Experts at the Johns Hopkins Women’s Cardiovascular Health Center are available through clinics in Maryland to help manage unique heart disease risk factors for women, including those related to menopause and pregnancy-related outcomes.

“Even decades after a pregnancy, we know things like preeclampsia, gestational diabetes and pre-term delivery are associated with an increased risk of cardiovascular disease in women,” says Erin Michos, director of women’s cardiovascular health at Johns Hopkins’ Ciccarone Center for the Prevention of Cardiovascular Disease. “We take a holistic approach to understanding women’s unique risk factors throughout their life spans to optimize their health.”

Michos and other cardiovascular disease specialists at the center see patients with specialized heart conditions that affect women at different points in their life. These conditions include:

• Microvascular angina. In many cases, women with heart pain (angina) do not have significant obstruction in the larger heart arteries. Cardiologists at the Women’s Cardiovascular Health Center help manage chest pain that results from dysfunction of the tiniest arteries feeding the heart. Because this type of angina presents differently in women than in men and doesn’t show up on a traditional angiogram, it can be missed without careful attention and specialized testing to determine the diagnosis, Michos says. Management is key to protecting against heart attacks and to improving symptoms.
• Spontaneous coronary artery dissection (SCAD). While most heart attacks are due to plaque rupture in the heart arteries, leading to a clot obstructing blood flow, SCAD is a unique type of heart attack that occurs instead from a sudden tear in the lining of the heart arteries. So, it presents differently and is managed differently than other types of heart attack. “SCAD is becoming increasingly recognized as a fairly common cause of heart attacks in younger women,” Michos says. “These are often healthy women who exercise and have normal blood pressure and lipids, who then have a major heart attack unexpectedly. We think that there may be some genetic component that makes their arteries more fragile.” Patients frequently go to the center after their heart event, and they are checked from head to toe to look for aneurysms and fibromuscular dysplasia, a condition that causes narrowing or enlargement of medium-size arteries. These problems are more common among women with a history of SCAD.
• Menopause and cardiovascular risk. Several cardiovascular risk factors, such as hypertension, elevated cholesterol, fat deposition in the abdomen and insulin resistance, can worsen after menopause transition. Cardiologists at the center help middle-age and older women review and manage their cardiovascular risk. If hormone therapy is desired to manage hot flashes, clinicians help determine how safe it is for the patient.
• Cancer survivorship and cardiovascular risk. Cardiologists at the center evaluate women with a history of breast cancer and other types of cancer to create a comprehensive approach to managing heart conditions that may develop.
• Cardio-obstetrics. Cardiologists at the center offer treatment and prevention for women with heart disease who are pregnant or trying to conceive. They also help manage cardiovascular risk after a woman has an adverse pregnancy outcome such as preeclampsia or gestational diabetes. The cardiologists work closely with obstetricians and maternal-fetal medicine experts to help optimize these patients’ outcomes long term and during delivery.

Lifestyle management is an important component of the center’s work, Michos says. Women evaluated by the center’s staff are offered education and counseling in fitness and nutrition, and referrals for management of stress, depression and anxiety. Patients who have surgical needs for issues such as carotid artery, aortic, peripheral artery or valvular diseases are referred to vascular and cardiac surgeons who have special interest in women’s cardiovascular health.

“Whatever the concern is, we have a number of faculty members who have real interest and expertise in caring for women experiencing these issues,” Michos says. “We’re happy to see any woman patient who desires a cardiovascular risk assessment.”