predominantly affect women can also be factors that we should be screening for, such as the age they went into menopause, the age of their first menstrual cycle, if it was early, if it was late. If they have polycystic ovarian syndrome, if they have infertility, those are factors people don’t realize.

So, the reproductive years really do tie into one’s future cardiovascular risk, just like pregnancy and any complications that may come with that. So, when we’re thinking about risk stratification, it’s extremely important that the first step is we’re taking a detailed medical history, we’re thinking about their personal history, we’re also factoring in their family history.

Sometimes you may factor in their blood work, getting their cholesterol checked, getting their blood sugar checked. Now our new guidelines are also recommending checking lipoprotein(a) universally, at least once in a person’s life. I often may check it twice after a woman goes into menopause because there is data to support that it could actually increase.

So, there’s so much data and so many areas that I think we as clinicians need to do a better job in terms of how we educate our patients on their overall risk, but the easy and best step is to take that detailed history.

Geralyn Warfield (host): (08:21)

If you had one key takeaway that you would like to leave with our audience, what would it be?

 

Rachel Bond (guest): (08:26)

I would say that the key takeaway is that we do need to do a better job in educating our women, but we also need to do a better job in believing their symptoms as well.

I see so many young women in mostly all stages of their life where they are coming in and out of the emergency department with symptoms, or they’re going through pregnancy very fearful because some of the symptoms they’re experiencing, they’re being told to them that they’re just due to their pregnancy when actually it’s a cardiovascular condition.

So, in addition to us, of course, educating our patients, we as clinicians believing them is really going to move the needle when we think about women’s health in general.

Geralyn Warfield (host): (09:10)

Thank you so very much for being here and sharing your expertise and your enthusiasm for women’s health with us today. Thank you so much.

Rachel Bond (guest): (09:15)

Thank you so much.

Geralyn Warfield (host): (09:16)

This is your host, Geralyn Warfield, 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.