At the Heart of Patient Care

More than 90 percent of women have at least one risk factor for heart disease, yet most women are unaware that heart disease is their leading cause of death in the United States.  Less than half (39%) of primary care physicians, including ob-gyns, consider cardiovascular disease to be a top concern for women.

Last month, ACOG and the American Health Association released a joint advisory calling on ob-gyns to use annual well woman exams as an opportunity to assess a woman’s risk for heart disease.  For many women, their ob-gyn is the only physician they see routinely, particularly women during their childbearing years. This emphasizes the important role of the ob-gyn to identify risk factors for heart disease and stroke—long before clinical signs are apparent.  Not doing so is a missed opportunity for early detection and intervention.

Research shows that pregnant women with complications like preeclampsia, gestational diabetes, and growth restricted babies, have three times the risk of later cardiovascular disease than women without these pregnancy complications.  Additionally, cardiovascular events and cardiomyopathy are the leading causes of maternal mortality in the U.S., together accounting for 25 percent of all maternal deaths.

As the leading health care providers for women, we can be a powerful voice for patients, counseling and educating them on how to achieve and maintain long-term heart health. Whether it’s advising patients about healthy diet and lifestyle, or taking advantage of high-tech solutions such as software algorithms that can trigger patient education and referrals by analyzing data contained in electronic medical records, the well woman exam is an opportunity for us to deliver patient-centered care.

I’m so excited to share more with you during my year in office, and to hear from you directly. Connect with me on twitter at @TXmommydoc.

Ob-Gyns Can Be the Secret Weapon in the Fight Against Heart Disease

As ob-gyns, we know that the care we provide to women goes far beyond reproductive health. Thirty-five percent of women consider their ob-gyn their sole health care provider, putting us in a unique position to address an array of common health conditions. Since heart disease is the number one killer of women—and February is Heart Health Month—now is a good time to remember the part we can play in changing the outcomes of this devastating disease.

Perhaps the biggest threat of heart disease is lack of awareness of the condition’s prevalence and dangers. Though heart disease causes one in three deaths among American women every year—and 90 percent of women have at least one risk factor for developing heart disease—only one in five believes that heart disease is her greatest health threat, according to the American Heart Association (AHA). Equipped with these statistics, ob-gyns should feel confident initiating a conversation with patients about their heart health.

Helping patients address heart disease risk factors, ideally before a heart disease diagnosis, is key. Nearly two-thirds of women who die suddenly of coronary heart disease have no previous symptoms, according to the Centers for Disease Control and Prevention. For many women, the first signs of heart disease are actually the symptoms of a stroke, heart failure or heart attack, when serious damage may have already occurred. However, a number of risk factors are mostly under a patient’s control: an unhealthy diet and/or lack of exercise (both of which can lead to other important risk factors, including being overweight and having high blood pressure, high LDL cholesterol, and diabetes); smoking; and drinking to excess. When women are educated about how to make important lifestyle changes, it can be lifesaving. According to the AHA, 330 fewer women are dying from heart disease every day as a result of making heart healthy choices.

There are some factors that are out of a patient’s control, including a family history of heart disease, preterm labor and delivery, and preeclampsia. Ob-gyns can play an essential role by communicating the steps women can take to reduce their odds of a heart disease diagnosis. Even by simply acknowledging and discussing the risks, ob-gyns can make a difference. So, while these conversations aren’t always comfortable, they’re important because many women may not be hearing this information from any other health provider.

Lastly, since the symptoms of heart disease are widely misunderstood, particularly in women, it’s critical to share them with at-risk women. While angina is the most common symptom associated with heart disease, women are actually more likely to experience pain in the neck, jaw, throat, abdomen or back; shortness of breath; and nausea/vomiting. Lightheadedness, dizziness or fainting are common signs, as well. These symptoms don’t always occur during exercise or periods of stress; they can happen during rest, too. By ensuring your at-risk patients are aware of these signs, it could mean they get treatment faster, which will ultimately lead to better outcomes.

Ob-gyns have a powerful opportunity to be the secret weapon in the fight against heart disease. We can help inform our patients about the dangers, symptoms, and necessary preventative care. Communicated early and effectively, we can help women manage the factors that are in their control to help them live healthier, longer lives.

Have We Really “Come a Long Way, Baby?”

Fifty years ago, Surgeon General Luther Terry submitted a landmark report linking smoking to illness and death and said the government should do something to curb tobacco use. At the time, a third of American women were regular smokers. Today, the rate is down to 16%.

There was a time when smoking was portrayed as glamorous. Now we know that smoking negatively impacts every body organ and is the leading cause of premature death for adults. Women smokers have greater risks of reproductive health problems, many forms of gynecological and other cancers, heart disease, chronic obstructive lung disease, and osteoporosis. Quitting smoking is one of the most important things a pregnant woman can do for her and her baby’s health.

There are a number of effective methods to help our patients stop smoking, and we should be as familiar with them as we are with methods of birth control. These include using the 5 As (Ask, Assess, Advise, Assist, and Arrange follow-up), referring patients to the smokers’ quit line (1-800-Quit Now), and prescribing therapy to ease nicotine withdrawal. Nicotine replacement and medication improve the chances for sustained smoking cessation in non-pregnant women by 20–36%.

Of course, ACOG has several great tools and resources to help ob-gyns and their practices address tobacco use.

So, yes, we have come a long way toward reducing women’s smoking, but we can’t stop now. We need to continue making it a priority to counsel our patients about the health hazards of smoking and offer them help in quitting. And we can have an impact in our communities by promoting hefty taxation on tobacco products and supporting clean air legislation.

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Don’t Invite Stress Home for the Holidays

The holidays are upon us. Are you joyous and bright? Or would “a heaping pile of stress” be a more accurate description? If you answered the latter, you’re not alone. The frenzy of the holiday season can amplify the everyday stressors we face, such as work, traffic, family obligations, being a caregiver, and the economy.

Stress is your body’s natural response to demand or pressure. While periodic stress is normal and can be good for you—helping you to act quickly, overcome challenges, and boost your immunity—ongoing stress can lead to a number of health problems.

Stress-related spikes in blood pressure may be damaging to blood vessels if they occur too often and can lead to long-term high blood pressure, heart attack, and stroke. Ongoing stress has also been linked to lowered immunity and physical, mental, or emotional symptoms such as headaches, fatigue, insomnia, stomach problems, anxiety, depression, irritability, crying spells, forgetfulness, poor concentration, and low productivity.

The way you handle the inevitable holiday and everyday stressors can make all the difference in your overall health. These helpful tips from National Foundation for Cancer Research may be a good place to start:

  •  Plan ahead. Stress can build up if you procrastinate your “To Do List.” Try to accomplish small tasks each day leading up to the holiday. Buying gifts, decorating, and cooking can be much more stressful if done last-minute.
  • Know your limits. Being overwhelmed with events during the holiday season can impede your daily responsibilities. Be sure to practice saying “no” and avoid overcommitting. Don’t be afraid to ask for help, and be sure to get a healthy amount of rest.
  • Try to eat nutritious foods and limit sweets during the holiday season. As tempting as it may be, consuming large amounts of unhealthy foods can contribute to decreased energy levels, not to mention feelings of guilt. Try to choose alternative options like whole grains, fruits and vegetables filled with cancer-fighting antioxidants, and lean meats. Still enjoy desserts (it is the holidays, after all), but keep it in moderation.
  • Let things go. Nothing’s going to be perfect. Relax and enjoy time with family, even if a pie burns or someone is disappointed with his (or her) gift. Reconcile the situation, move on, and embrace the holiday cheer!
  • Exercise. Exercise is not only a great way to stay fit and reduce your risk of getting cancer, but it increases your endorphin levels and helps keep you stress-free.

Best wishes for a healthy, happy, and easy holiday season!

Heart Month Pop Quiz: Which is Better, HDL or LDL?

Quick—which type of cholesterol do you want more of, HDL or LDL?

Answer: HDL, or the “Happy” or “Healthy” type.

A lot of people can’t remember which type of cholesterol is the “good” one and which is the “bad” one, but it’s an important distinction. High cholesterol is one of the main culprits in heart disease, the leading killer of women in the US.

LDL (low-density lipoprotein) is the “bad” cholesterol that causes buildup and blockages in the arteries, which leads to heart attacks and strokes. The healthiest LDL level is less than 130 mg/dL.

HDL (high-density lipoprotein) is the “good” cholesterol that helps keep the “bad” LDL cholesterol from sticking to your arteries. You want a high HDL number (60 mg/dL or higher) to help lower your heart disease risk. Your ideal goal is a total cholesterol level (HDL+LDL combined) of less than 200 mg/dL.

As women move past menopause, their overall cholesterol level tends to rise. Estrogen levels prior to menopause raise HDL cholesterol; this benefit is lost after menopause. But there are things you can do to raise your HDL level and lower your bad LDL cholesterol: Lose weight, reduce foods with saturated fats in your diet, stop smoking, and exercise regularly. Medication may also be needed to lower your cholesterol levels.

Know your cholesterol levels and get tested every five years. Do it for your heart.

Heart Disease in Women

For many years, heart disease was thought of as a man’s disease. Most heart disease awareness efforts and research dollars focused on recognizing heart problems in men. But today we know different. Heart disease kills more women annually than all cancers combined, and more women than men have died from it every year since 1984.

While awareness efforts among women are improving, it’s time for heart disease research in women to catch up. We need more people like Barbra Streisand—who recently discussed her personal efforts to raise money for Cedars Sinai Women’s Heart Center in pause® magazine—to invest in heart disease prevention and treatment for women.

More clinical study is key in the fight against heart disease, but it’s also important to remember that you are your own first line of defense. Family history, high blood pressure, high cholesterol, diabetes, being overweight, and smoking increase your heart disease risk. To that end, the tried-and-true health trilogy of eating right, exercising, and avoiding smoking still applies. In addition, you can protect your heart health by lowering salt intake, controlling diabetes, keeping blood pressure and cholesterol levels low, managing stress in a healthy way, and visiting your doctor regularly.

Your heart supports you and everything you do every minute of every day. Repay the favor by committing to treating it right.

Why I Wear Red

I’ll be wearing red tomorrow, and it’s not because it’s my favorite color or because I was born on Valentine’s Day. February 3 is National Go Red for Women Day, raising awareness of heart disease in women. As an ob-gyn, my career has centered on keeping women well, especially when they are pregnant. Heart disease is a formidable enemy for my patients and me, and its impact is hard to deny. Speaking of pregnancy, did you know that heart disease has become one of the major causes of maternal mortality in this country?

An estimated 42 million women in the US are living with heart disease, the no. 1 killer of American women. But despite its prevalence, heart disease in women can be hard to spot. Feeling tired (even after a full night’s rest) or anxious, having an irregular heartbeat, or having trouble breathing or sleeping can all signal heart disease, but are often overlooked or attributed to other problems.

Many times, the first symptom of a heart problem is a major cardiac event like a heart attack. Chest pain or discomfort is the main symptom of heart attack in both women and men. However, other more subtle cues—such as nausea; lightheadedness; shortness of breath; pain in the back, jaw, neck, or arms; and breaking out in a cold sweat—are more common in women. These symptoms may not seem to warrant special attention, but if you are experiencing them, consider it an emergency and seek medical attention right away. Brushing off these signs delays timely care and hampers recovery.

By donning red tomorrow, I’ll show my support for my patients and the fight against heart disease. So, go ahead and ask about my outfit. It’s an easy way to spark a conversation that could save a life.