Women: Talk to your doctor about your risk for heart disease

July 29, 2022

Providence Heart & Vascular Team

[5 MIN READ]

Women sometimes don’t share important signs of heart disease with their primary care provider.
Some conditions, such as diabetes, are a greater risk factor for heart disease in women than in men.
Start a checklist of questions or issues a week or more before your appointment, then use it to guide your conversation.

Heart disease is the leading cause of death for women in the United States. Yet, it’s rarely top of mind for them when they’re managing their everyday health. While women are much more likely than men to see their provider for preventive care visits, they may gloss over seemingly small issues that could indicate bigger heart problems.

It’s important for women to establish a relationship with their primary care provider. They don’t need to be shy about reporting any and all symptoms, says Melanie Santos, MD, FACOG, FPMRS, medical director of pelvic health for St. Jude Medical Center in Fullerton, California. While Santos is a urogynecologist who specializes in treating women with incontinence and other pelvic floor disorders, she often sees patients who have symptoms that could be a problem for their heart health.

This article is part of a series with Dr. Santos in which she talks about the relationship women should have with their primary care provider. Last month, Dr. Santos spoke about general health care issues for women ages 50-70.

“Some of my patients have had lower leg swelling which they attribute to their bladder issues, when in fact that swelling could reflect issues with their kidneys or heart,” says Santos. “They also discuss vague symptoms that they don’t feel are a concern. For instance, they may have been experiencing nausea and vomiting, but they assume their stomach is just getting sensitive as they grow older.”

In reality, nausea and vomiting could be a sign you are experiencing a heart attack.

Risk factors for heart disease

A primary care provider keeps a watchful eye on a patient’s risk factors for many different diseases, including heart disease. Several common risk factors for heart disease — such as high cholesterol, high blood pressure, and obesity — affect both women and men. But other factors may play a bigger role in the development of heart disease in women, says Santos.

Heart disease risk factors for women include:

Diabetes – Women with diabetes are more likely to develop heart disease than men with diabetes. Also, because diabetes can change the way women feel pain, they have an increased risk of suffering a silent heart attack — a heart attack without symptoms.
Emotional stress and depression – Stress and depression affect women’s hearts more than men’s. Depression may make it difficult for a woman to maintain a healthy lifestyle and follow the recommended treatments for other health conditions.
Smoking – Smoking is a greater risk factor for heart disease in women than it is in men.
Inactivity – A lack of physical activity is a major risk factor for heart disease.
Menopause – Low levels of estrogen after menopause increase a woman’s risk of developing disease in smaller blood vessels, such as in the heart.
Family history of early heart disease – Studies have indicated this is a greater risk factor in women than in men.
Inflammatory diseases – Rheumatoid arthritis, lupus, and other inflammatory conditions may increase the risk of heart disease in both men and women.

Keep your heart healthy

The best way to manage your risk factors is to focus on living a heart-healthy life. That starts with your primary care provider — not a cardiologist. In fact, you may not even need a cardiologist if you and your provider keep your blood pressure, cholesterol, weight and other important numbers in check. To take good care of your heart, you can:

Schedule an appointment with your primary care provider to learn your personal risk for heart disease.
Discuss any risk factors or signs and symptoms with your provider. “Even if you believe a certain symptom is unimportant, bring it up with your provider,” says Santos.
Quit smoking and try to avoid exposure to secondhand smoke.
Eat a healthy diet that includes whole grains, fruits and vegetables, low-fat or fat-free dairy products, and lean meats. Avoid saturated or trans fats, added sugars, and high amounts of salt.
Exercise and maintain a healthy weight. If you’re overweight, losing even a few pounds can lower heart disease risks.
Manage stress.
Avoid or limit alcohol.
Manage other health conditions. High blood pressure, high cholesterol, and diabetes increase the risk of heart disease.

Medication management

One of your primary care provider’s biggest functions is to help you manage your medications. It can be challenging to keep track of all the pills and other medications you need to take — and even more confusing to determine if they are interacting negatively with one another. There’s a reason why a staff member always checks your medication list at each office visit — they want to make sure you are taking a safe combination of prescriptions and over-the-counter medications.

Talk to your primary care provider before deciding to stop any of the drugs you are taking. “Sometimes, my patients will decrease or stop medications that make their bladder dysfunction worse — such as blood pressure medications — without notifying their primary care provider or cardiologist,” says Santos. “That can be very dangerous.”

Your providers can help you decide which medications are a priority, but only if you communicate with them.

Each time you see your primary care provider, bring along all your medications or create a list. You can also make a list of any signs or symptoms you have noticed over the last year. Trust your provider to help you spot any red flags you may have overlooked.

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