Decoding Cardiovascular Health with Dr. Anu Lala

Heart disease is the number one killer of women, but unlike many other major diseases, there’s no single screening test that can tell you if you’re at risk. So how do you know where you stand? Dr. Poynor is joined by cardiologist Dr. Anuradha (Anu) Lala-Trindade (Lala), the program director for the Advanced Heart Failure and Transplant Fellowship at Mount Sinai and a professor of cardiology, population health, and obstetrics and gynecology.

Together, they unpack the many factors that can shape a woman’s cardiovascular risk and break down why midlife is an especially important time to start paying attention to them.

Resources mentioned during this episode:

Dr. Anu Lala’s 14-part framework for an initial cardiology assessment:

1. Family history

2. Gynecologic history — pregnancy journey, fertility journey, and gynecologic surgeries, including fibroid surgeries

3. Laboratory results — genetic risk markers plus microalbuminuria (protein in the urine, as an early marker of cardiovascular-relevant kidney health)

4. History of high blood pressure — personal history, in-office reading, and family history

5. Cholesterol panel

6. Insulin resistance and inflammation biomarkers

7. History of autoimmune disease or inflammatory conditions

8. An EKG to check for any abnormalities

9. Weight and weight redistribution

10. Sleep

11. Movement (her preferred term over "exercise")

12. Diet — specifically processed food intake, alcohol, and food timing

13. Tobacco use and cessation

14. Mindfulness and well-being, or mind-body medicine

Here are the numbers Dr. Lala wants women to know.

1. Blood pressure

2. Cholesterol panel

3. Lp(a) — a genetic marker of atherosclerosis, checked at least once

4. Hemoglobin A1c — a marker of insulin resistance, metabolic risk, or diabetes

5. Microalbuminuria

For some women, she also recommends:

1. ApoB — not for everyone; informative specifically when LDL is elevated

2. Coronary artery calcium score — not for everyone; useful for those at intermediate-to-high risk, with high LDL, or with a relevant family history

About Dr. Lala: https://profiles.mountsinai.org/anuradha-lala-trindade#about

CDC overview of women and heart disease: https://www.cdc.gov/heart-disease/about/women-and-heart-disease.html

National Heart, Lung, and Blood Institute resources for women and heart disease: https://www.nhlbi.nih.gov/health/coronary-heart-disease/women#How-do-symptoms-differ-for-women?

A Harvard Health article on the heart attack gender gap: https://www.health.harvard.edu/blog/understanding-heart-attack-gender-gap-201604159495

Systolic Blood Pressure Intervention Trial (SPRINT) Study: https://www.nhlbi.nih.gov/science/systolic-blood-pressure-intervention-trial-sprint-study

Hypertensive disorders of pregnancy and peripartum cardiomyopathy: A nationwide cohort study: https://journals.plos.org/plosone/article?id=10.1371%2Fjournal.pone.0211857

Increased risk of cardiovascular disease in women with endometriosis: A systematic review and meta-analysis: https://www.sciencedirect.com/science/article/pii/S0301211525003574

The 2022 hormone therapy position statement of The North American Menopause Society: https://menopause.org/wp-content/uploads/professional/nams-2022-hormone-therapy-position-statement.pdf

If you're interested in using a risk calculator you can toggle to the left on the American Heart Association tool: https://professional.heart.org/en/guidelines-and-statements/prevent-calculator

Auditory stimuli and heart rate variability: the role of music in cardiovascular regulation: https://pmc.ncbi.nlm.nih.gov/articles/PMC13229774/

Adjuvant music therapy for patients with hypertension: a meta-analysis and systematic review: https://link.springer.com/article/10.1186/s12906-023-03929-6

Effects of music in exercise and sport: A meta-analytic review: https://pubmed.ncbi.nlm.nih.gov/31804098/

Association between spirituality/religiousness and quality of life among healthy adults: a systematic review: https://pmc.ncbi.nlm.nih.gov/articles/PMC8529786/

Spirituality in Serious Illness and Health: https://jamanetwork.com/journals/jama/article-abstract/2794049

Acupuncture in persons with an increased stress level—Results from a randomized-controlled pilot trial: https://pmc.ncbi.nlm.nih.gov/articles/PMC7377446/

Effects of sleep deprivation and 4‐7‐8 breathing control on heart rate variability, blood pressure, blood glucose, and endothelial function in healthy young adults: https://pmc.ncbi.nlm.nih.gov/articles/PMC9277512/

Effects of voluntary slow breathing on heart rate and heart rate variability: A systematic review and a meta-analysis: https://pubmed.ncbi.nlm.nih.gov/35623448/

Note: In this show, we use “women” as shorthand for people with XX chromosomes. We understand sex and gender are more complex, and acknowledge the experiences we describe reach beyond that word.

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