Check-up checklist: What women should ask their doctors about heart health, according to age

Heart disease remains a leading cause of early death for women in Canada,¹ and yet many tend to underestimate their risk, says Dr. Heather Warren, a Cardiologist and Vice-President of Medical Affairs at Waterloo Regional Health Network (WRHN), home of the PREVENT Clinic, which is powered by Manulife. This is partly due to a lack of awareness of how women’s physiology, risk factors, and diagnostic experiences often differ from men’s – knowledge gaps that stem from the fact that two-thirds of clinical research into heart disease and stroke has focused on male subjects.

• Ask how to best keep track of habits that could impact your heart health – such as duration and frequency of exercise, how much you smoke and drink (be honest!), and diet – and how often you should review them together. This can help to establish a baseline of your health profile, which can make it easier to identify potential symptoms of cardiovascular disease later.
• Ask if routine blood tests might be helpful to measure variables like blood sugar and cholesterol. “Blood tests can establish a baseline to refer to later on, which can be helpful in maintaining cardiovascular health,” says Stefanie Cooper, a Registered Nurse and the Program Manager for Procedural Cardiology at the WRHN.
• Ask if there are preventive habits or behaviours you should be integrating into your lifestyle. “It can be helpful to ask: Should I be doing more to protect my heart health? Is there anything I should be screening for? It’s never too early have these conversations,” says Dr. Amelia Yip, a cardiologist with WRHN. Nearly 80 per cent of premature cases of heart disease and stroke can be prevented through healthy behaviours.²
• If you’re pregnant or planning a pregnancy, ask your doctor whether it would be helpful to monitor any changes to blood pressure or blood sugars.
• If your pregnancy includes complications that can increase the risk of cardiovascular issues – including gestational diabetes³ or hypertensive disorders such as gestational hypertension and preeclampsia⁴– ask your clinician to help you understand your risk profile and recommended behavioural modifications that can help protect your heart. “Ask your doctor how they plan to monitor your risk after the pregnancy, as well,” Dr. Yip suggests.

• Ask for an explanation of your cardiovascular risk profile. “While some risk factors – such as smoking,⁵ high blood pressure,⁶ high cholesterol,⁷  and diabetes⁸ – are common to both sexes, other risk factors are specific to women,” says Dr. Warren, citing early menopause,⁹ polycystic ovarian syndrome,¹⁰ and pregnancy-related complications¹¹ as examples.  
• Request a discussion about your hormonal history. “Some women are more sensitive to hormonal changes than others,” says Dr. Yip. “Your experiences with menstruation and pregnancies, if applicable, can be harbingers for how the hormonal changes of perimenopause and menopause might affect your heart.”
• Ask which symptoms to watch for based on your history, lifestyle, and risk profile. “The symptoms of heart issues at this stage of life can be slow to progress and easy to write off,” says Dr. Yip. “When you know what to look for, you’re less likely to ignore them.”
• Ask whether there are any indicators in your risk profile that might warrant a stress test. (These are generally not necessary unless you’re demonstrating symptoms, according to Dr. Yip.)
• Check in on your baseline. Changes in your usual abilities – such as getting winded on a walk you easily managed a year ago – can signal cardiovascular issues, Cooper says. “There is not an automatic decline in your physical abilities when you turn 40,” she explains. “You shouldn’t dismiss changes as simply aging. Do your due diligence and seek answers from your physician or nurse practitioner.” 
• Ask about lifestyle changes that might help you reduce your risk of cardiovascular disease.

• Ask how your age might be affecting your risk factors. “As women get older, they are more prone to heart disease,” says Dr. Yip. “Age introduces greater risk of not just blocked arteries, but also diseases like atrial fibrillation and heart failure.”
• Ask about your energy levels. Fatigue can feel like a vague symptom to discuss with a doctor – and a natural part of getting older – but it can also indicate conditions linked with heart problems, like thyroid problems¹² and sleep apnea,¹³ according to Dr. Yip. “At this age, you want to make sure those are properly screened for and looked after.”
• Ensure you’re up to date on blood work – especially related to cholesterol. Cholesterol levels tend to peak in women between 55 and 65 – ten years later than men.¹⁴
• Ask your doctor to review and approve your preferred physical activities. “The number one thing women can do to care for their hearts as they age is move their bodies,” Cooper says.
• As in your 40s and 50s, check in for changes in your baseline functional capabilities. “If you notice you’re slowing down, it’s worth getting it checked out,” Dr. Yip says.

Women’s heart health can be complex. Increasing your own knowledge can help you feel more in control of your health and can help you self advocate. Cooper suggests asking your healthcare provider to recommend credible, vetted resources you can review on your own. “That way, you can arm yourself with trusted knowledge for these conversations” she says.