Podcast Summary

Welcome to Dr. Warrick's podcast channel. Warrick is a practicing cardiologist and author with a passion for improving care by helping patients understand their heart health through education. Warrick believes educated patients get the best health care. Discover and understand the latest approaches and technology in heart care and how this might apply to you or someone you love. Hi, my name is Dr. Warrick Bishop and I'd like to welcome you to my podcast station, my videocast station and of course the Healthy Heart Network. Today I'd like to talk a little bit about cardiac failure and specifically women in regard to cardiac failure. Historically, the trials done in cardiac failure have recruited men more often than women. In fact, at a ratio of about 7 to 3. So the vast majority of our historical research has been done predominantly on men. This is important because in the real world, it turns out that somewhere between 40 and 50% of all patients with cardiac failure are women. We know that cardiac failure affects 1 to 2% of the population. We know that that significantly increases as people reach 60 years of age or above. And we know that increases even more at 85 years of age or above. And at that time, women are being diagnosed with the condition at a much greater rate than men. What is interesting from our experience is that we see that men and women tend to have slightly different types of heart failure. There are two ways that we classify or two breakdown characteristics of heart failure. Those sorts of heart failure defined by the heart. not pumping properly, having a poor ejection fraction, a reduced ejection fraction. And then there's heart failure where the ejection fraction appears to be preserved. In the first, not enough is being pumped because the pumping mechanism of the heart is just not doing the job it should. In the second type, in preserved ejection fraction, what's occurring is that the heart is stiff and not relaxing properly. And the failure of that relaxation is what's giving rise to the failure of the heart as a pump. When we look at women in regard to cardiac failure, it turns out that women represent a greater proportion of preserved ejection fraction cardiac failure compared to men. Reasons that this has been suggested is that in general terms women have smaller hearts to start with. They seem to be more prone to poor relaxation of the heart. We call this diastolic dysfunction. So the heart not relaxing and allowing blood to pour in as normal during the relaxation phase. We also think that women may be more prone to the disease of the very, very small arteries that supply the heart muscle. We call this microvascular disease. When the risk factors for women to develop heart failure, particularly with preserved ejection fraction are looked at, there are two main outstanding risks that we need to be aware of. One is obesity and the other is hypertension. Both of these are amenable to some sort of intervention, and both of these together contribute to about two-thirds of heart failure within women. So it's a really significant area to be aware of and to deal with as appropriate. Heart failure with preserved ejection fraction can be difficult to deal with. Lowering blood pressure, if that is elevated, is certainly a very important starting point. Little bits of diuretic therapy may help with symptoms, but there's not been a lot of research to give us any insight into the sort of interventions that may improve mortality in the longer term for this group of patients. The last group of patients that's important when we think about sex differences are women who may have been exposed to chemotherapy. because of breast cancer. Some of the agents used in breast cancer we know can impact the heart and down the line lead to it just not working as well. So an important aspect for us to be aware of are women in their later years who may have received some of these agents for the treatment of their breast cancer and are now presenting with shortness of breath. In summary then, women make up somewhere between 40 and 50% of all cases of heart failure, which is a condition affecting 1 to 2% of the entire population that's becoming more and more prevalent after 60 years of age, and then much more prevalent as people age beyond that. The vast majority of women with heart failure, or sorry, a majority of women with heart failure have heart failure with preserved ejection fraction, more so than men. and this can be difficult to treat. It's really important to realise that blood pressure and obesity are significant risk factors that early in life should be targeted to mitigate that risk in later life. So please be aware of that blood pressure and please make every effort to keep that weight under control. It can be unavoidable. But past history of chemotherapy for breast cancer, specifically some of the agents that may impact the heart, is an important bit of history for women who may be developing shortness of breath in later life. Doctor needs to be aware of it because it may be intimately involved with the presentation and could be contributory to heart failure with preserved ejection fraction. So I've covered some stuff regarding women and cardiac failure. I hope I've given some interesting and useful information. If you have any queries or questions, please drop us a note. If you have any ideas for future podcasts, again, please free to let us know. Of course, I'd like to wish you the very best health. And until next time, please don't die from a heart attack. Goodbye. You have been listening to another podcast from Dr. Warrick. Visit his website at drWarrickbishop.com for the latest news on heart disease. If you love this podcast, feel free to leave us a review.