Episode 65: Women’s Reality of Heart Disease
Dr. Olivia Greenspan, ND joins us to discuss the unique risks of women when it comes to heart health.
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[01:38] Cassy Price: Thank you for tuning into Supplementing Health. Heart Disease is the leading cause of death in the United States and the second leading cause of death in Canada. Today we have Dr. Olivia Greenspan, ND here to discuss the unique risks for women when it comes to heart health. Dr. Greenspan is a naturopathic doctor and cardiac nurse, who after working in the cardiac critical care and caring for the sickest of the sick, made it her mission to remove heart disease as the top killer of women. She does this through education and application for a new heart health care paradigm. Welcome Olivia.
[02:10] Dr. Olivia Greenspan: Thank you for having me, Cassy.
[02:13] Cassy Price: So, women and men can both experience cardiovascular disease, but they experience it differently. What are some of those warning signs for cardiovascular health that get overlooked in women?
[02:26] Dr. Olivia Greenspan: To start with I always like to talk to my patients about women specific conditions that place women at a unique risk over men. I’ll go through a few of those really important ones Cassy if you would like me to. The number one thing that I find women are unaware of is conditions in pregnancy, and of course as men don’t get pregnant unfortunately and women do. Some of the conditions that can show up in pregnancy such as hypertension, gestational diabetes, preeclampsia, can put women at a significant risk after delivery and a lot of women feel that when their levels normalize, and their blood pressure and blood sugar normalise that they are out of the woods. It doesn’t mean that you are doomed if you have these situations arise in pregnancy, but the risk is still there. Screening is really important for these women especially when it comes to preeclampsia, we have a lot of data on that. It does put women at a two-fold increased risk to have a heart attack later on in life. That is a really important one. I think the postpartum period is a really important time to educate women about these risks. The other thing is menopause. The changing of hormones during that time. Oestrogen we know is very protective to the cardiovascular system. It helps regulate blood pressure, it acts as an antioxidant, it effects salt sensitivity, so as that oestrogen declines later on in life, we see that those women have a significant risk that matches men when it comes to the risk of heart disease or having a heart attack. So, a lot of women don’t really concern themselves too much until menopause when it comes to heart health and really that education and those preventative things that we can do, lifestyle things, there are so many things we can do needs to start much earlier than menopause.
[04:41] The other thing is PCOS or Poly Cystic Ovarian Syndrome with women can put them at risk as well because of blood sugar issues, insulin resistance plays a role in cardiovascular disease and endothelial dysfunction. So, that is a really important one. For women there are autoimmune conditions that affect women disproportionately more than men as well, such as Lupus for example. That chronic long-term exposure to inflammation, we know again puts women at risk for cardiovascular disease so anybody with an autoimmune condition should also have a heart health plan in place and should be having this conversation with their health care provider as to how they can further protect their heart going forward. Those are the few big differences in terms of specific conditions that affect women more than men.
[05:40] Cassy Price: Are there differences in the symptoms that women experience then compared to their male counterparts?
[05:46] Dr. Olivia Greenspan: Yeah. So, when it comes to having a heart attack, women can experience it differently than men. The most common sign is chest pain/chest pressure but that is not always the case. We see in the movies this dramatization of this crushing chest pain and an elephant sitting on our chest. Sometimes that is not the case and it confuses not just women but men as well about when to seek treatment. For women they will often feel not just chest pain and discomfort, but they might feel this extreme fatigue. I know a lot of women today running around and taking home schooling and taking care of older parents and feeling a lot of fatigue, this is an unusual fatigue that comes on out of the blue. They might experience more fatigue with daily activities than they did before. So, that is definitely a warning sign. The heart function is just not efficient and pumping as well if it is not getting enough blood flow. They might experience sleep problems that have come up out of the blue proceeding a heart attack or heart event. They might have more indigestion, lower chest pain, upper abdominal discomfort in that area. I had a patient recently, she did not go to the emerg right away, she was experiencing this left arm ache, it was not terrible, it wasn’t a pain, but it was this annoying left arm ache and low and behold she did suffer a heart attack. She did recover and do well but as an example I see that often in my work as a nurse where patients did not have that chest pain. They had mild symptoms and of course then don’t want to bother or go to emerg and complain about something that seems so trivial, but I always encourage people that if anything happens out of the abnormal then you are better off safe than sorry and seeking help right away.
[07:54] That is one of the reasons why it is more difficult to identify heart disease or heart attacks in women and they often so missed because they have these sorts of atypical signs. We also have that gender bias that heart disease happens more in men than women so if leads to a lot of disadvantages to women in terms of proper diagnosis, treatments, referrals and so on.
[08:21] Cassy Price: So, what are some of the lab tests that you use in your practice as part of diagnosis and determining a treatment protocol?
[08:29] Dr. Olivia Greenspan: So, I use a lot of the basic labs that patients will get done through their family doctors. So, the basic lipid panel, we can get a lot of information from that. It doesn’t necessarily give us the whole story all the time, but I will do that or if they have already it done we will look at the lipid panel. The fasting blood sugars and haemoglobin A1C but also fasting insulin levels because we do know that insulin resistance can put people at risk and can often show up years before diabetes will or any significant changes on a haemoglobin A1C. Looking at inflammatory markers such as HSCRP, so again chronic inflammation, we know that it is not necessarily diagnostic, but it does identify if there is inflammation there. Homocysteine is another one that I will look at. Also, lipoprotein particle testing. Of course, it depends on the patient and what is going on but especially if there are significant risk factors and family history and so on, that is another test that is more comprehensive. It covers a lot of ground in terms of identifying where we can optimize treatment plans for patients. Those are probably the big ones that I tend to use with my patients. There is other testing as well like oxidised LBL and fatty acid testing and those are things that we might discuss as well in terms of the benefits and other information that might show us if it is going to change our treatment plan. Sometimes doing labs doesn’t change our treatment plan and it can get expensive for patients. It can be a slippery slope when we start doing all this testing so there is always conversations with patients that we will have before just doing all this battery of tests.
[10:30] Cassy Price: Speaking of the lipoprotein particles, I have heard lipoprotein a testing can be very beneficial. Can you speak to how that marker contributes to heart disease?
[10:45] Dr. Olivia Greenspan: Yeah. Elevated lipoprotein a. It can significantly put patients at risk for having a heart attack or having a stroke and it might explain why half of the people that have a heart attack actually have normal cholesterol levels. So, doing a lipid panel, their LPL might be completely optimized with medication, yet they will still have a heart attack. So, the missing link might be this lipoprotein a. Unfortunately, in Ontario right now it is not a test that we can order but the exciting thing is that on the 2021 guidelines for dyslipidaemia, it actually includes lipoprotein a as a recommended test for patients at least once in their lifetime. So, it is genetically influenced, the lipoprotein a, and unfortunately there isn’t a ton that I have come across in the literature that actually significantly reduces this number. Statins don’t impact it because it is not created in a liver in the same pathway as LDL is, so statins don’t really lower lipoprotein a unfortunately. So, if someone does have it tested and it is high, really, we are just focusing on maximizing all of the other things that we have control over which can have a big impact in people’s health. So, it is important to know that it is actually more common, I think it is one in four people actually have an elevated lipoprotein a. So, I think it is more common than we think and if we are testing it more routinely, we might see that more but again just honing in on lifestyle pieces and optimizing all of those risk factors for patients is a key thing. There is some information or some data that shows that vegan diets may lower it by about 10% but that is always a tricky one for patients to do but just maximizing all of the controllable factors that we can would be my approach for patients.
[13:01] Cassy Price: So how frequently do you suggest women get screened and at what age should they start getting screened?
[13:07] Dr. Olivia Greenspan: Yeah. That is a good question. To be honest I don’t really have any hard and fast rule about specific ages. It really depends on the patient and what their whole risk profile looks like. There are some things, I think the general Canadian guidelines for testing is to start testing, for example I think it is a lipid panel, they will start testing that when men and women are over forty. I wouldn’t wait that long. Definitely if they have significant family history or other risk factors, things like PCOS, we may want to check those parameters early on someone who is twenty. If they have significant history in their family or elevated cholesterol levels, we might want to check that in their twenties. For sure, when patients are thinking about pregnancy and conception and doing all of those things so we can optimize that before pregnancy so we can optimize a pregnancy, the post-partum period, so that we don’t have these challenges in pregnancy like gestational diabetes and so on. Also, ethnicity plays a role, so you know African Canadian women are at significant risk for cardiovascular disease, Asian women, First Nations. So, you might want to check those women a lot earlier to check their risk. I don’t think there is a hard and fast rule. It is really patient specific. I think the earlier the better for sure.
[14:49] Cassy Price: So, with the rise of wearable technology people are getting more information about their heart rate variability, maybe their SPO2 levels and all these different metrics and doing heart math. So, what does this information provide for how your heart health is progressing?
[15:11] Dr. Olivia Greenspan: Well, in terms of heart rate variability, I think it is a really great tool. It is fairly easy to measure and gives people real-time feedback in terms of their stress response, the heart of their autonomic nervous systems, so we have two arms: the sympathetic and the parasympathetic, and we don’t want to be in that overdrive sympathetic mode all the time, we need to have a balance and heart rate variability can give us that real time feedback. So, heart rate variability in a nutshell is the beat-to-beat variation in your heartbeat. So, just because your heartbeat is sixty beats per minute it doesn’t mean that every second it is beating. There might be milliseconds in between there where there is a variation. People who have good heart rate variability, that would give us information about their autonomic nervous systems. There are going to be in less of a stressed state or have more resilience in terms of the stress response. People who have poor diets, who are not sleeping well, who are not handling stress I mean we can’t avoid it, but we can manage it better, not exercising, that can all impact our heart rate variability and lower our variability in our heart rate.
[16:40] So, it is a measure of our resilience, our overall cardiovascular health, it even indicates our immune health as well. People with diabetes seem to have lower heart rate variability. So, it is a nice little tool, and you can shift your heart rate variability really quickly with just doing simple techniques like breathing and when you are breathing focusing on more positive heart felt emotions like love or gratitude or thinking of someone that you care about. Focusing on that can actually change our heart rate variability within minutes. I have seen that in my practice with patients. If they come in really stressed and we put a device on them that can measure the heart rate variability and we get them to breathe, we can see that nice shift in the nervous system in what is working overtime during those sessions. So, it is nothing fancy. It is really simple, but it just goes to show you that just breathing and focusing our breath can make a huge impact on our physiology in a moment.
[17:51] Cassy Price: So, then a higher heart rate variability is better because then you would be in a more calm and relaxed state, correct?
[17:57] Dr. Olivia Greenspan: Yeah. Exactly. You can even feel that when you’re taking breaths and you are breathing in and out you can feel that sort of variation in your heart rate going up and going down. That can give us an indicator. The best one is on an actual ECG strip looking at the variability from beat to beat. Yeah, high heart rate variability is better and shows better cardiovascular health than a lower heart rate variability.
[18:31] Cassy Price: Is there a number range that people should be aiming for if they are using wearable technology so that they have an idea of where they should be?
[18:41] Dr. Olivia Greenspan: I think it really depends on the device that is being used and the baseline as well. Getting a baseline and tracking that can show whether you are improving or whether you are staying the same or getting worse. That is how I tend to do it with my patients.
[18:57] Cassy Price: Okay. Cool. So, you mentioned a little bit about how family history plays a role in heart disease. How important is it if you have a history of cardiovascular disease in your family to get the details of what it was and how that impacts you?
[19:16] Dr. Olivia Greenspan: Well, it is very important, family history, but it is one risk factor, but it is not the risk factor. We know that if you do have cardiovascular disease in the family or heart attacks in someone before the age of sixty-five in women or fifty-five in men that it can double your risk for heart disease compared to someone who doesn’t have a significant family history but we can actually those are genetically high risk for cardiovascular disease, we can actually significantly reduce that risk in half by basic optimizing all of those primers that we talked about, the lifestyle, getting that extra support. We can definitely reduce risk. So, it does play a really important role especially when there are significant genetic heart conditions. I mean, when we talk about cardiovascular disease, we are not just talking about ischemic heart disease where there is plaque build-up in the arteries but other heart diseases like arrhythmias. There are some arrhythmias that are genetically linked to run in families and that is really important information to know. So, there is different cardiomyopathies that predispose patients to arrhythmias, deadly arrhythmias, and people need to know that information. It is really important for people so they can get proper follow up and they need any further cardiovascular care that it is done timely. It is definitely important but just like anything it is one risk factor out of many.
[20:57] Cassy Price: One of the lifestyle factors that we hear about time and time again is of course exercise or movement. So, do you have specific types of exercise plans that are better for women with heart conditions or perhaps exercises that women with heart conditions should be avoiding?
[21:16] Dr. Olivia Greenspan: I really don’t. When it comes to exercise, I am not going to recommend a whole bunch of these exercise plans to people if they just don’t enjoy it because they are not going to do it and it is really hard to stick to. I always recommend that if people do have heart conditions they need to be seen by a cardiologist and they need to be cleared and they need to have that education about what they can and can’t do. I don’t have specific recommendations, but we know that exercise is extremely beneficial for the cardiovascular system and not just the cardiovascular system but our whole body. It is an antidepressant, it helps our mood, it helps reduce inflammation, it helps with body weight, for older women it is really important to maintain muscle mass it is really important that we don’t lose muscle or sarcopenia as we age. It helps with our cholesterol levels, it helps with inflammation, balance, bone health, it improves the mitochondrial health and their efficiency and the number of mitochondria. So, just getting people to move and recommending that walking is the easiest thing for people to do. It is the most accessible, just throw on some running shoes and get outside. Some little hacks, you can throw in walking poles, increasing your stride, doing hilly paths is going to increase your aerobic fitness. For some people doing high intensity interval training if they like it is also beneficial especially for people who don’t have a lot of time and getting more of that vigorous activity is really important, so moderate to vigorous, you want a combination of both.
[23:12] Cassy Price: Okay. That all makes sense. The other large part of the lifestyle piece is nutrition of course, so do you have your top five heart healthy foods that you think women should be incorporating into their diets?
[23:28] Dr. Olivia Greenspan: That is a really tough one to narrow to five. There are so many beneficial foods that are great for cardiovascular health. Some of the key ones that I do recommend for people are berries, so blackberries, blueberries, those deep purple pigments are really great for the cardiovascular system. They have a lot of antioxidants and are lower in sugar so that is always great because we want to eat more of that low glycaemic load diet to balance our blood sugars. Greens, beetroots are great, they have nitrates in them which help with healthy blood pressure. So, they help produce nitric oxide in the body which helps keep our blood pressure nice and healthy. The healthy fats so avocados which are great, it is a great healthy fat, fibre, it has glutathione in it, magnesium. Olives, olive oil, the polyphenols. Nuts are great to help support endothelial function. Of course, your fatty fish. Specifically, with women, some soy as long as it is not GMO and organic, the polyphenols are great in soy as well to help with the cardiovascular system and with menopausal symptoms we know that soy products can help.
[24:57] Fibre, so your ground chia, your ground flax. We have to remember when thinking about the cardiovascular system the gut has a tremendous impact on the cardiovascular system as well so we want to keep our microbiome nice and healthy because that can affect blood sugar and inflammation so keeping a nice healthy microbiome is really important. There is some interesting research about the health of the microbiome and healing after having a cardiac event because it does modulate our immune response. It can affect how the heart heals after a heart attack and can affect the remodelling of our heart after a heart attack. So, there is interesting research about that and using time restricted feeding as a tool to help heal after a heart attack. So, it is not robust, but it is definitely coming to light and it is really interesting and it falls along the category of sarcopenia medicine and how we have this body clock and how things shift so just an interesting titbit there. I sort of dipped out there for a second but…
[26:13] Cassy Price: Is it possible to reverse the damage that has been done to the heart after a cardiac event?
[26:18] Dr. Olivia Greenspan: To a certain extent I think it is but that is just a normal process. You can have damage and the heart does heal from it. I think it does depend on the extent of damage. If someone has a small heart attack where not so much of the heart muscle was damaged and how long they waited before they got treatment, all of those factors play a role. Like I said, all these other factors, managing inflammatory cascade, managing the circular rhythm, so sleep after a heart attack is really important as well because that is going to impact inflammation. So, some of it can be reversed and sometimes it can’t. it depends on the whole situation and timing of everything.
[27:08] Cassy Price: If you had to pick one or two most important things that you wish every woman knew about assessing their heart disease risk, what would those be?
[27:19] Dr. Olivia Greenspan: I would say for sure understanding the impact of your pregnancy history. I think that is really important. I come across that a lot in my practice that patients didn’t realize that these things impacted their health later on in life so understanding the impact of just intervening as early as possible and making your heart health a priority is super important. I think that is one of the key things. Knowing your unique risks, so not just the pregnancy piece but those other items that we talked about before that affect women so menopause, autoimmunity, PCOS, the role of hormones. I think that is really important and having those conversations with your physician over what you can do before it is too late. I think that is really important. Then just the impact of those basic lifestyle pieces. Exercise is critically important. We need to move on a regular basis, and we need to make time. It doesn’t have to be complicated. Just getting out for ten minutes or break it up during the day, I think that is really important. Patients that I see in the hospital that do the best are the ones that maintain a really active lifestyle even though they may have had a heart attack, because there is so much that we don’t know about cardiovascular disease, the ones that kept a very healthy lifestyle and did exercise on a regular basis and was always active, do the best I think for sure. So, those would be some key pieces that women need to be aware of for sure.
[29:06] Cassy Price: Awesome. Thank you so much for taking the time to share your insights and chat with me today. If our listeners would like to get a hold of you, work with you, or learn more from you, how would they go about doing that?
[29:17] Dr. Olivia Greenspan: So, they can check out my website. Oliviagreenspan.ca. I am on Instagram and on Facebook but the best way to get a hold of me would be to go to my website and all of that information is there.
[29:33] Cassy Price: Fantastic. Thank you again and thank you to the listeners who tuned into today’s episode of Supplementing Health.
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