Roxana Mehran, MD

Heart disease is the leading cause of death for women in the United States. Unfortunately, awareness about this fact remains low, with many believing breast cancer is the leading cause of death for women. Underestimation of heart disease risk in women has been an issue not only among women themselves but also among the health care community. However, positive change has occurred, with numerous campaigns and initiatives to increase women’s heart health awareness over recent years.

In this Q&A, Roxana Mehran, MD, Director of Interventional Cardiovascular Research and Clinical Trials at the Icahn School of Medicine at Mount Sinai and a world leader in women’s cardiovascular health, explains why it is important for women to know more about heart disease and to take control over their health.

What are the risk factors for heart disease?

Important and well-known risk factors for heart disease in women and men include high blood pressure, high cholesterol, and diabetes. However, there is increasing evidence about risk factors that exclusively affect women. For example, certain conditions related to pregnancy have been associated with the development of heart disease later on in life. These include high blood pressure or elevated blood sugar during pregnancy and delivery of a smaller baby than usual for the number of weeks of pregnancy. Women are also more likely than men to be affected by risk factors that are still underrecognized, such as depression, abuse, and intimate partner violence. And lastly, women are overrepresented among those living in less wealthy areas with less access to healthy food, exercise, and education, resulting in increased risk for heart disease.

Are there other differences in heart disease between women and men?

Yes. The underlying mechanisms of certain aspects of heart disease differ between women and men. Unfortunately, most of our study data on heart disease are derived from male populations. Therefore, diagnosis and treatment of heart disease are mainly based on data from male patients. Luckily, the differences in heart disease between women and men have gained the attention of researchers and become the focus of an increasing number of research studies. Although scientific evidence on the optimal diagnosis and treatment of heart disease in women is increasing, we still have a lot to learn about why and how heart disease develops and presents differently in women and men.

What are the signs of heart disease in women?

When there is insufficient blood supply to the heart muscle due to a blocked artery or other reasons, the most common symptom will be chest pain. However, the limited blood flow to the heart muscle can also cause other symptoms, such as extreme fatigue, nausea, and pain in the jaw, neck, and shoulder. These can be signs of a heart attack and are more commonly observed in women compared to men.

Is heart disease preventable?

The good news is that healthy lifestyle changes can prevent 80 percent of premature heart attacks and strokes. A healthy diet, regular exercise, and not using tobacco products (including vaping) are key to lowering your heart disease risk. In addition, screening and treatment of risk factors such as the ones mentioned above are essential to keep your heart healthy. Therefore, at Mount Sinai, we provide women with a comprehensive assessment of their heart health and heart disease risk. We help with initiating the important steps to a healthy lifestyle and recognizing and addressing heart disease risk factors, including those unique to women.

What is your advice to women about heart disease?

It is never too early and never too late to think about heart disease and learn how to prevent what is preventable. We are here to help when you start taking control over your heart health.

When we think about how to improve our heart health, we usually focus on eating right and exercising regularly. But getting a good night’s sleep can make a real difference as well.

“If you’re trying to improve your heart health, think about diet, exercise, and sleep,” says Deepak L. Bhatt MD, MPH, MBA, Director of the renowned Mount Sinai Fuster Heart Hospital.

In this Q&A, Dr. Bhatt explains how insufficient sleep can cause a wide range of symptoms and what steps you can take to remedy that.

Why is sleep important for heart health?

Not getting enough sleep, or not having good quality sleep, can cause increases in blood pressure and blood sugar levels. Chronically insufficient sleep can predispose you to weight gain and obesity. That could be because if you’re up until midnight binge watching and snacking, you might put on some extra pounds. But there are also more fundamental biological pathways by which insufficient sleep can increase cardiovascular risk. One of those might be by inducing inflammation, which is now known to be part of the pathophysiology of heart attacks and strokes.

Deepak L. Bhatt MD, MPH, MBA

What constitutes a good night’s sleep?

Sleeping seven to nine hours is ideal. For adults, more than nine hours isn’t necessarily better; it’s not like with exercise, where more is generally better. However, sleeping less than seven hours is not a good thing. Many people get less than six hours of sleep a night and think that’s sufficient. But with only six hours, you’re probably not as fully functional as you would otherwise be. Over the long term, a pattern of insufficient sleep increases the risk of cardiovascular disease. There is even some emerging data that it might be associated with an increased risk of dementia.

What about interrupted sleep?

Continuous sleep is better. But a lot of people sleep three hours, then get up and walk around, and then go back to sleep. The key is to not start watching TV or check your iPhone or electronic device, because that stimulates the brain. The light makes the brain think it’s daylight and time to wake up. As you go from being a bad sleeper to being a good sleeper, you don’t want to just hop into bed at 8 pm when you’re wide awake. That’s not going to work. Instead, you want to establish good sleep hygiene over time. That means trying to go to bed at the same time and wake up at the same time every day. Ideally, that would extend into weekends as well. It’s difficult to set a good plan for the week if you’re up until 2 am on Saturday night and sleep until 9 am on Sunday. It will make it hard to wake up on time on Monday morning.

How can you help yourself fall asleep?

Avoid excess stimulation right before going to bed, like binge watching TV or late-night snacking, which are bad for your health in any number of ways. Don’t check an email from your boss at 11 pm or binge-watch Netflix at 1 am. Also, you don’t want to eat a heavy meal, then go right to bed. Some people find that relaxation, meditation, and listening to gentle music right before going to bed can help them fall asleep. Exercise can be useful, because you’ve exerted yourself and are tired. But if you exercise right before going to sleep, your adrenaline is surging, and that can backfire. There is also an element of common sense and trial and error to figure out what works best for you. For some people, a glass of warm milk before bed might help—but that’s not going to work if you have lactose intolerance.

What does insufficient sleep do to your body?

Not getting enough sleep can increase your blood pressure, weight, blood sugar, predisposition to diabetes, and inflammation. These can raise your risk of heart problems. Inflammation isn’t often thought of in the context of cardiovascular disease, but the latest evidence shows that inflammation in artery plaque can trigger blood clots—and that’s what leads to the majority of heart attacks.

Does sleep apnea affect the heart?

Sleep apnea is different than having trouble sleeping. If you are not sleeping well, or you wake up feeling really fatigued despite the fact that you’ve been in bed for seven to nine hours, it might be worth getting checked out. People with sleep apnea wake up multiple times a night and have a much higher risk of high blood pressure, elevated heart rate, and heart rhythm problems like atrial fibrillation. Treatment for sleep apnea can really improve your quality of life and reduce some cardiovascular risks.

Can you talk about recent sleep research?

There has been a fair amount of work done on sleep, though there needs to be a lot more research. We still don’t understand a lot of fundamental things about sleep. But we do know that sleep seems to be important for organizing memories. Chronic sleep deprivation can lead to an accumulation of certain types of proteins, like tau and beta-amyloid, which are associated with Alzheimer’s disease. To sum up: Always remember that sleep, in addition to diet and exercise, is crucial to the health of your heart and your overall health.

Icilma Fergus, MD

Heart disease is the No. 1 cause of death in the United States, and because of disparities in health care, African Americans, nonwhite Hispanics, and Native Americans are especially hard hit. The good news is that taking some simple steps can produce a significant improvement in your heart health, and an important part of that is managing your risk factors by finding the right health care provider who understands your needs.

In this Q&A, Icilma Fergus, MD, Associate Professor of Medicine at the Icahn School of Medicine at Mount Sinai, and Director of Cardiovascular Disparities for the Mount Sinai Health System, explains how to ensure patients receive equitable care and offers some suggestions on how you can find the heart health care you need and deserve.

“Many conditions can be delayed or averted or minimized by managing your risk factors and taking care of yourself,” she says. “We know that many people are very busy these days with work, caring for children and their parents. Sometimes they neglect to take care of themselves. You should listen to your body. If you don’t feel right, get yourself checked out. We can help.”

What can I do to reduce my risk of heart disease?

A lot depends on you. Managing your blood pressure, following the guidelines of the American Heart Association. Managing your blood sugar, your cholesterol, and diabetes. Eating right, taking your medications, and getting enough exercise. The American Heart Association recommends exercising or getting physical activity on most days of the week for about 30 minutes. It doesn’t necessarily mean an expensive gym membership. It could simply be walking, taking the stairs instead of taking the elevator, or parking further away from the door so that you’re walking more. If you’re sitting down on a lot of calls, as many have done during the pandemic, you could be moving your feet, moving your arms if you’re not on camera. Getting up and walking while on the call will also be helpful. Making sure you get enough sleep and drink enough water. Knowing your family history and coming prepared when you come in to see your health care provider.

How are disparities in care affecting heart health?

When you look at cardiovascular care and outcomes in the United States, you can see different outcomes for Blacks, Hispanics, and other immigrants, compared with the white population. For example, Blacks are nearly twice as likely to die from preventable heart disease and stroke. Because there are adequate resources for all and great treatment for all, this is termed a disparity. Also, there are risk factors such as hypertension, diabetes, obesity, and others that are uncontrolled in certain populations, such as the Black population. This means additional resources should be provided to ensure that everyone can access the care they need and deserve. We also must address certain issues such as health literacy, understanding of culture, and providing access, to ensure that our patients are receiving equitable care.

What can be done about this?

We need additional education geared toward certain populations. Health literacy means patients have a better understanding of their medical condition and what needs to be done. Sometimes medical jargon delivered to patients may make them not only scared but they may not even understand what to do. Providing education and screening will ensure that people are coming to get care. We know that premature heart disease is 80 percent preventable. That means getting to the patient before the condition becomes almost incurable or very complicated is important. Managing the risk factors earlier on can prevent the progression that invariably may end up in the patient’s death or a significant compromise in their heart health.

What is Mount Sinai doing?

Mount Sinai is doing many things to educate patients and their families in our communities. We provide patient literature geared towards the appropriate age, appropriate demographics, and appropriate language, such as translating into Spanish and French, as well as having it at a level that patients can understand. We have a number of programs. Mount Sinai Heart in particular has a Diversity, Equity and Inclusion program that ensures we have a diverse staff and communities are aware of what’s going on. Valentin Fuster, MD, PhD, the President of Mount Sinai Heart, has a program that focuses on young children who are impressionable and could be coached and receive education about preventative measures—things like eating healthy, exercising, drinking water instead of sugary drinks. If they get this information early, then they’ll continue to do that later on in life. This program also focuses on getting the information to parents, grandparents, or other family members.

Any other examples?

There are a number of other programs, such as the one that I started in 2012, the Harlem Healthy Hearts. We conduct monthly workshops within the community. We discuss managing your cardiovascular risk factors and understanding how to talk to your health care provider. For example, the importance of writing things down, having a family member or friend with you so that they can help you to remember things or ask a question you might be afraid to ask. We talk about medication adherence. Some patients don’t understand their medications and may be afraid of them. For that reason, they’re not taking them, and they may not say anything to the health care provider. We discuss how to ask questions about your medications and how to speak to your health care provider about alternative solutions. We also talk to supermarkets in underserved communities to ensure that healthy foods are up front and available, such as fruit, vegetables, and water rather than sugary drinks and processed foods.

How does this help patients and consumers?

Patients are consumers of health. When it comes to any other item you are consuming or buying, people ask questions to ensure that they are satisfied, that they are receiving the care that they should, and the same goes for your health. You should be a healthy and happy consumer or patient when it comes to your health. Therefore, you should have a good rapport with your health care provider, whether it’s a nurse practitioner or doctor or anyone within the health care field so that you get your questions answered and feel comfortable. Mount Sinai provides a vast array of health care providers who are fluent in different languages, who are familiar with various cultures. If you go to the website, you can find a doctor or a health care provider who will ensure that you are a healthy and happy consumer.