February 2022 Featured Interview
Preventing Heart Disease in Women
Interview with
Nieca Goldberg, M.D.
Medical Director of Atria New York City
&
National Spokesperson for the American Heart Association
About Nieca:
Nieca Goldberg, M.D., is a nationally recognized pioneer in women’s heart health. She is medical director of Atria New York City and clinical associate professor of medicine at New York University Grossman School of Medicine. She is also the co-medical director of the 92nd Street Y’s Cardio Rehab Program, a cardiologist, author, and former radio show host of “Beyond the Heart" on Doctor Radio SIRIUS XM 81.”
Nieca is a national spokesperson for the American Heart Association and started the “Go Red for Women” campaign. Before joining Atria New York City, she was medical director of NYU Women’s Heart Program, Senior Advisor of Women’s Health Strategy NYU Langone Health, and the founder and Medical Director of the Joan H. Tisch Center for Women’s Health at the NYU Langone Medical Center.
Nieca is the author of Dr. Nieca Goldberg’s Complete Guide to Women’s Heart Health. She also authored the award-winning and highly acclaimed book, Women are Not Small Men, which was updated and titled The Women’s Healthy Heart Program: Lifesaving Strategies for Preventing and Healing Heart Disease (both titles published by Ballantine Books).
A graduate of Barnard College and State University of New York Downstate Medical Center, Brooklyn, she completed her medical residency at St. Luke’s-Roosevelt Hospital Center and a cardiology fellowship at SUNY Downstate.
Nieca is a national spokesperson for the American Heart Association and started the “Go Red for Women” campaign. Before joining Atria New York City, she was medical director of NYU Women’s Heart Program, Senior Advisor of Women’s Health Strategy NYU Langone Health, and the founder and Medical Director of the Joan H. Tisch Center for Women’s Health at the NYU Langone Medical Center.
Nieca is the author of Dr. Nieca Goldberg’s Complete Guide to Women’s Heart Health. She also authored the award-winning and highly acclaimed book, Women are Not Small Men, which was updated and titled The Women’s Healthy Heart Program: Lifesaving Strategies for Preventing and Healing Heart Disease (both titles published by Ballantine Books).
A graduate of Barnard College and State University of New York Downstate Medical Center, Brooklyn, she completed her medical residency at St. Luke’s-Roosevelt Hospital Center and a cardiology fellowship at SUNY Downstate.
About Atria Institute (New York City):
Atria Institute, based in New York City, provides a full range of health, medical and wellness services, including primary, internal, cardiology, gynecology, geriatrics, and neurology care plus health coaching, with a focus on disease prevention. The practice’s Academy of Science & Medicine includes medical, science-based, academic and research professionals who provide essential information on the latest healthcare trends. Through the Atria Health Collaborative, a 501 (c)(3) not-for-profit foundation, Atria will democratize access to breakthrough science and medicine globally while helping to deliver care to medically underserved communities locally.
Karen Shan, co-associate editor, spoke with Dr. Nieca Goldberg about risks to women’s heart health and how to prevent heart disease.
With February being American Heart Month, let’s start with the basics. What is heart disease?
Heart disease is a condition that could affect the arteries that supply the heart muscle with blood or the heart valves. The most common form of heart disease in the U.S. is coronary heart disease.
A combination of risk factors could be involved. Common risks are cigarette smoking, high blood pressure, diabetes, sedentary lifestyle, high cholesterol, and genetics – if your dad developed heart disease when he was younger than 50 or your mother had heart disease. The strongest risk is for people who are closest in their lineage.
What is the current state of women’s hearth health in the U.S.? Do some areas show a higher prevalence of women’s heart disease than others?
A higher prevalence is related to the social, economic and educational status of people. Someone’s background plays into risk [factors], sometimes because of a lack of access to care. It’s a concern for many women. Currently those at highest risk may not have easy access to care.
In our country, one in three women will die of heart disease. The south (e.g. Kentucky, Louisiana, Mississippi) and New York have high rates of heart disease. It shows us that we need to focus on risk factors and counseling people to exercise and treat with medicine. We have to find ways to engage communities, advocacy groups and doctors to help women identify heart disease and heart attack. (Find a map of death rates in women 35+.)
With February being American Heart Month, let’s start with the basics. What is heart disease?
Heart disease is a condition that could affect the arteries that supply the heart muscle with blood or the heart valves. The most common form of heart disease in the U.S. is coronary heart disease.
A combination of risk factors could be involved. Common risks are cigarette smoking, high blood pressure, diabetes, sedentary lifestyle, high cholesterol, and genetics – if your dad developed heart disease when he was younger than 50 or your mother had heart disease. The strongest risk is for people who are closest in their lineage.
What is the current state of women’s hearth health in the U.S.? Do some areas show a higher prevalence of women’s heart disease than others?
A higher prevalence is related to the social, economic and educational status of people. Someone’s background plays into risk [factors], sometimes because of a lack of access to care. It’s a concern for many women. Currently those at highest risk may not have easy access to care.
In our country, one in three women will die of heart disease. The south (e.g. Kentucky, Louisiana, Mississippi) and New York have high rates of heart disease. It shows us that we need to focus on risk factors and counseling people to exercise and treat with medicine. We have to find ways to engage communities, advocacy groups and doctors to help women identify heart disease and heart attack. (Find a map of death rates in women 35+.)
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Cases Worldwide: There are approximately 275 million women around the world with CVD [cardiovascular disease], with global age-standardised prevalence estimated at 6,402 cases per 100,000. (Lancet Commission study discussed at World Economic Forum).
What about the risks for women? There’s been more risk for women in the last five or six years. We need further evaluations of risk status. Doctor and gynecologic visits don’t necessarily address those issues. We find that women who had preeclampsia, high blood pressure during pregnancy, and pre-term birth tend to have a higher risk of heart disease in midlife. We’re trying to identify the exact mechanism. These women should schedule an appointment with their primary care doctor to find out more about their family history. Autoimmune diseases like lupus, rheumatoid arthritis and psoriatic arthritis are also risk factors. If you have an autoimmune disease, share that information with your doctor who can screen for other risk factors and follow through on them. Obesity is another risk. Women are more likely to develop belly fat around their middle [putting them at a greater risk for heart disease]. It’s not just your weight or body mass index, but how the weight is distributed. As women get older, they tend to develop belly fat. They can try to minimize belly fat with a combination of diet – cutting out simple carbs – and doing aerobic exercise. Cholesterol levels are also factors. A high LDL is a strong risk factor, and women with low HDL cholesterol are at a higher risk than men with lower levels. A lack of sleep – less than seven hours a night – and stress are concerns. Chronic stress can raise blood pressure and cortisol levels. Women are often time-pressed, juggling their job, family and caring for parents. It can be hard to find time to do the healthy things to prevent heart disease, but there are tools to help. [There are a variety of] apps available that can help people relax and sleep.
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A woman’s risk for cardiovascular disease rises as she ages. Some changes in the body are relevant to cardiovascular risk. Risk factors include:
Talk to your health care team about your risk factors and how to prevent cardiovascular disease before, during and after menopause. |
Are select groups of women more vulnerable to heart disease than others?
African American women have a higher rate of heart disease. There’s less awareness of the risks, like high blood pressure and diabetes. Following DASH, a dietary approach to stop hypertension by eating a Mediterranean diet, exercising, and taking prescribed medications can help.
South Asians also seem to have a higher risk of heart disease because the population tends to have low HDL cholesterol, high triglyceride levels, elevated blood sugar, and genetic and lifestyle factors.
We’ve discussed many issues that can increase a women’s risk for heart attack, some of them genetic and age-related. How can women combat those?
Women can’t erase some factors, but they can keep them in control. [Healthy lifestyle choices] really do make an impact and can help mitigate risk factors. It might not eliminate them, but people are much better off. It can provide an 80 percent risk reduction. Sometimes we recommend medications for cholesterol, blood pressure or diabetes. Several years ago, a study of people under the age of 65 followed through with those who lived the healthiest lifestyle and found that they were not admitted to the hospital. So, don’t give up.
That’s good news! What are symptoms we should be aware of?
Symptoms are chest tightness or pressure in the arm or jaw. The tightness could be anywhere in the chest. Severe exhaustion can be a symptom. Symptoms that go away when stopping stair climbing. If you have these, go to your doctor for a check-up.
If a symptom comes on all of a sudden, call 911. It’s important to get to a hospital right away. They can do an electrocardiogram, blood tests [to assess your heart], and procedures [if needed], such as a coronary angiogram to open clogged arteries and prevent heart damage that could lead to heart attack and heart failure.
At what point in a woman’s life should she pay close attention to the health of her heart?
Even young women have risk factors. It’s good to get a baseline of your health to know where you stand and follow up every few years. If you have a family history of heart disease, evaluate risk factors early on to see if treatment is needed. If you’re 50 or 60 and have never had an evaluation done, that’s the time to do it. Most can be done at a routine primary care visit.
Are there misconceptions about women’s heart disease? Can you give examples?
For a long time, the medical community [didn't focus on] women's heart disease. It was more common in men. Men may get it in their 50s, but women more commonly get heart disease 10 years after menopause. Every year 35,000 women under the age of 55 have a heart attack.* It’s important for women to know the risks and, [if needed], get checked at the hospital quickly for diagnosis and treatment.
*See Johns Hopkins' article Heart Attacks Striking Younger Women.
Heart disease is the number one killer of women in the U.S. But it’s a worldwide problem.
Recognition and awareness of the risk factors and impact on women has improved over the years, but there are still sections of the population that need to become more informed.
About four years ago, there were increasing rates of heart disease in women. Then the rates went down, and now they’re back up. A survey published in February 2020 showed that women’s awareness of risks for heart disease was decreasing. It seems that our message about prevention gets to women 50 and older, but younger women are less aware. African American and Latino women are less aware.
We have to make sure we reach the women at greatest risk – including those who are less aware. This can be [accomplished by] community-led efforts as well as a national effort. We need to focus on advocacy and working with communities and community-based physicians who deliver the care. The effort has been championed by women cardiologists, but we need to engage male colleagues as well.
The American Heart Association’s (AHA) “Go Red For Women” program was started in 2004 [to increase women’s heart health awareness]. It’s a good time to reassess where we’ve been. The AHA helps women improve on lots of levels and the Go Red campaign is the largest funded heart research program in our country.
Thank you for filling in the gaps about women’s heart disease. You’d mentioned that reducing stress can help mitigate the risk for developing heart disease. How do you destress? Where do you find sanctuary?
I find sanctuary in my exercise regimen. Since starting with Atria New York, I walk to work and back. The office is on 57th Street, and I live on 70th Street. I walk and have a lot of time to think and enjoy that part of the day. I also enjoy exercising on my Peloton [exercise bike]. It’s important during the pandemic to be able to do this.
African American women have a higher rate of heart disease. There’s less awareness of the risks, like high blood pressure and diabetes. Following DASH, a dietary approach to stop hypertension by eating a Mediterranean diet, exercising, and taking prescribed medications can help.
South Asians also seem to have a higher risk of heart disease because the population tends to have low HDL cholesterol, high triglyceride levels, elevated blood sugar, and genetic and lifestyle factors.
We’ve discussed many issues that can increase a women’s risk for heart attack, some of them genetic and age-related. How can women combat those?
Women can’t erase some factors, but they can keep them in control. [Healthy lifestyle choices] really do make an impact and can help mitigate risk factors. It might not eliminate them, but people are much better off. It can provide an 80 percent risk reduction. Sometimes we recommend medications for cholesterol, blood pressure or diabetes. Several years ago, a study of people under the age of 65 followed through with those who lived the healthiest lifestyle and found that they were not admitted to the hospital. So, don’t give up.
That’s good news! What are symptoms we should be aware of?
Symptoms are chest tightness or pressure in the arm or jaw. The tightness could be anywhere in the chest. Severe exhaustion can be a symptom. Symptoms that go away when stopping stair climbing. If you have these, go to your doctor for a check-up.
If a symptom comes on all of a sudden, call 911. It’s important to get to a hospital right away. They can do an electrocardiogram, blood tests [to assess your heart], and procedures [if needed], such as a coronary angiogram to open clogged arteries and prevent heart damage that could lead to heart attack and heart failure.
At what point in a woman’s life should she pay close attention to the health of her heart?
Even young women have risk factors. It’s good to get a baseline of your health to know where you stand and follow up every few years. If you have a family history of heart disease, evaluate risk factors early on to see if treatment is needed. If you’re 50 or 60 and have never had an evaluation done, that’s the time to do it. Most can be done at a routine primary care visit.
Are there misconceptions about women’s heart disease? Can you give examples?
For a long time, the medical community [didn't focus on] women's heart disease. It was more common in men. Men may get it in their 50s, but women more commonly get heart disease 10 years after menopause. Every year 35,000 women under the age of 55 have a heart attack.* It’s important for women to know the risks and, [if needed], get checked at the hospital quickly for diagnosis and treatment.
*See Johns Hopkins' article Heart Attacks Striking Younger Women.
Heart disease is the number one killer of women in the U.S. But it’s a worldwide problem.
Recognition and awareness of the risk factors and impact on women has improved over the years, but there are still sections of the population that need to become more informed.
About four years ago, there were increasing rates of heart disease in women. Then the rates went down, and now they’re back up. A survey published in February 2020 showed that women’s awareness of risks for heart disease was decreasing. It seems that our message about prevention gets to women 50 and older, but younger women are less aware. African American and Latino women are less aware.
We have to make sure we reach the women at greatest risk – including those who are less aware. This can be [accomplished by] community-led efforts as well as a national effort. We need to focus on advocacy and working with communities and community-based physicians who deliver the care. The effort has been championed by women cardiologists, but we need to engage male colleagues as well.
The American Heart Association’s (AHA) “Go Red For Women” program was started in 2004 [to increase women’s heart health awareness]. It’s a good time to reassess where we’ve been. The AHA helps women improve on lots of levels and the Go Red campaign is the largest funded heart research program in our country.
Thank you for filling in the gaps about women’s heart disease. You’d mentioned that reducing stress can help mitigate the risk for developing heart disease. How do you destress? Where do you find sanctuary?
I find sanctuary in my exercise regimen. Since starting with Atria New York, I walk to work and back. The office is on 57th Street, and I live on 70th Street. I walk and have a lot of time to think and enjoy that part of the day. I also enjoy exercising on my Peloton [exercise bike]. It’s important during the pandemic to be able to do this.
ADDITIONAL RESOURCES
Caring for your heart through a healthy diet and regular physical activity can help prevent heart disease. Real changes to your lifestyle can reduce the risk for heart disease by as much as 80 percent.
Go Red for Women - PREVENTION
Go Red for Women (FACTS)
92nd Street Cardio Rehab Program
Heart Attack Symptoms in Women
Lower Your Risk for the Number 1 Killer of Women (CDC)
Caring for your heart through a healthy diet and regular physical activity can help prevent heart disease. Real changes to your lifestyle can reduce the risk for heart disease by as much as 80 percent.
Go Red for Women - PREVENTION
Go Red for Women (FACTS)
92nd Street Cardio Rehab Program
Heart Attack Symptoms in Women
Lower Your Risk for the Number 1 Killer of Women (CDC)
