Gender Differences in Cardiovascular Disease

Intro: This is Weekly Dose of Wellness, brought to you by MemorialCare Health System. Here's Deborah Howell.

Deborah Howell (Host): Hello and good day and welcome to the program. You're listening to the Weekly Dose of Wellness brought to you by MemorialCare Health System. I'm Deborah Howell, and today's guest is Dr. Leila Rasouli, a board-certified interventional cardiologist practicing at Saddleback Memorial Medical Center in Laguna Hills, California. Her mission is to provide dedicated, advanced cardiac care from the heart. Dr. Rasouli completed her cardiovascular and interventional fellowship at Harbor UCLA and leads a full-service cardiovascular practice in the Orange County area. Welcome, Dr. Rasouli.

Leila Rasouli, MD: Thank you, Deborah. Nice to be here.

Deborah Howell (Host): I'm so glad we could get you for a few moments today. Women and men are quite different when it comes to heart disease, so let's get right into it. What are some of the general differences between women and men in the acute or hospital setting?

Leila Rasouli, MD: You're right, dear. Women and men are very different. And in the global society aspect, we've had books and media compare us to different planets. However, in the cardiovascular arena, it's a more sobering milieu, so to speak. Women are their own universe. Women are less likely to survive a heart attack if they have one compared to their male counterparts. Women have greater than 50% chance of dying during heart surgery. And typically they are more likely to develop heart failure or a weakening of the heart muscle. So you can see that this is a more sombering effect that comes over women. It's such that they are like an onion with different layers, different nuances. And at the center of this is the hormone, the estrogen theory, I'm convinced.

Deborah Howell (Host): Okay, because otherwise we simply don't know exactly why a woman would have a 50% chance of dying more so than her male counterpart during heart surgery.

Leila Rasouli, MD: We don't exactly know, but we have some thoughts of why this may occur. When women do have surgery, they're much older. So they have more comorbidities such as diabetes and hypertension.

Deborah Howell (Host): And this of course is on average.

Leila Rasouli, MD: On average, and it depends from site to site and the age of the woman. And it may not be as much with newer techniques. And certainly it's not to speak down against surgery, but because the women's vessels are smaller and they have higher comorbidities when they are operated on, they are sicker, so to speak. It becomes harder to take care of them.

Deborah Howell (Host): Tell our audience what comorbidity means.

Leila Rasouli, MD: Comorbidities are sicknesses that affect us. So diabetes puts you at a greater risk, puts you at a higher risk level than someone without elevated blood sugars requiring insulin and medications.

Deborah Howell (Host): Okay, so it's like more than one thing going on in your body.

Leila Rasouli, MD: More than one thing going on. Exactly.

Deborah Howell (Host): Now women have different symptoms than men. Why don't we get into that a little bit?

Leila Rasouli, MD: Yes. And this is at the core of why we miss heart disease in women. Typically the man comes in with an elephant sitting on his chest, gripping chest pressure and he's sweating and you know exactly what's going on. Well, for a woman, she may have had generalized fatigue for about two months or generalized body pain for two months. Neck pain, throat pain. And one of the most common ones is indigestion. I've had a woman that she actually thought that it was a burrito she had the night before. She came in, no one really thought it was a heart attack, and we ended up fixing two sites in her artery. So it is the great masquerader, so to speak. And we have to be vigilant both as the medical side and the woman herself and her family.

Deborah Howell (Host): It makes you want to send an email blast to every single woman you know with a video of these symptoms.

Leila Rasouli, MD: That's a very good point, Deborah. They already know. We have been on this for about 10 years trying to bring awareness to this issue. But the funny thing is, the woman will be the first one to jump and take her child to the urgent care or her husband, but when she gets this symptom, oh, let me see what happens.

Deborah Howell (Host): Right. We're caretakers.

Leila Rasouli, MD: We're caretakers.

Deborah Howell (Host): Except for ourselves.

Leila Rasouli, MD: Yeah, I've had a woman who actually she's a nurse, she knew all these, she had problems, she made dinner for her family, cleaned the dishes, and then drove herself to the ER.

Deborah Howell (Host): Yeah, that's a woman for you.

Leila Rasouli, MD: Exactly. So yes, it is nice to blast it, but also we have to act on it.

Deborah Howell (Host): Exactly. And this podcast will be a good way to at least start. And so I hope people listen and watch and learn. So let's learn some more. What theories have been offered on the differences in the disease process between men and women?

Leila Rasouli, MD: Well, certainly we're just scratching the surface. But we know that estrogen and hormonal changes have something to do with it. We know that low estrogen, the waning estrogen we have after menopause, certainly affects the heart vessels. Estrogen is critical.

Deborah Howell (Host): Let me stop you there. What about women who are taking hormones? Is this another incentive for women to take hormones?

Leila Rasouli, MD: No, it's actually the opposite. We used to push hormones on women thinking it was good for cardiac health. And that changed about 15 years ago when we found that they were actually not so doing well. However, that leaves us with a large population of women needing hormone therapy after menopause or they'll go straight crazy. They're going through a very difficult time. A decade of different things going on. Palpitations, hot flashes. And the only way we know how to treat it is with hormones, but it's the same thing that may be hurting their heart. So that is a difficult population and it's a population that's growing, my dear.

Deborah Howell (Host): Is it something you should speak with your doctor about, maybe getting a lower dose of hormonal stimulation every month?

Leila Rasouli, MD: We don't have the literature yet. However, we're thinking compounded hormones, those that are specially made to fit your body hormone levels, may be the ticket. But yes, absolutely speaking to your doctor and working together with a heart specialist. We have to open people's minds that yes, it's not necessarily very good for the heart, but as happened with my mother, she went to a doctor, an endocrine doctor, a hormone doctor that said I'm not going to prescribe anything. But she was going through a major change in her body that had her hospitalized. So you live in the grey zone and you need a good gynecologist and you need a good cardiologist or internist to be working together with you.

Deborah Howell (Host): And you need to go. You need to go every single year.

Leila Rasouli, MD: Yes. Not only that, but be in connection, read the internet. I tell people I do want you to read. Bring your questions to us and maybe we'll learn something. But normally it'll be a discussion. And if that discussion never happens, it's always inside of you, nothing's going to change.

Deborah Howell (Host): And part of that discussion should be to know your numbers.

Leila Rasouli, MD: Yes. And that's critical. Just like you know the size of your clothes. Just like you know the size of your husband's shirt. Knowing your numbers. Cholesterol. There's four main numbers to know. The good and the bad cholesterol. Find out what that means. Knowing where you need to be optimally. What your blood pressure needs to be. What your heart rate needs to be. You need to get out there and buy a blood pressure cuff and be aggressive in your own care. No one will care about you as much as you yourself. Your sugar level.

Deborah Howell (Host): BMI. And even your lipid profile. I mean most people I know, I certainly don't know what my lipid profile is, but it would be really beneficial to know that and why.

Leila Rasouli, MD: Well, we know that's one of the main ways that if it's elevated, we can change it with the arsenal we have, both with medication and with natural means to optimize that whole panel. And if we optimize it, then we're trying to move against this battle that we're losing with heart disease. If we can change your bad cholesterol and make your good cholesterol higher, then we are fighting some of the ways we know of making you healthier. 50% of the time, however, we don't know when you'll have a heart attack. 50% of the time we know. We know it's the cholesterol, we know it's the blood pressure, we know it's if you smoke, or if it's a family history. And those we can make a difference with.

Deborah Howell (Host): What about BMI? What are the parameters for BMI?

Leila Rasouli, MD: BMI, I won't go into the equation, but it's a more robust term in looking at you and your weight. If you have a certain weight, but you're six foot two, you're going to be in a different category than myself who's five-three. So BMI takes into effect both the height and the weight of a woman. And that is critical because we carry weight typically in the midsection.

Deborah Howell (Host): Okay, you know, we could go on for hours and hours, but unfortunately our time has flown. We hope to have you back because there's so much more that we need to cover.

Leila Rasouli, MD: Thank you, my dear. Thank you for your time.

Deborah Howell (Host): We've been speaking today with Dr. Leila Rasouli about the differences between women and men as it pertains to heart disease and how this awareness and knowledge will hopefully lead to prevention of heart disease in the future. We thank her so much for joining us today. I am Deborah Howell. We invite you to be with us again next time as we explore another Weekly Dose of Wellness, brought to you by MemorialCare Health System. Everybody get out there, know your numbers, and have a great day today.