Preventative Care From the Heart

By Alizah Salario | Photos: Stephen Legendre

Nausea. Abdominal pain. Tingling. Band-like pressure around the chest. These are classic heart attack symptoms in women—and all too often, they’re ignored.

Though heart disease is often characterized as a man’s disease, it is in fact a leading cause of death among women in America. A startling one in six women will die from heart disease, and it kills six times more women than breast cancer.

“When you look at those statistics, you realize there’s a huge gap in awareness. How can we close this gap and increase awareness?” said Salima Qamruddin MD, MPH, FASE, and Director of the Women’s Cardiovascular Clinic at Ochsner.

Dr. Qamruddin is raising awareness about women’s heart disease through a holistic approach to care. As a cofounder of the Women’s Cardiovascular Clinic along with Merill Stewart, MD, Dr. Qamruddin leads a team that counsels and treats women who have significant risk factors for heart disease, including diabetes, hypertension, hyperlipidemia, a history of smoking or a sedentary lifestyle. Breast cancer survivors who received chemotherapy or radiation to the chest also have an increased risk.

The Women’s Cardiovascular Clinic at Ochsner offers preventative tests, including cholesterol screenings, stress testing and calcium scoring to evaluate future risks. Doctors also help patients learn how to incorporate exercise, develop mindful eating habits and offer support to quit smoking or deal with stress.

“Our role is to find women with a high risk profile, and turn their risk around,” she said. “We come at it from the point of view of prevention.”

For Dr. Qamruddin, raising awareness starts with changing the narrative around heart disease. There’s a lack of publicity around heart attacks in women and older women’s health in general, Dr. Qamruddin explained, because men tend to have more heart attacks in their 50s, whereas cardiac disease typically strikes women aged 65 and over.

Heart attacks in women also have different mechanisms. “What’s been shown in studies is that women have blockages in smaller arteries. Think of it like a river with lots of tributaries and lots of branches. The main vessel doesn’t get blocked, but the branches do,” she said. Also, dissection in arteries of the heart, where the inside wall of the artery tears, is more common in women.

These blockages aren’t always recognized by the medical community because many cardiologists look for blockage of the main artery—which is far more common in men. “A lot of general cardiologists are going to tell you, ‘It’s okay, you haven’t had a heart attack,’” she said.

Limited research is yet another issue. “If you look at all the medical literature, women are underrepresented in clinical trials, so we don’t have enough data for women,” she said.

Then, of course, there are the symptoms. More people are aware of the typical heart attack symptoms in men, like excruciating chest pains, shortness of breath and excessive sweating. When women aren’t aware of the signs of a heart attack or heart disease, they miss a crucial opportunity for early detection, she added.

“The problem is that the hardening of the arteries starts early on, and that’s why prevention is so important.”

Emphasizing prevention, Dr. Qamruddin notes two scenarios where women should be aware of increased risk of heart disease.

The first is during pregnancy. Women who experience preeclampsia, have hypertension or diabetes before and during pregnancy should be screened early post-pregnancy for other comorbid conditions such as high cholesterol, which together puts them at a much higher risk for coronary artery disease and heart failure later in life.

— Dr. Salima Qamruddin

She notes that heart disease often goes undiagnosed because many women are going to OB-GYN appointments but not seeing a primary care doctor during their childbearing years. That’s when “women tend to put everyone else first,” she added.

“Ochsner’s cardiology program bridges cardiology and the OB-GYNs to catch at-risk women,” Dr. Qamruddin said. “It’s important to try and give women a recipe for what they can do in the first five years, and then we can assess them and look at the plaque buildup, and be even more aggressive whether it’s medication, or diet modification to try to get their cholesterol down and offer them lifestyle changes that reduce heart disease risk.” The next scenario involves women who are approaching menopause. Right after menopause there is a dramatic drop in estrogen, which may enhance existing risk. Part of her job is to offer safe hormone replacement to those that are high risk.

— Dr. Salima Qamruddin

In alignment with Ochsner’s mission, the cardio team is continuing to find innovative forms of community outreach and engagement. A series of educational videos about risk factors and nutrition are currently in the works. They’re looking into

group coaching sessions for women with similar risk factors to provide a supportive cohort, and they also recently introduced Connected Moms, a blood pressure monitoring cuff created with Apple. This take-home device allows women to self monitor and remotely transmit their blood pressure information to their doctor.

“It’s a way to get people actively involved in their own care, so we can catch [high blood pressure] right away and intervene as early as possible,” Dr. Qamruddin.

Ultimately, she adds, the goal of the entire program is to help women take charge of their health.