Scott Webb: Women's bodies go through many changes over the years, and today we're discussing how hormonal changes shape cardiovascular health through the decades. With Kaitlyn lke, she's a nurse practitioner with a special interest in women's cardiology care.

Scott Webb (Host): This is the Franciscan Health Doc Pod. I'm Scott Webb.

Scott Webb: Caitlyn, it's nice to have you here today. We've been,, talking lately about women's hearts and cardiology and care and healthy hearts and all that important stuff, and today we're talking hormones And the heart, you know, from periods to menopause. So let's start there. Like, what role does estrogen and other reproductive hormones play in women's cardiovascular risk throughout their lifetime?

Caitlin Luebcke: natural estrogen, at normal levels, and that's important 'cause we'll talk about a couple conditions that cause abnormal levels. For the most part it appears to be very protective throughout the lifespan. We don't. I completely, fully understand why.\ But some of the things we've noticed is that at any given age, women tend to have about half the risk of cardiovascular disease as their male counterparts, particularly in those premenopausal years.

And women do tend to lag about 10 to 15 years behind men in terms of cardiovascular incidents and death. We will talk about that does catch up a little after menopause, but those. we know that estrogen, can mediate some of our, like cholesterol metabolism in the liver. So, it does assist in lowering our bad cholesterol, in raising our good cholesterol.

And then we also know that it has some anti-inflammatory properties. That prevent the development of atherosclerosis or fatty plaques within the arteries. That is ultimately what leads to heart attacks And then other cardiac conditions as a result of that heart attack. And then, unfortunately when women hit menopause, there is a huge drop, in estrogen levels That is quite sharp.

it is. Unfortunately, we have found associated with a really rapid cardiovascular aging, so women, unlike men, really age in this massive spurt. And our risk rises, not overnight, but over the course of that menopausal period,

Scott Webb: Right, makes me wonder like are there some specific reproductive system conditions that are associated with an increased cardiovascular disease risk?

Caitlin Luebcke: Yeah. There are, so looking through the lifespan,, one of the big ones that, affects a lot of women is, polycystic ovarian syndrome or PCOS. This one specifically, if you know what it is, it affects ovarian function And the, our ovaries are the main producers of estrogen in the body.

And in a kind of complicated pathophysiology way, it causes an overproduction of testosterone in the body. So PCO. Is, associated with obesity,, insulin resistance like diabetes, And then elevated levels of a hormone called luteinizing hormone, and all of those, the obesity, insulin resistance, and elevated luteinizing hormone levels are all independently associated with cardiovascular risk.

So. If you have one of those for any condition, you're at a higher risk. And in PCOS you may be hit with all three of those issues, significantly increasing your risk. And then endometriosis, a bit more rare than PCOS, but endometriosis is, specifically associated with ischemic heart disease, like heart attacks, And then cerebral vascular diseases like stroke.

Again, they don't really fully understand why, but it's. Possibly thought to be related to the chronic inflammatory nature of the disease. We know inflammation breeds blockages in our cardiovascular system. So That is the thought for why, And then a few different disorders during pregnancy can raise your risk. We now know that any hypertensive disorder pregnancy, increases your risk for cardiovascular disease by as much as 63%.

Women who have a hypertensive disorder during pregnancy are, more likely to have premature. Cardiovascular disease incidences, compared to women who don't. And we're talking like maybe 10 years earlier than a woman who doesn't experience that during their pregnancy. And those who develop gestational diabetes have twice the risk. Of, future cardiovascular disease and those who don't have, that diagnosis.

And then finally, I'm, early menopause, and we're talking like menopausal symptoms and menopause by the age of 40. So really premature menopause symptoms, is associated with a 40% increased risk of coronary heart disease.

Scott Webb: Hmm. and I've been, learning from the franciscanhealth.org experts lately, about the, connection between pregnancy and cardiovascular risk. And, I'm sure listeners have been learning along with me as well. I, I guess, You know, the, just sort of popped into my head here, but like, what's the protective role of estrogen?

Like, what happens after menopause? Since we're on that subject.

Caitlin Luebcke: Yeah. So after menopause you do, like we said, you have that huge drop in estrogen. And that happens. Like I said, some, it starts happening during the, perimenopausal period And then completes during the menopausal period, And so women really lose like. They have sharp rises in their bad cholesterol.

They have drops in their good cholesterol. They lose a lot of that anti-inflammatory action, that estrogen provides prior, to menopause. And so that rapid aging women really just catch up to men. And, it places them, if you already had some risk for cardiovascular disease And then you've lost that protective mechanism.

It accelerates and really,, raises your risk, um,

Scott Webb: Yeah, it just, it just speeds everything up. You know, my mom, my wife, even my daughter, tell me it's not easy being a woman. And I have come to really embrace that and believe them, wholeheartedly. Are there some things that women can do, you know, ways in which patient's and providers can really like support heart health throughout this journey of being a woman.

Caitlin Luebcke: Yeah, there are. So just from a provider standpoint, providers, need to ask their patient's about some of these very sex specific risk factors, including the conditions I've mentioned. We traditionally don't do that. We often, don't ask women about their period status and whether they're still having periods unless there's a concern you could be pregnant when you go in and get a x-ray.

Of course we ask you that. But, You know, in your normal appointments, we don't necessarily ask you, are you still having periods to then think about your cardiovascular risk. Once we know that a woman has entered menopause, if a patient, has a history of the conditions, I've mentioned, or if there's a strong family history for, cardiovascular disease.

Even if a woman seems healthy, seems like she's doing well from a health standpoint. We need to be really diligent as providers in screening and treating our patient's early, to try to, catch these things and treat them, for patient's. Patient's should kind of do what we ask all patient's to do.

Do what you can to modify those risk factors that are within your control. Make sure you know your family and your personal medical history so you can advocate for yourself. Avoid or quit smoking or, or vaping. Get those regular health screenings. Make sure you get in and see a doctor, or a healthcare provider every year.

Do what you can to maintain a healthy weight. You know, we in the cardiovascular world love the Mediterranean diet,

Scott Webb: Mm. Yeah.

Caitlin Luebcke: We love encouraging people to get out there and participate in activity every single day, or at least 150 minutes of moderate activity a week. Avoid drinking a lot of alcohol, avoid illicit drug use. The big one, people are using now as THC in all forms. And we know that THC has a negative effect on the cardiovascular system.

And it doesn't matter if you are smoking, or if you are using edible formulations of that drug. But a lot of people don't realize that. And then. Try to, you know, manage your stress. Have frequent social interactions, get mental health support when you need it. Get seven to nine hours of sleep per night.

Chronic stress leaves to chronic inflammation. And then. The biggest thing you can do for yourself is really advocate for the fact that if you are having any concerning symptoms, even if they don't seem like what we call typical for cardiovascular disease, keep pushing, keep advocating for yourself to get tested or to get screenings.

Women often present differently than men. We don't get that big crushing chest pain. We tend to talk about like tightness or squeezing. A dull ache. We may have pain in our arms, our stomachs, our jaws neck, our back. We may just present with like shortness of breath or extreme fatigue, or like stomach upset.

Scott Webb: Yeah.

Caitlin Luebcke: so if you're having some of those symptoms and it doesn't really make a lot of sense, especially when you're doing activity. Just keep advocating for yourself and find providers that are willing to advocate for you. Recognizing that women, we're not small men. Like all the studies were done years and years ago.

We are, we are a very, we are a special majestic, of human that, that do present in these different ways.

Scott Webb: I love that. Yeah. We're not small, just smaller versions of men and I love that word. That's gonna stand out, majestic. Absolutely. That's been my experience with the women in my life. I appreciate your time and your expertise today, doctor. It's like a, a fine line between trying to educate folks and encourage them without scaring them.

Right. And, and you've given us a given listeners, women a pretty clear roadmap of how to take care of themselves, how to advocate for themselves. Things to avoid, things to eat, like Mediterranean diet and all that good stuff. So thank you so much.

Caitlin Luebcke: Yeah, absolutely. Thanks for having me.

Scott Webb: And to learn more, visit franciscanhealth.org dot org slash her heart.

Host: And if you found this podcast helpful, please share it on your social channels, and be sure to check out the full podcast library for additional topics of interest. This is the Franciscan Health Doc Pod. I'm Scott Webb. Stay well, and we'll talk again next time.