For the first virtual luncheon of the year, the Howell Foundation hosted three experts in women’s health: Dr. Christina Chambers, Dr. Cynthia Stuenkel, and Dr. Andrea LaCroix. Each presented the top research stories of 2020, and how these scientific results will affect women’s health from this point forward. To bring awareness of heart health month, Dr. Stuenkel focused her presentation on cardiovascular disease throughout women’s lifespan.
“I was a big fan of Dr. Howell and knew her. I think she would be so tickled to see some of the advances that have gone on in women’s health. I think she was very much an advocate for research and for finding the truth and emphasizing the value of science.”
The National Study of Physician Awareness and Adherence to Cardiovascular Prevention Guidelines brought to light how physicians followed cardiovascular health recommendations for prevention. Dr. Stuenkel stressed the need of refining and updating the guidelines to assess a women’s risk for heart disease. For her, it’s a two-prong approach: expand cardiovascular risk assessment guidelines, and the need for women to be aware of potential heart disease so they can be proactive about managing their own risk.
During heart health month, Dr. Stuenkel analyzed cardiovascular disease risks throughout a woman’s lifespan, starting at the reproductive age, through menopause, and ending with post menopause and later stages of life, for example, the age when women were thought to have heart attacks or strokes is around age 60 and above. But the facts are that there is a risk at every phase. Furthermore, factors like obesity and diabetes are a key component of detecting heart disease in women at an earlier age.
For her, it’s about opening the windows of opportunity to fully understand the implications of cardiovascular health in women. It is no wonder that, based on key findings, she is a proponent of introducing cardiovascular screening starting at the age of 20, every four to six years.
So on the 57th consecutive annual American Heart Health Month, these are the top stories that caught Dr. Stuenkel’s attention. Her presentation centered on cardiovascular disease in three key areas: pregnancy, breast cancer and menopause.
Early intervention: Pregnancy and heart disease
Dr. Sutenkel expressed the need to start assessing the risk for cardiovascular disease during the pre-pregnancy, pregnancy and post-pregnancy stages. “Some of the areas that we’re learning about in cardiovascular health are the troubles that women can have during their pregnancy and delivery, and the impact that this can have on future maternal cardiovascular risk.”
During the pre-pregnancy stage, the major risk factors leading to adverse pregnancy outcomes and maternal cardiovascular disease are obesity and diabetes – or a “double epidemic”—that along with glucose intolerance, hypertension and lipid disorders may increase the risk for heart disease during pregnancy.
Other pre-pregnancy risks that can add challenges during pregnancy are pre-eclampsia, gestational diabetes, having a small baby for its gestational stage, and pre-term delivery. These categories can, in turn, contribute to post-pregnancy disorders, such as high blood pressure, sustained diabetes, inability to lose weight, and metabolic syndrome; all leading to an increased risk of cardiovascular disease. Simply put: having one of these disorders during pregnancy increases the risk of CVD. Having a combination of more than two of them increases it by four to 10 fold!
Research is now leading the international and national medical and scientific community to include pregnancy-associated events into formal cardiovascular disease assessment tools. Just last year, the American Heart Association published, in its scientific statement, a set of cardiovascular considerations for the care of pregnant patients. Among them, the need to create a cardio-OBGYN team to evaluate women before, during and after pregnancy.
Cancer and cardiovascular disease: Commonalities and collaborations
Dr. Stuenkel once again addressed the relationship between heart health and breast cancer. During last year’s presentation, she mentioned how breast arterial calcification identified in a women’s mammogram could expand risk assessment tools of cardiovascular disease. This year she focused on the intersection of breast cancer and cardiovascular disease in 2 key areas: the common risk factors between both, and the negative effects of breast cancer treatments on the heart.
The overlap of healthy activities to reduce the risk of breast cancer also has a direct repercussion on reducing cardiovascular disease risks. Aside from the family history of breast cancer, leading a healthy lifestyle that considers diet, alcohol intake, obesity/overweight, physical activity and tobacco use also reduced our risks for cardiovascular health. “Even if they’ve had breast cancer, it appears that they’re able to reduce their likelihood of recurrence.”
Taking into account if a woman has cardiovascular disease when diagnosed with breast cancer, and new considerations of breast cancer risk assessment tools is necessary moving forward. Some chemotherapies can directly damage the heart, heart vessels, and heart valves – in some cases, even the heart muscle – that might ultimately compromise survivorship.
“Treatments include endocrine therapy (aromatase inhibitors) that are very powerful medications to lower the amount of estrogen in our body, practically to zero. So while they’re very good for helping reduce breast cancer recurrence, they may be associated with increased cardiovascular risks.” Dr. Stuenkel is a strong advocate for cardio-oncology teams during breast cancer treatment.
A hot trend: hot flashes and cardiovascular disease.
“The menopause transition is really a portal to the second half of life. It gives us a chance to step back, reassess our lifestyle, look at what’s going on with our health, really examine the areas that we can do better, and appreciate that it’s really never too late to take a proactive approach to our health.”
Among the health considerations for women going through menopause, Dr. Stuenkel focused on two areas that may increase women’s CVD health:
- Symptoms associated with CVD which include vasomotor symptom (hot flashes), sleep disturbances and depression;
- Cardio-metabolic health changes, such as metabolic syndrome, atherosclerosis and weight gain/fat distribution.
The American Heart Association has published its scientific statement regarding menopause transition and cardiovascular disease risks.
Special attention was given to surrounding concerns of vasomotor symptoms. For 20 years, the Study of Women Across the Nation, or SWAN, has followed women from reproductive age to menopause. It has found that, among the many menopause symptoms, hot flashes – or vasomotor symptoms– can be a predictor of a higher risk for heart disease. The study compared women who had some hot flashes to women who started having them early and continue to have them for decades beyond menopause. Their finding was that these women were twice as likely to experience cardiovascular events. New research is now focusing on why it happens.
Taking our health to heart: Reducing the risks of cardiovascular disease is within our reach
As to how to reduce the risk of cardiovascular disease risks, Dr. Stuenkel recommends following the AHA’s Life’s Simple Preventive Strategies of Optimizing Cardiovascular Health in Women, including:
• Keeping our blood sugar, cholesterol and triglycerides under control
• Exercising and adequate nutrition practices to keep a healthy weight.
• Getting rid of cigarettes.
The bigger conclusion, and what these stories on cardiovascular disease in women show, is that cardiovascular disease risks that were once considered to develop during a 40-year reproductive life span are now developing earlier, during a 30-year lifespan.
Knowing the stats on women and heart disease is a start. Happy heart health month!
About the Howell Foundation:
The Howell Foundation advances women’s health by funding undergraduate and graduate research scholarships, awarding grants to scientists who conduct research benefiting under represented women in the community, and supporting outreach efforts and events that promote health education and self-advocacy for the long-term health and well-being of women, their families and the community in which they live.