Women’s Health: What to know about heart disease

  • Dr Malissa Wood

  • Dr. Nandita Scott

Published: 1/29/2018 3:31:39 PM

Following, in a question and answer format, Dr. Malissa Wood and Dr. Nandita Scott, co-directors of The Elizabeth Anne and Karen Barlow Corrigan Women’s Heart Health Program at Massachusetts General Hospital in Boston, discuss why, when it comes to heart disease, women’s hearts are in a league of their own.

Q: What led you to specialize in cardiology?

Scott: I went into cardiology because it’s one of those fields where you can make a big difference in people’s lives. There are great diagnostic and treatment tools.

Wood: The biggest fascination for me was the recognition that cardiovascular disease is the number one killer. I trained a decade before Nandita, when new treatments were emerging. I wanted to use my talents to apply those techniques to help patients have better outcomes.

Q:Why is there a need for a heart health program for women?

Wood: Cardiovascular disease is under diagnosed in women. To close the big gaps in care, we wanted to pull together people who understand the pathophysiology — the study of disease and its impact on the body — of the heart of women, which is quite different than a man’s. Women’s hearts and arteries are smaller, for example. Symptoms of a heart attack can be different for a woman. Our program seeks to tailor therapy and research to women.

Q. When in life should women be most concerned about heart health?

Wood: All through life. We see patients from age 18 to 100.

Scott: There are dramatic changes in the cardiovascular system during pregnancy, for example. Blood volume increases and the heart is required to work harder. Pregnancy is like a stress test, a window into future heart health. Those who develop preeclampsia (a potentially dangerous condition that causes high blood pressure) have increased risk of future cardiovascular disease.

Q:What have you learned about young women who have a heart attack due to spontaneous coronary artery dissection or SCAD, a tear in the artery wall that blocks blood flow?

Wood: It used to be considered rare but that is because it was underdiagnosed. Because so many are referred to our program, we have a large register of SCAD patients we are studying. Over 90 percent of them are thin, fit and athletic.

Mark Lindsay, MD, PhD, looked at genetic differences and found that only 9 percent have a genetic abnormality. We are also finding that the cumulative effects of stress can trigger a SCAD-related heart attack in women, whereas men were more likely to have a heart attack while exercising. Reducing stress is extremely important for all women.

Q: Women fear breast cancer but isn’t heart disease more likely?

Scott: One in 10 women gets breast cancer and at least one in three women develops some form of cardiovascular disease. In women, it causes more deaths each year than the next two causes combined — cancer and chronic lower respiratory disease.

Q:Beside exercise and a healthy diet, what should women do to maintain heart health?

Wood: We found some answers to that question in our Happy Heart study at the MGH Revere HealthCare Center. Lifestyle changes reduced blood pressure, weight and cholesterol, all of which change unfavorably after menopause. We found, too, that chronic stress is a significant risk factor for women and that mind-body therapies can reduce risk. Heart disease is preventable.

Q:Several months ago, the American Heart Association announced revised guidelines for high blood pressure. How does this change relate specifically to women?

Scott: The new guidelines have redefined the values for elevated blood pressure and stages of hypertension, but do not differentiate by gender. Overall, more women and men will be diagnosed with hypertension, but the majority will not require additional medications. However, awareness of the importance of blood pressure management will be raised.

Dr. Nandita Scott, co-director of Mass General Hospital’s Corrigan Women’s Heart Health Program and assistant professor of medicine at Harvard Medical School, will be the featured speaker at the next Cooley Dickinson/Massachusetts General Hospital lecture Thursday from 6 to 7 p.m. in the Dakin Conference Room at Cooley Dickinson Hospital. Seating is limited. To register, call 888-554-4CDH (4234) or visit www.cooleydickinson.org/events.




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