HeartBeats Episode 26: Ladies Know Your Numbers!

Welcome, I'm Cathy Murtagh Schaefer and I'm your host for this episode of heartbeats. This podcast is brought to you by Shipley cardiothoracic Center, and educational series dedicated to providing our patients and the community with information and education about our cardiothoracic surgery program. Today. We kick off our series of podcast, dedicated to our female listeners, and celebrating the opening. Another woman's cardiac Surgery Center here at health, park in Fort Myers. The center is where a woman's heart surgery. Care is specialized to her needs. Today's podcast. Also celebrates our continued collaboration with our Cardiology colleagues without whom much of. This would not be possible. Today. Our guest is Dr. Elizabeth Cosmai, a cardiologist from Florida. Heart Association, Dr. Cosmai has an unique educational journey is not only board certified. In cardiovascular medicine. And but also nuclear Cardiology and CT angiography. She remains board eligible in echocardiography as well as a physician. She has a very strong bent towards educating patients on preventive, heart care and maintaining good heart health through proper nutrition exercise and reducing risk factors that lead to heart disease and stroke. She has a special interest in women's health. And today, we're going to be talking about what women need to know in order to optimize their health. Welcome, Dr. Cosmai, and thank you so much for being here today. Perhaps we can begin with you telling us a little bit about yourself. It's really a pleasure to be here. And I think it's great that we have a chance to educate our community. I came here from Connecticut, which I trained at Hartford Hospital for fellowship and I am a native of Kissimmee, Florida. So it made sense for me to return to Florida. Yeah, and I used to vacation in Cape Coral when I was was a young girl because I had godparents that lived here. So I arrived and I joined my medical practice, Florida, Heart, Associates in 2005, and I was the first female in the group and the first female in the county at the time. Oh, wow, so it really changed the landscape as time has gone by and we've obtained more female cardiologists and I think we're more aware of women's health and heart disease in the risk and women, so I'm happy. To continue the journey and see where it goes. Yeah. We're excited to be collaborating with you for sure. One of the many things I've been acutely aware of over the years. Is that in medicine we tend to lump men and women patients together physiologically as if there were no biological gender differences in caring for them. In fact, the only place that you see really any differences in OBGYN practice in your opinion. Why is this not an optimal approach? Well, women are biologically different in in terms of coronary artery disease. I think there has been studies. That have shown a difference. There are numerous other players in this whole picture. So I think from a from an anatomy standpoint, women may have a higher risk of having smaller arteries size diameter and that may play a role, especially if they need bypass surgery, producer the bypass graft and where to place it and its success rate. I think the other exposure that women have are different levels of their interpretation of stress and how they take care of, The family and some of the problems that women may also face as Elite presentation. Yes, and I think that's been shown in numerous studies as well. And and that's frustrating because of course the sooner you identify a problem and any person male or female you want to be able to get them the care that they need. And if women more predominantly or presenting late that just adds to the to the, to the problems that we may face in treating the coronary issue or if they need Either presenting late and I think their outcomes tend to not go as well as we'd like, yeah because of that late presentation. I think women tend to underestimate their their health risk. A lot of that because of caregiver burden, but also because I just don't think they've had that Focus through the media to recognize that they have their own personal health risk. I think they also don't recognize their risk of heart disease and it's a higher risk than breast cancer. So, yes, we as women often just here about the breast. Risk, which is certainly a concern. I'm concerned. But the risk of heart disease is much greater and I think most women don't realize that heart disease is still the number one killer of women in the United States. Yes. Along those same lines. We know over the years most of the research that's been done in heart disease has been predominantly weighted towards men. Meaning more men are enrolled in these studies than women and So the conclusions of these studies tell us more about male physiology than female physiology. How do you feel that's affected Women's Health Care. I think we extrapolate a lot from these studies to women. I don't think it's necessarily a bad thing that we are taking information from trials that are predominantly male. But of course, I think over time you're going to see more women involved in Trials because the the atmosphere is different. It's just like, you know, seeing with In my practice or patients that are female coming in. There's more and more that I've seen over the years and when I first started some of that may be an attraction to coming to a female cardiologists, right, but I think the, the awareness is much greater. And so I will say that the way the guidelines are being created, they are taking into account female differences. And I think that's really important that we're getting more information from a research perspective. So it's going to get better. Utter, I agree. We know that diseases, such as diabetes, kidney disease, COPD can have a significant impact on both male and female cardiac disease. Are there any specific diseases that women have that make them more susceptible to heart disease? For example, autoimmune disorders seem to be more prevalent in. Women are these diseases associated with heart disease, autoimmune disease. Connective tissue disorders. Are a risk factor. And in particular things like Attic sort of rheumatoid arthritis. You have diseases such as Scleroderma. The research is showing that there's an inflammation risk, that's associated with heart disease. So these types of diseases and they are frequently Associated more and women need to be evaluated addressed. I have many patients that come to see me for a primary risk prevention. And they have these disease processes and there's simple things that we can do just to Assess their Baseline. So the education for women who have risk factors, including the non-traditional arthritic, right? Active tissue autoimmune. They should be evaluated at least as a baseline. The medications that a lot of these autoimmune diseases require. Do they have an impact on heart disease as well? Yeah. Unfortunately we see risk with even and say it's so I often I have patients that are highly are high highly in need of and say it's and we have to discuss the small risk, but the risk is present and how to address pain relief and Pain Management, perhaps in a different way. So the medicines play a role. I think it leads to an activity, many of these diseases, and disorders. So you end up with more sedentary and it's driven by a lot of factors, of course, in these patients are in pain or they're in Mobile due to their arthritic complaints or their connective, tissue autoimmune discomfort. They're not going to want to go out and exercise. And, of course, that's what we want, right able to do to advocate for our patients. It's interesting. I've been reading recently that a lot of the intense exercise requirements that we have pushed out into social media are not exactly what we need to have. In fact, 10 minutes, a day can suffice an end, be helpful to reduce risk factors. There are many studies that have shown, at least if you are doing something and, like, you just mentioned, even It's 10 minutes of activity. You are going to get a benefit for benefit from that person who did zero minutes, right? And of course, you know, I advocate you start maybe a ten minutes and then you progress and you can do more and of course you get to a level where you can tolerate that and then of and then, you know, we see where where it goes, but at the minimum, we want five days of activity. One of the research articles I read recently indicated that fibromyalgia is associated with an increased risk of atrial fibrillation. I think afib is an Insidious disease. You often don't know, you have it until something bad happens. The worst is stroke caused by afib, and women tend to have more catastrophic Strokes than men do due to afib. Do we know why? And what can women do to prevent afib or care for themselves when they have a thin? Those are really good questions. I will say why women have a higher risk of stroke? And actually that's a risk. When we're determining, who has elevated stroke risk in general. They actually get a point if you will on a for being female. Yeah, for being female and sometimes I tell my patients, I'm sorry. It's unfair that you're a female and you have a higher risk. I don't think we have the exact signs of why that's the case. I think we can assume. That if we look at risk factors and perhaps women getting attention or identifying those risk factors up, probably plays a role. There are things about a stroke in, we're really processing this because it's very common. So one out of every four to five person after age, 65 can develop atrial fibrillation. So it's a very common disease and I think more research is showing The potential risk factors with atrial fibrillation development and we just have to focus on how we can reduce that risk. And it's there's a lot of options and there's also a lot of therapeutic options. Does exercise play a role in prevention. Yes, and interestingly, I think exercise people get concerned because obviously they're increasing their heart rate, right? Worry about it. There's if you look at even studies with heart disease and the risk of Mi the Shal exercise. Probably can increase your risk somewhat because you're increasing your heart, rate, your increasing, some pressure differences in your heart muscle, but the long-term benefit is what Al ways that so you give a long-term benefit of exercise. So, with atrial fibrillation, I have had very competitive athletes, professional athletes develop, atrial fibrillation really. Now, there's a lot of research that has looked into that perhaps and enhance vagal tone or perhaps some pressure. Jews in your Chambers and your heart muscle that can predispose you especially on some of these competitive athletes. However, again, the small percentage of that occurring, right? Does not outweigh the benefit larger group. Yeah. And so we, you know, even my patients, who have been diagnosed with atrial fibrillation exercises key, because they need to prevent other problems that are either going to make their atrial fibrillation worse or increase your risk of stroke. So it's all it's all tub of different things. I'm going to do. So this big episode that happened on Sarah, Jessica, Parker's new show with her husband dying on the Peloton bike. I think that just exacerbates the misconceptions of what exercise can do and and your risk of something like that happening. And I think they did a disservice to people in general by the train that I agree. And I think that again we don't know if we looked at his character as a real person. We don't know all of the other underlying risk factors. They don't know what his numbers which we'll talk about. We don't know what those were, what his vital signs were. What his overall General Exercise capacity in General Health, you know, there's so many and people unfortunately see that in, that's all they remember. So yeah, I agree. One of the things you mentioned in our conversations about the women's cardiac Surgery Center is education about knowing your numbers. Would you share with our listeners? What you mean by that? And why it's important. I've actually advocated that for as long as I probably have started practicing because I had patients that really don't know anything about their own vital signs or their own statistics of you will, I always tell patients if you have blood work trying to get a copy of it. Understand. What what what Were your statuses and not just go by whatever your providers telling you your Physicians telling you you have high cholestoral. What is it is going to ask us the question. So I always tell patients have an idea. What is your blood pressure? What's your heart rate? These are things that are easy to find. I mean, if you start off getting a blood pressure, heart rate Czech Republic's. That's fine. Right, right, but if you then maybe consider buying a blood pressure cuff, they're inexpensive. I remember back in the day. I bought a present for my mother blood pressure. A cup was $100. Oh, my now, you gotta get low for pharmacy. And that's fine. And even now is probably a good person who should be interested in their own health should have. And then, of course, you should know, like, I mentioned, what is your cholesterol? Don't say, well, my doctor told me. I have high cholesterol. Well, what is it? Because I think there's three basic characteristics. Sticks. You don't even have to get fancy and do the very extensive and expensive, Robin analysis. You can get your basic cholesterol analysis with three, basic important parts. Well, actually for so, your total, your your good cholesterol, which is your HDL, your triglyceride, and your LDL which is considered your bad cholesterol and you should have an idea. Okay. This is, these are my numbers and then when you're being treated you can follow it yourself. You can see what is your process. What is your success rate with whatever? Are doing and I think knowing those numbers also gives you the opportunity to impact them yourself. I mean there are things that you personally can do to enhance your HDL. For example, your good cholesterol and that's by exercising or taking a walk every night and your LDL, if that's high. Then maybe you need to cut back on some of the processed Meats, you're eating, you know, I'll give you a story as much as I exercise, and I think I'm relatively The I saw my cholesterol numbers and I think that was a wake-up call. Quite frankly. I saw and identified a problem and I said to myself. Okay. What am I doing with my diet? Am I disregarding? Perhaps I'm using my relative youth or relative Exercise capacity and disregarding what I'm eating and I made some changes and I think these are things that created a better a better media in And made you aware of something that you might not have been aware of if you hadn't had your cholesterol checked. And and now you can, you personally can make changes to impact your help. And I think that's what the for me. This is what is probably the most important aspect of all of this. If you can get yourself checked and you can make, you personally can make an impact on your own health with just diet and exercise. Its so Simple, you know, I get the question a lot doctor. How can I lose weight? What can I do? And I always start. I said, listen, you know, there's always pharmacology. There's always medicines. There's always some sort of surgery, but I think at the the core is diet and exercise. And you know, you say that in some people are frustrated. They may come in with a significant amount of weight gain and they want to lose it. Immediately. Obviously everyone does. But I said, why don't you take a look at what you're eating? You know, some some will say well I don't eat that much. Yeah, that's right. And that may be the case. But why don't you take a look and start reading the labels? Actually, I actually started reading the labels. Personally. It's scary. So it is very scary. Yeah. And simple things. I just want to know how much carbohydrates isn't package of food that I'm looking at and it's scary. So I tell my patients, just take a look at what you're eating. Just take a look because every pretty much every package has To have the the break down tissue, labels usual label. The breakdown of the ingredients, and you can have an idea and maybe you thought you were eating nicely. Yeah, you know, well, well, but maybe you aren't and something simple could be, actually, a big thing that you can get rid of. And for me, the big changes. I tend to have a sweet tooth and I eat a lot of cookies, a lot of cake and I realize how much that was impacting me. So that has had I had a had a significant change in intake, for sure. Covid-19 has been the topic of conversation now for almost three years. We've lost a lot of folks and our hospitals have been at capacity again. Although we seem to be trending down again. Are you seen patients with myocarditis or other heart problems? Related to covid. And are there any heart problems related to the vaccine? Yes. I have seen patients who present with findings. We end up determining as myocarditis or pericarditis it is it is something that we have more knowledge about I think in the beginning, let's say three years ago. No one did. Right. So now I have a case. I had a young male who actually got the booster and came in with Lord myocarditis well and asymptomatic, obviously, they came and were admitted and we had to treat them. And, you know, if you look at the accha. Lines, even we have to be aware of all these potential outcomes from either the infection or even from the vaccine treatment. We have to be aware because this is definitely affecting our community. Accha guidelines for instance have advocated for individuals and especially if you're a competitive athlete, whether you're a student athlete or adult athlete, if you have myocarditis, whether it comes from the infection itself, or if it occurs after the vaccine, And or booster you have to actually have a pause on your competitive, athletic athletic activity and that could go as long as three to six months. Wow, and then afterwards, you have to be reassessed. So that's that's that's significant significant and and especially for younger individuals, males predominantly are more affected. You have to look into the rest and the benefits, of course and, you know, We're dealing with all this information that's coming now. And that's why I think it's you know, three years ago. We did not know. Now we have an abundance of material and we have to be prepared and how to treat it, you know, treatment is limited and most of the time it is self-limiting which is a good thing. But but that's an example of some of the the Adverse Events. Yeah. Well and particularly for our young males who may be going to college on a scholarship athletic scholarship. Those are things that need to be thought about for sure. This has been a great conversation and I love the focus on our female patients. I think this is a great first step in providing them with useful information about their physiology and how to care for themselves. Is there anything else you would like to add before we close? I will say that women are very much at risk of heart disease and we know that especially over age 60 their risk lines with their male counterparts. And that Very important because we want to make sure that women assess their heart risk, as well. As of course of breast cancer risk any, you know risk that can develop with age as well. Chest pain is still the predominant symptom and I think it's it's been studied and it's been identified as the predominant septum. So I want women to always understand that chest pain is still highly likely to be there presenting something in addition. You're going to see other symptoms and we've identified that Women tend to have those other symptoms which are nausea shortness of breath, especially with exertion more fatigued with their activities, generalized malaise, just not feeling well, and these are these are things that women have to be aware of but it is still important that chest pain is still considered the number one, number one symptom. But outside of that. I want women to be very Vigilant their health status, their their risk factors. Should always be considered as they're taking care of other things, whether it's children, whether it's their parents parents to have another, you know, and whether they're working. Because women are in the workplace and Sharon and we get very busy and don't assume that your risk of heart disease is going to get less. So I think that's my take home message. Okay. Dr. Cosmai this has been such a great conversation and I thank you for being here. Until next time. I'm Kathy murtagh Shaffer. And this has been heartbeats Shipley. Cardiothoracic centers podcast, dedicated to Bringing research, Innovation and education to our patients and the community. Until next time.