Wellness Articles

Breast Cancer Prevention – Reducing Your Risk

October 12, 2021 By Deborah

Breast Cancer Prevention

There have been plenty of new medications and treatments for breast cancer. That is astounding news. Today, a woman’s overall 5-year relative survival rate for breast cancer is 90%. This means 90 out of 100 women are alive 5 years after they’ve been diagnosed with breast cancer. The 10-year breast cancer relative survival rate is 84% (84 out of 100 women are alive after 10 years). These survival rates are based on many things, most importantly the time of diagnosis. We have heard that the earlier the diagnosis, the better the prognosis. Early detection involves screening tests, most commonly a mammogram. Technological advances in imaging have created new opportunities for improvements in both screening and early detection. The problem: Breast cancer prevention has not been talked about enough.

I want to discuss prevention. What are the potential modifiable risk factors that we have control over? One thing we need to understand is that the 2 main risk factors for breast cancer is age and gender. Clearly things we have no control over. But what can we do to be pro-active in reducing our risk as much as possible?

Approximately 67-80% of breast cancers in women are estrogen receptor (ER) positive. Also, about 90% of breast cancers in men are ER positive. So perhaps we should start there. Excess estrogen exposure can come from endogenous (what we synthesize in the body) and exogenous (environmental exposure) sources. Improving estrogen metabolism can be of benefit in reducing the risk of breast cancer. I have often said, “its not how much estrogen you have, but where is it gong…how is it being broken down?”

This brings us to the liver where the metabolism of estrogen takes place. It is complex but very important in that these metabolites vary greatly in biological activity. There is testing that can give us answers to this question of metabolites. Estrogen metabolite tests are completed through a 24-hour urine test which can personalize what your body needs to beneficially modulate estrogen metabolism. Another test that can give us insight into risks is a comprehensive stool analysis. It can identify a certain enzyme that can be modified as well as make sure you are digesting adequate fiber and nutrients that are important in affecting gene expression in the biological effects of estrogen.

Here are 10 things you can do right now to reduce breast cancer risk:

Get a screening test. Talk to your provider about a breast mammogram, ultrasound or possibly a thermogram (a risk assessment tool). As I tell women…it’s important to just do something!
Manage your weight and reduce your insulin level if it is high. Both estrogen and insulin are growth factors. Growth factors stimulate tumor growth and increase inflammation. Fat tissue also secretes estrogen. There are supplements that can help.
Consider time restricted eating. Studies show that fasting daily for 14 hours can reduce breast cancer risk by 40%. Fasting also decreases the incidence of Type 2 diabetes, non-alcoholic liver disease and esophageal reflux. Limit or avoid alcohol.
Eat plenty of fiber, especially lignin (found in flaxseeds, bran, beans and seeds). It binds to free estrogen in circulation in the digestive tract which then gets excreted in the feces.
Take the supplement Bioresponse DIM. A naturally occurring compound derived from cruciferous vegetables such as broccoli, brussel sprouts and cabbage that is protective to estrogen sensitive tissues.
Consume isoflavones such as soy or kudzu. Soy has gotten a “bad rap” with it’s association with breast cancer. They are phytoestrogens (plant compounds) that have the capacity to bind to estrogen receptors and appear to have both estrogenic and anti-estrogenic properties. The average daily intake of Japanese women is 20-80 mg and are associated with low rates of hormone-dependent cancers. American women consume 1-3 mg daily.
Exercise everyday to reduce excess fat deposition where the enzyme aromatase converts adrenal hormones, like testosterone, into more estrogen and allows it to be more freely available.
Reduce Environmental Estrogen (Xenoestrogen) Load. This includes avoiding foods and products with pesticides, herbicides, and fungicides, as well as non-organic cosmetics and soaps (which contain petrochemicals). Do not use plastic containers, especially when heating food in a microwave. For more information, check out Xenoestrogens
Minimize stress: I know that is hard to do with the current state of the world. But find ways of calming the mind, such as meditation, yoga, therapy, reading books that inspire you and STOP listening/watching the news! Chronic stress raises Cortisol and depletes Progesterone leading to estrogen dominance and excess inflammation.
Get good sleep. At least 7 hours/night is needed to clear toxic residue, repair damage from the brain and reduce cancer risk.

There are many other natural compounds and hormone-modulating herbs that have a significant benefit in promoting healthy estrogen balance. The percentage of inherited genetic mutations that cause breast cancer is less than 25%, whereas 65% -75% of breast cancers are traced to modifiable lifestyle factors. Talk to your practitioner about individual testing to identify what your risks might be in preventing breast cancer.

Reference: Cancer.gov. national cancer institute. “Hormone Therapy for Breast Cancer.

Hall, D. Applied Nutritional Science Reports. “Nutritional Influences on estrogen metabolism”. MET451, 2001.

Lam, M. Estrogen Dominance. Preventative and Ant-Aging Medicine. www.designsforhealth.com.

COVID-19 Vaccines Benefit People with Past Infections

August 15, 2021 By Deborah

People that had SARS-CoV-2 infections may think that they have “natural immunity” and are protected from getting re-infected from this COVID-19 virus. But there are 2 new studies showing evidence that vaccination generates a more vigorous B and T cell (immune memory cells) response than does natural infection. It shows that vaccination is particularly stronger in people with previous SARS-CoV-2 infections.

Researchers evaluated people who were vaccinated with the mRNA vaccine after natural infection and people who were vaccinated but had no prior infection. Memory B cells against SARS CoV-2 were 5-10-fold higher when vaccination followed natural infection than after natural infection or vaccination alone. The most surprising result was that in people who were vaccinated after natural infections, neutralizing antibodies against the beta variant were higher. They were 25 times higher than after vaccines alone and 100 times higher than after natural infection alone. This was amazing since natural infections were almost never with the beta variant and that vaccines don’t target the beta variant spike protein.

Other studies as well have shown similar results. A study in the CDC (Centers for Disease Control and Prevention) Morbidity and Mortality Weekly report shows 2.3 times the number of reinfections with natural immunity compared to breakthrough infections in those who are vaccinated. It is unclear how effective natural infection is against other variants, particularly the Delta variant. This new variant, as well as the lambda variant, may weaken the protection provided by having been previously infected by SARS-CoV-2.

People who have had COVID-19 are advised to be vaccinated. It will very likely offer better protection against symptomatic reinfections, even with the Delta and future variants.

References: Diamond, F. Kavanagh, K. Get vaccinated even if you’ve gotten COVID-19, study suggests. Infection Control Today 2021, Aug 8.

Stamatatos, L et al. mRNA vaccination boosts cross-variant neutralizing antibodies elicited by SARS-CoV-2 infection. Science 2021 Mar 25; 372: 1413.

Long COVID Continues…

July 21, 2021 By Deborah

Deepti Gurdasani is a British-Indian epidemiologist who is a public researcher at the Queen Mary University of London. This is a part of a thread in which she discusses Long COVID and the implications in the community.

Several studies have put the overall incidence of long COVID between 10-50% of those infected. Scientific consensus is that Long COVID is not just a respiratory disease but a “real” multi-system syndrome that occurs in those infected- predominantly impacting the young. The Office of National Statistics (ONS) data and REACT-1 data compares symptoms post infection among those infected with control groups of those confirmed not to have infection. These are some of the most robust data on Long COVID based on PCR tests through random nationally representative surveys of thousands of people (ONS data 313, 216, and REACT-1 data 508,707 samples).

Here are some highlights:

Most people present with a combination of symptoms and of the 1 million people affected, 2/3rds said it impacted their day-to-day activity. About 400,000 have had persistent symptoms for over 1 year. Sadly this included 9000 children who have been affected for more than a year. Those with the highest risk factors were women, increasing age, smoking, and low income. There is strong evidence that even those with mild symptoms can have long-term structural brain changes including thinning of grey matter in brain areas related to smell, taste, memory and emotion. The risk of organ dysfunction was 38.9% in those aged 19-49 years. This clearly impacts a large proportion of young people.

So to summarize, long COVID is common- even in young children with mild infection. It usually includes multiple symptoms, that in many, affects day-to-day lives. Remember that children under the age of 12 cannot get vaccinated. Let’s do our part and get fully vaccinated for ourselves, our families (and children) and our community.

Follow the full thread at @dgurdasani1. Other links are Post Acute COVID-19 Syndrome and Survivor Corps

Neurological and Psychiatric Illness After COVID-19 Illness

June 6, 2021 By Deborah

Electronic health records were studied at multiple institutions in the U.K. Researchers estimated the incidence of neurological or psychiatric sequela in 236,000 people with COVID-19 infection. During the 6 month follow-up, 13% were diagnosed for the first time with either a neurological or psychiatric condition with no prior history of these conditions. Another 21% of patients who had prior conditions developed new conditions.

These rates were compared with rates in 342,000 people with influenza and other respiratory tract infections. The incidence of neurological and psychiatric diagnoses were significantly higher in COVID- 19 patients. The most common diagnoses were anxiety (17.4%), psychotic disorder (2.8%), ischemic stroke (2.1%), dementia (0.7%) and intracranial hemorrhage (0.6%).

The most concerning were those whose acute COVID-19 infection caused encephalopathy (defined as delirium or other altered mental states). In those with encephalopathy, the chances of developing mood disorder were 22%, anxiety disorder 22%, ischemic stroke 9%, psychosis 7% and dementia 5%.

This large study demonstrates that various psychiatric and neurological conditions develop with a relatively high incidence in 6 months following acute COVID-19 infection in people with or without previous disorders. We need to look for interventions to address these sequela for post COVID patients. It is not just about surviving this infection, but hoping that you don’t fall into the long-hauler conditions that are so debilitating. One site connecting people with these symptoms that provides support and resources is survivor corps.

It is unknown whether the post COVID mood and anxiety disorders are due to the psychological stress of the illness, or that they are triggered by neuro-inflammation caused by the infection. Regardless of whether it’s the “chicken or the egg”, these symptoms are real and thus far unpredictable as to how long they may last.

Reference: Taquet M et al. Six month neurological and psychiatric outcomes in 236379 survivors of COVID-19; A retrospective cohort study using electronic health records. Lancet Psychiatry 2021 April 8:416.

Protective Immunity After COVID-19

May 11, 2021 By Deborah

The question that remains on people’s minds is how effective and long lasting the immunity is from either having had the COVID-19 infection or the vaccine. Now we are starting to get some answers. According to a population-wide study in Australia using data from the SARS-CoV-2 national infection reporting system, the re-infection rate has been low.

Researchers compared the odds of SARS-CoV-2 re-infections of COVID-19 survivors of the first wave (February- April 30, 2020) versus the odds of first infections in the remainder general population (by tracking PCR confirmed infections of both groups) during the second wave (September 1st-November 30, 2020). Out of the almost 15,000 COVID-19 survivors of the first wave and 253,000 infections in the 8.9 million individuals of the remaining general population, only 40 tentative re-infections were recorded.

This shows a relatively low re-infection rate of SARS-CoV-2 in Australia. Assuming that convalescents were exposed to COVID-19 at the same rate as people in the general population during the second wave, reduction in risk for re-infection was >90% which lasted for at least 7 months. Protection against SARS-CoV-2 after natural infection is comparable with the highest estimates on vaccine efficacies. Based on this data, there appears to be considerable protective immunity for at least 7 months after COVID-19 infection and no urgent need for booster vaccinations in COVID-19 convalescents. More well-designed research is needed for improving evidence-based public health decisions and vaccination strategies.

Reference: Pilz S et al. SARS-CoV-2 re-infection risk in Australia. Eur J Clin Invest 2021 April; 51:e13520.

Gut Microbiome Linked to Major Depression

April 22, 2021 By Deborah

I’ve published many studies linking the gut microbiome to certain health conditions. One of the conditions that has shown significant interest is mood disorders, especially major depressive disorder (MDD). Studies that have linked the gut microbiome to major depressive disorder have been small and have been met with skepticism. A recent study from China may give us more insight into the mechanism by which bacteria in the gut might influence brain chemistry. Researchers collected 311 fecal samples from people with MDD (unmedicated) and from healthy controls. Microbiome researchers were looking for a more precise picture of the organisms present versus a genus level within a batch of microorganisms.

Results found 18 specific bacterial species that were more abundant in those with MDD. They also found 3 specific bacteriophages (viruses that infect bacteria), and 50 fecal metabolites that were significantly associated with MDD verses healthy controls. The gut bacterial metabolites that correlated with MDD were molecules that are involved in amino acid metabolism. The most important pathways were related to gamma-aminobutyric acid (GABA), phenylalanine, and tryptophan metabolism. These molecules enter the blood from the gut, affect neurochemistry, and have been implicated in MDD.

Researchers point out that GABA, a neurotransmitter in the brain, is made by gut microbes. Fecal levels of GABA and some of its metabolites were decreased in the MDD patients. GABA related microbial genes were also altered in MDD patients suggesting that microbes modulate GABA levels. It is possible that this may dysregulate the function of GABA in the brain, and could lead to depressive symptoms.

Scientists also hypothesize that an increase in certain phyla called Bacteroides could increase inflammation which has been linked to MDD. Also decreased Blautia bacteria which has been shown to have anti-inflammatory effects could contribute to MDD. Other studies have found that when fecal transplanting the entire microbiota of a person with MDD into a germ-free rat, it causes “depressive-like” behaviors in the rat.

Epidemiological researchers have found that many people with irritable bowel syndrome are also depressed. Also those on the autism spectrum tend to have digestive problems, and people with Parkinson’s disease are prone to constipation. Researchers have also noticed people taking antibiotics are more prone to depression compared to those taking antiviral or antifungal medications that leave gut bacteria unharmed.

So what is the mechanism behind the actually pathway from the gut to the brain? Some substances secreted by the gut microbes may infiltrate blood vessels for a direct ride to the brain. Other bacteria may stimulate the vagus nerve, which runs from the base of the brain to the organs in the abdomen. Indirect links might also exist. Gut bacteria is so important to proper immune function and studies show that having the wrong mix of microbes can promote inflammation. Microbial products can influence enteroendocrine cells which reside in the lining of the gut and release hormones and other peptides. Some of these cells regulate digestion and control insulin production. They also release the neurotransmitter serotonin which escapes the gut and travels throughout the body. This is where our gut flora might influence weight gain, sleep and how we respond to stress.

It’s crazy to think how much influence our gut has to our mood. Depressed symptoms can influence our diet behavior which can influence our gut characteristics and composition. On the other hand, our bacteria can produce some special metabolites and have a specific pathway that can influence our brain function. More research needs to be done to determine whether any of these pathways are actually causally related to depression. Nutritional psychiatry is a new emerging field that is so exciting. We may be able to target the microbiome through diet (and specific probiotics) which could alleviate some of the symptoms of depression.

This is one more piece of evidence that shows a strong association of microbiome function and mental wellbeing.

Reference: Yang J et al. Landscapes of bacteria and metabolic signatures and their interactions major depressive disorders. Sci Adv 2020 Dec 2; 6:eaba8555.

The Psychbiome

The Disproportionate Gender Differences of COVID 19

March 11, 2021 By Deborah

Women are disproportionately effected by the complications and disease outcome of COVID-19 compared to men.

Gender-specific conditions have the potential to worsen the heart and lung damage caused by this virus. COVID-19 is a vascular disease. Women, compared to men, have smaller blood vessels, which can become dysfunctional and affect the body’s ability to deliver oxygen and nutrients to the heart. This microvascular dysfunction leads to ischemia which results in plaque erosion, clot formation and a potential cardiovascular event, such as a heart attack or stroke.

Other risk factors include polycystic ovarian disease, early onset puberty and the fact that women have higher incidences of autoimmune disease–putting them at risk for cytokine storms (hyper-responses of the immune system). Even though males have higher plasma levels of immune cytokines (immune cells called to the site of infection), women with higher levels of these cytokines were associated with worse disease progression and outcome than men.

The risks to women who have had problem pregnancies (preeclampsia, gestational diabetes) and women going through menopause are also notable. Estrogen helps prevent cardiovascular disease, and as their estrogen levels decline, menopausal women experience a higher likelihood of developing heart disease. Depression increases the risk of heart attack in women by 50% although researchers are unsure why. Severe shock can also take its toll on women. Broken heart syndrome, or takotsubo cardiomyopathy can cause fatal heart damage to mostly menopausal and postmenopausal women who have undergone a sudden stress such as losing a spouse, a car accident or being a victim of a violent crime.

Effective therapy and prevention is needed which starts with educating women in knowing their risks.

Gender differences for increased heart disease were already in place before COVID-19, but it is important to understand the increased risk factors for women that present themselves due to the nature of this virus.

https://www.nature.com/articles/s41586-020-2700-3

Marijuana and Pregnancy- Not Recommended

February 16, 2021 By Deborah

As legalization of marijuana spreads, 7% of pregnant women in the U.S. are using this unregulated drug to help reduce morning sickness. But is it safe?

In some states that legalize marijuana, dispensaries can be as common as coffee shops. Like smoking cigarettes or alcohol consumption, anyone over the age of 21 can easily walk into a store and buy a variety of compounds recreationally for their own use. But there are risks to be aware of, especially for pregnant women. Are the people behind the counter knowledgable enough to give sound advice to pregnant women seeking medical advice?

A study at the University of Colorado looked into the type of information being provided by staff members of marijuana dispensaries. Investigators posed as 8-week pregnant patients and called 465 dispensaries which resulted in useful information from 400 locations. Investigators asked employees if they had products that were “safe for morning sickness.” Other questions were about any known risks to the mother or baby with taking these products and whether they should check with their own health care provider. Results were: 69% of staff members recommended marijuana products for morning sickness, and 36% said that it was safe to use in pregnancy. Only 32% recommended that the patient check with her physician, but after prompting, 81% eventually recommended it.

This may not be happening in every state, but this study gives you a glimpse of how many pregnant women are likely not asking their provider for advice on the safety of using marijuana for morning sickness. But instead are seeking medical advice from marijuana sales people who not only have a conflict of interest and lack of medical knowledge but also a lack of cautionary approach on the topic.

Currently marijuana products contain from 0.3% tetrahydrocannabinol (THC) up to 15% and, even some concentrations up to more than 50% THC. THC acts on CB1 receptors that have psychotropic effects. Cannabidiol (CBD) acts through its effects on serotonin and not CB1 receptors for the most part. Cannabis, the marijuana plant, contains up to 100 cannabinoids with the two that we most know about described above. Dependence and addiction affects about 9% of users. This is compared to 15% of the population addicted to alcohol. This can lead to the risk of addiction to the newborn, let alone other potential consequences of cannabinoid exposure in utero.

There have been studies showing that children exposed in utero to cannabis performed more poorly in visual problem solving, motor coordination, had attention deficits and childhood sleep problems for up to a decade compared to unexposed children. Yes, thats right. According to a University of Colorado, Boulder study and lead author John Hewitt, director of CU’s Institute for Behavioral Genetics, marijuana use can impact children’s sleep long term!!

Other potential effects include increased risk of stillbirth, low birth weight (if using cannabis more than once per week) and preterm labor (those using cannabis and smoking cigarettes). A few older studies have not shown any differences in adverse outcomes with pregnant users vs nonusers. With marijuana products not being regulated and not knowing the specific ratios of THC/CBD, it can be very confusing to know what may harm mother and/or baby.

One thing for sure, marijuana use has not been proven to be safe in pregnancy. It is recommended not to use cannabis products during pregnancy-whether for recreational or medical purposes. Consult your practitioner about other safe and effective natural options for nausea and vomiting of pregnancy.

The medical use of cannabis is legal with physician prescription in 35 states. The recreational use is legal in 14 states.

Even though the use of cannabis is federally illegal, some of its derivative compounds have been approved by the Food and Drug Administration fo prescription use. For non-prescription use, cannabidiol derived from industrial hemp is legal at the federal level, but legality and enforcement varies by state. This map can identify what your state laws are regarding the use of marijuana State map of marijuana.

References: https://disa.com/map-of-marijuana-legality-by-state

Dicson, B, et al. Recommendations from cannabis dispensaries about first-trimester cannabis use. Obstet Gynecol. 2018;131: 1031-1038.

Hudson, T. Marijuana in Pregnancy-Please Don’t. Townsend Letter. Women’s Health Update. Feb/March 2019. p. 30-33.

Ultraviolet Light Can Kill the COVID-19 Virus

January 30, 2021 By Deborah

The start of 2021 is all about getting this COVID pandemic under control. Distributing vaccines as quickly as possible and continue to social distance, avoid large gatherings, wearing masks and washing our hands will be an essential part of developing herd immunity and getting our lives back to what was once normal.

Another part of reducing the presence of SARS-CoV-2 (the virus that causes COVID-19) is to find ways to destroy the virus in the environment before there is an opportunity for it to infect us. Much research has looked at the benefits behind good filtration systems and higher humidity to reduce the virulence of the virus. We are now re-visiting the benefits of ultraviolet light and its ability to kill viruses, bacteria and mold. Scientists have known about the disinfectant capabilities of ultraviolet light for decades. More than a century after Niels Finsen in 1903 won the Nobel prize for discovering that ultraviolet (UV) light could kill germs, UV light started being used in hospital rooms and other public places.

There are 3 types of ultraviolet light based on wavelength. The longest wavelengths are UV-A (315-400nm) and UV-B (280-315nm) which are found in ordinary sunlight. These rays can cause sunburn if you are outside too long without protection. They have limited germ-killing ability. But UV-C light (200-280nm) is part of the ultraviolet spectrum that can inactivate pathogens like bacteria and viruses. Because of their effectiveness, they are incredibly useful for hospitals, senior living centers, fire and police stations, schools, airports, hotels, office buildings and pretty much everywhere. So what’s the problem?

Similar to UV-A and UV-B rays from the sun, UV-C can damage the skin and eyes. You need to follow strict safety guidelines when the products are being operated. Basically, UV lamps should not be run when anyone is nearby. Trained workers should use the right personal protective equipment (PPE) and make sure products are turned off before performing maintenance. So this is maybe not as simple as screwing in a lightbulb. Disinfection with far-UVC lamps remains largely experimental but it may be safer in that it does not cause temporary skin burns and eye damage.

The other main problem is that if a surface is in shadow, it will not be disinfected. In a recently published study, a standard UV-C lamp was placed in the center of a typical hospital room and some places were partly or completely in shadow and did not receive the full dose needed to assure 99.99% disinfection. To address this problem, UVD Robots, a company based in Odense Denmark, developed a UV system that moves around the room autonomously. These robots are now available in 2000 Chinese hospitals and they are being used in more than 50 countries.

A company called Healthe has made progress on far UV-C lighting. They have developed systems that will be affordable for bars, restaurants, and other small businesses while close to eliminating the potential for spreading viruses. An LED version of UV-C may eventually be in our homes and offices. This can stop all viruses and bacteria. Can this finally be the cure for the common cold?? We will have to wait and see, but I can’t imagine a better time to push the technology envelope to help eliminate this pandemic and any future infections.

References: Lindblad M., Tano E., Lindahl C., Huss F. Ultraviolet-C decontamination of a hospital room: amount of UV light needed. Burns. 2019;46(4):842–849. [PubMed] [Google Scholar] [Ref list]

Mauldin, John. The Grip tightens. Jan 15, 2021. Mauldin Economics. https://www.mauldineconomics.com/frontlinethoughts/the-grip-tightens/

Tornberg, B. Using UV Light to kill Viruses Like COVID-19. Dec. 16, 2020. https://insights.regencylighting.com/can-uv-light-kill-viruses-like-covid-19

Mackenzie, D. Ultraviolet Light Fights New Virus. June 27, 2020. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7319933/

Myocardial Infarction With Nonobstructive Arteries

January 17, 2021 By Deborah

About 6- 15% of myocardial infarctions (heart attacks) are associated with nonobstructive coronary disease on angiography. This means that far less than 50% of heart attacks are due to blocked arteries. Also, these types of heart attacks occur more commonly in women.

A multinational study was done in which investigators enrolled 170 women with myocardial infarction with nonobstructive coronary arteries (MINOCA). These women were scheduled to undergo cardiac magnetic resonance imaging (MRI) and coronary optical coherence tomography (OCT). The OCT test uses infrared light to acquire cross-sectional images of the coronary artery using an intravascular catheter. This allows it to have a higher resolution than intravascular ultrasound.

In 145 women who underwent OCT, 67 had a possible or definite culprit lesion, such as plaque rupture or layered plaque. In 116 women who had an MRI, 62 had an ischemic (reduced blood flow) pattern of abnormalities and 24 had a nonischemic pattern, such as myocarditis or nonischemic cardiomyopathy (heart disease causing an enlarged heart). Overall, A cause for MINOCA was identified in 98 women, with an ischemic etiology in 74, and nonischemic in 24 women.

This study shows the benefit of using multiple imaging tests to identify the mechanism of MINOCA in most cases. It showed almost two thirds of cases related to an ischemic cause, despite the absence of severe obstructive coronary disease by angiography. Women tend to have microvascular disease which affects them four times more than men. They also have different symptoms of myocardial infarction than men. Both genders can exhibit symptoms of chest pain or discomfort but women are more likely to experience shortness of breath, nausea/vomiting and back or jaw pain. It’s best for physicians to order multimodality imaging especially for women with these symptoms to prevent the progression of a heart attack.

Reference: Reynolds, HR et al. Coronary optical coherence tomography and cardiac magnetic resonance imaging to determine underlying causes of MINOCA in women. Circulation 2020 Nov 14; [e-pub]. (https://doi.org/10.1161/CIRCULATIONHA.120.052008).