Chileshe Nkonde-Price (third from left) with members of Penn Medicine's cardiovascular team on "Go Red" Friday.
Most women fear breast cancer more than heart disease but, in fact, cardiovascular disease is the more deadly. Indeed, more women die from a cardiac condition than all cancers combined. “More men are diagnosed with heart disease, but, when a woman gets it, she’s more likely to die,” said Chileshe Nkonde-Price, MD, of Cardiovascular Medicine.
Still, with the right vigilance during the many stages of a woman’s life, the trend can be reversed. And that’s where the new Penn Women’s Cardiovascular Center comes into play.
“We’re creating a culture of women’s cardiovascular health that’s for women, by women,” said Nkonde-Price, who serves as director of the new Center. “By continually assessing risk factors and educating women, we have the tools to prevent heart attacks in the future.”
A Focus on Maternal Heart Health
Cardiac disease is now the leading cause of maternal death in the US, Nkonde-Price said. Many factors contribute, but one stands out: the changing profile of women getting pregnant. “Women are older and may enter pregnancy with a heart condition,” she said. For example, “simple congenital lesions [“holes in the heart”] are now so easily fixed that women enter adulthood with no need to see a cardiologist. But pregnancy puts a huge strain on the heart and we haven’t yet seen how these women cope with it,” she said.
In addition, symptoms that might alert a woman to a brewing cardiac condition, such as feeling tired, out of breath, or swelling, are similar to those of pregnancy. But it could also be preeclampsia. This potentially serious condition, which develops in 1 of 30 pregnant women, starts with elevated blood pressure and extreme swelling in the feet, legs, and hands. “People think delivery ends the problem but not necessarily,” Nkonde-Price said. “These patients are twice as likely to develop regular hypertension in their lives if they have it during pregnancy. It’s a window of what might happen in the future.”
Pregnancy and early post-pregnancy are important times to assess a woman’s cardiac risk factors to create a road map and treatment plan that can guide her through pregnancy, labor and delivery, and beyond, she added.
The Next Stage: Raising a Family
Studies show that women tend to put their loved ones first when it comes to health care and are less likely to see a doctor themselves. When it comes to heart health, that can have serious consequences. Women can easily ignore the often vague symptoms of heart disease, such as nausea, fatigue, and shortness of breath, with or without chest discomfort.
That’s why it’s essential to initiate – and maintain -- a heart healthy lifestyle, Nkonde-Price said. At the Penn Women’s Cardiovascular Center, “we educate women about healthy behaviors [eg, regular exercise and not smoking] but can also refer them to other Penn services that will help them reach their goals, for example, the Penn Center for Women’s Behavioral Wellness. Research links a person’s psychological well-being to heart health.”
Nkonde-Price considers menopause – the next milestone in a woman’s life -- to be a particularly vulnerable time for women when it comes to their hearts. The incidence of heart disease increases dramatically around peri-menopause and it correlates directly with the decrease of estrogen, she said. “At this point, the number of women suffering heart attacks catches up with men,” she said.
The risk is even greater for women on hormone replacement therapy, which she said has been linked to heart disease.
“We take every new chest pain or shortness of breath very seriously,” she said. “It’s extremely important to assess a woman’s numbers –including blood pressure, cholesterol, fasting glucose – and take steps to bring any risks under control.”
Between-Visit Connections
Staying connected with patients outside of office visits is a priority for Nkonde-Price. She often uses MyPennMedicine, the UPHS patient portal, to share information that a patient might find interesting and relevant. For example, she shared a recent study showing that eating a cup of blueberries a day helps prevent women who have borderline high blood pressure from crossing over into the highest risk level. Patient feedback shows that women are not only reading her messages but are glad to receive the information.
As a member of Penn’s Center for Healthcare Innovation team, Nkonde-Price is involved in two pilots investigating how today’s technology can help doctors keep this connection. One will investigate the use of mobile apps that allow patients with high blood pressure to take and send their blood pressure measurements through a connected health device, which will automatically incorporate into PennChart, the Health System’s electronic medical record system. The apps might help doctors predict how to care for these patients in a more precise way.
Another pilot asks patients to keep photographic food diaries and share them via MyPennMedicine or email as a way to get and stick with a heart healthy diet. “They can send photos of food in their fridge, or of a meal and we’ll use that information to converse about heart health and establish a baseline measure of how well they’re doing.”
Because even common heart conditions present differently in women, which can delay diagnosis and treatment, “women have told me that they’ve been blown off with ‘It’s only anxiety. Relax. ’” she said. “I’m excited about creating a a clinical home that’s dedicated to their cardiovascular health.”