February is Heart Health Month, which makes sense, since the holiday of hearts is smack in the middle of it. However, despite all the information that’s out there, heart disease remains the #1 killer of men and women in the US.
The good news is, as much as 80 percent of your risk of heart disease may be within your control, says Dr. Sarah Speck, cardiologist, internist, and co-founder of POTENTRx, a medical fitness company. Exercise, stress-management, avoiding tobacco exposure: all of these can go a long way to protecting your heart health.
“Preventing illness is the best approach to managing health
and maintaining vitality at whatever stage of life.”
– Dr. Sarah Speck
Dr. Speck partners with her patients to identify health risks and put together a plan to help them be proactive in maximizing their health. She is an educator in illness prevention, disease-reversal and disease-management techniques, teaching patients and the public about lifestyle choices that protect their hearts and health. (Read the full transcription below.)
Dr. Speck’s focus on a heart-healthy lifestyle came about in part due to her own experience. When she started to experience the signs of menopause, she decided not to go on Hormone Replacement Therapy (HRT) to ease the symptoms, because the Women’s Health Initiative study seemed to indicate there was a higher risk of heart disease from HRT.
However, after a string of sleepless nights started to impact her ability to make the best medical decisions for her patients, she decided to go on the patch.
She did this for a decade. When the time came to go off HRT, Dr. Speck was astonished to see her LDL (bad) cholesterol numbers shoot through the roof. Despite a very healthy lifestyle, she had inherited her mother’s high cholesterol – and without the protective benefits of estrogen, her “inheritance” had kicked in full force.
This served to reinforce Dr. Speck’s decision to promote preventative, proactive care for her patients. Even those with genetic risks can see huge benefits to their health by making the right lifestyle choices.
In honor of Heart Health Month, team Gennev wants to issue a challenge to our community: pick one thing you’ll start doing today to increase your wellness and reduce your risk of heart disease.
At the end of February, find us on Facebook. Let us know what you’ve been doing and how it’s working for you. Get inspired, be inspirational – we can’t wait to hear what you come up with!
Need ideas? Be sure to listen to the podcast above, and you’ll get some great ones.
Next up on the Gennev podcast: we talk with author and motivational speaker Juju Hook. We reviewed her book on “rebranding” midlife – Hotflashes, Carpools, and Dirty Martinis – and enjoyed it so much we had to invite her to speak with us. Her fresh, feisty, irreverent look at the myths and stereotypes of midlife are really good for your heart too, if in a different way….
Have you dealt with heart disease, are you managing it now, are you worried about your risks due to genetic or lifestyle factors? We’d love for you to share with us. Please share in the comments below, on Gennev's Facebook page, or in Midlife & Menopause Solutions, our closed Facebook group.
Jill: February is Heart Health Month, and heart disease is the number one killer of women, I understand. Can you tell us a little bit more about that statistic, because I think that’s really shocking?
Dr. Speck: Well, it’s an unfortunate statistic, but in fact more women die of heart disease every year than men do. By the time we reach menopause, it’s an equal opportunity disease for men and women. But unfortunately, by the age of 45, one in nine women will have some form of heart disease as opposed to one in five men. By the age of 65, one in three women will have heart disease as opposed to one in two men. So, we have a real opportunity, if we can turn that around, in early menopause to impact our risk of developing heart disease later in life.
Jill: Why is that statistic; why are women more prone to this than men? It sounds like women catch up to be an equal opportunity player, sadly. I’d rather we were equal opportunity in lots of other ways, but why do women catch up, and why is it killing women as a number one killer?
Dr. Speck: Well, I think, I take your first question: the fact that we lose our natural estrogens, we lose elasticity in our skin, our hair changes, our eyes change, and our blood vessels change. And our blood vessels … the further away we get from our natural menopause, the more difficult, the more brittle, if you will, our blood vessels become. And more vulnerable to developing cholesterol-related plaque. So, that’s really why we catch up. Even taking synthetic estrogens don’t really restore the health of our blood vessels that we had pre-menopause.
Jill: That’s fascinating. So, taking synthetic estrogen, how about the bio-identical? Is there any form of estrogen in HRT or any hormone-related therapy that can reverse that damage to our blood vessels?
Dr. Speck: We’ve not been able to identify a hormone replacement therapy – either bio-identical or whether it’s patch or whether it’s oral therapy – that actually reverses or restores the flexibility. So, what we really want to do is to concentrate on those risk factors that we know can create more inflammation than just losing our natural estrogens. And those are high blood pressure, diabetes, having high cholesterol, being obese, being exposed to tobacco products. Those are the big five, if you will. For men and for women. But the women become much more vulnerable to those after their menopause.
As to your second question, I think the reason women may die more of heart disease is because we don’t recognize that we are necessarily at risk. So, if you have any of those big risk factors, you may have atherosclerosis. Even if you are just having nausea. Even if you are just having unusual shortness of breath. Even if you are just unusually tired. It may be that your arteries are clogged, and your heart isn’t able to function as well as it used to. And so, those individuals that have those risk factors, need to seek attention from their providers.
Jill: So, I was about to say the word “fascinating,” because I think it is. When I think about heart disease versus a heart attack, I know what a heart attack is, but heart disease as a disease, what is that? How do you know when you’ve now got it? And then obviously it’s something you manage, but is it like other diseases where there are symptoms, you do things to control it but it never really goes away?
Dr. Speck: Good question. There are several aspects of the heart obviously; there’s the muscle, the valves, there are the electrical fibers and there are the blood vessels that supply the heart. So, any of those can become diseased, and there are congenital reasons for people to have heart disease that they are born with. But what we wanted to talk about today, I think, are the diseases of the blood vessels that are more or less acquired. Those individuals that have diseases of blood vessels, again, that can be very insidious. It can happen over decades before it actually declares symptoms. So, that’s why we want to pay so much attention to those risk factors. Because really what causes heart disease that causes heart attacks or those that cause strokes also, is that there is inflammation on the inside lining of the blood vessel. And when there’s inflammation on the inside lining of the blood vessel, it looks very much like the skin of someone who is having a bad outbreak of psoriasis or eczema; it’s cracked, it’s weepy, it’s red, it’s angry. And as the blood goes flowing by, the particles of bad cholesterol, the lousy cholesterol, the LDL cholesterol, literally drop through the cracks and start to form plaque in that little layer between the lining of the blood vessel and the muscle layer. That can happen decades before anyone develops any symptoms.
Jill: The symptoms that you mentioned earlier: feeling tired, shortness of breath; they’re kind of everyday symptoms. What are the top symptoms you encourage women to look for? And at what point should they take those symptoms seriously enough to come in and get checked?
Dr. Speck: Well, women may have symptoms that are unique to them and somewhat different than men. The reason women have symptoms of heart disease is the same, and that is the heart muscle is not getting enough oxygen to be able to pump the blood forward effectively to the rest of the body. So, like any pump when it doesn’t pump well, it creates a back pressure. Often at times, the first place it creates that back pressure is in the lungs, so you start to feel short of breath. So, if on your routine walk you’re feeling like, “wow, I don’t know why I can’t get through this today.” And you have high blood pressure, or you have diabetes, or you’re overweight, or you have high cholesterol, or you have a family history of heart disease, that’s something to pay attention to. Certainly, if you walk up James Street from the ferry dock, and you’re gasping for breath and there’s an elephant sitting on your chest, whether you are a man or a woman, you need to seek medical attention. More or less immediately.
Jill: It seems pretty straightforward, but do you see in the majority of your patients, people waiting far too long? What are trends you see in terms of that level of awareness of people coming to you to say, “I think I need to get checked.” Or do they wait far too long? Where do people line up?
Dr. Speck: In the immediate throes of having a heart attack, women traditionally wait an hour longer than men do to call 911. Because they think, “Oh, it’s just indigestion,” or “I don’t want to upset anybody, I don’t really want to wake my husband, I don’t really want to call my daughter, particularly if I’m living alone.” So, they may not be getting the life-saving treatments that are offered, fast enough to delay the consequences of having a serious heart attack. But in the more preventive sense, I think again women need to be aware that heart disease is the biggest killer. And just like we get our annual mammograms, we need to know our numbers annually. What’s your blood pressure? We all know what our weight is, what’s your waist measurement? If your waist measurement is greater than 35 inches, you are at significantly increased risk of heart disease and diabetes, and you need to take care of that. If your blood pressure is greater than 130/80 now, according to the American Heart Association standards, that needs to be addressed. It doesn’t necessarily need medication, but it needs to be addressed and it needs to be followed. If your blood sugar is greater than 100, certainly if it’s greater than 110 or 125, you need to be addressing diabetes or pre-diabetes. If you’re smoking, or if you’re exposed to tobacco, stop.
Jill: Very simple.
Dr. Speck: But the other thing that is unique to women, that I think is now coming forward, is if you’ve had gestational diabetes, high blood sugar during pregnancy, if you’ve had high blood pressure during pregnancy – even if you don’t have a family history of heart disease –at age 50, you are more likely to develop high blood pressure or diabetes than someone who hasn’t had that during their pregnancy. So, you’re that one who is carrying that information, you’re the one that needs to be taking care of that for yourself.
The other thing I think is really important is that we all start to think about building our own health portfolio, just as carefully as we do building our own financial portfolio. We find a provider we can work with, we find somebody we can trust, to put investment in that health portfolio, we take care of what we need to, and we go forward building it together.
Jill: I think that’s a fascinating way to think about it because even you just listed out a number of numbers that you should know and be aware of, which as you called them out, I’m certainly not aware of mine, and it shows how important it is for a person, a woman or a man, to be tracking their own numbers.
Dr. Speck: That is very correct. The sooner you jump on it the more opportunity you have to not develop serious disease in the future. The other thing is we now have a variety of techniques that can detect early atherosclerosis or early plaque development. One is called Carotid IMT Scanning. Basically, it is just an ultrasound of the carotid artery that looks for early development of plaque. That’s paid for by your insurance after you’ve had a stroke, but that means you had a plaque build-up that’s 80, 85, 90 percent. I’m talking about detecting something that’s 10 or 15 percent. Well, at 10 or 15 percent you are not going to have any symptoms, but if you’ve got it, you can stop it by paying attention to the risk factors that may contribute to it over time. While it’s not covered by insurance, it’s usually an out-of-pocket expense somewhere between $100 and $200. Those kinds of things are readily available in the medical community. So, even if your insurance company doesn’t pay for it, doesn’t mean it’s not worthwhile.
Jill: Now here at Speck Health, you are big on prevention and you’re starting to go there in our conversation. Tell me about POTENTRx – it’s a program you have here – and how you’re really advocating for prevention with your patients.
Dr. Speck: So, we pronounce it POTENTRx, Your Prescription for Your Full Potential. It grew out of my experience as the Medical Director for Cardiac Rehabilitation Services at Swedish Medical Center for the last two decades. Again, after you’ve had a heart attack, after you’ve had bypass surgery, your insurance company will pay for you to learn about proper nutrition and how to exercise, to prevent your second event. That seemed a little backwards to me.
Jill: That you have to have an event first before…
Dr. Speck: Exactly. There are all kinds of guidelines from the American Heart Association, the American College of Cardiology, the American Medical Association, telling people that exercise and nutrition will prevent disease. But again, unfortunately, our medical system doesn’t pay for that under the insurance system. So, I partnered with Dr Dan Tripps, who’s a PhD exercise physiologist and psychologist, and he and I looked at what people were getting in cardiac rehab and said, “I think we could do this beforehand.” Help people who are concerned about disease, or have early risk factors, or have early disease, prevent them from developing more severe and more debilitating illness.
So, what we do is basically take the same science that does assessments for elite athletes, where these people know exactly what their body’s burning, exactly what their body’s using, exactly what nutrition so they can get that extra 100th second across the finish line. And we bring it to the world of mere mortals, because we are all on the same physical performance curve. And what we do is precisely measure an individual’s body, how they use carbohydrates, how they use fats, how their muscles work, and we design a nutrition and exercise prescription for them that will help them lower their blood sugar, lower their body weight, improve their heart’s performance, lower their cholesterol, whatever their goal is, and then we assist them through that.
Jill: Fantastic. So, you are like a quote-unquote personal trainer but much more in depth?
Dr. Speck: We like to talk of ourselves as a “medical fitness company.” Again, I think personal trainers are very valuable, but I think they don’t have that medical knowledge as to how a person’s body truly performs to reach their medical goals as opposed to getting down the slopes a little faster.
Jill: So then, approaching the medical goals, how do you price this? Just to go there? Because I’m assuming it’s not covered under insurance. But if I were to think of the mental model, a lot of us spend a lot of money on classes or a personal trainer, or a health club membership.
Dr. Speck: So, the assessment services range anywhere from $200 to $700. And then depending on what kind of ongoing coaching you would like, that can be done over the web, through email, or through fitness apps; again, it depends on what the client is trying to achieve.
Jill: I love the whole notion that you have taken the recipe that elite athletes use and brought it down to… I shouldn’t say “down,” brought it over to those that are aging and want to manage their personal health in this area.
Dr. Speck: We’re all on a continuum of performance. We’re fit, we’re athletic, but that fit and athletic can become injured, and that’s where we’re injured and impaired when trying to deal with health issues. And we are just trying to move you toward more healthy and more fit.
Jill: So, going back to the topic of women versus men, are the indicators or symptoms that you are having a heart attack the same across both, or do women have to watch for different things? Not just isolated to heart attack, but heart disease? Are the symptoms the same across both sexes?
Dr. Speck: Again, if you’re having chest pain while you’re walking up a hill, whether you are a man or a woman, that should indicate this could potentially be heart disease. If you are knowing you have high blood pressure, if you are knowing you have high blood sugar, if you know you have high cholesterol, you have a family history of heart disease, and you developed chest pain because your daughter came home and told you she was getting divorced – that’s a symptom woman have more often than men do. Those kinds of emotions produce very real biochemical change that can alter the way your heart’s blood vessels react to that change and can produce a symptom of chest pain. Undue shortness of breath: again, what I mean by “undue” is if suddenly you are pushing a cart around a grocery store and you’re [imitating gasping for breath], then that’s unusual. And that needs to be investigated. Heart disease is something that is progressive. So, if you have a symptom one week and the next week you have it three times, again, that’s something to listen to and not dismiss. Not “oh that was just indigestion” or “oh I was just kind of tired that day” or “my asthma was acting up.”
Jill: What would you recommend to women who are on the other side of menopause or even going through it? Obviously the impacts of lower estrogen in the body have taken effect, what would you recommend for just lifestyle and prevention? It’s probably quite apparent in terms of no smoking, diet, exercise etc., but I think it’s good to just remind and reiterate.
Dr. Speck: If we think of this as a disease of inflammation, and you think your blood vessels are on fire, inside; and what you want to do is calm the fire. So, what we know does that is regular exercise. If you move the muscles between your waist and your knees, which are big muscles, as all women know, for thirty minutes every day, that reduces inflammation in your blood vessels. It may not cause you to lose weight. It may not make you more fit, but it reduces inflammation inside your blood vessels. And it doesn’t even have to be all at once. Ten minutes three times a day is just as good as thirty minutes all at once. So, that’s where those Fitbit counters come in, those step counters are helpful to get people to move more. That’s number one.
Number two is eating a double cheeseburger is like putting a Brillo pad inside your blood vessels. So, what you want to do is eat more sensibly. Eat more responsibly. Eat more plant-based foods. The American Heart Association recommends 5/5: five servings of fruit everyday and five servings of vegetables. A serving is a half a cup. So if you have an apple, you’ve had two servings of fruit. If you have a salad, throw in some Craisins, throw in some nuts. It’s not too hard to get there if you pay attention. Those things are pretty easy and accessible to most of us.
I think the other thing is to try and embrace joy every day. Find a way to manage your stress so your stress doesn’t manage you. If you can do just those three things, you’ll create an environment where you can start to look at your own health portfolio more seriously and more proactively.
Jill: That’s fantastic. Are there any innovations in this space that are coming, that you are really excited about?
Dr. Speck: There are several, actually. First of all, I’m really excited about the fact that people in the medical community now realize that heart disease can be prevented. So, even though our insurance system is lacking in terms of actually paying for prevention, your provider is going to ask you what your blood pressure is. Your provider is going to be checking for these things and embracing your efforts to improve them over time and early. I think that level of awareness is just going to continue to grow.
I think that cardiac genomics, the whole genomic revolution, is not only going to revolutionize cancer but also the treatment for heart disease. We have now commercially identified four or five genes that you can just get a simple blood test to see whether or not you are carriers of those. It doesn’t mean you are going to get heart disease, but it means you’ve had them since you were born. And so they have been interacting with whatever else you have been doing to try and cause heart disease. So, once you identify whether or not you are a carrier of those, you can be even more proactive in reducing the things you know you can control. Because even with people who have a family history of heart disease, 80 percent of getting heart disease is still under our control. That’s phenomenal!
Jill: In a world where we don’t get to control a whole lot, that’s pretty fantastic. This has been a pleasure. Oh my gosh, you know, we hear so much about heart disease and yet we never really understand what it is and that it is so preventable. So, thank you.
Dr. Speck: Thank you very much for having me and good luck to you and to your health portfolio.
Jill: Thank you so much.