Speaking of Women's Health
The Speaking of Women's Health Podcast is excited to bring you credible women's health information from host and Executive Director, Dr. Holly L. Thacker. Dr. Thacker will interview guest clinicians discussing relevant women's health topics and the latest news and tips.
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Speaking of Women's Health
Women's Heart Health: Combat Hypertension and Stroke
In this episode, Holly Thacker, MD explores the connection between hypertension and women's heart health, emphasizing the need for awareness and proactive management. She discusses risk factors unique to women and practical lifestyle modifications to reduce hypertension and prevent strokes.
• Discusses the historical context of heart health awareness
• Explains the importance of monitoring blood pressure regularly
• Highlights lifestyle changes to combat hypertension
• Addresses unique cardiovascular risks faced by women
• Provides practical tips for better heart health
• Stresses the urgency in recognizing stroke symptoms
• Encourages collaboration among healthcare providers for comprehensive care
If you've enjoyed this episode and you want to help support us at Speaking of Women's Health, please share it with others. You can donate on our nonprofit speakingofwomenshealth.com site and you can leave a five-star review.
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Welcome to the Speaking of Women's Health podcast and happy new year. I'm your host, dr Holly Thacker, the Executive Director of National Speaking of Women's Health, and I am back in the Sunflower House for a brand new episode of our Speaking of Women's Health podcast, and this is season three. February 2025 is American Heart Month, a time when the nation spotlights heart disease Heart disease, the number one killer of Americans, men and women. So President Lyndon B Johnson was among one of the millions of people in the United States who suffered from heart attacks In 1964, quite a long time ago, over 60 years ago issued the first Surgeon General Report on Smoking and Health, and this was published on January 11th that's my son's birthday, but it was 1964. This landmark publication was released by then Surgeon General Luther Terry, md, and this was the first time the federal government reported a link to smoking and negative health impacts, including lung cancer and heart disease, including the dangers of even secondhand smoke. Now, sadly, take, I think, quite a while for physicians to note this, and years ago there were doctors smoking in the operating room when they were operating on people's lung cancer. Just like during the time of our first president, george Washington, they were leeching and taking out blood as a treatment, which of course is not a good treatment and is named after him, the cryo building. He was drummed out of medical societies because he suggested just a lumpectomy instead of radical mastectomy for breast cancer. And now that is standard of care. And Semmelweis, an Austrian, made the notation that if people washed their hands before going between women to deliver babies, that there wasn't as much peripheral fever. And they thought this was a heretic. And he died in an insane asylum. It was terrible. So there is this history in medicine where sometimes it takes what I think is probably a little bit too long for the health community, public health physicians in general, to come clean and note different associations. So, with that said, it wasn't that long ago 1964, but that's when we got some attention to all of this.
Speaker 1:And I do have a Smoking Cessation podcast with a guest podcaster coming up soon. And for any of you, if you're smokers, if you have loved ones who are smokers, if you just want to find out really what's the latest and greatest in smoking cessation, please tune into that. And if you don't already subscribe to our podcast, hit the subscribe or follow button and you'll be notified when there's a new podcast, but in this episode what I want to focus on is high blood pressure, hypertension and stroke risk in women. Three of my four grandparents died from stroke and it's not uncommon to have a stroke in women, especially over age 65. And I've done other podcasts that you can listen to, talking about the heart and cholesterol and heart risk assessment, and I talk about how I have a lot of conversations with my patients where I'll say, no, your blood pressure is elevated, and they'll say, no, it's always good. And I said, well, the last several times I pull up the record and they say, but it's always been good, and then my answer is yes, everybody's blood pressure is always great until it's not. And I pretty much tell all my patients if they're over 45, they should have a blood pressure cuff. And increasingly people are monitoring their sleep, other biometric aspects of their health, and so you know you might only see a doctor once or twice a year and it might be under circumstances where you're uncomfortable and in pain or nervous. So I think to get a lot of readings in different situations is really the right thing to do.
Speaker 1:So hypertension, also called high BP, high blood pressure is when the pressure in your blood vessels is just too hot and this over time can damage your arteries and it's like with every heartbeat, your brain and your heart and your kidneys are kind of taking a beating. If that pressure is really really high and there can be blockages or blood clots or damage to the blood vessels that give blood and oxygen to all your vital organs. And without oxygen and nutrients, the tissue can die. And without oxygen and nutrients, the tissue can die and that's why high blood pressure can lead to strokes and heart attacks. Brain attack is another term for stroke, kidney failure, which is on the rise, and heart failure.
Speaker 1:So, in terms of hypertension, the DASH diet we talk about helping to reduce heart risk and globally, one in every three adults ages 30 to 79 have hypertension. A 2022 study looked at following this DASH diet as a lifestyle intervention to reduce cardiovascular disease in people with mild hypertension, and this study found that this dietary change could prevent nearly 3,000 deaths in the United States alone. It's been estimated worldwide that over a billion adults have high blood pressure and two-thirds of them can live in low or middle-income countries, and hypertension can be a deadly condition, causing 7.5 million deaths annually, and previous research showed that there could be several lifestyle changes that will improve a person's blood pressure, including regular exercise and reducing alcohol intake and ingesting whole foods, healthy foods, heart, healthy fats, limiting processed foods. If you didn't listen to last season's podcast on food freedom and so many foods that are in the United States food supply that are banned in other countries, it's really worth listening to. I have so many friends who love to travel the world and many go to Italy and they say that they have their pasta and their bread and their wine and they don't gain weight. They actually lose weight, whereas here in the United States they eat less and have much more trouble with their weight. So I think there is a lot to additives things that make food taste addictive that can really influence your palate. So the DASH diet was presented at the American Heart Association Scientific Conference in 2022. They estimated that they could save events in both men and women in the United States significantly.
Speaker 1:Now, sometimes hypertension symptoms in women are mistaken for menopausal symptoms, for menopausal symptoms, and some of the unique issues in women is that pregnancy complications like preeclampsia, and also early menopause before the age of 45, and certainly premature menopause before the age of 40, definitely increases a woman's risk for future heart disease, a woman's risk for future heart disease. Now cardiologists, gynecologists, women's health specialists, endocrinologists have recommended how midlife women can help prevent later heart problems. And since 50% of women by age 55 will have hypertension, just like 50% of women by age 55 have osteoporosis. But sometimes when women have hot flashes and palpitations it's just blown off or oh, you're going through the change, you're in perimenopause, you're in menopause and it could be cardiac. So that does have to be dealt with.
Speaker 1:And high blood pressure is also called hypertension in men, but in women sometimes it's blown off as oh, it's stress, it's menopause. Many times blood pressure is treated less well in women compared to men, putting them at increased risk for atrial fibrillation, heart failure and stroke. Now if you or one of your loved ones had preeclampsia in pregnancy, which is elevated blood pressure, that is linked to a four-fold increase in heart failure and double the risk of stroke. So women who've had early natural menopause not surgical, but they've just gone into premature menopause before the age of 45, and those before the age of 40 for sure have a definite increased risk of cardiovascular disease at least a 3% raised risk for each early year that they lose the sex hormones and estrogen, which is very cardioprotective. Especially estrogen is cardioprotective for normal arteries. It's not a treatment for diseased arteries.
Speaker 1:Now, autoimmune inflammatory conditions such as rheumatoid arthritis and lupus are a lot more common in women compared to men and that also is a risk for cardiovascular disease. So there's several phases of life when we can identify subgroups of high-risk women. Certainly, any elevated blood pressure in pregnancy is a warning and we always take obstetrical histories of women, even when they're coming in for a midlife evaluation or a menopause consult or an osteoporosis consult. And if you have high blood pressure that happens when you enter early menopause and it's not treated, there's also an increased risk of dementia. And if you don't address blood pressure when you're in your 40s and 50s and you're busy and you're in that sandwich generation, you're definitely going to have problems by the time you're 70. And it generally becomes harder to treat Optimal management of menopausal health in women with PCOS polycystic ovarian condition.
Speaker 1:If you didn't hear my interview with Dr Ula Abed, our center endocrinologist, on PCOS, that's a great one to listen to. So women with PCOS have a much higher rate of type 2 diabetes. They have elevated risk of both hypertension and diabetes in pregnancy both hypertension and diabetes in pregnancy and gestational diabetes increases the risk of sleep apnea significantly. And if you didn't listen to season one podcast in June of 2023 with dentist Dr Margaret Frankel, she talked about dental treatments for obstructive sleep apnea syndrome. I usually regularly will look in the mouth of my patients to look at the back of their oropharynx, check their neck, ask if they're snoring, gagging, choking, have any unusual sleep behaviors, and we've got lots of podcasts on sleep. If you do not get sleep, your body cannot regenerate and refresh. So having a really good collaboration with cardiologists, gynecologists, women's health doctors, endocrinologists is really needed to give optimal patient care to our women in our practice and making earlier diagnoses.
Speaker 1:Knowing about complicated pregnancies and early menopause are important things to bring to your doctor's attention. So what are some of the lifestyle tips to lower your blood pressure? Well, number one limit sedentary time. There is an inverse dose response relationship between physical activity and the incidence of hypertension in adults who start out with normal blood pressure. In addition, physical activity reduces blood pressure amongst adults with normal blood pressure, pre-hypertension and hypertension, and I certainly monitor this. I take my blood pressure and there's times it's okay but not great, and if that correlates with me kind of slacking off some of my intense exercise regimen. It makes sense if I haven't been eating as well. So it's important to try to aim for at least 10,000 steps a day. For most people it's not possible with all people with orthopedic problems, but brisk walking is free and easy and effective and is good for you. You can plan for physical activity ahead of time in your schedule.
Speaker 1:Pick things that you enjoy doing. I like to dance, I like to hike, I like to run around and chase my grandchildren. Um, I like to run around and chase my grandchildren and? Um, I sometimes like to take the long ways around. I like to, if I have time, walk patients out all the way to the front desk. They really like that touch and gets them oriented, as when they see the scheduler and where the lab is. Um, you really have to do things you like to do. Um. Stationary bike in the winter. I love getting up early in the morning and being like the first one to have my recreational exercise center almost to myself. I get so spoiled that when someone's on one of my machines you know, like my elliptical, which is, you know, much less pressure on the knees and hips I kind of get irritated, thinking it's my machine. It reminds me of Beatrice's my machine. It reminds me of Beatrice, my granddaughter, mine, mine. That was like one of the first words she learned Chair yoga is popular with seniors. Swimming is an excellent exercise that really takes a lot of pressure off the joints.
Speaker 1:Number two stop smoking. There's a significant dose positive response between smoking and the onset of high blood pressure and cardiac disease, and it's not just with cigarette smoking, electronic cigarettes, vaping, cigars, hookah, which is water pipe smoking, not good. Number three limit alcohol because there is a dose response to alcohol consumption and the onset of hypertension. So really a woman should not ever have more than one drink a day and a man not more than two drinks a day. And really women should not drink more than a couple times a week max because it does increase cancer risk. A couple times a week max because it does increase cancer risk. And one drink is 12 ounces of beer, 5 ounces of wine or 1.5 ounces of 80 proof liquor.
Speaker 1:Choose herbal teas instead of caffeinated teas. Studies show that hibiscus tea decreases blood pressure, similar to blood pressure medicines, so I love hibiscus tea. Decreases blood pressure similar to blood pressure medicines, so I love hibiscus tea. And hibiscus tea also can help reduce uric acid and if you haven't looked at the list of foods high in purines which raise uric acid, that's important. If you're on a thiazide diuretic, you might want to get your uric acid levels checked. As a woman, the thiazide diuretics are great for bone. They help reduce kidney stones if you're leaking too much calcium out the urine, but they can reduce your uric acid excretion. So hibiscus and lemon and Greek yogurt and cherries are all very good at helping to get rid of some of that extra uric acid. Very good at helping to get rid of some of that extra uric acid. The other thing that's natural that can lower blood pressure significantly.
Speaker 1:My son's blood pressure was starting to creep up a little bit and he started adding some red beet powder to his drinks because when he did that in college as a college athlete, that was part of the pre-workout and that improves nitric oxide, which improves vasodilation and blood flow in the blood vessels, and he noticed that when he started to add a little bit of that back. Some people like to eat red beets. I love red beets, but if you eat a lot it makes your stool look like it's red and you're bleeding and I've had more than one patient come in concerned about GI bleeding who's just eaten a lot of red beets. Now captopril, which is a blood pressure medicine, may actually also improve a little bit of the lipids. Now, captopril is an ACE inhibitor and I'm not as much of a fan of ACE inhibitors in women as in men, because women have a higher rate of cough. So if you're put on a blood pressure medicine and you get a dry cough, they could put you on an ARB. That's similar to an ACE inhibitor.
Speaker 1:So a meta-analysis of five randomized controlled studies published in 2015 show that regular drinking of hibiscus tea can decrease your systolic blood pressure 7.5 and diastolic 3.5 millimeters, and so every little bit helps. 120 over 80, which a lot of people think is normal. Okay, that's now pre-hypertension and you only need a couple readings of 130 over 85 to get you the diagnosis of hypertension. So you can make your own hibiscus tea at home with a teaspoon of loose, dry hibiscus flowers or tea bags and sip it throughout the day.
Speaker 1:Now my latest new favorite tea is Yerba Mate Y-E-R-B-A the next word is M-A-T-E, y-e-r-b-a the next word is M-A-T-E and our endocrinologist, the expert in thyroid weight and PCOS and fertility in women, dr Ula Abed, who's been on our podcast a couple of times and she's also an artist. I think I showed you the beautiful engraved with pearl jewelry box that she made for me and sometimes we've posted pictures of the two of us together in clinic. She tipped me off to some research showing that Yerba Mate actually acts like a GLP-1 inhibitor, like the so-called ozempic class of medications, and she said my in-laws drink that tea all day long and they are so stick thin. Well, I'm not drinking it all day long, but I am drinking it and it does seem to have a nice mild appetite suppressant effect.
Speaker 1:And I think that intermittent fasting and taking out the carbs in your diet and just focusing on protein and heart-healthy fats also curb your appetite. As a midlife woman, that is the number one concern and I have women come to me because they think something's off with their hormones, because they're gaining weight but they're having regular periods. So that's not menopause, that's not hormone imbalance, that's a lifestyle diet, diet and energy expenditure problem. So watching out for highly processed foods that have a lot of extra sodium added is important. Home-cooked meals generally are healthier, having more fiber and vegetables and legumes and nuts and seeds not being as processed, not using these seed oils, but all the commercially prepared foods, like fast food and TV dinners, and most mayonnaise, most salad dressings and chips and sweets tend to be loaded in calories, low in nutritional value and tasty addictively tasty and they're always usually found in the middle part of the grocery store, and anything that has more than five items in it kind of meets the criteria for ultra-processed.
Speaker 1:Now, besides salt, sugar, oils and fats, you want to look for other food substances that aren't usually used in regular culinary preparations, such as hydrolyzed protein, modified starches. Stay away from hydrogenated oils, any of the inflammatory seed oils, especially cottonseed oil, which, when it's crystallized, is Crisco, which is terrible. Don't use that. Even canola oil maybe if it's cold pressed it's a little bit better, but soybean oil, even peanut oil, safflower, corn oil stay away from those. Olive oil, extra virgin olive oil and I have a lot on the website about olive oil and speakingofhimselfcom and avocado oil are good, and you can use coconut oil in moderation as well. That's another option. And fully saturated fats are like butter and beef tallow and ghee. So a study that was published a few years ago concluded that if you have four or more ultra-processed foods a day, it's independently associated with a 62% increased all-cause mortality, and we in America aren't as healthy as other countries and we need to change that because we want to be the leaders of the world. We want to be the leaders in health and wellness. We want to be the leaders in educational achievement and safety and scientific advances, and your health really impacts all of these areas.
Speaker 1:So you might ask why does high blood pressure increase stroke risk? Well, it makes your heart work harder, it damages your organs and arteries and, compared to people who have much better blood pressures and better heart rates, they're less likely to have stroke or some vascular catastrophe. And if you damage the arteries, they clog more easily. About 87% of strokes occur when the blood vessel feeding the brain gets blocked. It could be from a clot, like an ischemic clot. It can be from amyloid that has weakened the blood vessel wall, even in people who don't have high blood pressure, like my pap-pap, who lived well into his 80s and over time the vessels just don't hold up to the pressure and they rupture and that's a hemorrhagic stroke. And 13% of strokes are of this type.
Speaker 1:And high doses of atorvastatin Libitor is the brand name in older women is associated with a twofold increased risk of hemorrhagic stroke in the SPARQL trial and statins don't have good evidence of any primary prevention of heart disease in women. Now they do in men, but women are not men and we know that women who are given hormone therapy within 10 years of menopause do have a much lower risk of both diabetes and heart disease. And usually menopausal hormone therapy, even given orally, doesn't increase blood pressure. It may actually reduce blood pressure by improving the symptoms. Rarely it can.
Speaker 1:Transdermal does not. Transdermal natural estrogen does not increase stroke risk either, and you know I do so many consults every week with women who've been on transdermal estrogen and you know they just keep having birthdays, which is great. It's wonderful to have birthdays, right? I mean, next year our country is going to have its 250th birthday. Isn't that exciting? So longevity is great and that's something that we strive for and we've had discussions and podcasts on longevity strive for, and we've had discussions and podcasts on longevity.
Speaker 1:And so, because you want to extend your life, really one of the only things we do at Midlife for Women to do that is hormone therapy. And when women don't take hormone therapy which is fine, there's choices. One size does not fit all. We have non-hormonal options. Not everyone flashes. We have lots of great treatments for bone and lots of good treatments to keep the genitourinary system in good shape. So for women who can't or won't take hormones, I say you know, don't worry, we have a lot of other things for you.
Speaker 1:But a lot of times at that time of life the weight goes up, the cholesterol goes up, the blood pressure goes up, the cardiovascular risk goes up and it's kind of a fast, more downward spiral. So at midlife you've got to keep track of all these numbers and you need to have your results with you, hard copies and kind of take ownership for your health. So some of the risk factors that do increase your chance of developing hypertension, some you can treat, you know, some you can't. You cannot change your genetics okay, but you can work to become smoke-free. There are some great treatments for diabetes, type 2 diabetes. Many of my patients can get into remission. You can work on being having a closer to normal body weight and we've had many podcasts on weight and nutrition.
Speaker 1:Physical inactivity most of the time can be dealt with. A poor diet, eating processed foods, too much sodium, not enough potassium and magnesium and drinking too much alcohol sometimes become more common in people who are stressed Now, things that you can't change. We can't change our family history and we can't change our race and ethnicity or our age, our birth date. We can't change our gender and men do tend to get cardiovascular disease at an earlier age than women. Cardiovascular disease at an earlier age than women, chronic kidney disease and autoimmune disease also increase cardiovascular disease risk. Now, obstructive sleep apnea is a risk, definite risk for heart disease and a shorter lifespan, and after alcohol and drug abuse, is the second most common cause of accidents on the roadway. But we can treat that and it's not just nasal CPAP but weight loss, oral dental treatments. There's the Inspire device changing sleep positions. So a lot of people don't want to do a sleep study when I'm concerned about their risk for sleep apnea and I really encourage people to get evaluated if this is a concern.
Speaker 1:So stroke is cardiovascular disease and it's the number five killer and it can lead to a lot of disability. And a stroke occurs when a blood vessel that carries oxygen and nutrients to the brain is either blocked by clot or burst or ruptures. It's a brain attack. The good news is strokes can be prevented many times from treating the blood pressure, having a healthy diet, smoking cessation and treating atrial fibrillation, which is a risk for stroke. You can take a stroke risk assessment on strokeorg to see what your risk for stroke is. You know I was fascinated that neurologic conditions and damage doesn't necessarily have to be permanent, and I'm going to have an upcoming podcast with an orthopedic surgeon, acupuncturist, from China, and they do acupuncture after stroke to stimulate the peripheral nerves so that when the brain recovers there's better peripheral control, and he also advocates acupuncture for trigeminal neuralgia that there's a faster recovery and there are some complementary and alternative therapies that people may employ.
Speaker 1:Time is certainly of the essence and if you think that anyone is off, they can't speak clearly, they can't communicate what they're thinking, their face drops, their arm or leg is weak, it's time to call 911. So that sudden numbness or weakness, confusion, trouble speaking, trouble seeing in one or both eyes, trouble walking, loss of balance, incoordination or, like the worst headache of your life, could be a subarachnoid hemorrhage. So you must act fast to help stroke patients get the treatment they need, and we want to do it hopefully within an hour, certainly no more than three hours, because time is of the essence. If you don't act fast F is for face. Ask the person to smile. If the face droops, it's a problem Arm. Ask the person to raise both arms S speech. Ask the person to repeat a simple sentence T time. If you see any of these changes, dial 911.
Speaker 1:Note the time when these symptoms appear and give a clear and coherent history to the healthcare team. Do not drive to the hospital yourself. If you think you're having a stroke, or even you know a loved one, call the ambulance. What should you do to treat a mini stroke, so-called transient ischemic attack? If you have stroke symptoms and they go away, it might be a TIA or a mini stroke. It's a serious sign and you do need medical evaluation and treatment Now.
Speaker 1:Sometimes, especially in younger women, a TIA may be actually a migranous effect, but you need to still seek treatment. Unfortunately, because TIAs completely clear up, many people just ignore them, but paying attention to it can save your life. So what are the chances that someone will have a second stroke? Well, one in four survivors will have another stroke. So you've got to get that lifestyle together, and the risk of a second stroke is as high as almost 13% in the first week after a TIA, and the second stroke within the next five years can be as high as 30%. Now, fortunately, 80% of recurrent strokes can be prevented with diet modification, exercise, blood pressure control, appropriate cholesterol reduction with statins or other medicines if needed, as well as antiplatelet medicines.
Speaker 1:So again, be healthy, be strong and be in charge. Don't smoke or vape. Don't eat junk food. Plan for physical activity. Learn about the foods that are not good for you. You can still enjoy wonderfully delicious foods without all the extra chemicals and substances that are not good for you. Limit alcohol use and if you have a problem with alcohol, if you're drinking by yourself, if you're day drinking, if you're drinking in the morning, if you've had a DUI driving under the influence, if other people are concerned about your drinking, you need to seek help, and there's a lot of help out there. Know your blood pressure. Get one of those arm sphingomamometers. Bring it into your doctor's office so the nurse can check your blood pressure with your machine and their machine Work to reduce stress.
Speaker 1:A little bit of stress in someone's life can be motivating. Reduce stress. A little bit of stress in someone's life can be motivating, but if it leads you to overeat or not get exercise or do unhealthy habits, you need to seek treatment for it. Make sure you see your primary care physician once a year at least. Check your height and weight and blood pressure, get an exam, get some baseline medical work labs done and get adequate sleep. We've got some great podcasts on sleep. You need at least seven to nine hours of sleep for adults and more for children, teenagers and, of course, young children and babies.
Speaker 1:Now, heart disease symptoms can vary from one woman to another. Some women have palpitations, others just have fatigue. Some women might notice swollen legs and ankles and shortness of breath from early heart failure. So any of these conditions that you might have bring to the attention to your physician. If your blood pressure's up, you should have a baseline EKG heart tracing. You should know what your fasting lipids are. Lp little a is a marker and if it's high that can increase the risk of heart disease.
Speaker 1:Inflammation levels can be very important. I'm not as much worried about cholesterol If the HDL, high density cholesterol, is good and the triglycerides are low and there's no inflammation and no other risk, because some of it is genetic. But people with high triglycerides, metabolic syndrome, so-called syndrome X, which is central weight those are much more concerning and knowing what your omega-3 to 6 fat ratio is important. I've been doing that test lately. We're going to have an upcoming podcast going into that in more detail and it's very important to have those ratios at a good level. So thank you so much for listening to the Speaking of Women's Health podcast. You can subscribe for free on Apple Podcasts, spotify, tunein wherever you listen to your podcast. If you've enjoyed this episode and you want to help support us at Speaking of Women's Health, please share it with others. You can donate on our nonprofit speaking of women's healthcom site and you can leave a five-star review, and we're going to look forward to seeing you next time in the sunflower house. Be strong, be healthy and be in charge. Charge.
