News flash: Women are different from men. Obviously, our bodies are different. Our roles and responsibilities and behaviors are different. But did you know that the way we experience heart disease is also different?
Two UVA Health physicians are shining a light on the unique ways heart disease affects women. They’re also working to ensure we’re providing the personalized and comprehensive cardiovascular care women need at every stage of their lives. How? By creating a multidisciplinary Women’s Heart Program.
This new initiative is to improve education for women and also for healthcare providers, to expand our research and reduce social barriers to cardiovascular care. We have a vision to create a collaboration among the many healthcare disciplines that provide care for women across their lifespan, from adulthood to middle age to geriatric. —Patricia Rodriguez-Lozano, MD, cardiologist and director of the Women’s Heart Health Program
Just Launched: Women’s Heart Program
The Women’s Heart Program kicked off in August, and now includes three dedicated clinics.
Our cardiology team provides comprehensive care for women with heart disease risk factors, microvascular disease and coronary artery disease. A multidisciplinary team sees patients weekly on Tuesdays and Fridays at Fontaine.
“We not only have physicians. We have other specialists — a nutritionist, social workers, exercise physiologist, genetic counselor, clinical pharmacist. The goal is to give women multidisciplinary care to really improve their outcomes in terms of cardiovascular events,” says Rodriguez-Lozano.
The team also strives to make this multidisciplinary care as seamless and hassle-free as possible. “We try to take a holistic approach to each visit, but there are certain things that cannot be done in 30 minutes,” adds Rodriquez-Lozano. “So we are doing some after visits just to follow up in that initial encounter. A lot of these visits are done virtually.”
Spontaneous coronary artery dissection (SCAD) is a serious heart condition commonly associated with fibromuscular dysplasia, which causes weakening of the artery walls. “Ninety-five percent of SCAD cases are women,” says Rodriguez-Lozano. “We get referrals from as far as Japan.”
Rodriguez-Lozano, co-director of the clinic, teams up with vascular medicine to care for these patients on the second Tuesday of the month in the Primary Care Clinic.
The newest clinic to open, the OB Heart Clinic launched in January and provides specialized obstetric care for pregnant women with heart disease risk factors like high blood pressure and gestational diabetes. The clinic is held in tandem with the OBGYN and maternal fetal medicine teams on the second Monday of the month in the Battle Building, so patients can be seen by multiple specialists in one visit.
We know that more women are now getting pregnant later in life. They have more comorbidities like diabetes, high blood pressure, and coronary disease. We help maternal fetal medicine providers manage these patients. Our focus is on what we can do to safely get women through pregnancy and delivery, whether it’s a vaginal birth or a C-section. Together, we try to determine how we can appropriately manage these patients, looking at what risks they may potentially be exposed to or what complications they may have during pregnancy that we could potentially avoid. — Kelly Wingerter, MD, cardiologist and cardio-OB expert
Specialized Heart Care for Women: Why It Matters
To understand the push to create a heart program dedicated to women, we turn to the research. Rodriguez-Lozano has dedicated her career to studying the nuanced ways heart disease affects women. Her findings prompted her to take action and strive to make a difference.
“As a clinician-scientist, I have learned a lot of things that I didn’t know as a general cardiologist,” she says. Some of the key takeaways from her research:
- Women have a specific phenotype of ischemic heart disease.
- Women have less calcification and more nonobstructive coronary artery disease
- Women have a higher prevalence of microvascular disease.
- Women have different risk factors, different symptoms and higher mortality compared to men.
- Women are less likely to be offered optimal medical therapy and less likely to be offered revascularization.
- Women are traditionally underrepresented in cardiovascular clinical research.
“In clinical practice, I can see what all of the manuscripts were talking about. So many women tell me how doctors do not take them seriously. They don’t take the time to look at a patient’s history, whether she’s in menopause or has anxiety.”
Rodriguez-Lozano adds that this kind of awareness among care providers is critical because women have non-traditional risk factors for heart disease. “There are risk factors specifically for women, she says. These include:
- Polycystic ovary syndrome
- Autoimmune diseases (e.g., lupus, rheumatoid arthritis, psoriasis)
- Breast cancer and associated treatments
- Premature menopause
- Adverse pregnancy outcomes (e.g., preeclampsia, gestational diabetes mellitus, gestational hypertension, low weight for gestational weight)
- Psychological stress
“Not all cardiologists take these things into account,” adds Rodriguez-Lozano. “So I think that is the reason that this clinic is very important.”
Wingerter adds that having female cardiologists on the team is a bonus in terms of our ability to offer comprehensive, personalized care. “Women make up a very small percentage of cardiologists,” she says. “I think we see things a little bit differently sometimes as women, the world we live in, raising children and being involved in the household. So I feel like we can relate to women on a different level.
Getting the Word Out
As the Women’s Heart Program continues to take shape here at UVA Health, Rodriguez-Lozano says they’re currently ramping up efforts to reach out and educate women in our community, particularly women of color. Collaborating with our Division Director of Midlife Health Center JoAnne Pinkerton, MD, and cardiologist Max Luna, MD, who leads the UVA Latino Health Initiative, Rodriguez-Lozano aims to work on raising awareness. “We don’t want the community to come to us. We want to come to them. So we need to work on education.”
The most important lesson for all of us to keep in mind: 87% of heart disease is believed to be preventable.