In this engaging discussion, Dr. Erin Michos, a renowned preventive cardiologist at Johns Hopkins, dives deep into the rising threat of cardiovascular disease in women. She highlights how unique factors like pregnancy and menopause influence risk and emphasizes the critical need for early preventative measures. Dr. Michos explains the importance of managing LDL-cholesterol and the role of new treatments like GLP-1 agonists and PCSK9 inhibitors. Listeners also gain insights into the gender-specific nuances of heart health and practical lifestyle changes to reduce risks.
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insights INSIGHT
CVD Mortality in Women
CVD mortality is rising in younger women, especially those aged 45-64.
If this continues, heart disease may become the leading cause of death for young women, surpassing cancer.
insights INSIGHT
Misplaced Fear
Many women mistakenly fear breast cancer more than CVD, despite CVD's much higher mortality rate.
This misconception may stem from underrepresentation of women in clinical trials and lingering stereotypes.
insights INSIGHT
FH and Premenopausal Protection
Women with familial hypercholesterolemia (FH) do not have the same premenopausal protection as other women.
They experience early onset of CVD, similar to men with FH, highlighting the importance of early treatment.
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Erin Michos is an internationally-known leader in preventive cardiology and women’s cardiovascular health. In this episode, Erin discusses current trends in cardiovascular disease (CVD) through the lens of female biology and the observation that major adverse cardiac events in both sexes are on the rise. She walks through risk factors including LDL-cholesterol, apoB, and Lp(a) and makes the case for the importance of early preventative measures. She explains various interventions for reducing risk including a discussion of statins, GLP-1 agonists, PCSK9-inhibitors, and drugs that lower Lp(a). She goes in-depth on female-specific factors that contribute to CVD risk such as pregnancy, grand multiparity (having five or more children), oral contraceptives, menopause, and polycystic ovary syndrome (PCOS). Additionally, she explains her approach with patients as it relates to the use of hormone replacement therapy and provides advice for people wanting to lower risk both through lifestyle changes and medications.
We discuss:
Erin’s background in preventive cardiology and women’s health [2:30];
Recent trends in cardiovascular disease in women, mortality data, and how it compares to cancer [5:15];
Why early preventative measures are critical for cardiovascular disease risk [13:15];
ApoB as a causal agent of CVD, and why high apoB levels are not being aggressively treated in most cases [19:45];
The rising trend of metabolic syndrome and other factors contributing to the regression in progress of reducing cardiac events [27:00];
GLP-1 agonists—Promising drugs for treating diabetes and obesity [33:30];
Female-specific risk factors for ASCVD (pre- and post-menopause) [37:15];
Polycystic ovary syndrome (PCOS): prevalence, etiology, and impact on metabolic health, lipids and fertility [47:00];
The effect of grand multiparity (having 5+ children) on cardiovascular disease risk for women [52:30];
The impact of oral contraceptives on cardiovascular disease risk [55:00];
The effect of pregnancy on lipids and other metabolic parameters [58:45];
The undertreatment of women with familial hypercholesterolemia (FH) and how it increases lifetime risk of ASCVD [1:02:00];
How concerns around statins have contributed to undertreatment, and whether women should stop statins during pregnancy [1:09:45];
How Erin approaches the prescription of statins to patients [1:16:00];
PCSK9 inhibitors and other non-statin drugs [1:21:15];
Advice for the low- and high-risk individual [1:28:30];
The impact of nutrition, stress, and lifestyle on lipids and CVD risk [1:31:00];
Lp(a) as a risk enhancer for cardiovascular disease [1:41:15];
The effect of menopause on cardiovascular disease risk [1:50:30];
How Erin approaches decisions regarding hormone replacement therapy (HRT) for her patients [1:55:30];
The urgent need for more data on women’s health [2:03:30];
Erin’s goal of running a marathon in every state [2:09:45]; and
The Peter Attia Drive