The Art Of Aging: The Heart Of The Matter

Next Question with Katie Couric

Katie Couric sits down with cardiologist Dr. Stacey Rosen to discuss the critical state of women's heart health, highlighting decades of historical bias in

Key takeaways

• Only 38% of participants in cardiovascular clinical trials are female, despite heart disease being the leading cause of death in women.
• Women often present with atypical heart attack symptoms like breathlessness, back pain, or jaw discomfort rather than classic chest clutching.

Main topics

• Women's cardiovascular health disparities
• Heart attack symptoms in women vs men

Notable quotes

"Women have been understudied, underrepresented in clinical trials, and too often misdiagnosed for decades."

Conclusion

The episode delivers a compelling call to action for women to become proact

Transcript preview

Speaker 1 (0:00) Women have been understudied, underrepresented in clinical trials, and too often misdiagnosed for decades. That's why I'm so encouraged by the work being done at Northwell Health's Katz Institute for Women's Health. The Katz Institute brings together a network of more than a thousand women's health experts across 26 specialties to provide coordinated, personalized care. From heart health and menopause to nutrition, pelvic floor health, and more, they're helping ensure women have access to the support they need at every stage of life. You can learn more by going to northwell.edu slash kcm. Speaker 1 (0:49) Hi, everyone. I'm Katie Couric, and this is Next Question. Guess what, everyone? I'm turning 70 in January, and I'm on a mission to not just live longer, but to live better. And I don't know about you, but I am having a really hard time determining which articles, videos, supplements, products, and practices are science-based and which are just baloney. So we now present The Art of Aging. 12 conversations with people who have actual expertise in taking care of different parts of your body, including your heart, your gut, your skin, your sex life. We're not talking about the biohacking we hear from bros in the manosphere. We're talking about evidence-based science, separating fact from fiction that will help us hopefully live longer, healthier lives. And so for this first episode, we're starting at the heart of the matter. Heart disease is the number one killer of women in America. And yet for decades, the research, the warning signs, the treatment protocols were nearly all designed around men. Women were left out of the equation and the cost has been devastating. My first guest. Dr. Stacey Rosen, one of the country's foremost cardiologists and a tireless advocate for women's cardiovascular health. She is also the executive director of the Katz Institute for Women's Health at Northwell Health, an immediate past president of the American Heart Association. She has spent her career making sure women's hearts get the attention they deserve. We had a lot to talk about. So I hope you find our conversation as interesting and important as I did. And a huge thank you to our presenting sponsor, Northwell Health's Katz Institute for Women's Health for making this episode possible. Dr. Rosen, first of all, thank you so much for being here. And it's great to see you again. I thought we'd start by talking about women's heart health in general. I was... disheartened when I learned that only 38 % of participants in clinical cardiovascular trials are female, despite it being the number one killer of women. Why is that the case? Oh, it's so discouraging and disheartening. Speaker 2 (3:07) And that data of 38 % actually includes certain conditions that are much more prevalent in women. So it almost skews it. So things like heart attacks, heart failure, rhythm problems, the percentage of women participating is even lower. It's the history of heart disease. We thought this was a man's illness. We studied men. We treated men. We even thought women didn't get the disease, so we minimized their symptoms. So it was sort of this combination of bad... missed Speaker 1 (3:42) opportunities that basically perpetuated each other. And it reflects sexism in medicine in general, not just when it comes to heart disease, right? Absolutely. Tremendous amount of bias. Speaker 2 (3:52) If a woman's symptoms or presentation doesn't fit in a box, then it's called atypical. It's... referred to stress. It's in your head, dear. I don't love the term gaslighting, but there's a whole lot of data about that we don't take Speaker 1 (4:09) women as seriously with medical conditions. How has that affected diagnostics and treatments for more than half the population? Speaker 2 (4:18) Right. I've been, my practice is totally focused on women and I've been called a niche. clinician. And I'm like, 51 % of the population. We really can't call that niche. So imagine if you don't think a population gets the disease. We haven't done the studies to see how she would do with diagnostic testing, with treatment options, with prevention strategies. And then maybe she puts her whole family before herself. So she comes late. She minimizes her symptoms. So it's the whole... ecosystem of opportunities to mistreat and undertreat women. Speaker 1 (4:57) Is that starting to change? Speaker 2 (4:59) It has to. You know, first of all, it's bad science. So, right, everybody's looking to do science better. So you can't call 51 % of the population a niche. We know that sex matters. Every cell in your body is a female cell or a male cell, and that has to be different. So I see it as a golden opportunity. There are more women in medicine. It shouldn't take that. And in science. And I think even the tech world, the finance world are seeing this as an amazing opportunity to improve health outcomes, to Speaker 1 (5:32) develop new science and to implement better. How did the mythology that this was really just a man's disease, how did that happen and how was it perpetrated? Speaker 2 (5:45) Yeah, I had the privilege of giving what's called the presidential address at the American Heart Association last fall at their scientific session. And I spoke just about that. And it started by the fact that there was historical bias. We didn't include women in the 40s, 50s and 60s. We didn't think they could give consent appropriately. We thought that women's health was just entirely related to reproductive health. And so we excluded them. Men do present on average with heart disease 10 years earlier than women. So we certainly didn't want to include older women. So we missed that opportunity. Women sometimes do present in a different way with symptoms of heart failure or heart attacks than men. So none of them. Women didn't fit into the male stereotype, the male model of the way heart disease was beginning to be investigated in the 50s, 60s, and 70s. Speaker 1 (6:40) And culturally, I think, you know, we see dramatic, you know, images of a man clutching his chest. A Hollywood heart attack. Right? A Hollywood heart attack. What is a Hollywood heart attack? It doesn't happen very often. Speaker 2 (6:55) So it would be the cartoon would be a man in a suit with a briefcase and a cigarette and a pastrami sandwich and clutching his chest like this. And that would be the way we imagined heart disease. I graduated from medical school the year that more women started dying of heart disease than men. But for the early years of my training, we were taught it was a man's disease. And when a woman came with back pain or belching or just a little jaw discomfort, it was unimaginable to us that this could be heart disease because Speaker 1 (7:32) we didn't see it, we didn't learn about it, and we dismissed it. How are the symptoms of a heart attack different in women than men? Speaker 2 (7:42) So the majority of people who present with a heart attack will have chest pain. It may not be the elephant sitting on my chest that we relay and define as the Hollywood heart attack, but most will have chest pain. Women, though, as opposed to men, will have other symptoms at the same time. So it may be a little discomfort. Women don't like to use the word pain, but mostly breathlessness. Or maybe my back just hurts or my head feels a little foggy. And it's less likely to be only chest pain. And so what we historically call that confluence of symptoms, we call that atypical, which is also pretty funny because it's 51 % of the... population. How could that be atypical? Are they more subtle, the symptoms? They may be. more subtle. So you start with the woman not thinking she can get heart disease because we worry about breast health and reproductive health in our families. Physicians often miss the subtle clues, so we don't rush them to get an electrocardiogram or put them in that part of the emergency room. And so each of these things kind of pile on to, unfortunately, Speaker 1 (8:57) still continue to have women with bad outcomes. Isn't there something about your arms, like pain going down your arm? Because my mom used to have a little diagram of that on her mirror. Interesting. So, yes, Speaker 2 (9:09) sometimes the classic chest pain will start in the left side of your chest. It will be described as a heaviness, and it can radiate to the neck, the jaw, and the left arm. And women? in both men and women, but nobody's heart attack symptoms are like anyone else's. So my goal is that we should educate scientists and doctors to understand why women may present differently. And more importantly, let women know that even if they're not having, it didn't really feel like an elephant on my chest, doctor. It went to my right arm, not my left arm. It doesn't matter. If you're having symptoms that feel unusual or concerning to Speaker 1 (9:50) you, get them checked out. A lot of women are reticent to go to the ER. You know, they're embarrassed. They don't want to overreact. And is there a point where you think, I'm in serious trouble, I better get medical attention? Far Speaker 2 (10:07) before you think about being embarrassed. Because our running joke with my population, with my friends, is the worst thing could be to miss a heart attack, if this was the bad Chinese food you ate last night, or if it is a little bit of muscle pain from something else, that's fine. Because the flip side of that is sitting home with a heart attack and not going in is potentially catastrophic. So better safe Speaker 1 (10:35) than Speaker 2 (10:35) sorry. Are Speaker 1 (10:36) there things you should do? Let's say you want to call 911, which I think is preferable than... Driving to a hospital, right? Do not Speaker 2 (10:46) drive to a hospital. Do not wait, see if it passes by taking Tums. The moment you think you might be having a heart attack is the time to call 911. And don't underestimate and minimize your symptoms. Oh, I'm sure it's nothing. I took a Tums. tell them you think you're having a heart attack because then they will get you there faster. They will do a first evaluation by the first nurse or doctor to see you quickly, quickly, because time is truly essential at that point. Speaker 1 (11:15) Is there anything you're supposed to do while you're waiting for the ambulance? I remember Rosie O'Donnell a few years back. Didn't she take an aspirin Speaker 2 (11:23) or a Speaker 1 (11:23) baby aspirin? What is Speaker 2 (11:25) the protocol? Absolutely. If you think you're having a heart attack, The best thing to start is to let the emergency technicians know. And if you have baby aspirin in the house, take four of them and chew them. And tell the emergency medical Speaker 1 (11:40) people who come to your home that you've just taken four baby aspirin. What about regular aspirin? Speaker 2 (11:45) Regular aspirin is the equivalent of a couple of baby aspirin. So one full aspirin. Absolutely. More people Speaker 1 (11:53) at home will have baby aspirin because that's the prevention strategy. But Speaker 2 (11:58) I Speaker 1 (11:58) think about, should I carry baby aspirin in my purse? You Speaker 2 (12:01) know, it's funny because I have suffered from migraines and every handbag, every wallet has my migraine medicine. So the truth is, it's probably not a bad idea. And Speaker 1 (12:11) for a full aspirin, an adult size aspirin, are you supposed to put it under your tongue? You can chew it or you can swallow it. But ideally, the baby aspirin are easier to chew. Okay. But for Speaker 2 (12:22) an adult size, chew or swallow? Either one is fine. Okay. Speaker 1 (12:25) Let's talk about family history. How important are genetics when it comes to heart health? Both my grandfathers died of heart attacks in their 50s. And my mom had angioplasty. She had a heart disease as well. How concerning should it be if you do have relatives who... have experienced this. So how you decide to Speaker 2 (12:54) do lifelong prevention is based on everything about you. So the first thing is your family history. And I think it's really important to know it because, you know, Knowing the age, you told a perfect story because sometimes I hear my grandfathers both had. And when we dive a little deeper, they had their first event at 87 and 92. So it's premature heart disease. So it's having your first heart attack or stroke as a young person, 40s, 50s, 60s for women. That gives you sort of a check in the how aggressive are we going to be in your lifetime of prevention? So it becomes, and it's not, we can't modify it, but it's important to know, it's important to tell your daughters that that history exists because, you know, you want that to be something that continues over generation. And for those who have really significant family histories, we may start earlier on preventive strategies. We may start earlier on testing, if necessary, to sort of avoid, not dissimilar to what we do with cancer screening, right? If you've got a family history. Then we start things younger for the children and the grandchildren. So we like to think of the genetics of heart disease the same way. It raises your awareness. Speaker 1 (14:11) Let's talk about the phases of a woman's life, starting with those under the age of 40. When should women under 40 start getting their cholesterol checked? That's a great question. Speaker 2 (14:23) Depending on their other risk factors, if there's no diabetes, no hypertension, no tobacco, no family history, every three to five years. And if they have other risks or reasons to check it more frequently, that's fine. It's a simple blood test. We Speaker 1 (14:39) want to ask young women Speaker 2 (14:40) about their periods. If your first menstrual period was before 12 or your first menstrual period was over the age of 16, you are at a slightly higher risk for heart disease. Whether your periods are irregular or miserable, all of that matters. In fact, the American College of OBGYN consider a menstrual history as a vital sign. Nobody asks young women that. Certainly nobody asks older women that. So it starts, did you have trouble conceiving? Did you nurse after children? Did you have pregnancy losses? So everything that goes on in your OBGYN office has to come to your internist or cardiologist's office. And then, depending on your family history, you have cholesterol checked at regular times throughout your life. Speaker 1 (15:23) There are other risk factors for young women, like something called PMOS. How does that increase your risk of heart disease? Speaker 2 (15:32) So it is pretty common, 6 % to 10 % of young women. And it presents itself with potential for high blood pressure. for lipid abnormalities, for blood sugar abnormalities. And it's because of the way their metabolic milieu is not entirely healthy. And these women are at higher risk for cardiovascular conditions as they age. We used to just tell young women it was a challenging period or you're not menstruating correctly. Maybe you'll have some fertility issues, hair suit. But we didn't put the whole story together on this being a metabolic. syndrome that can impact on heart health over a lifetime. Speaker 1 (16:15) Let's keep going through phases of life because I know pregnancy can actually increase your risk of heart disease. And cardiovascular disease is now the leading cause of death in pregnant women and those who are postpartum. I had no idea. What is it about pregnancy that increases your risk so much? It's a stress test, basically. It is truly Speaker 2 (16:39) a stress test. So fewer than 50 % of women who become pregnant