Latest / Clearly Hormonal / Why Women’s Heart Disease Gets Missed with Dr. Ambreen Mohamed

Transcript

Why Women’s Heart Disease Gets Missed with Dr. Ambreen Mohamed · Clearly Hormonal

• 0:01
  Dr. Komal Patil-Sisodia: Welcome to Clearly Hormonal, the podcast where we stop googling our symptoms at midnight and actually start understanding what's going on in our bodies.
• 0:09
  Dr. Komal Patil-Sisodia: I'm Dr.
• 0:10
  Dr. Komal Patil-Sisodia: Komal Patil-Sisodia, an endocrinologist, internist, obesity medicine specialist, and a Menopause Society Certified Practitioner, which is really just a whole lot of words to say hormones are my jam.
• 0:21
  Dr. Komal Patil-Sisodia: I've spent 17 years watching women try to navigate their hormonal health without ever having been taught the language for what's happening in their own bodies, and then meeting clinicians who want nothing more than to help them figure it out, but are up against 10-minute appointments and a system that just wasn't built for it.
• 0:37
  Dr. Komal Patil-Sisodia: This podcast is my answer to that gap.
• 0:40
  Dr. Komal Patil-Sisodia: We'll cover menopause, metabolism, hormones, and everything in between with real evidence, not trends, and without the overwhelm.
• 0:47
  Dr. Komal Patil-Sisodia: A quick disclaimer: I'm a physician, but this is education, not personalized medical advice.
• 0:52
  Dr. Komal Patil-Sisodia: Take what resonates and discuss it with your own healthcare team.
• 0:56
  Dr. Komal Patil-Sisodia: Now, let's get into it and talk about what's clearly hormonal and what's not.
• 1:02
  Dr. Komal Patil-Sisodia: All right.
• 1:03
  Dr. Komal Patil-Sisodia: Hi, everyone.
• 1:04
  Dr. Komal Patil-Sisodia: Welcome to Clearly Hormonal.
• 1:05
  Dr. Komal Patil-Sisodia: I am your host, Dr.
• 1:06
  Dr. Komal Patil-Sisodia: Komal Patil-Sisodia, and I'm very excited to introduce Dr.
• 1:10
  Dr. Komal Patil-Sisodia: Ambreen Mohamed.
• 1:11
  Dr. Komal Patil-Sisodia: She is a pre- preventative and advanced imaging cardiologist based in Southern California in San Diego, and she completed her undergrad training at UC Irvine.
• 1:22
  Dr. Komal Patil-Sisodia: She went to Ross University School of Medicine, then went on to do her internal medicine residency at the University of Connecticut, and her cardiology fellowship at Drexel University College of Medicine.
• 1:32
  Dr. Komal Patil-Sisodia: She was the chief fellow there, and then went on to do additional subspecialty training in cardiac MRI and structural cardiac imaging at Scripps Clinic in San Diego.
• 1:41
  Dr. Komal Patil-Sisodia: So welcome to the podcast.
• 1:42
  Dr. Komal Patil-Sisodia: I'm so excited to have you here.
• 1:45
  Dr. Ambreen Mohamed: Thank you so much.
• 1:46
  Dr. Ambreen Mohamed: When you initially reached out, I was like,"Oh my God, this is so cool." I'm so happy to do this, so happy to connect with you, and I'm excited about our conversation.
• 1:54
  Dr. Komal Patil-Sisodia: Thank you.
• 1:54
  Dr. Komal Patil-Sisodia: I saw all of your stuff on TikTok, and I just thought,"My God, she's putting such amazing information out there about cardiovascular health." We're both South Asian, and I was hearing what you were talking about, and so much of it was resonating with me because like I shared with you before, my mom developed heart disease at a pretty young age when I was in high school, and then my husband had a heart attack about 10 years ago, and this is just a very common thing in the South Asian population.
• 2:23
  Dr. Komal Patil-Sisodia: And heart disease is the number one killer of women, right?
• 2:25
  Dr. Komal Patil-Sisodia: So for my platform, I've felt very passionate about this.
• 2:28
  Dr. Komal Patil-Sisodia: I'm not a cardiologist.
• 2:29
  Dr. Komal Patil-Sisodia: I'm an endocrinologist, but I see a lot of that precursor disease that goes into the development of heart disease.
• 2:36
  Dr. Komal Patil-Sisodia: So I was just very excited that you agreed to come on and chat with us today and share your expertise.
• 2:42
  Dr. Ambreen Mohamed: Yeah, absolutely.
• 2:43
  Dr. Ambreen Mohamed: And I love that, endocrinology and cardiology are meeting, right?
• 2:48
  Dr. Ambreen Mohamed: Because I feel like the union is so needed, especially in this space, right?
• 2:54
  Dr. Ambreen Mohamed: Not only is heart disease the number one killer of women, however, women are also developing heart disease earlier and earlier, right?
• 3:01
  Dr. Ambreen Mohamed: And especially in our community.
• 3:02
  Dr. Ambreen Mohamed: And, listen, I never thought I would be on TikTok and Instagram's front news- but here we are.
• 3:08
  Dr. Ambreen Mohamed: Here we are in our, prime, doing the TikTok thing, and it's great because, we're able to reach bigger communities, and the response that I've gotten from a lot of South Asians has been so positive and people have just said all around"Hey,""we-" We didn't know about this.
• 3:25
  Dr. Ambreen Mohamed: We are gonna go get our cholesterol checked.
• 3:27
  Dr. Ambreen Mohamed: We're gonna go get our lab work.
• 3:29
  Dr. Ambreen Mohamed: I'm gonna put this in the family group chat.
• 3:31
  Dr. Ambreen Mohamed: Let me tell you, one of the biggest compliments that anyone can give you is spreading this news to other people that they love and care about, because truly, this information is needed.
• 3:39
  Dr. Ambreen Mohamed: And just how you shared, like you've had family members your husband, your mom, who've had, heart disease at really young ages.
• 3:46
  Dr. Ambreen Mohamed: And when you don't have that information and that this is happening, it can be a really scary thing.
• 3:52
  Dr. Ambreen Mohamed: So to empower people with information is one of the biggest blessings, I think, that, I can have.
• 3:58
  Dr. Ambreen Mohamed: And if I can share and, be able to save lives, like what other purpose is there, yeah, so I'm happy to do this, and I think we're gonna have a really good conversation today.
• 4:08
  Dr. Komal Patil-Sisodia: And so today I wanted to focus more on the intersection of women's health.
• 4:13
  Dr. Komal Patil-Sisodia: Talk a little bit about the South Asian diaspora, and then just talk about prevention in general.
• 4:18
  Dr. Komal Patil-Sisodia: There's also new cholesterol guidelines that just came out.
• 4:21
  Dr. Komal Patil-Sisodia: And I think caused a bit of a frenzy, like for the endocrinologists,.
• 4:24
  Dr. Komal Patil-Sisodia: I can't even remember what the first set of guidelines were.
• 4:26
  Dr. Komal Patil-Sisodia: Those were pretty clear.
• 4:27
  Dr. Komal Patil-Sisodia: The last ones were a little nebulous.
• 4:29
  Dr. Komal Patil-Sisodia: These ones, I think, are leaning towards getting more clear on exactly what to do and what targets to treat towards, so I'm excited to talk about all of that.
• 4:36
  Dr. Ambreen Mohamed: Yeah.
• 4:37
  Dr. Ambreen Mohamed: I'd
• 4:38
  Dr. Komal Patil-Sisodia: like to just focus a little bit on, reframing heart disease in women.
• 4:42
  Dr. Komal Patil-Sisodia: For so many years, especially in my training, it was mainly put out as this is a male disease, right?
• 4:48
  Dr. Komal Patil-Sisodia: This happens in men.
• 4:49
  Dr. Komal Patil-Sisodia: But we now know that heart disease is the number one killer in women.
• 4:53
  Dr. Komal Patil-Sisodia: So I'd love to hear your thoughts on the shift of looking at that and what the data shows around that.
• 4:59
  Dr. Ambreen Mohamed: Historically, heart disease in men has been at the forefront, and so we see this because if you look at research studies dating back decades and decades, unfortunately, most of those research studies primarily looked at men.
• 5:14
  Dr. Ambreen Mohamed: Women were excluded for a lot of different reasons, women were excluded because of hormonal changes, because they were too complex to understand, because of, pregnancy and all of that surrounding that.
• 5:24
  Dr. Ambreen Mohamed: So it's just easier to be able to just exclude women, put them on the side, and then primarily study men.
• 5:29
  Dr. Ambreen Mohamed: So if you're gonna do that over and over again, you're gonna see that the data is really just reflecting what happened.
• 5:36
  Dr. Ambreen Mohamed: And then on top of that, when you look at the presentation of how heart disease presents in men and women, it can actually be quite different, right?
• 5:44
  Dr. Ambreen Mohamed: So you know, there's this classic, symptomology that we see of like the elephant sitting on the chest, and crushing chest pain, and- Nausea and diaphoresis, and yes, that can happen in both populations, but that classic presentation can happen more often in men.
• 5:59
  Dr. Ambreen Mohamed: And unless people have that kind of presentation, and a lot of times women don't, their symptoms can be ignored, and so that's something to really look at as well.
• 6:08
  Dr. Ambreen Mohamed: And why is the presentation different?
• 6:10
  Dr. Ambreen Mohamed: Because women's pathophysiology can be a little bit different.
• 6:12
  Dr. Ambreen Mohamed: Like that classic coronia- cor- coronary disease that occurs in men doesn't necessarily occur in women.
• 6:17
  Dr. Ambreen Mohamed: Women can have more, microvascular disease.
• 6:20
  Dr. Ambreen Mohamed: Women can have endothelial dysfunction that doesn't necessarily happen, in men.
• 6:24
  Dr. Ambreen Mohamed: Women can have plaque erosion, and so the presentations of how they present can just be different.
• 6:29
  Dr. Ambreen Mohamed: Look at the cultural narrative, right?
• 6:31
  Dr. Ambreen Mohamed: Like that Hollywood drama how it's being presented, that typically, was highlighted in men.
• 6:38
  Dr. Ambreen Mohamed: If you're gonna, if you're gonna be exposed to that over and over again, it's not easy to see that it can actually be, different in women.
• 6:45
  Dr. Ambreen Mohamed: Fortunately we have a huge movement in our, specialty now, especially over the past few years, where we have a lot of, powerhouse women in our field, and even our societies like the ACC, AHA really recognizing that, women are dying from heart disease more than anything else, and they can present differently.
• 7:02
  Dr. Ambreen Mohamed: And so we really have to recognize them, recognize how they present, recognize what the pathophysiology is behind that, and really highlight that and understand that.
• 7:10
  Dr. Komal Patil-Sisodia: And how do you see...
• 7:11
  Dr. Komal Patil-Sisodia: like we talked a bit about the symptomatology in men, right?
• 7:14
  Dr. Komal Patil-Sisodia: It's that classic what in the Hollywood movie, the grabbing at the chest, the grabbing of the arm.
• 7:19
  Dr. Komal Patil-Sisodia: They fall over.
• 7:20
  Dr. Komal Patil-Sisodia: What are the symptoms in women that you typically see, and, what are things that if women are starting to feel these things they need to get themselves to an ER?
• 7:28
  Dr. Ambreen Mohamed: Yeah.
• 7:28
  Dr. Ambreen Mohamed: Again, women can classically present like men.
• 7:32
  Dr. Ambreen Mohamed: Okay?
• 7:33
  Dr. Ambreen Mohamed: So it's not that they don't have those symptoms.
• 7:36
  Dr. Ambreen Mohamed: However, women can also have different kinds of symptoms, and so this is where it gets a little bit dicey.
• 7:41
  Dr. Ambreen Mohamed: So again, the classic symptoms of a heart attack would be intense chest pressure, maybe radiating to the back or the neck or the jaw or the arm, the left arm, and associated with, trouble breathing, diaphoresis, nausea.
• 7:56
  Dr. Ambreen Mohamed: But, in women it could actually sometimes be different.
• 7:59
  Dr. Ambreen Mohamed: Just feeling a lot more fatigue than usual, and that's really different from them.
• 8:03
  Dr. Ambreen Mohamed: Maybe they're starting to get really dizzy and lightheaded, and they don't understand why.
• 8:07
  Dr. Ambreen Mohamed: Maybe they're just getting more short of breath, especially with activity or even at rest.
• 8:12
  Dr. Ambreen Mohamed: Maybe they are having chest discomfort, but it feels more like an indigestion or just like some kind of uneasiness that they have that they can't describe that they weren't experienced before.
• 8:23
  Dr. Ambreen Mohamed: Maybe they're, having like indigestion, but along with that comes like a little bit of nausea, but then they'll just say"Oh, maybe I just ate something," or whatever, so it definitely can present, we call these like constitutional type of symptoms.
• 8:35
  Dr. Ambreen Mohamed: Yeah.
• 8:35
  Dr. Ambreen Mohamed: We really don't have a box that we can put it in.
• 8:38
  Dr. Ambreen Mohamed: And I also talked about like the referred pain, so sometimes it could maybe just be isolated pain that they have theirs.
• 8:43
  Dr. Ambreen Mohamed: Maybe their jaw is like starting to really hurt, and they don't know why, or maybe their left arm is really hurting, but they don't have that classic chest pain.
• 8:51
  Dr. Ambreen Mohamed: All of these things need to be taken into consideration.
• 8:53
  Dr. Ambreen Mohamed: And I will say I've seen a lot of women over the years and, I've just recognized more and more that women themselves can downplay their symptoms.
• 9:02
  Dr. Ambreen Mohamed: And then they don't really know what to ask or what we're supposed to be looking for.
• 9:07
  Dr. Ambreen Mohamed: But fortunately, because I've seen this so much, I tend to take these things very seriously.
• 9:11
  Dr. Ambreen Mohamed: So if by the time you're coming to me, if are complaining of something, it would be really easy for me to just pass it off as"You're anxious.
• 9:18
  Dr. Ambreen Mohamed: Not a big deal," yeah.
• 9:19
  Dr. Ambreen Mohamed: Or,"It's just a little indigestion.
• 9:20
  Dr. Ambreen Mohamed: Take some Tums.
• 9:21
  Dr. Ambreen Mohamed: You'll be fine." I'm like,"No," by the time they're seeing a cardiologist, they feel like something is wrong, or they're getting a second opinion, and I'd much rather be conservative and, get the extra testing because had I not done that, we could have missed something, and potentially something that could have been devastating for them.
• 9:39
  Dr. Komal Patil-Sisodia: Yeah.
• 9:39
  Dr. Komal Patil-Sisodia: And I, it's so true.
• 9:40
  Dr. Komal Patil-Sisodia: I watched my mom navigate this when I was in high school, and she was starting to get a little more short of breath, right?
• 9:47
  Dr. Komal Patil-Sisodia: Our driveway had just a little bit of an incline, and she was having difficulty going up the driveway.
• 9:52
  Dr. Komal Patil-Sisodia: Yeah.
• 9:52
  Dr. Komal Patil-Sisodia: And it wasn't really anything else.
• 9:53
  Dr. Komal Patil-Sisodia: It was like such a subtle presentation.
• 9:56
  Dr. Komal Patil-Sisodia: It took her almost two years to get to a cardiologist because people just couldn't figure it out.
• 10:00
  Dr. Komal Patil-Sisodia: It was,"Oh, maybe she's anxious.
• 10:02
  Dr. Komal Patil-Sisodia: Maybe it's her lungs.
• 10:03
  Dr. Komal Patil-Sisodia: Maybe it's asthma.
• 10:05
  Dr. Komal Patil-Sisodia: And we went down like every rabbit hole except the right one.
• 10:09
  Dr. Komal Patil-Sisodia: And by the time they found it, she was very lucky she didn't have a heart attack before that, because it was- an 80% blockage.
• 10:14
  Dr. Komal Patil-Sisodia: It's a big deal in the left anterior descending, which is one of the main arteries of the heart.
• 10:19
  Dr. Komal Patil-Sisodia: And so I feel very lucky that my mom is still here, but I saw how long it took her to get there.
• 10:24
  Dr. Ambreen Mohamed: Wow.
• 10:25
  Dr. Komal Patil-Sisodia: I think that I'm just so happy to hear that there are cardiologists out there like you who are taking these complaints more seriously, and other primary care doctors as well.
• 10:34
  Dr. Komal Patil-Sisodia: I went in to see my primary care doctor because I was lifting at the gym and I tweaked my left shoulder, and it was like radiating up to my neck.
• 10:41
  Dr. Komal Patil-Sisodia: And I'm sitting there in her office just very calmly telling her how I injured my shoulder and it's been hurting for a few days, and she just looked at me, she goes,"Why are you here?" And I said-"I tweaked my shoulder." And she's"Repeat your history with your family history back to yourself, and then tell me whether you should be in my office." And I was like,"Oh my God, I'm so sorry." But I really- You're the doctor, and you're the-
• 11:03
  Dr. Ambreen Mohamed: I'm the
• 11:03
  Dr. Komal Patil-Sisodia: But I had really truly just tweaked my shoulder, but it bought me a cardiology workup, and I'm so grateful she did it because of my mom's history.
• 11:11
  Dr. Komal Patil-Sisodia: But yeah you have these moments where you're like,"Oh my gosh," it doesn't register for yourself sometimes.
• 11:17
  Dr. Ambreen Mohamed: Yeah.
• 11:18
  Dr. Komal Patil-Sisodia: One of the other things that I wanted to talk to you about is this hormone connection that we see in women, right?
• 11:23
  Dr. Komal Patil-Sisodia: We know that women who go through premature ovarian insufficiency, if we don't get them on hormones right away, they will develop cardiovascular disease at very high rates.
• 11:32
  Dr. Komal Patil-Sisodia: I think our biggest question is what happens to women in midlife, right?
• 11:36
  Dr. Komal Patil-Sisodia: And what are these hormone connections that are there?
• 11:39
  Dr. Komal Patil-Sisodia: And then I see a lot of women who have PCOS who are at high risk for metabolic syndrome, right?
• 11:44
  Dr. Komal Patil-Sisodia: Hormones, I think, play a bigger part in female heart disease than we give them credit for, and I'd love to hear your thoughts on that.
• 11:50
  Dr. Ambreen Mohamed: Before menopause...
• 11:52
  Dr. Ambreen Mohamed: heart disease is traditionally diagnosed, and you can even see this in terms of what's considered premature heart disease- premature heart disease is actually earlier in men, earlier onset in men than it is in women.
• 12:03
  Dr. Ambreen Mohamed: And really why is that is because our hor- hormones are protecting us before menopause, fortunately.
• 12:08
  Dr. Ambreen Mohamed: And so why is that?
• 12:09
  Dr. Ambreen Mohamed: So estrogen is a huge player in the field here, right?
• 12:13
  Dr. Ambreen Mohamed: Estrogen is a huge player in our vascular system.
• 12:16
  Dr. Ambreen Mohamed: It can improve vasodilation, it can impru- improve endothelial function it can, lead to healthier lipid profiles, healthier inflammatory profiles.
• 12:26
  Dr. Ambreen Mohamed: And so we know that with all of that, and if we see that as protective or heart protective, then when you start to hit perimenopause and menopause, you start to see shifts.
• 12:38
  Dr. Ambreen Mohamed: You start to see shifts in your body where your fat distribution starts to change, and more of that, centripetal obesity which we know is very metabolically active.
• 12:46
  Dr. Ambreen Mohamed: We start to see more insulin resistance.
• 12:49
  Dr. Ambreen Mohamed: We start to see our blood pressure increase.
• 12:51
  Dr. Ambreen Mohamed: We start to see changes in our cholesterol profile, increase in inflammation sometimes.
• 12:57
  Dr. Ambreen Mohamed: And so what is all of that mean?
• 12:59
  Dr. Ambreen Mohamed: It means that all of these different things are all risk factors for heart disease.
• 13:03
  Dr. Ambreen Mohamed: So it doesn't necessarily mean that, hey, you hit menopause and you're absolutely going to, develop something.
• 13:09
  Dr. Ambreen Mohamed: But it means that because all of these other things are going on, compounded can actually have a significant effect and, lead to an event if we're not really aggressive about care.
• 13:18
  Dr. Ambreen Mohamed: And then, you talk about PCOS.
• 13:21
  Dr. Ambreen Mohamed: So PCOS I think traditionally has been seen as this reproductive thing, right?
• 13:24
  Dr. Ambreen Mohamed: You know- Correct, yeah you have some difficult issues with fertility, and it's just a reproductive diagnosis.
• 13:29
  Dr. Ambreen Mohamed: Maybe when they're young, they have, a ton of acne, and they have facial hair, and so you just gotta combat that and put them on some metformin, and they're gonna be fine.
• 13:37
  Dr. Ambreen Mohamed: This is also a huge cardiometabolic, risk signal.
• 13:40
  Dr. Ambreen Mohamed: It's like a bat signal.
• 13:41
  Dr. Ambreen Mohamed: And if somebody is diagnosed with PCOS young, now they're gonna be battling that for, a very long time.
• 13:47
  Dr. Ambreen Mohamed: Why?
• 13:47
  Dr. Ambreen Mohamed: It's because of a lot of the risk factors I already talked about.
• 13:50
  Dr. Ambreen Mohamed: You can see changes in lipid profile, changes in fat distribution.
• 13:53
  Dr. Ambreen Mohamed: You can see changes in blood pressure.
• 13:55
  Dr. Ambreen Mohamed: You can see changes in insulin resistance.
• 13:57
  Dr. Ambreen Mohamed: And again what does all of that mean?
• 13:59
  Dr. Ambreen Mohamed: That means that, you're increasing your risk of heart disease.
• 14:01
  Dr. Ambreen Mohamed: PCOS isn't you get to the fact that you're gonna be pregnant, and hopefully you get pregnant, and then everything is fine.
• 14:08
  Dr. Ambreen Mohamed: Correct.
• 14:08
  Dr. Ambreen Mohamed: No, you're now dealing with these risk factors as well, and so we have to be much more aggressive with tackling like the blood levels and all of that, but then looking at the lifestyle factors too, because other things can change.
• 14:20
  Dr. Ambreen Mohamed: Your sleep patterns can change.
• 14:21
  Dr. Ambreen Mohamed: Like I said, your weight distribution can change.
• 14:23
  Dr. Ambreen Mohamed: And so we really have to package this as not only just looking at it from a reproductive perspective, but also from a cardiometabolic perspective and being much, much more aggressive, I would say, in terms of risk factor reduction earlier on.
• 14:37
  Dr. Komal Patil-Sisodia: I see so many young women, and I think one of the hardest things about PCOS is that women will present in their teens, right?
• 14:44
  Dr. Komal Patil-Sisodia: Late teens they'll start having symptoms, but we are so hesitant to give them a label- because it has such a long impact on their life over time.
• 14:52
  Dr. Komal Patil-Sisodia: But I think we almost do women a disservice by not telling them sooner, right?
• 14:56
  Dr. Komal Patil-Sisodia: It is scary to hear in your teens or early 20s that this is going to be a lifelong issue for you, but I think we have to be more transparent and find better ways of communicating that information.
• 15:06
  Dr. Komal Patil-Sisodia: Pregnancy itself can be A risk as well, right?
• 15:09
  Dr. Komal Patil-Sisodia: We see gestational diabetes, we see high blood pressure in pregnancy.
• 15:13
  Dr. Komal Patil-Sisodia: Can you talk a little bit about how that affects cardiometabolic health long term?
• 15:18
  Dr. Ambreen Mohamed: Yeah, so you have to think of pregnancy as a stress test.
• 15:21
  Dr. Ambreen Mohamed: Your body's having a stress test- for nine months, right?
• 15:24
  Dr. Ambreen Mohamed: You're increasing your blood volume, you're increasing your cardiac output, and your hemodynamic changes to your body significantly increase.
• 15:32
  Dr. Ambreen Mohamed: So if you're healthy otherwise, you're a young girl, you're healthy and you're pregnant, most people can withstand pregnancy during that whole entire time and they're fine.
• 15:39
  Dr. Ambreen Mohamed: They don't really have any complications, they deliver okay, and then you just continue to monitor and they're doing okay.
• 15:44
  Dr. Ambreen Mohamed: However, in a lot of women, they have something that kind of is unmasked during their pregnancy, so they can develop gestational hypertension they can develop gestational diabetes, they can develop a pre-eclampsia, eclampsia, have preterm delivery, and then we go into the postpartum.
• 16:01
  Dr. Ambreen Mohamed: They can have postpartum complications.
• 16:03
  Dr. Ambreen Mohamed: And all of these things have to be taken in consideration'cause it's not just a pregnancy issue.
• 16:07
  Dr. Ambreen Mohamed: This can actually mean that if you develop high blood pressure even within the realm of pregnancy, that puts you at an elevated risk of heart disease later on.
• 16:15
  Dr. Ambreen Mohamed: If you develop diabetes within pregnancy, that puts you at an elevated risk later on.
• 16:20
  Dr. Ambreen Mohamed: So not only do you have to be really focused on making sure that they're well controlled during the pregnancy, of course, for the health of you and your baby, but then even after you deliver, you have to make sure that you're staying on top of all of your lab work, your blood work and your lifestyle changes because you don't know the type of risk that you could have accumulated and continue to accumulate later on.
• 16:41
  Dr. Komal Patil-Sisodia: And I think that's one of the things that we see fall off pretty quickly in medicine, right?
• 16:45
  Dr. Komal Patil-Sisodia: You now have a new little human you're in charge of, right?
• 16:48
  Dr. Komal Patil-Sisodia: And you have all these responsibilities and you may not be sleeping well, you may n- you just don't have the time for self-care that you may have had prior to a pregnancy, and then I think with each next child, that responsibility compounds.
• 17:00
  Dr. Komal Patil-Sisodia: And so what I frequently see is women who've had gestational diabetes or gestational hypertension, sometimes they don't come to their follow-up, right?
• 17:07
  Dr. Komal Patil-Sisodia: And we skip out on the postpartum testing and that, if you are a young woman who happens to be listening to this and you had these complications during pregnancy please go back to your doctor.
• 17:18
  Dr. Komal Patil-Sisodia: Yeah.
• 17:18
  Dr. Komal Patil-Sisodia: We want to help you.
• 17:20
  Dr. Komal Patil-Sisodia: We want to make sure that your gestational diabetes resolves or the high blood pressure resolves.
• 17:25
  Dr. Komal Patil-Sisodia: I think they're a bit better about the high blood pressure.
• 17:27
  Dr. Komal Patil-Sisodia: The diabetes piece, people are like,"Eh, it's fine now," right?
• 17:31
  Dr. Komal Patil-Sisodia: "I'm not pregnant anymore."
• 17:32
  Dr. Ambreen Mohamed: I think it's like,"Oh, I delivered." Yeah.
• 17:34
  Dr. Ambreen Mohamed: That was such a tough thing in and of itself.
• 17:37
  Dr. Ambreen Mohamed: Yeah.
• 17:37
  Dr. Ambreen Mohamed: I don't wanna have to deal with anything else.
• 17:39
  Dr. Ambreen Mohamed: I know.
• 17:39
  Dr. Ambreen Mohamed: I don't wanna take more medication.
• 17:41
  Dr. Ambreen Mohamed: I don't wanna have more follow-ups, right?
• 17:43
  Dr. Ambreen Mohamed: Exactly.
• 17:43
  Dr. Ambreen Mohamed: But I think, again, if we look at this as more of a long game- even if you're thinking of getting pregnant again, you're just putting yourself at a higher risk.
• 17:50
  Dr. Ambreen Mohamed: And so it doesn't...
• 17:52
  Dr. Ambreen Mohamed: I feel like we talk about all of this stuff, and it's just people get so scared, right?
• 17:56
  Dr. Ambreen Mohamed: 'Cause they're so inundated with the information.
• 17:58
  Dr. Ambreen Mohamed: We're giving them all the facts and this and that, but I think it's really just to empower women to say"Hey, you know that this is what has happened, and now you know that this is what has happened.
• 18:08
  Dr. Ambreen Mohamed: You know it can come with an increased risk, and you wanna live a long, healthy life, not only for you, but your children as well."
• 18:15
  Dr. Komal Patil-Sisodia: Yes.
• 18:15
  Dr. Ambreen Mohamed: So if you think about it that way, what are the things that you can do to try to help yourself as much as possible?
• 18:21
  Dr. Ambreen Mohamed: It doesn't mean getting checkups every week, but it means at least doing your annuals and keeping up, with your blood work to make sure that if something is a little bit off, that's looked after a little bit more, because that potentially could save your life down the line.
• 18:33
  Dr. Komal Patil-Sisodia: Yeah, absolutely.
• 18:34
  Dr. Komal Patil-Sisodia: I couldn't have said it better.
• 18:36
  Dr. Komal Patil-Sisodia: Now I'm gonna ask the controversial question,
• 18:38
  Dr. Ambreen Mohamed: which
• 18:38
  Dr. Komal Patil-Sisodia: is hormone therapy menopause hormone therapy, do you feel like it's protective or risky?
• 18:44
  Dr. Komal Patil-Sisodia: And I know where I stand on it, but I think your answer will probably be similar to mine.
• 18:48
  Dr. Ambreen Mohamed: Honestly, I think it's really dependent.
• 18:50
  Dr. Ambreen Mohamed: I think it's dependent on why you're giving it, I think it's dependent on when you're giving it, and I think it's dependent on who you're giving it to, right?
• 18:57
  Dr. Ambreen Mohamed: So we know that if you're giving hormone replacement therapy within 10 years of onset of menopause or less than age 60, then this potentially could have either neutral or potentially even positive cardiovascular, benefits, right?
• 19:11
  Dr. Ambreen Mohamed: But if you're giving hormone replacement therapy later on in life or very far off from menopause, it potentially can have an adverse effect.
• 19:19
  Dr. Ambreen Mohamed: So yes, can it be good?
• 19:21
  Dr. Ambreen Mohamed: Sure, but it has to be given to the right person, especially to the person who is having those vasomotor symptoms, absolutely it should be tailored to them, and then also, again, in women that are younger and are closer to onset of, menopause.
• 19:36
  Dr. Ambreen Mohamed: It also shouldn't be looked at as a preventative tool for cardiovascular disease, because it's not, and we've seen this over and over again.
• 19:42
  Dr. Ambreen Mohamed: I think, if you looked at hormone replacement therapy honestly, not even too long ago there were studies that were done years ago that have paved the way and said,"Absolutely not.
• 19:51
  Dr. Ambreen Mohamed: This is bad.
• 19:52
  Dr. Ambreen Mohamed: This has adverse cardiovascular effects." We're seeing that's not really the case anymore, but again, you have to really individualize treatment.
• 19:59
  Dr. Ambreen Mohamed: So I would prioritize the age of the patient, If they're having symptoms or not, how far they are out from menopause, and again, individualizing treatment, and then also understanding their inherent risk.
• 20:10
  Dr. Ambreen Mohamed: If they have a history of vascular disease and things like that, you have to take that stuff into consideration because you wanna make sure that these hormones, even though they're hormones at the end of the day, it can still have, a negative effect.
• 20:21
  Dr. Ambreen Mohamed: There's no safe, 100% safe medication out there.
• 20:24
  Dr. Ambreen Mohamed: So you wanna go to a specialist like yourself who understands the nuances of the medication, what you need, what may not be beneficial for you, continue to have talks, continue to have adjustments.
• 20:36
  Dr. Ambreen Mohamed: It's not a one-size-fits-all, but I think if it's done in a safe way, it potentially could be beneficial.
• 20:40
  Dr. Ambreen Mohamed: I hope I gave you the right answer, Komal.
• 20:41
  Dr. Komal Patil-Sisodia: No.
• 20:41
  Dr. Komal Patil-Sisodia: That's exactly how I feel about it.
• 20:43
  Dr. Komal Patil-Sisodia: I might wait.
• 20:43
  Dr. Komal Patil-Sisodia: I'm gonna wait to see what she says.
• 20:45
  Dr. Komal Patil-Sisodia: No.
• 20:45
  Dr. Komal Patil-Sisodia: I don't.
• 20:46
  Dr. Komal Patil-Sisodia: That was the test.
• 20:47
  Dr. Komal Patil-Sisodia: No.
• 20:48
  Dr. Komal Patil-Sisodia: But when I was in my fellowship, my program director pointed out something so interesting to me, right?
• 20:53
  Dr. Komal Patil-Sisodia: Which was, as our hormone levels start to decline, all the protective effects start going away, and it's almost like our genetics get unmasked.
• 21:00
  Dr. Ambreen Mohamed: Yeah.
• 21:01
  Dr. Ambreen Mohamed: So
• 21:01
  Dr. Komal Patil-Sisodia: if you have a family history of heart disease, if you have a family history of high blood pressure, if you have a family history of high cholesterol or diabetes, all of those things start to come out, right?
• 21:09
  Dr. Komal Patil-Sisodia: I will have women who have stone-cold normal blood sugars and cholesterol, and all of a sudden they hit perimenopause.
• 21:15
  Dr. Komal Patil-Sisodia: They have not changed anything.
• 21:16
  Dr. Komal Patil-Sisodia: They're doing the same workouts.
• 21:17
  Dr. Komal Patil-Sisodia: They're eating the same foods.
• 21:18
  Dr. Komal Patil-Sisodia: And all of a sudden the cholesterol's double what it used to be, right?
• 21:21
  Dr. Komal Patil-Sisodia: And it's fascinating to me to watch that.
• 21:24
  Dr. Komal Patil-Sisodia: Now, how that looks in everybody in terms of how they respond to hormone therapy is widely different, right?
• 21:30
  Dr. Komal Patil-Sisodia: I have one person that, you know...
• 21:33
  Dr. Komal Patil-Sisodia: And I track these things.
• 21:34
  Dr. Komal Patil-Sisodia: I look at cholesterol levels before and after.
• 21:36
  Dr. Komal Patil-Sisodia: I look at glucose levels before and after.
• 21:39
  Dr. Komal Patil-Sisodia: For some people, it actually helps drop the levels close to what the baseline was.
• 21:43
  Dr. Komal Patil-Sisodia: Not exactly there, but closer to what the baseline is.
• 21:47
  Dr. Komal Patil-Sisodia: For other people, it makes no difference at all, right?
• 21:49
  Dr. Komal Patil-Sisodia: Yeah.
• 21:49
  Dr. Komal Patil-Sisodia: And these are the things that we don't understand, but if we're not tracking, we'll never know.
• 21:52
  Dr. Komal Patil-Sisodia: Yeah.
• 21:52
  Dr. Komal Patil-Sisodia: And you can never, to your point, just blindly give somebody something and be like,"Oh, that's it for you.
• 21:57
  Dr. Komal Patil-Sisodia: You're good now," right?
• 21:58
  Dr. Komal Patil-Sisodia: That's not gonna work out well for people.
• 22:00
  Dr. Komal Patil-Sisodia: So I love the approach of making sure that, you know- how far out somebody is from menopause or if they're in that perimenopausal window.
• 22:08
  Dr. Komal Patil-Sisodia: I feel like we still need to do so much more research on perimenopausal women.
• 22:11
  Dr. Komal Patil-Sisodia: And the impact of this, because I think we may potentially see benefit.
• 22:15
  Dr. Komal Patil-Sisodia: At least that's what my gut tells me.
• 22:17
  Dr. Komal Patil-Sisodia: I don't have evidence for that.
• 22:18
  Dr. Komal Patil-Sisodia: So hopefully that's the case.
• 22:20
  Dr. Komal Patil-Sisodia: I think encouraging women that like getting this information about their health is going to be a way for them to take control over what their future is, right?
• 22:29
  Dr. Komal Patil-Sisodia: Because at the end of the day, like if you fall in that group of people who can't have hormones because you have a contraindication like a series of unprovoked blood clots or, a recent heart attack or stroke, or an estrogen fueled cancer of some sort, breast or gynecologic, a lot of women come into my office and they feel so hopeless.
• 22:46
  Dr. Komal Patil-Sisodia: They're like,"Oh my gosh- It's like- I'm just gonna die now because I have nothing else." And I tell them, I'm like, it's a series of pillars." Hormones are one piece of everything, and the reason we have medicine and we have research and we have innovation is that if you can't take option A, right?
• 23:02
  Dr. Komal Patil-Sisodia: You can take option B.
• 23:04
  Dr. Komal Patil-Sisodia: But if option A is something you can take but it's not working well for you, you still have option B, right?
• 23:10
  Dr. Komal Patil-Sisodia: Like we're trying to make sure that we're giving you all of the things that are getting your health back to a baseline where you're not increasing your risk for heart disease long term.
• 23:20
  Dr. Komal Patil-Sisodia: And that's a hard thing for people to swallow because I feel like they think that it's their fault or that they are failing or it's a moral failure on their end, when it's really your genetics are the hand of cards you were dealt in life.
• 23:33
  Dr. Komal Patil-Sisodia: It is what it is, right?
• 23:35
  Dr. Ambreen Mohamed: Yeah.
• 23:35
  Dr. Ambreen Mohamed: And I explain this to patients all the time, from, perimenopause and menopause aside, or even just women aside, women in general.
• 23:41
  Dr. Ambreen Mohamed: I really try to explain to patients that heart disease is not a one-size-fits-all.
• 23:45
  Dr. Ambreen Mohamed: Yeah.
• 23:45
  Dr. Ambreen Mohamed: And this goes back to just even foundational things"Doctor I have a great diet and I exercise.
• 23:51
  Dr. Ambreen Mohamed: My cholesterol shouldn't be like this," or,"I don't have to take medication because, I do all of these things.
• 23:57
  Dr. Ambreen Mohamed: Why do I have to do this?
• 23:58
  Dr. Ambreen Mohamed: Why is it still this way?" And I'm like,"Because it's not just your diet and exercise.
• 24:02
  Dr. Ambreen Mohamed: There's other things that come into play." And I think that, when we have patients that are coming into offices like yours or mine- a lot of times they're really in a vulnerable position, and they're just looking for any kind of help.
• 24:13
  Dr. Ambreen Mohamed: They're seeking any kind of answer.
• 24:15
  Dr. Ambreen Mohamed: And again, a lot of times they don't know- what they're looking for.
• 24:19
  Dr. Ambreen Mohamed: They just want you to help them.
• 24:21
  Dr. Ambreen Mohamed: And so when you tell them that, the thing that they think they need may not be the best option, it can be really frustrating for them, and so to then to explain like,"Hey," you have to be really gentle.
• 24:33
  Dr. Ambreen Mohamed: "Hey there's different options here.
• 24:35
  Dr. Ambreen Mohamed: We have, option A, option B, option C.
• 24:37
  Dr. Ambreen Mohamed: It doesn't mean that we can't help you.
• 24:39
  Dr. Ambreen Mohamed: We just have to tailor treatment individually for you, and it's also not gonna change overnight." I've seen a lot of female patients that are on hormone therapy, and they're like, my doctor started it, and I'm still not feeling better.
• 24:50
  Dr. Ambreen Mohamed: I don't understand," and all of this stuff.
• 24:51
  Dr. Ambreen Mohamed: And it's just"Hey it's not going to just shift overnight.
• 24:54
  Dr. Ambreen Mohamed: Sometimes it takes a little bit of trial and error to see what works for you."
• 24:57
  Dr. Komal Patil-Sisodia: Yeah.
• 24:58
  Dr. Komal Patil-Sisodia: And your silver bullet may not be somebody else's silver bullet, right?
• 25:01
  Dr. Komal Patil-Sisodia: Hormones may work well for patient A, but not work well for patient B, right?
• 25:05
  Dr. Komal Patil-Sisodia: Because the hormones may not be the actual problem, right?
• 25:09
  Dr. Komal Patil-Sisodia: That's the other thing, is if you don't see an improvement after a period of time, you have to be open to changing your approach.
• 25:15
  Dr. Komal Patil-Sisodia: You can't keep forcing the same thing and hoping for a different outcome.
• 25:19
  Dr. Komal Patil-Sisodia: It doesn't work that way, right?
• 25:20
  Dr. Komal Patil-Sisodia: But that's where that personalized, individualized care comes into play, and I think your patients are so lucky to have a cardiologist who looks at it that way, right?
• 25:29
  Dr. Komal Patil-Sisodia: I remember going with my mom to some of her early cardiology appointments, and there was one in particular that left me very rattled and very angry, because he just was not willing to listen to or work with my mom in any capacity.
• 25:43
  Dr. Komal Patil-Sisodia: Yeah.
• 25:43
  Dr. Komal Patil-Sisodia: And that's really hard to watch, right?
• 25:44
  Dr. Komal Patil-Sisodia: Especially when women in general don't tend to ask for help, and then you put them in a position where they feel like they have no options because nothing they're doing is right?
• 25:55
  Dr. Komal Patil-Sisodia: It actually just creates this environment where they don't wanna ask for help.
• 25:59
  Dr. Komal Patil-Sisodia: Yeah.
• 25:59
  Dr. Komal Patil-Sisodia: I think in general that's harder for women, but I think in South Asian women particularly, it tends to be hard, and we're both South Asian by background.
• 26:06
  Dr. Komal Patil-Sisodia: So
• 26:07
  Dr. Ambreen Mohamed: I'd
• 26:07
  Dr. Komal Patil-Sisodia: love to switch gears a little bit and talk about heart disease in South Asian women, because that tends to be a very high risk group, and that is really where you've put a lot of your efforts into education and putting good information out there, not just for South Asian women, but for South Asians in general.
• 26:24
  Dr. Komal Patil-Sisodia: So I'd like to chat with And I'll hand it over to you.
• 26:27
  Dr. Ambreen Mohamed: Yeah.
• 26:27
  Dr. Ambreen Mohamed: This has become like a passion project of mine.
• 26:29
  Dr. Ambreen Mohamed: And I will tell you, back in my day when I was doing fellowship- Yeah we didn't really learn about the nuances of this, we understood that, certain ethnicities had maybe a little bit of a higher risk, and so I knew a little bit, but I wasn't really- I don't know if I wasn't, if it was like I wasn't really taught, or we just weren't really exposed or, or whatever the case might be.
• 26:47
  Dr. Ambreen Mohamed: But it wasn't this whole thing of like we really have to be vigilant about, this particular type of ethnicity.
• 26:53
  Dr. Ambreen Mohamed: And it was only until recently when I started really, deep diving into the research and really, even just listening to family, listening to friends, listening to colleagues, listening to my community and their concerns, and really seeing patterns and really alarming rates of heart disease at younger ages which I was just like, what is happening here?" Yeah.
• 27:12
  Dr. Ambreen Mohamed: And why is this not being brought to more people's attention?
• 27:15
  Dr. Ambreen Mohamed: And then you talk to them and they don't even understand really what's going on because, it's everybody has diabetes.
• 27:22
  Dr. Ambreen Mohamed: Like- Yeah everybody has diabetes, right?
• 27:24
  Dr. Ambreen Mohamed: Or, one in two, three, four people have some type of heart issue.
• 27:28
  Dr. Ambreen Mohamed: It's so common- that people are just, they just live with it.
• 27:31
  Dr. Ambreen Mohamed: And they're just like,"Whatever.
• 27:32
  Dr. Ambreen Mohamed: It's just a part of how it is.
• 27:33
  Dr. Ambreen Mohamed: And so I'm just gonna continue doing what I'm doing.
• 27:35
  Dr. Ambreen Mohamed: It's not gonna make a difference.
• 27:36
  Dr. Ambreen Mohamed: It's still there." And so I think when we talk about why South Asians are at high risk, I put them into a couple of buckets.
• 27:43
  Dr. Ambreen Mohamed: I think there's the genetic bucket, where we have genetic, factors that cause us to have an increased risk of heart disease, and then there's the lifestyle bucket.
• 27:52
  Dr. Ambreen Mohamed: And now you put these things together and they start to compound on each other, and now you're left with some really, big consequences for our ethnicity.
• 28:02
  Dr. Ambreen Mohamed: And so when we talk about the genetic bucket, there's a few things.
• 28:05
  Dr. Ambreen Mohamed: We have a very complex lipid profile.
• 28:07
  Dr. Ambreen Mohamed: So it's not just the general cholesterol panel that hopefully all of us are getting screened once a year.
• 28:12
  Dr. Ambreen Mohamed: But a lot of times, our LDL, which is a quote unquote bad cholesterol, that's the type of cholesterol that can lead to plaque formation, so a lot of times, a lot of South Asians will have borderline LDL or sometimes even normal LDL.
• 28:25
  Dr. Ambreen Mohamed: But then you take a peek behind the curtain and you look at other, what we call advanced lipid markers.
• 28:29
  Dr. Ambreen Mohamed: So they can have higher rates of lipoprotein A.
• 28:32
  Dr. Ambreen Mohamed: So what is that?
• 28:32
  Dr. Ambreen Mohamed: Lipoprotein A is basically a cholesterol marker that makes the LDL stickier.
• 28:38
  Dr. Ambreen Mohamed: So what happens with that?
• 28:39
  Dr. Ambreen Mohamed: You have accelerated plaque progression a lot of times at earlier ages.
• 28:44
  Dr. Ambreen Mohamed: And many a times, your primary care doctor, not because they're bad or anything, they're just not checking for it because they don't know.
• 28:50
  Dr. Ambreen Mohamed: A lot of cardiologists, were not screening their patients for- protein A.
• 28:54
  Dr. Ambreen Mohamed: And this is a genetic marker that if it's high.
• 28:57
  Dr. Ambreen Mohamed: If it's low.
• 28:58
  Dr. Ambreen Mohamed: It doesn't really change over your lifetime.
• 28:59
  Dr. Ambreen Mohamed: Sometimes, diet and lifestyle can alter it a little bit, but we don't even have any medications right now specifically tailored to lower that.
• 29:06
  Dr. Ambreen Mohamed: There's some in development though, right?
• 29:08
  Dr. Ambreen Mohamed: There's some in development, and that's really exciting for us because we've never had a medication that could directly lower that.
• 29:13
  Dr. Ambreen Mohamed: And so hopefully within the next, year or two, we can start to see some of these medications on market.
• 29:18
  Dr. Ambreen Mohamed: But right now, like we have PCSK9 inhibitors like Repatha and that might lower it maybe like 20-ish percent, but there's not a clear indication there, right?
• 29:25
  Dr. Ambreen Mohamed: Like it's not guideline based that we can give that.
• 29:27
  Dr. Ambreen Mohamed: It's like a off-label thing.
• 29:29
  Dr. Ambreen Mohamed: Other than that, we put you on a statin, it's really because we're trying to reduce your future risk of heart disease, because it's gonna lower that.
• 29:34
  Dr. Ambreen Mohamed: So usually about one in four South Asians have an elevated LPA level, right?
• 29:40
  Dr. Ambreen Mohamed: And then we also have apolipoprotein B or ApoB.
• 29:43
  Dr. Ambreen Mohamed: So that actually has really come on the up and has really been seen as, this indicator of plaque formation in the future, increased risk of heart disease, in the future.
• 29:54
  Dr. Ambreen Mohamed: And why?
• 29:54
  Dr. Ambreen Mohamed: Because it's a surrogate for, atherogenic particles that are swimming around or a surrogate for LDL particle numbers.
• 30:00
  Dr. Ambreen Mohamed: So when you're looking at the general cholesterol profile and you look at that LDL, that's actually reflective of how heavy the LDL is, the mass.
• 30:07
  Dr. Ambreen Mohamed: And so then again, when you take a peek behind the curtain and you start looking at LDL particle numbers, you start looking at the size of the LDL, small versus big.
• 30:15
  Dr. Ambreen Mohamed: We know the smaller particles are the not so good ones'cause they have a easier way of causing plaque formation.
• 30:20
  Dr. Ambreen Mohamed: There's one ApoB that's attached to every LDL particle.
• 30:23
  Dr. Ambreen Mohamed: So the higher the ApoB, the more of a predisposition you would have- of a potentially developing plaque.
• 30:29
  Dr. Ambreen Mohamed: That has also been shown to be significantly more elevated in South Asians as well.
• 30:34
  Dr. Ambreen Mohamed: And so again, increasing your risk.
• 30:36
  Dr. Ambreen Mohamed: We also have more insulin resistance.
• 30:38
  Dr. Ambreen Mohamed: Diabetes runs rampant.
• 30:39
  Dr. Ambreen Mohamed: And it's not just diabetes.
• 30:41
  Dr. Ambreen Mohamed: This is even just pre-diabetes- and just having elevated fasting blood glucose.
• 30:44
  Dr. Ambreen Mohamed: Maybe you weren't diagnosed with diabetes yet, but you have a family history of it, so it's coming.
• 30:47
  Dr. Ambreen Mohamed: Reducing that- You're watching the train out of the corner of your eye.
• 30:50
  Dr. Ambreen Mohamed: And diabetes is one of the biggest risk factors for heart disease.
• 30:53
  Dr. Ambreen Mohamed: And then also just our genetic predisposition of our fat distribution.
• 30:57
  Dr. Ambreen Mohamed: So we tend to have more visceral fat.
• 31:00
  Dr. Ambreen Mohamed: That's that not so good fat that can be surrounded, on, around our organs.
• 31:04
  Dr. Ambreen Mohamed: And so We might look okay on the outside, but we might have something really bad going on the inside, and that visceral fat is actually metabolically active.
• 31:12
  Dr. Ambreen Mohamed: And so that means that it can lead to more insulin resistance, and it can potentially change your lipid profile.
• 31:20
  Dr. Ambreen Mohamed: It can potentially lead to increased inflammatory markers.
• 31:23
  Dr. Ambreen Mohamed: So again, all of this can increase your risk of heart disease, and most of us are very unaware.
• 31:29
  Dr. Ambreen Mohamed: And then you have the lifestyle bucket.
• 31:31
  Dr. Ambreen Mohamed: So we tend to not have the greatest diet.
• 31:34
  Dr. Ambreen Mohamed: Our food tastes amazing, but it's not always- good for us, right?
• 31:38
  Dr. Ambreen Mohamed: Yeah.
• 31:38
  Dr. Ambreen Mohamed: We tend to have more sedentary lifestyles.
• 31:40
  Dr. Ambreen Mohamed: Like physical activity in our community is not something that is celebrated or I would say is considered normal.
• 31:47
  Dr. Ambreen Mohamed: We don't tend to deal with our stress very well.
• 31:50
  Dr. Ambreen Mohamed: And that could be for a lot of reasons.
• 31:51
  Dr. Ambreen Mohamed: There's a lot of immigrants in this country coming from South Asia that have to deal with a lot of stress of, like adjusting to a new country.
• 31:57
  Dr. Ambreen Mohamed: There's a lot of family dynamic issues.
• 31:59
  Dr. Ambreen Mohamed: Chronic stress is just something that we all, deal with.
• 32:02
  Dr. Ambreen Mohamed: And then I think, also just, looking at sleep patterns and all of those things.
• 32:07
  Dr. Ambreen Mohamed: So I think, taking everything together, again, it's not just we eat bad food.
• 32:12
  Dr. Ambreen Mohamed: You take the genetics plus the bad food, the genetics plus the chronic stress, the genetics plus the sedentary lifestyle, and you start to compound this stuff, you're starting to see higher rates of heart disease much earlier.
• 32:23
  Dr. Komal Patil-Sisodia: And it's interesting because when I look at my family history, my grandfather, my paternal grandfather, he had diabetes.
• 32:31
  Dr. Komal Patil-Sisodia: It was totally diet controlled, but he was a civil engineer.
• 32:34
  Dr. Komal Patil-Sisodia: And he owned farmland.
• 32:36
  Dr. Komal Patil-Sisodia: So back in India, he was walking all his civil engineering projects.
• 32:38
  Dr. Komal Patil-Sisodia: He was walking his farmland every day.
• 32:40
  Dr. Komal Patil-Sisodia: And he lived well into his 80s and had a stroke then, but was never on any diabetes medications, right?
• 32:46
  Dr. Komal Patil-Sisodia: We moved to the States, where it's higher stress, more sedentary, all of these things, and my dad had a much harder time controlling his diabetes just because of the change in the environment, right?
• 32:56
  Dr. Komal Patil-Sisodia: And the change of the stressors.
• 32:57
  Dr. Komal Patil-Sisodia: So it's very interesting to see that difference generationally.
• 33:01
  Dr. Komal Patil-Sisodia: And then I think, to your point, all of that compounded, we see that increased risk of heart disease as well.
• 33:07
  Dr. Komal Patil-Sisodia: I know you had mentioned the MASALA Study when we were talking earlier.
• 33:11
  Dr. Komal Patil-Sisodia: Can you talk a little bit about that?
• 33:12
  Dr. Komal Patil-Sisodia: Because I don't think I've read that one.
• 33:14
  Dr. Komal Patil-Sisodia: I'd love to hear it.
• 33:15
  Dr. Ambreen Mohamed: Yeah.
• 33:15
  Dr. Ambreen Mohamed: So the MASALA Study, and don't ask me what it stands for.
• 33:18
  Dr. Ambreen Mohamed: I already forgot.
• 33:18
  Dr. Ambreen Mohamed: But it basically is like the first of its kind, where it was studying South Asian population within the United States.
• 33:26
  Dr. Ambreen Mohamed: So it basically started in San Francisco and Chicago at two big academic centers, and they were studying basically South Asians and why, South Asians were getting heart disease- at earlier ages or why their risk was elevated.
• 33:41
  Dr. Ambreen Mohamed: So they were looking basically at all of these parameters looking at lipid profiles, looking at, coronary CTAs and calcium scores to see, do they have, an increased amount of plaque?
• 33:51
  Dr. Ambreen Mohamed: Do they have increased, calcification in their arteries?
• 33:54
  Dr. Ambreen Mohamed: They were looking at fat distribution and found that, there was more of that centripetal obesity and visceral fat.
• 34:00
  Dr. Ambreen Mohamed: And the way that they were able to find that out is that they actually did CAT scans and saw that there was more of a visceral fat distribution in this patient population.
• 34:07
  Dr. Ambreen Mohamed: Chronic stress and then dietary patterns, and then looking at all of these things and seeing what the heart disease rates were.
• 34:13
  Dr. Ambreen Mohamed: MASALA was just I think an initial project, and then the sub-studies that have come from it- Yeah there are multiple studies that have come from it.
• 34:21
  Dr. Ambreen Mohamed: Even until this day, they're still doing more and more studies on this- patient population, to really understand the demographics.
• 34:28
  Dr. Ambreen Mohamed: It's...
• 34:29
  Dr. Ambreen Mohamed: I feel like prior to MASALA really the I feel like the research within our, community- It was,
• 34:34
  Dr. Komal Patil-Sisodia: like, nonexistent.
• 34:35
  Dr. Ambreen Mohamed: So this was actually pretty revolutionary for us, especially in the United States for it to be understood.
• 34:41
  Dr. Ambreen Mohamed: And now if you actually look at guidelines, back in 2019, the ACCHA came out with the prevention guidelines, and being of South Asian ancestry is considered a high risk-enhancing factor.
• 34:55
  Dr. Ambreen Mohamed: That is with no other ethnicity.
• 34:57
  Dr. Ambreen Mohamed: These people are paving the way for us to be able to be understood on a greater scale.
• 35:02
  Dr. Ambreen Mohamed: And you and I talked offline a little bit about this before, about, how the general, risk calculators that are out there, ACCHA just came out with the PREVENT calculator.
• 35:11
  Dr. Ambreen Mohamed: It used to be something a little bit different before.
• 35:14
  Dr. Ambreen Mohamed: But it's still not taking different ethnicities, especially our ethnicity, into consideration and our factors into consideration.
• 35:21
  Dr. Ambreen Mohamed: For example, if I had an elevated LPA and I had a larger waist circumference but my BMI was normal, my cholesterol profile looked normal, I had a normal blood pressure, I don't smoke, no diabetes, my risk score, 10-year risk score for developing heart disease would be very low.
• 35:36
  Dr. Ambreen Mohamed: But that's actually not the case.
• 35:38
  Dr. Ambreen Mohamed: But it won't be picked up by that.
• 35:39
  Dr. Ambreen Mohamed: And if that could potentially cause a huge issue down the line, I have a problem with that, and so I just, I feel like we just need to continue to have open conversations about this.
• 35:49
  Dr. Ambreen Mohamed: I'm so proud of the people that started this research and continue to do this research.
• 35:53
  Dr. Ambreen Mohamed: Now there have been more, research studies that have come up.
• 35:56
  Dr. Ambreen Mohamed: There's been the INTERHEART study.
• 35:58
  Dr. Ambreen Mohamed: That's more of a global study.
• 35:59
  Dr. Ambreen Mohamed: There's been the LALE study that recently came out.
• 36:02
  Dr. Ambreen Mohamed: There's a lot of South Asian cardiologists have now, big academic centers have been studying this as well.
• 36:07
  Dr. Ambreen Mohamed: And so I really think that there's more and more of an effort to Get more of this information out there and study our patient population at a grander scale to be able to make more of an impact.
• 36:17
  Dr. Komal Patil-Sisodia: I think that's fantastic, right?
• 36:18
  Dr. Komal Patil-Sisodia: And I have so many questions too.
• 36:20
  Dr. Komal Patil-Sisodia: My sisters and I, we've been getting screened for heart disease since our mid-30s, since our mom was, like, 42 when she had hers.
• 36:27
  Dr. Komal Patil-Sisodia: And it was interesting for me that I, after I had my son, I struggled a bit with my weight, and so I really...
• 36:35
  Dr. Komal Patil-Sisodia: But at that point, my lipoprotein little a was normal, and I did all of the lifestyle things, lost weight on my own, I work out several times a week, I cook at home, and I hit perimenopause, and it doubled, and it went to 98, right?
• 36:47
  Dr. Komal Patil-Sisodia: Yeah.
• 36:48
  Dr. Komal Patil-Sisodia: And all of my lifestyle stuff was dialed in.
• 36:50
  Dr. Komal Patil-Sisodia: I was healthier in perimenopause than I was five years prior.
• 36:54
  Dr. Komal Patil-Sisodia: And so for me, it's always been like what the heck?
• 36:56
  Dr. Komal Patil-Sisodia: I can't really do anything else," right?
• 36:59
  Dr. Komal Patil-Sisodia: Yeah.
• 36:59
  Dr. Komal Patil-Sisodia: And so I think we- I have so many questions around what does happen, right?
• 37:03
  Dr. Komal Patil-Sisodia: For people who have these high-risk features i- especially in our South Asian communities, right?
• 37:09
  Dr. Komal Patil-Sisodia: What is the effect of estrogen on those women, right?
• 37:12
  Dr. Komal Patil-Sisodia: Because it, the, right now, the current guideline says you check lipoprotein little a once in your life.
• 37:18
  Dr. Komal Patil-Sisodia: Yes.
• 37:18
  Dr. Komal Patil-Sisodia: But what if you check it when you're 30 and not when you're 45?
• 37:21
  Dr. Komal Patil-Sisodia: And it's important to- So it's a really,
• 37:23
  Dr. Ambreen Mohamed: it's a really good point that you brought up that I forgot to mention before- Yeah when it came to lipoprotein, but there actually has been, some research has been done that shows that estrogen estrogen and hormone replacement therapy can actually decrease lipoproteinlevels.
• 37:37
  Dr. Ambreen Mohamed: Again, should not be used as a sole treatment.
• 37:39
  Dr. Ambreen Mohamed: Correct.
• 37:40
  Dr. Ambreen Mohamed: Yeah.
• 37:40
  Dr. Ambreen Mohamed: It just goes to show that, it can potentially be beneficial, and it is something that needs to be studied more.
• 37:46
  Dr. Ambreen Mohamed: Yeah.
• 37:46
  Dr. Ambreen Mohamed: Because if it can be given in a way where women are at significantly higher risk- Yeah and it can be given safely and potentially help them, I think that would be a huge game changer as well, right?
• 37:56
  Dr. Ambreen Mohamed: Totally.
• 37:57
  Dr. Ambreen Mohamed: Because this is killing people, worldwide.
• 37:59
  Dr. Ambreen Mohamed: Yeah.
• 38:00
  Dr. Ambreen Mohamed: And so what are different ways that we can be able to, treat it?
• 38:03
  Dr. Ambreen Mohamed: So I think that there's, a lot of more interesting things to learn- and so much more research to be done to be able to help people.
• 38:10
  Dr. Komal Patil-Sisodia: Yeah.
• 38:11
  Dr. Komal Patil-Sisodia: And it's interesting, like I had somebody ask me, they're like what does South Asian mean?
• 38:15
  Dr. Komal Patil-Sisodia: What countries are those," right?
• 38:16
  Dr. Komal Patil-Sisodia: And I was like I'm pretty sure it's like India, Pakistan, Nepal, Afghanistan." But the rest of Asia has pretty low cardiovascular risk except for when you get out to the Philippines.
• 38:26
  Dr. Komal Patil-Sisodia: I think their heart disease is also like ours for whatever reason, right?
• 38:30
  Dr. Komal Patil-Sisodia: Or similarly in that way.
• 38:32
  Dr. Komal Patil-Sisodia: But I think just for understanding, like if you are from a country that is not South Asia, and I had to Google this to figure out which ones were in there because my patient asked
• 38:42
  Dr. Ambreen Mohamed: I know.
• 38:42
  Dr. Ambreen Mohamed: It's seven or eight countries that are within that South Asian continent.
• 38:46
  Dr. Ambreen Mohamed: But it doesn't necessarily mean that if you're not within that specific continent- you do not have an elevated risk at all.
• 38:52
  Dr. Ambreen Mohamed: This can go into, Middle Eastern ancestry.
• 38:54
  Dr. Ambreen Mohamed: This can go into- the Southeast Asian, you know- Asia area.
• 38:57
  Dr. Ambreen Mohamed: And so I just think like looking at, even African Americans, like the black population- actually has elevated LPA levels, across- the board as well.
• 39:05
  Dr. Ambreen Mohamed: So it doesn't just mean that, oh, we're the highest risk and we shouldn't pay attention to anybody else.
• 39:10
  Dr. Ambreen Mohamed: But Yeah unfortunately, just with everything like we talked about compounding, we are, at a very elevated risk and it shouldn't be ignored.
• 39:16
  Dr. Komal Patil-Sisodia: Yeah.
• 39:17
  Dr. Komal Patil-Sisodia: And it's interesting because I read all those lipoprotein little A studies that you were talking about with the estrogen.
• 39:22
  Dr. Komal Patil-Sisodia: As soon as I realized mine had doubled and I like freaked out, but you're right, like there's no data showing that even lowering those lipoprotein little A levels will prevent heart disease in the future.
• 39:33
  Dr. Komal Patil-Sisodia: So what does that mean?
• 39:33
  Dr. Komal Patil-Sisodia: Yeah.
• 39:34
  Dr. Komal Patil-Sisodia: We don't really actually know, right?
• 39:35
  Dr. Komal Patil-Sisodia: No.
• 39:36
  Dr. Komal Patil-Sisodia: Yeah.
• 39:36
  Dr. Komal Patil-Sisodia: But I think just the act of being aware sets people up on such a better trajectory than being like-"Meh, doesn't matter," right?
• 39:43
  Dr. Komal Patil-Sisodia: So- yeah.
• 39:43
  Dr. Komal Patil-Sisodia: It's it's definitely fascinating.
• 39:45
  Dr. Komal Patil-Sisodia: I feel like I could talk about this stuff all day.
• 39:49
  Dr. Komal Patil-Sisodia: I have so many questions both selfishly and for our listeners- Yeah who are there.
• 39:54
  Dr. Komal Patil-Sisodia: Absolutely.
• 39:55
  Dr. Ambreen Mohamed: It's hard to fit all this information in just an hour, that's why this podcast is wonderful and it's gonna educate a lot of people.
• 40:01
  Dr. Ambreen Mohamed: But I also think putting the information out there day to day and, having people follow along- for a long period of time, you'll be able to learn a lot, as we're learning too.
• 40:10
  Dr. Ambreen Mohamed: It's not like we know everything.
• 40:11
  Dr. Ambreen Mohamed: We're learning this stuff, too.
• 40:12
  Dr. Ambreen Mohamed: Yeah.
• 40:13
  Dr. Komal Patil-Sisodia: Exactly.
• 40:13
  Dr. Komal Patil-Sisodia: And I think, that's the thing that people have to realize is doctors don't have all the answers, right?
• 40:19
  Dr. Komal Patil-Sisodia: And what we tell you today could be different in five years, because there's- gonna be research that happens in those five years, right?
• 40:24
  Dr. Komal Patil-Sisodia: So it's important to- If
• 40:26
  Dr. Ambreen Mohamed: doctors could just be given...
• 40:27
  Dr. Ambreen Mohamed: if we could just be cut some slack.
• 40:29
  Dr. Komal Patil-Sisodia: Just a tiny bit.
• 40:30
  Dr. Komal Patil-Sisodia: Tiny bit, right?
• 40:31
  Dr. Komal Patil-Sisodia: But we don't know, right?
• 40:32
  Dr. Komal Patil-Sisodia: God, our creator, whoever you believe, created the system, created our bodies, right?
• 40:37
  Dr. Komal Patil-Sisodia: Mother Nature, whatever you wanna call it, we know a fraction of what our creator intended.
• 40:41
  Dr. Komal Patil-Sisodia: And it's...
• 40:42
  Dr. Komal Patil-Sisodia: I will say that being a doctor is probably one of the most humbling professions.
• 40:46
  Dr. Komal Patil-Sisodia: It really is.
• 40:46
  Dr. Komal Patil-Sisodia: Because the more you learn, the more you realize you don't actually know a whole lot, right?
• 40:50
  Dr. Ambreen Mohamed: And we have to be very honest about it, right?
• 40:53
  Dr. Ambreen Mohamed: There is so much to say about, what a privilege it is to be a physician, to be able to be knowledgeable in your field, all of this stuff, but then at the same time to also understand that there is a lot of unknown.
• 41:05
  Dr. Ambreen Mohamed: And to be able to show that to your patients"Hey, sometimes I'm not going to have all of the answers." And sometimes it is gonna take a little bit of trial and error, or sometimes we have to learn a little bit more about this, and that's okay, right?
• 41:19
  Dr. Ambreen Mohamed: I am not an encyclopedia.
• 41:20
  Dr. Ambreen Mohamed: I still have to study and learn.
• 41:22
  Dr. Ambreen Mohamed: Everybody has to study and learn.
• 41:24
  Dr. Ambreen Mohamed: And so pe- you know, I feel like people should be giving us a little bit of grace, but then we also shouldn't put out there that we know everything, because we don't.
• 41:31
  Dr. Ambreen Mohamed: That's right.
• 41:31
  Dr. Ambreen Mohamed: And there are people- Yes that are in our profession that do put out there that they know everything, and they are overly confident, and, I don't know if that's the best way to be.
• 41:40
  Dr. Ambreen Mohamed: I think it's good to be confident.
• 41:41
  Dr. Ambreen Mohamed: Of course, be confident- Yeah about the stuff you know, but then also- Yeah be confident in saying"Hey, there, there are some things that I don't know, and I'm still learning, and I'm still growing, and if it's not in my field-" Exactly I'm definitely going to leave it to somebody who knows better.
• 41:53
  Dr. Komal Patil-Sisodia: Yeah, and I think that's a shift away from patriarchal medicine and the Socratic method of how we u- used to get taught, right?
• 42:01
  Dr. Komal Patil-Sisodia: You had to be confident and, I'll say 50 years ago there was less stuff to know because there was less research.
• 42:07
  Dr. Komal Patil-Sisodia: Yeah.
• 42:07
  Dr. Komal Patil-Sisodia: You didn't know everything- Absolutely that there was to know at that time.
• 42:10
  Dr. Komal Patil-Sisodia: Yeah.
• 42:10
  Dr. Komal Patil-Sisodia: But that doesn't mean that's always gonna be the case.
• 42:12
  Dr. Komal Patil-Sisodia: So I love that, and I think that, If more doctors are embracing that mindset, we can actually help people more so with prevention as opposed to treating the end stage of disease, and I think, we can very nicely segue our conversation to there, because I did wanna talk to you about, when you are coming in to see a cardiologist or you know you have a high-risk family history, what are the tests that one, women should ask for, and two, if you have, strong family history or South Asian profile or you're in some other high-risk group what are the things you should be asking for?
• 42:46
  Dr. Ambreen Mohamed: Yeah.
• 42:46
  Dr. Ambreen Mohamed: So it's not just the annual, Unfortunately, it's not just the annual checkup.
• 42:50
  Dr. Ambreen Mohamed: Yeah.
• 42:50
  Dr. Ambreen Mohamed: One of the main things that I'm really try- trying to push our community, and it really should be pushed in women as well, is you need to ask for more.
• 42:58
  Dr. Ambreen Mohamed: And so what is that?
• 42:59
  Dr. Ambreen Mohamed: We talked about some of this stuff before, but it's not only just the complete lipid panel, but it's also getting additional markers like ApoB and lipoprotein A, especially if you haven't gotten screened before.
• 43:08
  Dr. Ambreen Mohamed: You absolutely should get that checked at least by the time that you're 30.
• 43:11
  Dr. Ambreen Mohamed: If you have a strong family history of heart disease, I would advocate getting the lipoprotein A checked maybe a little bit earlier in your 20s.
• 43:18
  Dr. Ambreen Mohamed: But, at least by the time you're 30, you need to start really working on, prevention and getting some of this stuff screened.
• 43:25
  Dr. Ambreen Mohamed: So the lipoprotein A, getting a full lipid panel, getting an A1C, getting a fasting blood glucose.
• 43:31
  Dr. Ambreen Mohamed: I kinda wanna know your thoughts on fasting insulin level, because I see a lot of that and I know fasting insulin levels can be elevated in patients that don't necessarily have diabetes.
• 43:44
  Dr. Ambreen Mohamed: Yeah.
• 43:45
  Dr. Ambreen Mohamed: But I don't really strongly advocate for it because I feel like it should only be done, in certain like-
• 43:50
  Dr. Komal Patil-Sisodia: yeah.
• 43:50
  Dr. Komal Patil-Sisodia: I would agree with that, right?
• 43:51
  Dr. Komal Patil-Sisodia: I think we can- look at the pattern of tests sometimes and just know somebody is insulin resistant, right?
• 43:58
  Dr. Komal Patil-Sisodia: Like for example, if in your 20s your fasting glucose is around 70, right?
• 44:03
  Dr. Komal Patil-Sisodia: And then every year you're gaining a few pounds here and there, and then by the time you hit 30 your fasting glucose is like in the 80s, right?
• 44:11
  Dr. Komal Patil-Sisodia: That's a 10-point jump.
• 44:12
  Dr. Komal Patil-Sisodia: You've developed some insulin resistance there because your beta cells, in my opinion, are like factory assembly line, right?
• 44:19
  Dr. Komal Patil-Sisodia: And when you get more visceral fat, it's like the factory assembly line has to run faster.
• 44:23
  Dr. Komal Patil-Sisodia: You have to make more insulin to cover the same number of carbs when you gain more visceral fat.
• 44:28
  Dr. Ambreen Mohamed: And
• 44:28
  Dr. Komal Patil-Sisodia: so you see this creep in blood sugar slowly that goes up over time, right?
• 44:33
  Dr. Komal Patil-Sisodia: So if your fasting blood sugar goes from 70s to 80s to 90s and it's hovering you have developed insulin resistance.
• 44:40
  Dr. Komal Patil-Sisodia: I don't necessarily need an insulin level to tell you that.
• 44:43
  Dr. Komal Patil-Sisodia: But sometimes in women who have PCOS and we're doing that initial thing and they're having a hard time understanding or believing it, sometimes as from a demonstrative perspective for people who want to see that insulin level, it can be a helpful tool, right?
• 44:59
  Dr. Komal Patil-Sisodia: Do we need it?
• 45:00
  Dr. Komal Patil-Sisodia: No.
• 45:00
  Dr. Komal Patil-Sisodia: Can it be helpful to help people understand their disease?
• 45:04
  Dr. Komal Patil-Sisodia: Yes.
• 45:04
  Dr. Komal Patil-Sisodia: It's not recommended in any of the guidelines, and usually by the time people have an elevated A1C they...
• 45:12
  Dr. Komal Patil-Sisodia: That's why we have two things that we look for prediabetes now, right?
• 45:15
  Dr. Komal Patil-Sisodia: We look at either an elevated fasting blood glucose between 100 and 125 for a diagnosis of prediabetes, or an A1C of 5.7 or to 6.4, right?
• 45:26
  Dr. Komal Patil-Sisodia: Yeah.
• 45:26
  Dr. Komal Patil-Sisodia: You only need one to be abnormal to, for it to be true, and the number of people who I have who have normal glucose but a slightly elevated A1C, those, there's insulin resistance there.
• 45:37
  Dr. Komal Patil-Sisodia: So I feel like I can talk patients through it where we don't necessarily need those levels, but then, some people are like,"I really just want to see the numbers so I feel better about it and I understand how it's impacting." I have one of my partners, she is a PCOS expert, she advocates for insulin levels in everybody, right?
• 45:55
  Dr. Komal Patil-Sisodia: And when she sees her patients, she will check them again and- You know, if they're struggling with overweight or obesity, she's also an obesity medicine specialist- and she puts them on a GLP-1-
• 46:03
  Dr. Ambreen Mohamed: it's
• 46:03
  Dr. Komal Patil-Sisodia: really nice to see that insulin resistance come down.
• 46:06
  Dr. Komal Patil-Sisodia: So I think from that perspective, it can be a very helpful teaching tool.
• 46:10
  Dr. Komal Patil-Sisodia: Do I need it to make a diagnosis?
• 46:12
  Dr. Komal Patil-Sisodia: Probably not.
• 46:12
  Dr. Ambreen Mohamed: Some of the other, things should be checked.
• 46:15
  Dr. Ambreen Mohamed: We talked about lipid profile, ApoB, lipoprotein A, fasting glucose, A1C, and then also other things outside of your blood work.
• 46:23
  Dr. Ambreen Mohamed: So if you have a normal BMI, you would also at least once would wanna get your waist circumference checked as well, right?
• 46:30
  Dr. Ambreen Mohamed: Because we know that there can be a difference where your BMI could be normal and you could be considered normal weight, but you could still be at an increased risk.
• 46:38
  Dr. Ambreen Mohamed: So also getting your waist circumference checked, looking at your blood pressure, and not only just getting it checked once, but also making sure that you're looking at trends, right?
• 46:45
  Dr. Ambreen Mohamed: Especially if you have a history, like a family history of high blood pressure.
• 46:49
  Dr. Ambreen Mohamed: And then also not just saying"Oh, my blood pressure looks normal and I don't ever have to care," or the top number is normal.
• 46:57
  Dr. Ambreen Mohamed: Even the bottom, the diastolic number matters.
• 47:00
  Dr. Ambreen Mohamed: And we've, had many updates to our blood pressure guidelines over the years where we can see that it's just getting stricter and stricter.
• 47:06
  Dr. Ambreen Mohamed: And so even when you're in a pre-hypertension stage-
• 47:09
  Dr. Komal Patil-Sisodia: Yeah
• 47:10
  Dr. Ambreen Mohamed: it still can increase your risk, right?
• 47:12
  Dr. Ambreen Mohamed: And then also looking at, your history and your family history.
• 47:16
  Dr. Ambreen Mohamed: So do you have a family history of heart disease?
• 47:18
  Dr. Ambreen Mohamed: Do you have a family history of premature heart disease?
• 47:20
  Dr. Ambreen Mohamed: Do you have a, if you're, if you've been pregnant before, do you have a history of gestational hypertension?
• 47:25
  Dr. Ambreen Mohamed: Do you have a history of gestational diabetes?
• 47:27
  Dr. Ambreen Mohamed: Do you have a history of having any pregnancy complications?
• 47:30
  Dr. Ambreen Mohamed: Did you have postpartum complications?
• 47:32
  Dr. Ambreen Mohamed: Did you have preterm, delivery?
• 47:34
  Dr. Ambreen Mohamed: All of these things matter because this can increase your risk in the future as well.
• 47:37
  Dr. Ambreen Mohamed: What is your physical activity like?
• 47:39
  Dr. Ambreen Mohamed: Are you sedentary?
• 47:40
  Dr. Ambreen Mohamed: Are you moving?
• 47:40
  Dr. Ambreen Mohamed: What kind of foods are you eating?
• 47:41
  Dr. Ambreen Mohamed: What are your dietary patterns like?
• 47:43
  Dr. Ambreen Mohamed: And then what are your sleeping habits like?
• 47:45
  Dr. Ambreen Mohamed: Because we also know that patients that don't sleep well and don't sleep consistent- that can in and of itself, increase your risk for heart disease.
• 47:52
  Dr. Komal Patil-Sisodia: Yeah.
• 47:52
  Dr. Komal Patil-Sisodia: And there is an association between sleep apnea and heart disease as well, correct?
• 47:57
  Dr. Komal Patil-Sisodia: Yes.
• 47:58
  Dr. Komal Patil-Sisodia: Yeah.
• 47:58
  Dr. Komal Patil-Sisodia: Absolutely.
• 47:59
  Dr. Komal Patil-Sisodia: And I think it's underdiagnosed,
• 48:01
  Dr. Ambreen Mohamed: It's very significantly underdiagnosed because I think it used to be, it used to just be seen as like a diagnosis in- overweight or obese people, but that's not really the case anymore.
• 48:11
  Dr. Ambreen Mohamed: And so we know that, and like for us, like we see a lot of patients with high blood pressure, and one of the things that we'll do, or even just arrhythmias, and we know that sleep apnea can trigger arrhythmias.
• 48:21
  Dr. Ambreen Mohamed: We also know sleep apnea is a Huge cause for high blood pressure, and a lot of patients have no idea that they have sleep apnea.
• 48:28
  Dr. Ambreen Mohamed: And so once we get them screened, all of a sudden they get diagnosed with it, they start, wearing a CPAP and, their numbers get better and it's"Whoa, like I, I didn't even know that this was like an issue." So absolutely it's a huge risk factor.
• 48:41
  Dr. Ambreen Mohamed: And I would say the other thing, like the only diagnostic test I would consider would be a coronary artery calcium score.
• 48:47
  Dr. Ambreen Mohamed: Now- Okay.
• 48:48
  Dr. Ambreen Mohamed: That's fair yeah, there's a lot of nuance to this, and I think, again, I have a love-hate relationship with coronary artery calcium scores.
• 48:54
  Dr. Ambreen Mohamed: It's a huge thing.
• 48:55
  Dr. Ambreen Mohamed: But, if you are borderline or intermediate risk we talk about that like prevent like we, there's, we're, talking about a lot.
• 49:03
  Dr. Komal Patil-Sisodia: We've been all over the place today.
• 49:04
  Dr. Ambreen Mohamed: Yeah, so but that prevent risk calculator, and you can find it on ACC website, there's different like risk categories.
• 49:11
  Dr. Ambreen Mohamed: So if you're at like the borderline or intermediate risk where you're not really sure if a patient should be started on statin therapy or they'll benefit from it or maybe they're a little bit hesitant, then you can get a coronary artery calcium score.
• 49:23
  Dr. Ambreen Mohamed: Now the guidelines are saying in men that are greater than 40, women that are greater than 45.
• 49:28
  Dr. Ambreen Mohamed: It doesn't mean across the board everybody gets it.
• 49:31
  Dr. Ambreen Mohamed: It doesn't mean that if you're already on cholesterol lowering therapy, you get it.
• 49:34
  Dr. Ambreen Mohamed: You do not get it.
• 49:36
  Dr. Ambreen Mohamed: That's one of my biggest pet peeves.
• 49:37
  Dr. Ambreen Mohamed: People are just getting serial, coronary artery calcium scores.
• 49:40
  Dr. Ambreen Mohamed: They're not getting any utility from it.
• 49:42
  Dr. Ambreen Mohamed: Their score's going up.
• 49:43
  Dr. Ambreen Mohamed: They're on, statins.
• 49:44
  Dr. Ambreen Mohamed: They have no idea why.
• 49:44
  Dr. Ambreen Mohamed: I'm like, this is not- Yeah a detector for plaque." That's not what it's used for.
• 49:48
  Dr. Ambreen Mohamed: But it can be used in certain scenarios where you're unsure about whether to start lipid lowering therapies or not, and sometimes if even if it's a little bit elevated, then we'll say"Hey, you're already starting to develop calcified plaque.
• 50:01
  Dr. Ambreen Mohamed: It may be a good idea for us, to start this." So that's like the one thing that's like a little bit nuanced.
• 50:05
  Dr. Ambreen Mohamed: I don't like to say like absolutely get it, but as long as it's done in the appropriate cases, I think it could be useful.
• 50:11
  Dr. Komal Patil-Sisodia: Yeah.
• 50:12
  Dr. Komal Patil-Sisodia: So I'm starting to hear a lot online about CT coronary angiogram.
• 50:16
  Dr. Komal Patil-Sisodia: You knew I was gonna ask.
• 50:17
  Dr. Komal Patil-Sisodia: I'm just curious, what is the utility there, right?
• 50:20
  Dr. Komal Patil-Sisodia: Yeah.
• 50:20
  Dr. Komal Patil-Sisodia: So
• 50:21
  Dr. Ambreen Mohamed: It's so funny that you mention that.
• 50:22
  Dr. Ambreen Mohamed: So in my practice, I actually work a lot with AI analysis, even with coronary CTAs and, just all of the advancements is- significantly different than what we used to do before.
• 50:34
  Dr. Ambreen Mohamed: Even when I was in fellowship, we barely were using coronary CTAs, and now we're, using them so often.
• 50:38
  Dr. Ambreen Mohamed: I use them a lot more than I just do, stress tests.
• 50:41
  Dr. Ambreen Mohamed: Now, I think the thing that people have to understand is even, guidelines now do not support coronary CTAs for the general public.
• 50:48
  Dr. Ambreen Mohamed: So just because you want one doesn't mean you can have one, which is gonna be covered by insurance.
• 50:52
  Dr. Ambreen Mohamed: You have to have an indication for it.
• 50:54
  Dr. Ambreen Mohamed: Do I think it's an amazing test?
• 50:55
  Dr. Ambreen Mohamed: Yeah.
• 50:56
  Dr. Ambreen Mohamed: It's a non-invasive angiogram, and it's, like the quality's become so good, and now with these like AI analysis platforms, with HeartFlow, we have Clearly, these startup companies that are doing amazing.
• 51:05
  Dr. Ambreen Mohamed: I think, we can actually see really r- really good resolution, on this plaque, and it's saved a lot of lives.
• 51:12
  Dr. Ambreen Mohamed: It's helped a lot of people understand what's actually going on.
• 51:16
  Dr. Ambreen Mohamed: I wish it was available to more people, but if the general public wants to get it, they have to pay money.
• 51:20
  Dr. Ambreen Mohamed: So do I think it's indicated?
• 51:23
  Dr. Ambreen Mohamed: No, unless you're having symptoms, you have an abnormal stress test, you speak with your cardiologist, but do I think it's something that could be really beneficial?
• 51:31
  Dr. Ambreen Mohamed: Yeah I've actually changed my attitude a little bit.
• 51:32
  Dr. Ambreen Mohamed: I used to think- Yeah"Why are people doing this?" And now I really think it can be beneficial because I feel like once you see that you have plaque in your arteries, if you were not taking your health seriously before- 100%, yeah I believe you are gonna be taking it seriously now.
• 51:44
  Dr. Ambreen Mohamed: And I'll, I'll I'll kinda give a little side stories.
• 51:47
  Dr. Ambreen Mohamed: We recently had the American College of Cardiology National Conference a couple weeks ago, and my company was doing...
• 51:53
  Dr. Ambreen Mohamed: They paired with HeartFlow to do screening CCTAs for- conference participants, and that has never been done at a conference before.
• 52:01
  Dr. Ambreen Mohamed: Bringing in a mobile CTA- to the conference- to do this.
• 52:04
  Dr. Ambreen Mohamed: And so I was lucky enough to get one'cause I was like,"Hey, I'm just gonna put myself on the wait list and see- if I'm lucky enough to get one." And it was like the coolest, craziest experience.
• 52:14
  Dr. Ambreen Mohamed: Amazing.
• 52:15
  Dr. Ambreen Mohamed: I know.
• 52:16
  Dr. Ambreen Mohamed: But then to think"Oh, my God.
• 52:18
  Dr. Ambreen Mohamed: Now, if I have something, I'm a cardiologist." This doesn't feel good.
• 52:23
  Dr. Ambreen Mohamed: I was so scared.
• 52:24
  Dr. Ambreen Mohamed: I was like,"If I have something what am I going to do?" But fortunately, everything was fine, but it really was an eye-opening experience for me.
• 52:31
  Dr. Ambreen Mohamed: Yeah.
• 52:32
  Dr. Ambreen Mohamed: And then just hearing stories of other participants, and the fact that people were having things diagnosed that they didn't know about before, and these are all cardiologists that are getting screened, it's just a wild thing to think about.
• 52:44
  Dr. Ambreen Mohamed: But I really think we're gonna start to see a shift in how coronary artery disease is screened and treated in the future, in the very near future, with the advent of all of these different types of technologies.
• 52:56
  Dr. Ambreen Mohamed: So I feel like if you're able to get one, and you're able to afford it if you don't have a clear indication for it, it might be something worthwhile considering.
• 53:04
  Dr. Ambreen Mohamed: But do I absolutely recommend it?
• 53:07
  Dr. Ambreen Mohamed: I don't, know.
• 53:08
  Dr. Ambreen Mohamed: As long as your cholesterol is very well controlled, and it's treated, and it's at goal as you discuss with your doctor, you don't need it, but it is like a nice to have if you're able- to get it.
• 53:18
  Dr. Komal Patil-Sisodia: Yeah.
• 53:18
  Dr. Komal Patil-Sisodia: We have a company here locally that does them.
• 53:20
  Dr. Komal Patil-Sisodia: I send them all of my CT coronary artery calcium scores- Yeah for the people that I'm trying to convince they should probably go on a statin when they have- Yeah high lipids.
• 53:29
  Dr. Komal Patil-Sisodia: But I was curious because it seems like it would be helpful to know, right?
• 53:34
  Dr. Komal Patil-Sisodia: But without all of the stress that comes with having a, an actual coronary.
• 53:39
  Dr. Ambreen Mohamed: Yeah.
• 53:40
  Dr. Komal Patil-Sisodia: Okay.
• 53:40
  Dr. Komal Patil-Sisodia: Thank you.
• 53:41
  Dr. Komal Patil-Sisodia: That's really helpful.
• 53:42
  Dr. Komal Patil-Sisodia: And, for me it's similar in the diabetes space when I put somebody on a continuous glucose monitor.
• 53:47
  Dr. Komal Patil-Sisodia: When- they see their pattern of blood sugars- it's"Oh, I'm not gonna touch that food again," right?
• 53:52
  Dr. Komal Patil-Sisodia: I did that to my dad.
• 53:53
  Dr. Komal Patil-Sisodia: My dad I'm gonna call him out a little bit here, but he- he was telling me how he felt like he could feel his blood sugars, and I was like,"Daddy, you're an engineer.
• 54:01
  Dr. Komal Patil-Sisodia: You can't feel your blood sugars," right?
• 54:02
  Dr. Komal Patil-Sisodia: Yeah.
• 54:02
  Dr. Komal Patil-Sisodia: So we put him on the Dexcom Stilo, and sure enough, like he saw how what he was eating was shifting his blood sugars in a way that didn't look great, and he changed his eating habits and it's like back down to target goal-
• 54:18
  Dr. Ambreen Mohamed: That's amazing
• 54:19
  Dr. Komal Patil-Sisodia: Just from seeing the data, right?
• 54:20
  Dr. Komal Patil-Sisodia: And that was helpful for him.
• 54:21
  Dr. Komal Patil-Sisodia: So I'm really excited to see how technology can help people make these health decisions for themselves.
• 54:28
  Dr. Komal Patil-Sisodia: And you're right, it does create behavioral change that we need.
• 54:31
  Dr. Komal Patil-Sisodia: It does.
• 54:31
  Dr. Ambreen Mohamed: Does.
• 54:32
  Dr. Komal Patil-Sisodia: All right.
• 54:32
  Dr. Komal Patil-Sisodia: If you were talking to somebody who is listening, like one of our listeners, what would you want them to know that they could start doing now to start decreasing their risk overall?
• 54:45
  Dr. Ambreen Mohamed: So I would say that if there are things that you could start like today, one would be movement, right?
• 54:51
  Dr. Ambreen Mohamed: So get in your movement.
• 54:52
  Dr. Ambreen Mohamed: We all say that we don't have enough time in the day to really, do anything, but it's really are you gonna prioritize that time or not?
• 54:58
  Dr. Ambreen Mohamed: And it could be something as simple as taking a walk after meals.
• 55:02
  Dr. Ambreen Mohamed: We know that decreases glucose levels, especially like- Post-meal walks.
• 55:06
  Dr. Ambreen Mohamed: So maybe if you don't wanna do it alone, do it with your family, do it with your partner, do it with your kids.
• 55:11
  Dr. Ambreen Mohamed: Make it a group activity.
• 55:12
  Dr. Ambreen Mohamed: It doesn't necessarily mean that you have to get your steps in.
• 55:15
  Dr. Ambreen Mohamed: I know that- Yeah that's always the thing that everybody's hyped about is"We have to get 10K steps." But you don't necessarily need to do that.
• 55:21
  Dr. Ambreen Mohamed: It's more so just focusing on being consistent with your activities.
• 55:24
  Dr. Ambreen Mohamed: So we have, different ways that we categorize activity.
• 55:27
  Dr. Ambreen Mohamed: Moderate intensity, something like walking.
• 55:29
  Dr. Ambreen Mohamed: 30 minutes a day, five days a week.
• 55:31
  Dr. Ambreen Mohamed: So on the low end, that's 150 minutes a week up to 300 minutes a week, so that's 60 minutes a day, five days a week.
• 55:36
  Dr. Ambreen Mohamed: You can break that down however you want to.
• 55:39
  Dr. Ambreen Mohamed: But just to be able to build up to that and start being consistent.
• 55:42
  Dr. Ambreen Mohamed: We know the significant cardiovascular benefits of even just something as low impact as walking.
• 55:47
  Dr. Ambreen Mohamed: And then of course, if you're into more high-intensity stuff I'm a runner running, jogging, swimming, dancing, biking, whatever is your cup of tea, 75 to 150 minutes a week.
• 55:56
  Dr. Ambreen Mohamed: So either moderate or high intensity, and then also incorporating some resistance training.
• 56:01
  Dr. Ambreen Mohamed: So especially as women, we know that as we age, our bone health start to deteriorate.
• 56:06
  Dr. Ambreen Mohamed: We start to lose lean muscle mass, and so we wanna be able to protect that.
• 56:11
  Dr. Ambreen Mohamed: And what is the way that we protect that?
• 56:13
  Dr. Ambreen Mohamed: We have to make sure that we maintain our muscle and we, improve our bone health or at least maintain our bone health.
• 56:18
  Dr. Ambreen Mohamed: And what is one good way that we can do that is start with strength training.
• 56:21
  Dr. Ambreen Mohamed: Let me tell you, as somebody who is a cardio junkie, like- Yeah hate lifting weights.
• 56:26
  Dr. Ambreen Mohamed: I will say it on record, I hate it.
• 56:28
  Dr. Ambreen Mohamed: It's so hard for me to be consistent, but...
• 56:31
  Dr. Ambreen Mohamed: And I'm like,"I'm not seeing a difference.
• 56:32
  Dr. Ambreen Mohamed: My body just hurts.
• 56:33
  Dr. Ambreen Mohamed: This is stupid." I, all of this stuff goes through my head, but I'm like,"No, I cannot be the person that preaches all of this stuff- Yeah and then doesn't practice it." I have- It's the
• 56:41
  Dr. Komal Patil-Sisodia: I hate running with a passion.
• 56:43
  Dr. Komal Patil-Sisodia: Really?
• 56:43
  Dr. Komal Patil-Sisodia: I wish I loved running No, but I actually really enjoy lifting weights, so it's like- Oh my God a struggle just for me for cardio.
• 56:51
  Dr. Ambreen Mohamed: Both of our minds together, we'd be like the perfect specimen.
• 56:54
  Dr. Komal Patil-Sisodia: It's funny but to your point walking is so underrated, right?
• 56:57
  Dr. Komal Patil-Sisodia: So I told my doctor- Yeah I'm just not gonna be a runner, but I'm gonna walk.
• 57:01
  Dr. Komal Patil-Sisodia: So I'm- gonna walk and I'll lift her and it's fine, right?
• 57:04
  Dr. Ambreen Mohamed: Yeah, any kind of movement or activity, and then just doing two or three days, a week of some resistance training, whatever your cup of tea is, I think could be really beneficial.
• 57:13
  Dr. Ambreen Mohamed: And then also the other thing that you can start working on right away is your meals.
• 57:17
  Dr. Ambreen Mohamed: So looking at your dietary habits, what are some small changes that you can make?
• 57:21
  Dr. Ambreen Mohamed: You can maybe increase your protein intake.
• 57:23
  Dr. Ambreen Mohamed: Maybe you can increase your fiber intake.
• 57:25
  Dr. Ambreen Mohamed: Maybe you can eat, more whole fruits and vegetables.
• 57:29
  Dr. Ambreen Mohamed: Maybe you can, decrease the amount of refined carbs that you're eating, decrease the amount of, sweets that you're having, and start to, change your plate, a little bit.
• 57:38
  Dr. Ambreen Mohamed: And you don't have to make an overnight change.
• 57:41
  Dr. Ambreen Mohamed: It's really hard to go from eating, a certain way to eating completely healthy, and we're human at the end of the day.
• 57:47
  Dr. Ambreen Mohamed: We wanna enjoy our food.
• 57:48
  Dr. Ambreen Mohamed: But, I tell people,"If you start to make these small shifts and you do it every day, it's gonna start to stick with you, and it'll become a habit." So I think, making dietary changes, starting to move your body, and then it's really easy to pick up the phone and call your doctor and schedule your lab work.
• 58:04
  Dr. Ambreen Mohamed: It's the easiest thing to do.
• 58:06
  Dr. Ambreen Mohamed: I, as a good old doctor, hate needles.
• 58:10
  Dr. Ambreen Mohamed: Same.
• 58:10
  Dr. Ambreen Mohamed: I hate needles.
• 58:11
  Dr. Ambreen Mohamed: I'm the worst patient.
• 58:13
  Dr. Ambreen Mohamed: They're always like,"Are you gonna faint?""What's wrong?" I'm just like,"Just do it.
• 58:17
  Dr. Ambreen Mohamed: Don't tell me.
• 58:17
  Dr. Ambreen Mohamed: Put the needle in." But then, I was hesitating for two years.
• 58:20
  Dr. Ambreen Mohamed: I'm being honest.
• 58:21
  Dr. Ambreen Mohamed: For two years I didn't get my labs done because I was just like,"I don't wanna go.
• 58:23
  Dr. Ambreen Mohamed: I don't wanna go." And then I was like,"Again, what the hell?
• 58:25
  Dr. Ambreen Mohamed: I can't say all of this stuff and not..." So I did it, and then I was like,"Why didn't I do it before?
• 58:30
  Dr. Ambreen Mohamed: It wasn't that bad." So it's so easy to just...
• 58:34
  Dr. Ambreen Mohamed: Once you make the appointment, it's just easy to go.
• 58:36
  Dr. Ambreen Mohamed: It potentially, again, could save your life.
• 58:39
  Dr. Ambreen Mohamed: If there's something that you find on there that it doesn't look great, then you have to work with your doctor to start to make changes, and it's better to find that stuff out sooner than later.
• 58:48
  Dr. Komal Patil-Sisodia: And then just as we close out, a lot of women feel like they get dismissed when they go in to see a doctor, right?
• 58:55
  Dr. Komal Patil-Sisodia: What are your tips for women to have themselves be heard when they walk into a doctor's office, right?
• 59:04
  Dr. Komal Patil-Sisodia: Because that I think is the hardest part of the experience.
• 59:07
  Dr. Ambreen Mohamed: Yeah, and even us as physicians, like we're women- Yeah but, we're physicians, but we're also women, and I think that I even, will go into the doctor's office and I sometimes am just like,"It's, it's fine.
• 59:17
  Dr. Ambreen Mohamed: I don't really-" Downplay it, right?
• 59:19
  Dr. Ambreen Mohamed: But that's what we do as women Yeah We don't I think a lot of times the big issue with this is that we downplay our own symptoms.
• 59:27
  Dr. Ambreen Mohamed: We're constantly prioritizing our families.
• 59:29
  Dr. Ambreen Mohamed: We're prioritizing our children.
• 59:30
  Dr. Ambreen Mohamed: We're pri- prioritizing our partners.
• 59:32
  Dr. Ambreen Mohamed: We're prioritizing our parents, our family, our community, our patients, for doc- whatever, and we're downplaying what's going on with us, and a lot of times that's gonna lead to delay in care.
• 59:41
  Dr. Ambreen Mohamed: It's gonna lead to you not being able to advocate for yourself, and, then if something happens, what do you do?
• 59:47
  Dr. Ambreen Mohamed: Now you're dealing with the aftermath of it, and you can't take care of the people that you need to take care of.
• 59:51
  Dr. Ambreen Mohamed: So you know what's that whole thing of when you're sitting in the plane and they're giving you the instructions, put your oxygen mask on first before you, put it on your kid.
• 59:58
  Dr. Ambreen Mohamed: It's, the same theory here is that you really need to advocate for yourself, and I think, women's intuition I think is something not to be messed with.
• 1:00:05
  Dr. Ambreen Mohamed: And so if you feel like something is wrong with your body, you need to advocate for yourself absolutely.
• 1:00:09
  Dr. Ambreen Mohamed: If you feel like when you're going to somebody and they're not taking you seriously, you go and get a second opinion, right?
• 1:00:16
  Dr. Ambreen Mohamed: And so now you're going to this expert and, you're telling them like,"Hey, I don't feel good." You need to tell them what is actually going on.
• 1:00:22
  Dr. Ambreen Mohamed: Try to verbalize okay, it started at this time.
• 1:00:26
  Dr. Ambreen Mohamed: This is the thing that triggers it.
• 1:00:27
  Dr. Ambreen Mohamed: This is what makes it worse.
• 1:00:28
  Dr. Ambreen Mohamed: This is what makes it sometimes better.
• 1:00:30
  Dr. Ambreen Mohamed: I used to feel this way, and now I feel this way now.
• 1:00:33
  Dr. Ambreen Mohamed: What do you think could be going on?
• 1:00:35
  Dr. Ambreen Mohamed: Does this fit into a certain category?
• 1:00:38
  Dr. Ambreen Mohamed: Hey, my mom had, a heart attack in her 40s, and she didn't really know what was going on until it just happened.
• 1:00:45
  Dr. Ambreen Mohamed: She wasn't even able to describe it." Ugh.
• 1:00:48
  Dr. Ambreen Mohamed: "And so I'm scared that's gonna happen- Yeah to me.
• 1:00:51
  Dr. Ambreen Mohamed: So these are the symptoms that I'm having.
• 1:00:53
  Dr. Ambreen Mohamed: Is there anything that I can do about it?
• 1:00:55
  Dr. Ambreen Mohamed: Are there any tests that I can get?
• 1:00:57
  Dr. Ambreen Mohamed: I feel like I'm not able to have the same quality of life.
• 1:01:01
  Dr. Ambreen Mohamed: I was able to run around with my kids, and I was able to walk up a flight of stairs and do the laundry, or I was able to clean the whole house, and I can't even do half of that stuff anymore.
• 1:01:12
  Dr. Ambreen Mohamed: Stuff is piling up at work.
• 1:01:13
  Dr. Ambreen Mohamed: I just feel really like foggy and tired, and I don't know-" This is a shift in how I feel.
• 1:01:19
  Dr. Ambreen Mohamed: And then, say"Hey," again, bring up your family history.
• 1:01:22
  Dr. Ambreen Mohamed: Bring up the fact that you're South Asian.
• 1:01:24
  Dr. Ambreen Mohamed: A lot of doctors don't even know that your ethnicity is a high risk.
• 1:01:27
  Dr. Ambreen Mohamed: "I'm South Asian, I know I'm high risk.
• 1:01:29
  Dr. Ambreen Mohamed: I've seen it everywhere and I'm just nervous that this could be something that, is heart disease related." Or,"Hey,""I'm in that perimenopause era.
• 1:01:37
  Dr. Ambreen Mohamed: Is there something that's that could be going on?" Or,"Hey, I actually had gestational diabetes when I was pregnant, and I just want to make sure that my symptoms along with that, and I have a couple other risk factors." Try to just say as much as you can say, and ask the expert"Hey you know these things.
• 1:01:54
  Dr. Ambreen Mohamed: Here is the story that I'm telling you.
• 1:01:55
  Dr. Ambreen Mohamed: Do you feel like it fits into a certain category?" And if you feel like despite that you're still not being heard, absolutely get a second opinion.
• 1:02:03
  Dr. Ambreen Mohamed: Yeah.
• 1:02:03
  Dr. Ambreen Mohamed: Or you can just ask for a referral- to say"Hey, you know what?
• 1:02:07
  Dr. Ambreen Mohamed: I've been feeling like this for a long time, and I would just really appreciate if you would just refer me to a cardiologist.
• 1:02:11
  Dr. Ambreen Mohamed: I'd really like to speak to somebody."
• 1:02:14
  Dr. Komal Patil-Sisodia: Thank you for saying that, because I think people are so afraid of offending doctors if they go out and seek a second opinion.
• 1:02:19
  Dr. Komal Patil-Sisodia: You are the most important person in that visit.
• 1:02:21
  Dr. Komal Patil-Sisodia: It's not my ego.
• 1:02:23
  Dr. Komal Patil-Sisodia: It's not the ego of any other doctor that's there.
• 1:02:25
  Dr. Komal Patil-Sisodia: If you're not getting what you need out of that visit, go find somebody that you feel is hearing you.
• 1:02:30
  Dr. Komal Patil-Sisodia: So thank you for saying that.
• 1:02:31
  Dr. Komal Patil-Sisodia: I think that is such a great way to close out our episode on heart health- especially in women.
• 1:02:37
  Dr. Komal Patil-Sisodia: And thank you so much for taking the time today, Dr.
• 1:02:41
  Dr. Komal Patil-Sisodia: Mohamed.
• 1:02:41
  Dr. Komal Patil-Sisodia: I really appreciate it.
• 1:02:42
  Dr. Komal Patil-Sisodia: Oh, yeah, of course.
• 1:02:42
  Dr. Ambreen Mohamed: And I
• 1:02:43
  Dr. Komal Patil-Sisodia: I'd love to have you back in the future as a guest if you're game.
• 1:02:45
  Dr. Komal Patil-Sisodia: I'd love it.
• 1:02:45
  Dr. Komal Patil-Sisodia: Yeah.
• 1:02:45
  Dr. Komal Patil-Sisodia: I feel like there's many more things we can talk about.
• 1:02:48
  Dr. Ambreen Mohamed: Yeah.
• 1:02:49
  Dr. Ambreen Mohamed: I love talking about this stuff, and I also love talking to people that are outside of my field.
• 1:02:53
  Dr. Ambreen Mohamed: I feel like there's so much, in the endocrine space, I feel like there's so much that I don't know and I love to learn.
• 1:02:58
  Dr. Ambreen Mohamed: And I just feel when we all collaborate together, we can really make huge impact and have really great conversations that can actually really, help people.
• 1:03:07
  Dr. Ambreen Mohamed: And so it was a privilege to be able to be here.
• 1:03:10
  Dr. Ambreen Mohamed: This is my first podcast appearance.
• 1:03:12
  Dr. Komal Patil-Sisodia: Is it really?
• 1:03:12
  Dr. Komal Patil-Sisodia: You're a natural.
• 1:03:14
  Dr. Komal Patil-Sisodia: You did so well.
• 1:03:15
  Dr. Komal Patil-Sisodia: Thank you.
• 1:03:17
  Dr. Komal Patil-Sisodia: You did fabulous, and I'm sure that I will get all of that feedback from people who are listening, so- thank you.
• 1:03:23
  Dr. Komal Patil-Sisodia: Can you tell people where we can find you on social media?
• 1:03:26
  Dr. Komal Patil-Sisodia: 'Cause I love your TikTok channel.
• 1:03:27
  Dr. Komal Patil-Sisodia: That's how I first-
• 1:03:28
  Dr. Ambreen Mohamed: Thank you
• 1:03:29
  Dr. Komal Patil-Sisodia: came across you, and I was like,"Oh, she's amazing." need to talk to her."
• 1:03:33
  Dr. Ambreen Mohamed: I'm on TikTok@ambreenmd, and then I'm also on Instagram@drambreenMohamed.
• 1:03:40
  Dr. Ambreen Mohamed: I'm on LinkedIn, Ambreen Mohamed.
• 1:03:42
  Dr. Ambreen Mohamed: I have a website, ambreenmohammad.com, so you can contact me and email me from there.
• 1:03:46
  Dr. Ambreen Mohamed: And then I also have a Linktree that's linked to both my Instagram and my TikTok.
• 1:03:50
  Dr. Ambreen Mohamed: I have a YouTube channel that I kinda cross-post everything.
• 1:03:53
  Dr. Ambreen Mohamed: Maybe thinking of doing some longer form content.
• 1:03:55
  Dr. Ambreen Mohamed: The people that are dedicating their lives to social media, let me tell you, it is tough.
• 1:04:00
  Dr. Ambreen Mohamed: Oh my God.
• 1:04:00
  Dr. Ambreen Mohamed: It's not easy.
• 1:04:01
  Dr. Ambreen Mohamed: It's not easy for someone who's working full time.
• 1:04:04
  Dr. Ambreen Mohamed: I'm like,"How?
• 1:04:05
  Dr. Ambreen Mohamed: When?
• 1:04:05
  Dr. Ambreen Mohamed: What's happening?" Yeah.
• 1:04:06
  Dr. Ambreen Mohamed: I don't know.
• 1:04:07
  Dr. Ambreen Mohamed: Is the camera angle okay?
• 1:04:08
  Dr. Ambreen Mohamed: I look funny here.
• 1:04:10
  Dr. Ambreen Mohamed: I just, whatever.
• 1:04:11
  Dr. Komal Patil-Sisodia: No.
• 1:04:11
  Dr. Ambreen Mohamed: Anyways yeah.
• 1:04:12
  Dr. Ambreen Mohamed: But I will
• 1:04:12
  Dr. Komal Patil-Sisodia: say, your colleagues and then the people who are out there listening who are potential patients everybody is so appreciative.
• 1:04:18
  Dr. Komal Patil-Sisodia: Of course thank you again for being here.
• 1:04:20
  Dr. Komal Patil-Sisodia: You're welcome.
• 1:04:21
  Dr. Komal Patil-Sisodia: And to the listeners, thank you for tuning in, and I will see you on the next episode.
• 1:04:24
  Dr. Ambreen Mohamed: Woo-hoo.
• 1:04:26
  Dr. Komal Patil-Sisodia: And that's a wrap on today's conversation with Dr.
• 1:04:28
  Dr. Komal Patil-Sisodia: Ambreen Mohamed.
• 1:04:30
  Dr. Komal Patil-Sisodia: And I have to say, I don't think I've ever had a guest on this show who I connected with so immediately, so personally, and on so many levels.
• 1:04:37
  Dr. Komal Patil-Sisodia: We're two South Asian womens, both carrying our family's history into work every single day, both of us watching women we love navigate a system that wasn't built to hear them.
• 1:04:48
  Dr. Komal Patil-Sisodia: If you heard me share the story about my mom today, the shortness of breath going up our driveway, the two years it took to finally get the right doctor, and the 80% blockage they found in one of her coronary arteries, and something in that story felt familiar, I need you to sit with that feeling.
• 1:05:05
  Dr. Komal Patil-Sisodia: Don't file it away, because the theme of this entire conversation was that women's symptoms get explained away, minimized, and missed, and the cost of that is devastating.
• 1:05:16
  Dr. Komal Patil-Sisodia: The best thing Dr.
• 1:05:17
  Dr. Komal Patil-Sisodia: Mohamed said today, and she said a lot of great things, was that you need to put your oxygen mask on first.
• 1:05:23
  Dr. Komal Patil-Sisodia: You cannot keep going to the back of the line of your own life.
• 1:05:28
  Dr. Komal Patil-Sisodia: So here's what I'm asking you to do right now.
• 1:05:30
  Dr. Komal Patil-Sisodia: Save this episode.
• 1:05:32
  Dr. Komal Patil-Sisodia: Text it to your mom, your sister, your friend who's been feeling off and can't get anyone to take her seriously.
• 1:05:38
  Dr. Komal Patil-Sisodia: That's who we made this for.
• 1:05:40
  Dr. Komal Patil-Sisodia: And if you haven't yet, please leave a rating and review wherever you listen.
• 1:05:44
  Dr. Komal Patil-Sisodia: It's what helps other women find Clearly Hormonal when they're searching for answers at midnight, and we both know they are.
• 1:05:51
  Dr. Komal Patil-Sisodia: Now, if today's conversation made you want to understand your own cardiovascular and hormonal picture more clearly, your lipids, your lipoprotein little A, your metabolic risk, how your hormones are interacting with all of it, this is exactly why I designed the Midlife Health Compass.
• 1:06:08
  Dr. Komal Patil-Sisodia: It's a free tool I've been developing for women in perimenopause and menopause that looks at all of these systems together, the way they connect in your body, and it gives you something real and specific to bring to your next appointment.
• 1:06:21
  Dr. Komal Patil-Sisodia: I'm going to release it in the next few weeks.
• 1:06:24
  Dr. Komal Patil-Sisodia: You can find it at the midlifehealthcompass.com.
• 1:06:27
  Dr. Komal Patil-Sisodia: It's free for anyone to use because my mission is to make sure no woman has to navigate this alone, dismissed, or without the language for what's happening in her own body.
• 1:06:37
  Dr. Komal Patil-Sisodia: I'll see you next week.