Ask Us Anything About… Women’s Heart Health

A female physician holds a stethoscope up to a female patient's chest. They are seated next to a window.

Heart disease is the leading cause of death for women in the U.S, according to the Centers for Disease Control and Prevention. Although heart disease is sometimes thought of as a “man’s disease,” it kills roughly the same number of women and men each year.

February 16, 2021Penn State Health News

In this interview, Dr. David Zisa, a cardiologist at Penn State Health, provides important information for women and their heart health.



View full transcript of video


Barbara Schindo – Good afternoon and thank you for joining us. This is Ask Us Anything About Women’s Heart Health. I’m Barbara Schindo. As you may know, February is heart month, which is a time to raise awareness for cardiovascular health. According to the American Heart Association, cardiovascular disease is the number one killer of women causing one in three deaths each year. That’s approximately one woman every minute. Joining us today to talk about women’s heart health and answer your questions is Doctor David Zisa, our card and interventional cardiologist at Penn State Health, St. Joseph Medical Center. If you have a question for Doctor Zisa, please feel free to put your question in the comment field below this video. Whether you’re watching this live or watching on playback, we welcome your questions for Doctor Zisa. Doctor Zisa let’s start, kind of, with the big number at the top. Cardiovascular disease killing one in three women seems really high, you know, is — are women more at risk for cardiovascular disease than men?

Dr. David Zisa – First of, thank you so much for having me in especially in the month of February, which is heart health awareness month for women. As you know, or as most people don’t know, heart disease is the biggest health threat for women. Heart disease kills more women every year in all forms of cancer. And this is a fact that’s not well recognized among many women. Well, men are generally twice as unlikely as women to have a heart attack. Women typically do worse after a heart attack compared to men. And women typically develop heart disease 10 years later than men do.

Barbara Schindo – So then that’s — I guess we can backtrack a little bit and start from the beginning. Can you explain what causes heart disease? What is heart disease?

Dr. David Zisa – Yeah. Heart disease is a pretty broad term. And there are several different problems that affect the heart. But the most common type of heart disease is coronary artery disease. In coronary artery disease, plaque builds up in the walls of the arteries that carry blood to the heart. And over time, this buildup causes the arteries to narrow and harden, which is a process that’s called atherosclerosis. And this prevents the heart from getting all of the blood that it needs. It can also lead to the development of blood clots. And if a blood clot blocks flow to the heart, this can lead to a heart attack.

Barbara Schindo – So heart disease, cardiovascular disease, that’s a really broad term and I’m sure there’s different forms. Can you talk a little bit about what are the different forms of cardiovascular disease?

Dr. David Zisa – Yes. So, cardiovascular disease can generally be broken up into really four major categories. The first is ischemic heart disease or blockages in the arteries of the heart, which is also called coronary artery disease. There’s heart disease that affects the valves of the hearts, which is called valvular heart disease. And these include conditions like aortic stenosis, which is the narrowing of the heart valve that can lead to symptoms like shortness of breath, chest pain, or even episodes of passing out. There’s heart disease that’s called congestive heart failure and that can be when the heart is not pumping very well and leads to fluid building up in the lungs or in different parts of the body. And there’s heart disease caused by abnormal heart rhythms called arrhythmias.

Barbara Schindo – So, I think that’s really helpful because I think when people hear the term cardiovascular disease, they just think heart attack. So I think it’s important, you know, to know that there’s more than one form and more than one thing. So how do — you know, how would I or how would any woman know that they’re at risk for heart disease?

Dr. David Zisa – Right, so there are many different risk factors that can put someone at risk for heart disease. One of the most important ones is a family history. So if your siblings or mother or father had a history of heart disease, it does increase your risk for developing that condition as well. There are also several habits that can lead to increased risk of heart disease as well, including smoking, eating an unhealthy diet, physical inactivity, a lot of alcohol consumption, or having high levels of stress in your life. There are other conditions which we can control with medications including high blood pressure, high cholesterol, being overweight, or obese, or having diabetes. And those are conditions you can work with your doctor in order to help reduce your risk. Other factors that you can’t control, unfortunately, is your age, your family history, as we’ve mentioned before. And also whether you’re postmenopausal that also increases your risk for heart disease as well.

Barbara Schindo – Okay, you are watching Ask Us Anything About Women’s Heart health, with Doctor David Zisa, interventional cardiologists at Penn State Health, St. Joseph. We welcome your questions for Doctor Zisa. If you have any questions for him, please feel free to put them in the comment field below this video. Whether you’re watching live or on playback, we will get an answer for you. So you mentioned, you know, one in three women, again, that’s just such a high number. Is there any female-specific disorders or things like that that lead to that increase in, you know, women’s risk for cardiovascular disease?

Dr. David Zisa – Yes, so there are some conditions that are more common in women that would lead to increased risk of developing heart disease. Specifically, inflammatory disorders like lupus or rheumatoid arthritis can lead to increase in risk for developing coronary artery disease. A condition called polycystic ovarian syndrome which is associated with diabetes and obesity can also lead to an increased risk of heart disease. Even being pregnant slightly increases your risk of cardiovascular disease in the time of pregnancy, and conditions such as [inaudible] and — are more common during that time period. But the most common condition that affects all women is menopause. And that condition in which the estrogen levels drop, usually between fourth and sixth decade of life, we see your highest increased risk of coronary artery disease. And that’s because estrogen provides protective factor in terms of reducing and improving your lipid profile, and also protecting the arteries as well.

Barbara Schindo – So what can women do to limit the risk of cardiovascular disease?

Dr. David Zisa – Yeah, so there’s a lot of things women can do to reduce the risk of cardiovascular disease. And the first of which is to have healthy habits, including not smoking, eating a healthy diet, including foods that are low in cholesterol, eating lots of fruits and vegetables and nuts, and trying to avoid excessive amounts of alcohol. Also, being physically active is very important. So, getting at least 30 minutes of physical activity in every day of aerobic nature, can really reduce one’s risk of developing coronary artery disease. Furthermore, working with your doctor to control risk factors like high blood pressure, high cholesterol, overweight, or obesity, or diabetes can also help reduce your risk as well.

Barbara Schindo – Exercise being a really good way to — sorry, can you hear me? I think I was muted. So you mentioned exercise being a good way to mitigate risk of cardiovascular disease. Is there a certain type of exercise you recommend? Is there, you know, one form of exercise that’s better to mitigate risk than another?

Dr. David Zisa – Yeah, so any type of aerobic exercise, that’s the type of exercise where you’re increasing your heart rate above its baseline level is very good for the heart. So these would be activities such as walking, jogging, cycling, swimming, even dancing would be a great activity to help reduce your risk of cardiovascular disease. The recommendation is to try to get 30 minutes of exercising every day, or around 200 minutes per week.

Barbara Schindo – So what do you think — would you recommend aerobic exercise over, you know, resistance training or strength training to mitigate cardiovascular disease?

Dr. David Zisa – That’s correct. It’s really the aerobic exercise that’s known to be the most beneficial. Weight training is good for toning your muscles, but really, it’s the aerobic exercise that helps reduce your risk of coronary artery disease.

Barbara Schindo – Okay, that’s really good to know for me personally, because I do — I prefer, you know, the strength training, weightlifting kind of thing. So I need to personally work on doing a little more of that aerobic exercise. And I want to ask you this, I guess this is maybe kind of a myth-busting question. So I’ve heard that you know, heart disease or women who, you know, women who experience a heart attack can experience symptoms differently than men. And mainly that, you know, women may not experience it in the way that is typically portrayed and you know, on TV or movies or things like that, you know. Is that true that heart attacks look very different for men and women?

Dr. David Zisa – That is true women can experience symptoms different than the typical symptoms you would consider for a heart attack such as chest pain or chest pressure. Women often develop symptoms that are somewhat atypical and may lead to delayed diagnosis of a heart attack or delayed diagnosis of coronary artery disease. The symptoms often include shortness of breath, lightheadedness, dizziness, decreased energy levels, as well as nausea, vomiting, or even upper abdominal pain, or back pain.

Barbara Schindo – So it’s not always your typical, you’re going to think you’re going to have, you know, excruciating chest pain. But that’s not always what it is like, for somebody suffering a heart attack.

Dr. David Zisa – That’s true. Women can experience atypical chest pain symptoms, but a lot of it — a lot of the times they can experience other symptoms as well. What’s also interesting is that sometimes women experience no symptoms at all, and have what’s called a silent heart attack.

Barbara Schindo – Okay, that’s really interesting. So then I want to ask you a little more about that. Is that — you know, how do you know that that happened to you if you don’t experience any symptoms? Like how might you or I guess maybe your doctor someday realize, you know, that’s what happened.

Dr. David Zisa – Right. So if you were to have a screening electrocardiogram, it may be picked up on that study, or if you were to have a stress test, or an ultrasound of your heart called an echocardiogram, those studies may pick up that you’ve had a prior heart attack before.

Barbara Schindo – Wow, that’s really interesting. That’s really good to know. I have just a couple more questions for you. But I just want to remind everybody watching ask us anything about women’s heart health with Doctor David Zisa from Penn State Health, St. Joseph Medical Center. If you have any questions for Doctor Zisa whether you’re watching this now live or you’re watching on playback, please feel free to put those questions in the comment field below this video and we will get an answer for you. I just wanted to circle back to one thing you had mentioned earlier when you said that women have a harder time recovering after a heart attack than men do. Do you have any idea why that is?

Dr. David Zisa – Yeah, what women tend to do worse after a heart attack because they often experience heart attacks a little differently. In men, typically, when they have a heart attack, it’s due to a blockage in one of the large blood vessels of the heart. It’s often treatable with either a stent in the artery or bypass surgery. When women experienced a heart attack, it often involves the smaller blood vessels which aren’t as easily treated with those interventions.

Barbara Schindo – So for a woman who is recovering from a heart attack, you know, what kind of recommendations, you know, would you make as a physician to help her through recovery?

Dr. David Zisa – Yeah, so, first of all, is to work with your physician about making sure you’re on the right medications after you have a heart attack. It’s been well studied that women often don’t get treated with the same or the appropriate medications that men do after a heart attack. So it’s very important that you work with your physician to make sure you’re on all the right medications. To often include aspirin, cholesterol-lowering medication, blood pressure medication, to make sure that you’re treated properly, also making sure that you improve your lifestyle and your habits in order to reduce your risk of having a future event. So if you are a prior smoker, stop smoking, if you are physically inactive, trying to become more physically active and exercising on a regular basis, improving your diet as well as making sure that if you have any symptoms, you seek your doctor out for treatment and not to ignore them.

Barbara Schindo – Okay, well, Doctor Zisa, thank you so much for joining us today for Ask Us Anything About Women’s Heart Health. A lot of really helpful and important information. I think especially because as you had pointed out earlier, this is something that not a lot of people realize is a very serious disease for women. So thank you again very much for your time. And for those of you who are watching this and thinking, I still have a question, that’s okay. Even though we’re not live anymore, you can put your question in the comment field and we will get it to Doctor Zisa. So thank you very much for those of you who tuned in and again, Doctor Zisa, thanks for your time.

Dr. David Zisa – Thank you so much for having me.

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