Exploring the intersection of heart health and women's health

Contemporary OB/GYN:

I'm here with Dr. Bello to discuss heart health and women's health and how these 1 fields intersect in honor of American Heart Month. Do you want to introduce yourself, Dr. Bello?

Natalie Bello, MD, MPH, FACC:

I'm Dr. Natalie Bello. I'm an adult cardiologist and the director of hypertension at the Smidt Heart Institute at Cedars-Sinai Medical Center in Los Angeles, California.

Contemporary OB/GYN:

So what is the importance of American Heart Month and why is focus placed on women during this time?

Bello:

That's a great question. So, February is American Heart Month, a time when all people but especially women are encouraged to focus on their cardiovascular health. And basically, we know cardiovascular disease is the leading cause of death for both men and women. But we also know that most women do not perceive heart disease as a substantial health concern, and in fact, there's been lots of surveys asking people what are their leading causes of death and if they have any information about heart disease, and unfortunately, trends are going in the wrong direction. Awareness amongst women that heart disease is the leading cause of death has actually declined from 2009 to 2019. I think most distressingly, not only has awareness declined, but it's been particularly steep declines amongst Hispanic and non-Hispanic Black women who we know have very high risk for heart disease, and among younger women aged 25 to 34 years. And these are groups in whom primary prevention or primordial prevention, which is prevention either before risk factors develop, or once risk factors for heart disease are present, but not heart disease itself. We know that we can prevent about 80% of cardiovascular disease if we appropriately identify and treat risk factors, and so, it's really important to get the news out there, and that's why Heart Month is super important. So, we can try these large scale public health campaigns to just bring more awareness to how important heart health is. We know women often overestimate their risk I said compared to cancer, so cardiovascular disease actually kills more women than all of the other cancers combined in a single year. So really kind of puts it into perspective.

Contemporary OB/GYN:

Yeah, I agree. And how does pregnancy impact cardiovascular risk factors?

Bello:

So, we actually have a growing body of evidence that pregnancy complications, both those that are experienced by mom as well as pregnancy complications that impact the fetus and baby, offer us a glimpse into mom's future cardiovascular health and risk factors. So, when we think about adverse pregnancy outcomes, like preeclampsia, gestational hypertension, gestational diabetes, but even preterm delivery and delivery of a small for gestational age infant, we now have really good evidence that those events are actually associated with an increased risk of all sorts of heart disease and cardiovascular disease in the future, including heart attack, heart failure, stroke, and even things that we know are related to hypertension, like dementia or Alzheimer's disease are becoming more linked to earlier pregnancy complications. The other thing we know is that people who have what traditionally had been considered sort of temporary risk factors, things like gestational hypertension, gestational diabetes, which by definition, are occurring during pregnancy and then resolve. We never really put much stock into how important those were as markers for future cardiovascular risk, and depending on an individual's risk profile, we know in some situations, more than half of people who had gestational hypertension, for example, will go on to develop chronic hypertension within the first year postpartum. So, even though their blood pressure gets a little better, they're at very high risk for having high blood pressure that either needs to be treated with diet and lifestyle modification, or for some people, we know that they're going to need medications to get their blood pressure controlled.

Contemporary OB/GYN:

And with this in mind, what advice do you have for clinicians to we'll be dealing with pregnant patients who might have increased cardiovascular risk factors.

Bello:

So, I think not only is it important for us to realize that cardiovascular disease is the leading cause of death for women in the United States, it's actually the leading cause of maternal mortality as well. So, a third of deaths that occurred during pregnancy are due to heart disease, and two thirds of deaths that occur in the first postpartum year are also due to heart disease. So, I think for folks who are taking care of pregnant patients, it's really important to have a high index of suspicion for cardiovascular disease, and to think about those risk factors. It's also really important for clinicians who care for patients around the time of pregnancy to realize that this may be one of the only touch points our patients have with the medical system. You know, they come into their OBGYN for regular checkups for pregnancy care, and they don't get a ton of screening and education. So, I think it's super important for these clinicians who have that touchpoint with pregnant patients, to educate their patients about how their pregnancy might impact their future heart and brain health, and ensure that also after the pregnancy ends, the patient understands if they had any of these high risk factors that will impact their heart health in the future, and create a nice plan for a warm handoff to a primary care clinician, or for really complicated cases who might need a cardiologist, someone to help that patient navigate their risk factors and ensure that they get appropriate and ongoing risk factor screening and modification.

Contemporary OB/GYN:

That's great advice. Thank you. We're just about ready to wrap up. Is there anything you want to add first?

Bello:

I just think the only other thing I'll add is that it's really important to remember that just because you have risk factors for heart disease, there's lots that we can do to prevent you from getting heart disease and keeping you healthy, and the American Heart Association's life's essential aid is a really nice overview of key measures that we know are really important for heart health. And most importantly, blood pressure is the number 1 modifiable risk factor for heart disease. So, for individuals who have had high blood pressure during their pregnancy, it's really important to remember that that was your risk factor. Tell all your other clinicians that you've had that risk factor and get your blood pressure checked regularly in addition to other things like your cholesterol and making sure you don't have diabetes.