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Heart Health
WOMEN'S HEART HEALTH:
Why It's Time to Rewrite the Narrative Heart disease remains the leading cause of death among women, yet many still believe it's primarily a man's disease. Dr. Beth Abramson, Paul Albrechtsen Chair in Cardiology University of Toronto, Preventive Cardiology & Women's CV Health, St. Michael's Hospital , explains why women need to start putting their heart health first — and what every Canadian should know about prevention. Heart disease is still widely viewed as a men's disease. Why does that misconception persist, and what do you wish every woman knew? Heart disease is the leading cause of death and disability among women — not just in Canada, but around the world. While we've made progress, many women still don't recognize that they are at significant risk. The face of heart disease has changed. It's no longer a disease affecting only older men. Women develop cardiovascular disease too, and while some of their risk factors and conditions are unique, many of the common causes of heart attack and stroke affect both men and women. There are also "sex specific risk factors" such as high blood pressure and diabetes during pregnancy, and premature menopause. The most important message is simple: women need to understand that heart disease is their leading health threat, and they need to make their heart health a priority.
How does cardiovascular disease differ between women and men? Women often develop traditional cardiovascular disease later than men, largely because estrogen provides some protection before menopause. After menopause, however, that protection begins to disappear, and women quickly catch up. The traditional risk factors remain the same — high blood pressure, high
cholesterol, diabetes, smoking, excess weight and family history — but they often become much more apparent after midlife. Women can also develop certain cardiovascular conditions more commonly than men, but the biggest issue is ensuring women recognize that the "common" forms of heart disease and stroke absolutely affect them too.
Which heart disease risk factors are most commonly overlooked? One of the biggest misconceptions is believing you're healthy simply because you feel well. Many cardiovascular risk factors don't cause symptoms until significant damage has already occurred. A heart health assessment doesn't require expensive scans or advanced imaging. It starts with the basics: • Knowing your blood pressure • Checking your cholesterol • Understanding your diabetes risk • Discussing family history • Maintaining a healthy weight • Staying physically active One test that's increasingly important is Lipoprotein(a), or Lp(a) — a genetically inherited form of cholesterol that should be checked at least once during adulthood. Many people have elevated levels without realizing it.
To read the full interview with Dr. Beth Abramson, visit healthinsight.ca.
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A Heart Surgeon's Call to Action for All Canadians on World Heart Day
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We sat down with internationally recognized Toronto heart surgeon and researcher, Dr. Subodh Verma, to talk about heart health issues and risks facing Canadians today.
r. Verma is a Professor at the University of Toronto, Canada Research Chair in Cardiovascular Surgery (Tier 1) and Co-Director of the CardioLink Trials Platform and heart surgeon at St Michael’s Hospital. He was awarded the Canadian Cardiovascular Society’s Research Achievement Award and the Canadian Society of Cardiac Surgeons’ Achievement Award in 2025. Dr. Verma has authored over 1,000 scholarly articles.
Therefore, discussing prevention in relation to children in my opinion is critical and can have an indelible impact on their lifetime heart health. By promoting healthy behaviors in youth - encouraging children to be physically active daily, consuming nutrient-dense diets and obtaining adequate restorative sleep we are setting up our children for healthier cardiovascular futures.
How much of heart disease is caused by things we can control? While genetics and aging are unavoidable causes of some cases of heart disease, there are still many that are caused by avoidable behaviors and conditions. According to a large study, approximately 99 per cent of adults who develop coronary heart disease, heart failure, or a stroke have at least one modifiable, traditional risk factor — high blood pressure, unhealthy cholesterol levels, high blood sugar, or smoking. Know your blood pressure, your cholesterol levels, your blood glucose levels, your kidney function, and your family history. Don’t smoke. Be physically active. Get regular sleep. Eat mostly minimally processed foods. Maintain a healthy body mass index. The sooner you start practicing these behaviors, the greater the benefits in the long run.
You often refer to the "Cardiovascular Continuum". Can you explain what this refers to? Heart disease typically does not occur suddenly in the days prior to a heart attack. Often it occurs years in advance due to a variety of risk factors including high blood pressure, high cholesterol, elevated Lp(a), insulin resistance, diabetes, excessive abdominal fat, kidney disease or chronic inflammation. The continuum includes maintaining good cardiovascular health, recognizing cardiovascular risk factors, treating early signs of cardiovascular disease, and preventing subsequent cardiovascular events. The earlier in the continuum interventions occur, the better the outcomes tend to be. Think lifetime risk and earlier risk factor control.
As a heart surgeon, I know an operation can save a life. But the greatest victory is helping create a life in which that operation was never needed. Is stress really significant in terms of heart health? Chronic stress, combined with other factors like depression, anxiety, feelings of isolation or loneliness, and inadequate sleep can impact blood pressure, inflammation, metabolic processes, and compliance with prescribed medications. Stressors that interfere with daily functioning should be addressed by individuals because caring for mental health contributes to caring for overall heart health. There is a much current attention on the importance of prioritizing mental health as a core pillar of heart protection.
What puts South Asians at higher risk of developing cardiovascular problems? Visceral fat (abdominal obesity),
The most important heart surgery may be the one that was never needed.
insulin resistance (metabolic syndrome), unique patterns of lipid profiles (e.g., hypertriglyceridemia, low HDL-C), genetic predispositions, dietary factors (e.g., increased consumption of saturated fats), physical inactivity and socioeconomic disadvantages all contribute to the earlier onset of cardiovascular disease in South Asians compared to other ethnic groups. I must stress that ethnicity is not fate per se, it rather represents an opportunity to evaluate risk factors earlier in life rather than waiting for symptoms to manifest.
What do doctors miss when it comes to diagnosing heart disease in women? We need to pay more attention to women’s heart health. For too long this has been neglected. While women often have classic cardiovascular risk factors along with sex-specific risk factors such as preeclampsia during pregnancy, gestational diabetes mellitus and premature menopause, women may also exhibit different symptomatology than men. These symptoms may be ignored or misattributed to anxiety or panic attacks. Therefore, healthcare providers must listen more attentively and provide earlier preventative measures for women in addition to providing equitable diagnostic capabilities and gender-balanced research participation.
What are the next frontiers in cardiovascular science? Two areas that are being actively researched include lipoprotein(a) [Lp(a)] and systemic inflammation. Lp(a) is primarily inherited and remains elevated regardless of lifestyle choices. Identifying Lp(a) levels through one-time measurements in adulthood may reveal previously unrecognized risk factors among individuals experiencing premature cardiovascular disease or having a first-degree relative with established cardiovascular disease. Clinical trials assessing whether reducing Lp(a) can reduce future cardiovascular events are underway. Inflammation is also identified as a primary contributor to cardiovascular risk. Elevated high-sensitivity C-reactive protein indicates ongoing inflammatory risk. Researchers are investigating whether reducing systemic inflammation can decrease future cardiovascular events.
What do you feel is your proudest achievement throughout your career? I am grateful for the opportunity to have helped people as a heart surgeon in times of tremendous distress and uncertainty. I am proud of advancing cardiovascular research in the area of heart failure, diabetes, obesity and cardiac surgery. But I most grateful for the opportunity of mentoring many trainees within the field of heart surgery and research. However, beyond professional accomplishments — I am most thankful for my family — particularly my wife Sandra who has provided unwavering support, encouragement and insight throughout my career. Additionally, my children: Raj, Meena, and Sonia.
Your TedX video on Interdependence has garnered over 70 Million social media views. What is at the core of this concept? Human hearts beat over 100 thousand times per day and nearly three billion times throughout a typical individual’s lifespan. They receive no accolades for doing so – no public recognition — no acknowledgement. Yet, our heart shows up every day. It supports us in a tireless fashion in every moment of our life. Through thousands of surgeries, I have come to understand that the human heart operates as part of a larger network: family members; neighbors; local medical professionals; educators; researchers; healthcare systems; policies and trust. That is what I call interdependence. There is no individual who achieves anything without relying on others. Every heart operation depends on interdependence.
Why is focusing on Children's Heart Health so important on World Heart Day? Cardiovascular health has a beginning point. That point occurs long before symptoms arise and before heart attacks occur in most cases. There is an assumption that heart attacks, strokes and heart failures happen exclusively to people aged 50-80+. However, the development of cardiovascular disease actually begins much further back than this — during the earliest stages of life. All habits, exposures and experiences that shape heart health develop across an entire lifetime.
This is a collaborative effort and cannot solely rely upon parents to provide for their children's heart health. An environment conducive to cardiovascular wellness is created by schools; neighborhoods and communities with safe spaces for children to walk, bike, or play; accessibility to fresh produce; availability of clean water; affordability of fruits and vegetables; safety from exposure to cigarette and tobacco products, vaping, and pollution; access to preventive medical services; etc. I must mention that preventing cardiovascular disease is not only a medical issue but also one of social justice. For examples, some children begin their lives with fewer opportunities for optimal health than others. If we delay until these inequalities lead to diabetes, hypertension, coronary artery disease, and heart failure decades later — we are delaying far too long. Therefore, protecting children's heart health is not a secondary goal in cardiovascular medicine — it is one of our most promising avenues for impacting the course of disease before it takes root.
On World Heart Day — what do we need to change regarding how we view heart disease? As a cardiac surgeon, I meet many patients nearing the end stage of the cardiovascular continuum when an artery is severely occluded or a valve fails or when the heart can no longer pump effectively. This is a remarkable place — modern medicine has made incredible strides in resuscitating people in ways that would have been unimaginable a few dacades ago. However, the operating room is usually the final stop on a journey that began many years ago. Therefore, I believe we must move upstream from fixing disease late in life to preventing it altogether. My hope is that in the future more resources are dedicated to anticipating illness and preventing heart disease as opposed to reacting and treating it at the end. To me that is the fundamental message behind World Heart Day. We should judge ourselves not only by how successful we are at saving lives once disease has taken hold but also by how many people never require rescue at all. On World Heart Day — my message is straightforward: learn your risk profi le early and take action now — please know your numbers. If you know how much money you have in your bank account, why should we not know your BP, cholesterol, A1C, Lp(a), etc. Also, look out for one another, and stay socially connected. At the end, let us appreciate the beating heart that selflessly supports us throughout our lives.
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