Occupational Health Clinic
January 4, 2019

​​In this episode we talk to Dr. Sharmin Basher, Assistant Professor of Medicine in the Division of Cardiovascular Medicine and physician at the Vanderbilt Women's Heart Program, about important differences in heart disease in women as compared to men.

Read more information on the Vanderbilt Women's Heart Program.

Begin Transcript

Welcome to this edition of the Vanderbilt Health and Wellness wellcast.  I'm Shaina Farfel with Occupational Health.  Today, we are speaking with Dr. Sharmin Basher, Assistant Professor of Medicine in the Department of Cardiovascular Medicine and physician at the Vanderbilt Women's Heart Program.  Hi, Dr. Basher.  Thanks so much for joining us today.

Dr. Sharmin Basher:  Hello.  Thank you.  I'm happy to be here.

Shaina Farfel:  Many of us already know heart disease is a leading cause of illness and death in this country.  We hear about heart disease in the context of men a lot, and today, I wanted to specifically focus on heart disease and what it looks like in woman, as there can be some important differences that people should be aware of.  How common is heart disease in women?

Dr. Sharmin Basher:  Cardiovascular disease is the number one killer of women.  In fact, it contributes to one in three deaths for women a year, and if you look at the American Heart Association statistics, that is approximately one death every minute for women.  The Centers for Disease Control actually estimate that 44 million women in the United States are affected by cardiovascular disease and actually 90% of women have one or more risk factors that develop cardiovascular disease down the line.

Shaina Farfel:  Do signs and symptoms of heart disease differ in women as compared to men?

Dr. Sharmin Basher:  Actually, that is true.  The most common symptom that most people are aware of when they think of a heart attack is centrally-located pain in the chest, crushing chest discomfort, maybe radiation down the left arm, but sometimes they symptoms are not particularly common in women.  They can actually be a little bit more subtle.  These symptoms may not even be the most prominent symptom that they present with.  And sometimes, women can have symptoms that are not even associated with chest pain.  For example, they could have more GI-related symptoms, such as nausea, vomiting, or some abdominal discomfort.  They could also experience some significant fatigue or generalized malaise that is unusual for them, and also sweating, shortness of breath, pain going down both arms, and they can also experience jaw pain and maybe shoulder or upper back pain as well.  These symptoms typically are not quite as significant as the crushing, sort of "Hollywood heart attack" that most people are aware of.  They can be more subtle, and because of this, women can tend to downplay their symptoms.  As well, the diagnosis for, you know, cardiovascular disease may not be quite as easily picked up when they are initially seen.  In fact, there is data that shows that women tend to show up in emergency rooms for care after a significant amount of heart damage has already occurred because of the subtlety of these symptoms, so it is really important to be aware of these symptoms if they come along.  And actually, fewer women than men survive their first heart attack, which is really noteworthy.  Eighty percent of cardiovascular disease can be prevented by lifestyle changes and education.

Shaina Farfel:  Do you mind telling us about some risk factors for developing heart disease in women?

Dr. Sharmin Basher:  Absolutely.  These are really important because these are very preventable in many cases.  So, diabetes is a major risk factor because it accelerates the degeneration of good vascular tone, which can accelerate heart disease.  Also, smoking is a major risk factor as well for similar causes.  Having a high LDL cholesterol is a major risk factor.  Also, having a sedentary lifestyle where you are not exercising quite so much - that can also promote heart disease.  Family history is also really important.  So, if you have a first-degree relative, such as parents or siblings, that have already had heart disease at an early age, that is a significant risk factor that is not modifiable and is worth noting.  Also, women who are in menopause, because of the low estrogen levels, can also promote the development of heart disease.  Certain chemotherapeutic drugs can also affect cardiovascular decompensation as well as radiation exposure to the chest.  Radiation can actually accelerate vascular disease.  Also, patients who have developed high blood pressure or diabetes in pregnancy, so, gestational hypertension and gestational diabetes can actually increase the woman's long-term risk of developing those two disorders, even after delivering the child, and those two risk factors, in and of themselves, can also increase your risk of heart disease as well.  And lastly, women who have chronic inflammatory diseases, such as rheumatoid arthritis, Crohn's disease, or lupus, because of the high level of inflammation, they also have a significantly-elevated risk of having heart disease.

Shaina Farfel:  Is diagnosis and/or treatment of heart disease different in women than it is in men?

Dr. Sharmin Basher:  Typically, the diagnosis and treatment tend to be similar.  So, the treatment can span from something as noninvasive as medication adjustments to as invasive as a bypass surgery, if needed.  In a typical sense, if someone presents with a heart attack due to a plaque rupture within the arteries, the treatment includes stenting the vessel or even angioplasty, and that applies to both men and women.  I should mention that there is a disorder that particularly relates to women called microvascular coronary dysfunction, where they present with the symptoms that are very typical for cardiovascular disease, or even the symptoms we talked about earlier that are more subtle, and after some amount of cardiovascular diagnostic imaging or testing, they do not have any evidence of large-vessel coronary dysfunction.  In fact, they can have smaller vessel or inner lining disease of the small coronary vessels that branch off of the larger vessels that are not easily visible on the traditional studies and it is definitely worth to keep this in mind for all practitioners that this might be something that could affect women.

Shaina Farfel:  What are some preventative measures that women can take to help protect their heart?

Dr. Sharmin Basher:  Definitely, consuming a healthy diet is important, so, a low-saturated fat, high-fiber diet is very important, being very active, so maintaining a good, regular exercise regimen (the American Heart Association currently recommends 150 minutes of aerobic exercise for all healthy adults), and also maintaining a good healthy weight.  So, going to the primary care doctor and checking your BMI is really important, and also in the same vein, having your blood pressure checked regularly.  Having high blood pressure is a silent killer.  Most people are not even aware that they have hypertension until they get screened.  So, that is really important.  Then, also, something that a general internist can also check for is a fasting lipid panel screening to look for elevation of LDL cholesterol, which can actually cause plaque

development at an early age, and also blood sugar checked to make sure that diabetes isn't playing a role.  So, I think those are the important things, and also, lastly, I forget to mention - smoking.  So, if you are smoking, stop smoking immediately, and do not start.

Shaina Farfel:  And as we mentioned, you are a provider at the Vanderbilt Women's Heart Program.  Can you tell us a little bit more about the program and how folks can access it if they are interested?

Dr. Sharmin Basher:  Absolutely.  So, here, at the Vanderbilt Women's Heart Program, we are located at the 100 Oaks complex, 719 Thompson Lane, and we provide a lot of consultative approach to our patients initially when they are being seen, and what we do is we do a more individualized risk assessment and then do a personalized plan to help modify risk factors and maybe even consider therapies, if needed, with medications.  So, it is a really personalized approach to cardiovascular risk prevention.  So, if any women are interested, or if men are interested about any women in their family, feel free to contact us.  We are happy to see anyone if you have any questions or any concerns.

Shaina Farfel:  Well, thank you so much for your time and for sharing this really valuable information for our listeners.  We really appreciate it.

Dr. Sharmin Basher:  No problem.  Happy to help in any way that I can.

Shaina Farfel:  Thank you.

Dr. Sharmin Basher:  Thank you.

Shaina Farfel:  Thanks for listening.  If you have a story suggestion, please email it to us at health.wellness@vanderbilt.edu or you can use the "Contact Us" page on our website at www.vumc.org/health-wellness. 

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