Your Health

“Women need to make sure they take care of themselves.”

Dr. Beth Abramson’s research throws light on new risk factors of heart disease for younger – and older – women.

Dr. Beth Abramson is as much a passionate advocate for women as she is a top-flight cardiologist. She’s the Paul Albrechtsen Professor in Cardiac Prevention and Women’s Health. In the Division of Cardiology at St. Michael’s Hospital, where her research is razor focused on identifying risk factors for heart disease in women. She’s also on the frontlines of policy, writing national guidelines on menopause and cardiovascular disease in collaboration with the Society of Obstetricians and Gynecologists of Canada.

In general, are women aware of the heart risks they face?

We’re still seeing a knowledge gap in the general public and among health-care providers. We want to close that gap because the face of heart disease has changed. I’m still having to say this: Heart disease is not only the disease of older, grey-haired men. Women are at risk as well. St. Michael’s Hospital has always been dedicated to taking care of marginalized, at-risk patients – and in some ways, women are marginalized in our society. I will continue to help to address this problem with the team at St. Michael’s Hospital.

Certain women have a higher risk of cardiovascular disease earlier in life. Who is at risk?

Women who have had diabetes or high blood pressure in pregnancy are at higher risk of cardiovascular risk in the long run – it could be 10-20 years down the road. Pregnancy may be a stress test for future problems. It’s a warning sign. We can reduce our risk of future problems through healthy eating, maintaining a healthy body weight and regular physical activity, as well as checking cholesterol, sugar and blood pressure regularly with your family doctor.

The most important thing you can do is to get back to a pre-pregnancy weight. This may help reduce the risk of future high blood pressure, diabetes and heart disease. Certain women may require medication.

What is the role of estrogen in women’s cardiovascular risk?

The role of estrogen is complex. There is no doubt that as estrogen levels fall in mid-life, and estrogen to testosterone ratios change, a woman’s risk for heart disease starts to increase. Although we think estrogen can relax blood vessels, a lack of estrogen can have multiple effects on one’s risk for future coronary heart disease. That does not mean that supplementing with estrogen is the right thing to do. Canadian guidelines recommend that we do not replace women’s hormones post-menopausally unless they are having severe symptoms of menopause. We take menopause as an opportunity for heart-healthy behaviour. Hormones are not the answer.

What are warning signs women should watch for?

I think if women are having chest discomfort that comes on with activity and goes away with rest, that is concerning. If there is a serious discomfort out of the blue – they’re short of breath, cold and clammy, the pain goes into the jaw, it wakes them from sleep – they need to get it checked out. Pain can go into the chest, up to the jaw, below the nose and almost down to the belly button.

Women are busy taking care of everyone else. They need to make sure they take care of themselves.