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Getting a Beat on Heart Disease and Women

Cardiovascular disease differs in women—but it’s just as common in men.

By Nancy Sokoler Steiner

Pregnant with her second child, Tricia Drum-Lal felt weak and tired. She chalked up the feeling to her busy life. After all, she was caring for a toddler, tending to her ill, elderly parents and working long 12-hour shifts as a physician’s assistant in the Providence Saint John’s Health Center emergency room.

Drum-Lal’s symptoms worsened right after giving birth, when she became short of breath. She was diagnosed with cardiomyopathy, a decrease in the heart’s ability to pump. The condition can cause a backup of fluid and can lead to congestive heart failure.

Developing cardiomyopathy related to childbirth is one of many ways that women experience heart disease differently than men. In fact, heart disease is just as much an issue for women as for men. More than 60 million women—44%—in the United States live with some form of heart disease, according to the Centers for Disease Control and Prevention.

“Many people don’t realize heart disease is the leading cause of death in women,” says Nicole Weinberg, MD, a cardiologist at the Pacific Heart Institute. “Cardiovascular disease kills more women than all forms of cancer combined.” Heart disease doesn’t just affect older women. According to the American Heart Association, 45% of women ages 20 and older have some form of cardiovascular disease.

“There are significant differences in women’s heart health and men’s heart health,” says Dr. Weinberg. “You have to treat each patient as an individual and tease out their history and risk factors in order to best treat them.”

Pacific Heart Institute is affiliated with Providence Saint John’s Health Center, providing state-of-the-art care and leadership on women’s cardiovascular health and setting the gold standard for women’s heart health in Los Angeles.

Specialty care for women
Dr. Weinberg calls pregnancy “a woman’s first stress test” because pregnant women may experience conditions that significantly increase their risk for cardiovascular disease during pregnancy or in the future. They include fertility issues, clotting issues, preeclampsia, gestational diabetes and pregnancy-induced hypertension. In addition, polycystic ovary syndrome increases heart disease risk. So do autoimmune inflammatory diseases, such as lupus and rheumatoid arthritis, which strike more women than men.

Women’s coronary artery disease risk also increases within the 10 years following menopause. As estrogen levels drop, women face a higher risk of blood clots, plaque in the arteries and increased cholesterol levels. “When a postmenopausal woman shows a sudden increase in blood pressure, it can’t just be considered a fluke or white coat hypertension, which is elevated blood pressure in medical settings caused by anxiety,” notes Dr. Weinberg. “It may signal a cardiovascular issue.”

Women may experience cardiovascular disease differently than men, she adds. Symptoms more common among women include shortness of breath, nausea or vomiting, and back or jaw pain, according to the federal Office on Women’s Health.

Dr. Weinberg and her colleagues at Pacific Heart Institute and Saint John’s aim to educate women about the prevalence of heart disease, encouraging them to advocate for themselves and others. This could mean raising the topic at a medical exam, asking about advanced tests for heart disease or sharing knowledge with loved ones. It includes learning about ways to lower cardiovascular risk through lifestyle behaviors such as diet and exercise.

For the last decade, Dr. Weinberg has spearheaded an annual Women’s Heart Symposium, supported by the Saint John’s Health Center Foundation. The gathering brings together medical professionals and community members to hear about current cardiovascular developments.

Held in February at Hotel Casa del Mar in Santa Monica, this year’s symposium featured keynote speaker Dipti Itchhaporia, MD, past president of the American College of Cardiology. About 200 people attended in person with another 300 tuning in via live stream.

Saint John’s trustee Merle Mullin supports the symposium and hosted a lunch where the organizers brainstormed plans for each conference. “Education is the pathway to understanding the facts about cardiac disease in women and destroying the myths,” she says. “Philanthropic efforts allow us to continue this work and outreach.”

Individualized Care
The physicians at Pacific Heart Institute understand the unique issues that affect women’s heart health. Four of the group’s 17 cardiologists are women—a higher percentage than at many cardiology group practices.

Drum-Lal, who had suffered cardiomyopathy around the birth of her second child, came to Dr. Weinberg for care after developing a second bout of the condition. “I was taking a lot of medications to protect my heart, but my blood pressure was very low and I’d have episodes where I felt like I was going to pass out,” she says.

Dr. Weinberg determined that Drum-Lal had arrhythmias, or irregular heartbeats, and a low ejection fraction (which measures the ability of the heart to pump blood). She referred Drum-Lal to her colleague Sarina van der Zee, MD, who implanted a defibrillator. This device can restore normal heartbeat or shock and revive the heart if it stops beating. The defibrillator also helps increase ejection fraction.

Dr. Weinberg also reduced the number of medications Drum-Lal took. “There are new combination drugs that can reduce fluid in the heart and increase the heart’s squeezing capability,” she says. “They are typically better for young women, who tend to have lower blood pressure and don’t tolerate traditional medications that reduce their blood pressure.”

“The care I received from Dr. Weinberg was complete and comprehensive,” says Drum-Lal, who knew Dr. Weinberg through professional interactions in the ER. “She understood me and my situation. She saw the pressure I was putting on myself and how I was putting all my roles—mom, daughter, wife, provider, caregiver—ahead of caring for myself.”

Drum-Lal left her high-stress position in the ER and now works as a physician’s assistant for a Saint John’s-affiliated internal medicine physician. She no longer suffers from congestive heart failure and feels secure that she will continue to be present for her husband and children.

“I feel blessed to be part of Saint John’s,” she says. “I appreciate the hospital’s faith-based mission. The medical staff and support staff are amazing. And with Dr. Weinberg, I know my best interests are kept in mind.”

Philanthropy makes it all possible
“If we could lower the staggering number of people—men and women—affected by cardiovascular disease, that would be amazing,” says Dr. Weinberg. “And the only way to do that is through philanthropy. That’s what makes education possible, and that’s what fuels new technologies and treatments.”

She notes that research supported by the Saint John’s Health Center Foundation helped develop the Watchman. This implantable device, about the size of a quarter, can reduce the risk of strokes in patients who cannot tolerate blood thinners—the standard stroke prevention therapy. Shephal K. Doshi, MD, director of cardiac electrophysiology and pacing at Saint John’s, served as a principal investigator for the device and continues to pioneer methods of performing the procedure.

Dr. Weinberg created a nonprofit called Have A Heart, Save A Heart to launch the Women’s Heart Symposium, raise awareness of women’s heart issues and support research. “Saint John’s is a top-tier partner for Have A Heart, Save A Heart,” she says. “Our community education efforts would not be possible without Foundation support.”

To learn more about how you can support women’s cardiovascular education and services, contact Marquina Munoz-Freedman, RN, director, donor engagement, at 310 829-8348 or
Marquina.Munoz-Freedman@providence.org.