>> From WXXI News.

This is Connections.

I'm Evan Dawson.

Our connection this hour was made with a new study on heart disease published yesterday.

According to the research, women who go through menopause before the age of 40 are significantly more likely than their peers who don't go through premature menopause to have heart attacks over the course of their lifetimes.

To be more specific.

That first group of women had 40% more fatal and non-fatal heart attacks than the women who did not go through early menopause.

The new data comes during a time when experts say heart disease needs a bit of a rebrand and a re understanding, especially when it comes to awareness among younger women.

They say it needs its pink ribbon moment, so to speak.

Surveys show that many young women view heart disease as an older person's problem, and specifically an older man's problem.

But the prevalence and deadliness of heart disease is on the rise for young women, according to Vox.

It's the leading killer of cisgender American women, and new projections show the share of U.S.. women with heart disease will keep rising through 2050, affecting more than 22 million women.

They anticipate the sharpest increases will be among younger women, those aged 20 to 44.

So how can we raise heart disease awareness among a new generation of people, especially women?

And how can younger women protect themselves from a disease that develops over time?

Our guests are here to discuss all of that, and there's a lot of different places we can go.

But I really do hope that people listening this hour can use this information.

Maybe help someone you know, there's some really, really compelling stuff coming your way here.

And I want to welcome our guests who are with us in studio here.

Dr.

Rebecca Schallek is here, assistant professor of clinical medicine in the Division of Cardiology, and a cardiologist with the Cardiac Care Women's Heart Program at UR Medicine.

Thank you for being here, doctor.

>> Yes.

Thanks for having me.

>> Welcome to Dr.

Amanda Coniglio, who is an advanced heart failure and transplant physician at Rochester Regional Health.

Thank you for being here.

Thank you.

And we're going to hear Jessica Driffill story as a heart patient, a remarkable story at that.

Thank you for being here to share it.

>> Oh, thank you.

>> So let me just start with the doctors and before we get into Jessica's story here, first of all, the overall problem with awareness and and younger women, you know, it's interesting.

doctor Schallek, I'll start with you just reading the stories and the comments of patients who didn't expect to be heart patients at, at this, probably at this point in their life, the characterization of this as an older person's disease or the very many, many types of heart disease as an older person's disease, often a man's disease.

What do you think we need to understand about this as we go forward this hour?

And what do you want the audience to understand?

>> Yeah, absolutely.

I think the article brought up a lot of really good points.

I think we underestimate heart disease in women, especially because it's it's kind of underrepresented in our younger generations and our younger patients.

But I think they point out that early detection can be really important.

So even a discussion like today's is important to, to get awareness out there.

The pink ribbon moment, I think is important for breast cancer detection.

But what we're missing in heart disease and in cardiology is that a lot of women don't know the signs and symptoms.

So that's really important to talk about.

>> Dr.

Coniglio, what about you?

What do you hope the audience understands this hour?

>> I think there's a lot of different types of heart disease, heart attacks, heart failure, abnormal heart rhythms.

And women can present differently for each of those different types of heart disease.

And so patients need to be able to understand their risk, know what they can do to help prevent this and really be an advocate for themselves when they know that something is wrong.

>> So reading some of what Vox reports on this, trying to understand the question of why do younger women face unique risks of heart disease some of their reporting indicates the following.

And I'll ask our, the experts in the room to kind of tell us more about this.

They say that it's rooted in physiology at times.

It can be related to having your first period before the age of 12 associated with a higher risk of heart problems.

So our irregular periods, which affect around 20% of women.

So in general here, doctor Coniglio, are there sort of common themes about why younger women face unique risks here in this story?

>> I think younger, younger women in general, I would say we still don't see a lot of, you know, 30, 40 year old people coming in with heart attacks.

So I'd like to just preface that.

Sure.

certainly the same risk factors exist.

Obesity, smoking.

I mean, those are the people that we're seeing coming in with very early heart attacks.

But we know that when people go through menopause earlier, when they have their periods earlier, those people do have a higher risk long term.

We also focus a lot on the era of pregnancy.

So when patients are developing pre-eclampsia, diabetes or gestational diabetes while pregnant, those people are much, much higher risk.

So it's not necessarily that we're seeing people with heart attacks at a young age, but there's a lot of red flags during the younger years that we need to be keeping a closer eye on to help recognize these symptoms and these diseases and treat them more aggressively to prevent the long term side effects of that.

>> Do you want to add to that, Dr.

Schallek?

>> Yeah, I think she touched on a lot of really important points.

We certainly know there's hormone.

relations to heart disease.

and it comes up in things like pregnancy because pregnancy is what we call essentially a stress test for, for the heart, because it's a lot of changes to the body that are natural, normally healthy, changes things like your heart rate changes how much blood volume a woman is carrying when she's pregnant changes.

So there's a lot of normal changes that that most women will handle very well.

Some women can have some actual problems during pregnancy.

That can be an early sign of heart disease that will that will come up later in their life.

So we use it as a sort of stress test for the heart during pregnancy.

That can be a marker for early problems to come later.

>> Can you give us a definition.

>> Of pre-eclampsia, by the way?

>> Yeah, so pre-eclampsia is what I call in the spectrum of blood pressure related diseases during pregnancy.

So there's people who have high blood pressure before pregnancy.

They will have high blood pressure throughout their pregnancy, and they will continue to have high blood pressure after pregnancy.

Then during pregnancy itself, there's something called gestational hypertension.

That is where you develop high blood pressure.

Typically after around 20 weeks of pregnancy.

And that will typically get better after pregnancy.

But it's called gestational hypertension because it's only present during pregnancy at that point in time.

And then there's something called pre-eclampsia.

And pre-eclampsia is a little bit of a confusing word because it can happen during the second and third trimester, but it can even happen after delivery.

So it's, it's a spectrum of this high blood pressure disorder that actually has consequences to both the woman and potentially the fetus, where there are other organs involved, the heart can become involved.

The brain can become involved, the kidneys can become involved, the liver can become involved.

So there's actually damage to some of the organs during pregnancy that can actually happen with relation to high blood pressure during pregnancy.

>> I'm a father of two and pre-eclampsia came up during one of the pregnancies.

I want to tell you what the way my brain first interpreted that word and why I think we need better education.

I didn't know anything about it.

I thought, well, if it's pre-eclampsia, there must be eclampsia and at least it's pre-eclampsia.

It's probably the not dangerous part.

Like like the warning sign, like maybe be worried about it.

Just kind of take care of yourself.

What you don't want is eclampsia.

Preeclampsia is, you know, it's the canary in the coal mine.

Probably not that.

>> No, I agree completely.

I think the name it, the name frustrates me because it gives that connotation.

I think we all get kind of hung up on the pre part.

Full blown eclampsia is when women are actually having essentially seizures from from the disorder.

>> Okay, so there is a clamp.

>> There is.

>> A clamp, but pre-eclampsia should not be viewed as, you know, sort of minimized, I guess.

>> Right.

So pre-eclampsia is essentially a medical emergency.

It sometimes leads to preterm delivery.

So the treatment of pre-eclampsia is actually delivery.

So if a woman is diagnosed with pre-eclampsia often they will be admitted to the hospital and either watched carefully or sometimes we will even start to prep for delivery because it can be life threatening.

>> Yeah, my son was born pretty early last year because of it, and I, I had a lot to learn.

So and I, I suspect a lot of our audience members have a lot to learn on a lot of the subjects we're going to cover this hour.

Anything you want to add to to that section there?

Dr.?

Coniglio.

I agree.

Okay, so I want to understand Jessica's story here because I think in so many ways, our guests, the doctors in the room have been describing pregnancy as kind of as a stress test, a chance to not only understand how hard is functioning, but sometimes it could shine a light on early detection.

Is that fair?

Doctors.

Okay, so.

>> Jesse, early signs of multiple diseases, right?

So of potential coronary disease, but also of heart failure and valvular related disorders.

>> Okay.

And so, Jessica, you said here today, you're doing pretty well.

>> Yeah, I'm doing great right now.

>> Okay.

And, you've got a boy who's doing pretty well.

>> Yep.

He's eight.

>> He's eight years old.

but it wasn't an easy road for you, and I want you to take us back and and tell your story and and as much time as you want, and then we'll have questions about it, but go ahead.

>> Okay.

well, I was pregnant with Jackson when I was 32, and at 26 weeks, my water broke.

So I went to the hospital.

I stayed there for three weeks.

being his little incubator.

And that's when I went into heart failure at at 29 weeks, went into heart failure.

And my symptoms were I just, I couldn't breathe.

I felt like I had really something really heavy on my chest and they immediately took X-rays of my chest and everything looked fine.

But later that day, they did, they did see the accumulation of liquid in my lungs.

So they did a c took Jackson out and did an MRI later that day or the next day.

And they found that I had scarring on the heart, which meant I had had a heart attack at one point and not realized it.

So what I had at the time, it was called peripartum cardiomyopathy, and it could have been as a result of that possible heart attack that I had in the past.

And then a few months later, I got a pacemaker, a defibrillator, and that seemed to help temporarily.

>> and then at 39 or I'm sorry, at 35, that's when I got implanted with the Lvad, which is a left ventricular assist device.

It's a heart pump and it helps pump all the blood to my extremities.

Just helps my heart out.

So there's more to it, more to the story.

But that's the general gist.

>> So it's a bit of a surprise for a 35 year old, you know, to.

Yeah, to have that procedure.

But yeah, you're doing well.

>> I'm doing well right now.

>> Okay.

>> Last year I did have a strep blood infection caused by an infection of the driveline of the Lvad, which gave me aneurysms on the brain.

So last year it was rough.

I missed Christmas, but yeah, I'm good right now.

>> So let me go back to the pregnancy and delivery.

your son is Jackson.

You said.

Yes.

He was born at 20, delivered at 26 weeks.

>> 29 weeks, 29.

My water broke at 26.

Okay.

He was delivered at 29.

>> Okay, so 29 weeks.

And what did he weigh when he was born?

>> 2 pounds, four ounces.

Wow.

Yeah.

>> Amazing.

It is amazing what they can do, isn't it?

>> And he's totally perfect right now.

Nothing wrong with them.

>> You wouldn't meet him and go, this this guy was was premature, but he's doing great.

No, no, it's really, really.

He's awesome.

That is a that's a phenomenal medical success story.

Yeah.

But when you were learning about what they were telling you about your own heart, first of all, what goes through, I mean, you're young, you're healthy.

What's going through your mind when they're telling you not only what you're what you were dealing with then, but also what they detected from, you know, what had happened earlier in your life.

>> shock.

I, I couldn't wrap my mind around it.

I don't know, I just, I don't know.

>> Did it make sense to you?

>> No, it made no sense.

No, I'd always been active as a kid, horseback riding and gymnastics, cheerleading.

So it came as a surprise.

I really didn't know.

>> Cardiomyopathy doctors is a weakened heart muscle.

Is that.

Is that correct?

Okay, so let's pull back a little bit here and talk about some of this story.

So I'm going to just turn to both of you here to kind of weigh in.

What are we learning when, when a patient gets a diagnosis like this, what comes to your mind as a doctor and what are we learning?

What is it telling us about why this is happening and what has led to this point?

Do we know.

>> There's some that we know and there's a lot that we don't know?

I think Jessica's story is remarkable for many reasons.

it's, it's great to hear that you're doing very well, but it's also such a shock to the system when it's happening.

And in a lot of ways, I think exactly like what you described, it happens very quickly.

It happens with not a lot of warning signs.

certainly I'm sure, you know, you were nervous with pregnancy and things like that, but you're kind of checking in with your doctors, you're doing all the things you're supposed to, and then this can happen really quickly and out of the blue.

So, so the warning signs aren't always there ahead of time.

so that, that kind of speaks to how much we don't know if we could say, this is what I want you to look out for at 25 weeks.

We're going to monitor for peripartum cardiomyopathy.

I think it would be, you know, helpful, but we just don't have that kind of I think, you know, goals to, to look for.

But what we do know is that a lot of peripartum cardiomyopathy can be treated with a lot of good options now.

So we have many more treatment options than we used to have.

But I think it just keeps coming back to how much we don't know.

>> Okay.

Well, to add to that, Dr.

Coniglio.

>> We're doing a lot of work in the genetic space to try to understand what puts some patients at more risk of having pericardial peripartum cardiomyopathy.

there's still a lot to, to be learned with this.

We know that women that are older in age, women with multiple pregnancies are at much higher risk of peripartum cardiomyopathy.

Obviously, you don't fit that bill at all.

and so it always comes as a surprise to providers when we're taking care of these patients, when this comes really out of the blue.

But I agree from a heart failure standpoint, we have lots of medications now.

And fortunately, the Lvad, I'm an Lvad and transplant doctor, so we have a lot of different options to help patients with profound heart failure, whether it's peripartum or unrelated.

and there's a lot of different causes for that, even independent of peripartum cardiomyopathy.

>> So again, the Lvad, which Jessica talked about is designed to improve heart function.

It is the left ventricular assist device.

How common are you.

>> Not incredibly common, but as you can see with Jessica, sometimes these people can be walking or sitting in a room with you and you would have no idea, which is incredible.

>> So, so that's related to a general question that the audience may have about, is there a way to get ahead of this kind of a problem, or do you only discover it when you're in someone like Jessica's case?

So this is not a story about me.

This is not an hour about this, an hour about women, but my own experience as a 17 year old who got diagnosed with Wolff-parkinson-white syndrome.

I spent my senior year of high school, couldn't play sports, trying to figure out why did I continue to have these tachycardia experiences.

I didn't know what was going on.

I collapsed on a basketball court and eventually I had a catheter ablation.

You know, it worked great.

I had to learn a lot as a teenager what was going on.

But I remember being like, why didn't we know this?

Like, I was a senior in high school, wanted to play sports, and was frustrated.

That is pales in comparison to the family that's afraid of losing a mom, losing a child to, you know, complications.

And wondering, is there a way to get ahead of this?

So in general, is there anything that that we that people that young women can do that would diagnose or shine a light earlier or sometimes?

Is that not possible?

I'll start with you, Dr.

Coniglio.

>> I think there's a couple different aspects to this.

So, Jessica experienced peripartum cardiomyopathy.

So a heart failure that presumably happened because of the stress of pregnancy.

Patients can have heart failure before pregnancy or after pregnancy.

And sometimes that is often underdiagnosed in women, which I think is highlighted in this article as well.

So if somebody has heart failure before pregnancy, they are much less likely to be able to tolerate that pregnancy and present earlier on in pregnancy with issues.

But again, somebody may get through pregnancies in their 20s and 30s and be fine.

And all of a sudden in their 40s start to struggle with all these symptoms.

So the symptoms of heart failure that we always ask folks to think about are shortness of breath, like Jessica described.

Sometimes people feel this chest heaviness swelling in their legs.

Oftentimes that's more later in the presentation.

But some patients will present with just generalized fatigue.

I can't really keep up with with my kids now.

I can't keep up to do the things that I used to do.

And that should really raise suspicion that maybe something is going on.

I always encourage patients, if you have a strong family history of heart disease of any kind, you should be very proactive in what you can do to prevent that.

So we do a lot of genetic testing at Rochester Regional.

We have a cardiovascular genetics space.

and so patients that have a family history of significant heart failure, particularly at a young age, we're finding that there's a lot of genetic manifestations to that, that people can get testing for ahead of time.

And if you're positive, we are starting people on treatments very early to help prevent them from having heart failure.

>> What are the kind of things that you may be positive for?

I mean, again, I'm not saying any of these are common.

Common, but we're trying to do is educate better all of us so we can be better prepared.

So when you say if your genetic testing is positive, it's not just one thing here, right?

>> It can be.

So there's about we usually do a test with about 92 different genes that are associated with heart failure and arrhythmias, abnormal heart rhythms, because a lot of times there can be overlap.

There was actually a great study in the Journal of the American College of Cardiology that came out recently about the differences in women with genetic cardiomyopathy.

So just because you inherit a gene that predisposes you to having heart failure, women with that gene can present very differently than men in their family.

And so knowing about your genetic risk for something like heart failure can have a huge impact on how you are treated and how you are monitored to help prevent more significant disease, leading to something like an Lvad or a transplant.

>> One more thing before I turn to your colleague, you talk about what may what the impact may be if there has been heart failure.

I think heart failure was the term used for, for women, for, for example, before they become pregnant and whether they can tolerate the pregnancy.

If you know of those kind of events, do you counsel women out of it?

Are there?

You do counsel women out of pregnancy?

>> There's really great guidelines surrounding this.

I mean, if someone is able to still exercise, I mean, the goal with heart failure is that you can treat it and you can improve it, and you can keep someone stable.

And so if a patient is doing very, very well we, we discuss functional status, right?

If somebody is able to climb up a flight of stairs and do their grocery shopping and walk or run, you know, they're doing really quite well with their heart failure, we may be able to support them through a pregnancy, but certainly if you can't lie flat in bed, which, you know, Jessica experienced all these things, right?

If you can't lie flat in bed, if you have swelling in your legs, if you're short of breath, just trying to get up and walk across the room, your heart is not in a spot where you're going to be able to tolerate a pregnancy, and we're never going to be able to get you at that state through a through to term.

>> Everyone is thrilled with Jackson's story today, but it's possible that if everybody knew everything about Jessica, she would have been counseled away from pregnancy.

>> It depends.

If we knew if she had heart failure before.

Typically when we describe peripartum cardiomyopathy, we're talking about a heart failure that develops during pregnancy.

And it sounds like you had no symptoms prior to pregnancy.

So there was nothing about Jessica that we would say, no, we can't proceed with this safely.

>> Okay.

really, really important stuff here.

Now let me turn to your colleague, Dr.

Schallek.

When it comes to, understanding the value of testing, understanding how to try to get ahead of problems, you know, what do you want people to understand about early detection or doing everything you possibly can to be aware of possible problems?

>> Yeah, that's a great question.

And I think there's two things that I'm really sort of a big advocate for.

One is I work with a lot of our, our OB GYNs and our high risk mfms at the U of R and I think just counseling healthy pregnancy guidelines.

But, but part of that comes to sort of knowing your numbers.

I love meeting women almost during pregnancy because it's a good little check in where women will seek out more.

I think healthcare during pregnancy, because there's certain visits, there's milestones, there's ultrasounds, and then our ob gyn colleagues are so good at screening for a lot of these things.

So it's checking blood pressure at every OB visit.

it's checking for healthy weight gain during pregnancy.

it's checking to make sure women are still staying healthy with things like exercise and healthy eating.

so I think that really just routine health care during pregnancy is a really good sort of screening across the board for, for any woman who's pregnant or even considering getting pregnant and doesn't know if she has risk factors, they do pre-conception counseling as well.

So I love working with our OB GYNs because they actually do a lot of the screening for for a lot of those things throughout pregnancy.

The second thing I think that's really been helpful and I think really proactive for a lot of people, men and women are there's a lot more technology now.

People are wearing a lot more, you know, smart devices or wearable devices.

They're more aware of their numbers, things like normal heart rates, normal blood pressures.

But it's the sort of American Heart Association campaign.

Know your numbers.

so they have a great sort of website where you can sort of look into it.

They have personal calculators, you can plug in your own data, and we're all sort of data driven now, and everybody likes knowing their normal numbers, but it can really help with prevention too.

>> So do you look back?

Jessica Jessica Driffill is a heart patient, a mom.

Do you look back and feel like you wish you had done anything differently?

>> no, because if I did anything differently, the end result wouldn't be here, which is my son.

So no, I'm with you.

There's nothing else I could have done.

>> And for just for the the duration of the pregnancy.

Can you describe again what you were experiencing?

Some of the symptoms that we've talked about here?

So people understand.

>> Yeah.

So I couldn't breathe very well.

They, the hospital.

>> I mean like how deep into the pregnancy.

>> Oh.

>> When did you start to really.

>> Feel 29 weeks is when it literally it happened and I was and I went in and they took Jackson out that same day.

>> It wasn't four weeks in your pregnancy.

Eight weeks in.

Nope.

You were moving along pretty well.

Yeah.

Okay.

>> Yeah.

It came on suddenly overnight.

Yeah.

>> Okay.

And, and at that point, you didn't look back and say, I, I had missed this sign or anything else.

Nothing.

Nope.

I mean, that is wild, isn't it?

Yeah.

Really?

>> Really really.

>> Really, really remarkable.

How much do you feel like you have learned about heart health throughout this?

Do you feel like the expert now?

>> No, I do not feel like the expert.

I had to write down my notes.

no, but I, I try to stay off Google.

I trust my doctors and I just do what they say because there's too much to know.

>> I actually want to take that that comment and ask both the doctors here, would you like all of your patients to stop googling and just ask you guys what's up?

Yes, doctor Coniglio you would love it if we would stop doing that.

Yeah.

Okay.

Why is that?

>> some of the, some of what we find on Google is a lot of what we find is not accurate.

And so some of the diseases that I treat, if you Google, it's going to tell you that you're going to die in a year or two.

And I would much rather tell you that I can treat you and, you know, keep you living a long and healthy life and around to see your family.

>> So people jump to the worst case.

Correct?

Well, don't worry, A.I.

will now tell us all the right things.

Tell us everything.

Yeah, I still yeah, still problems with the I. Okay, how do you feel about trying to find answers online?

>> I think the doctor Google phenomenon.

It's real.

I talk to people about it all the time.

I think you have to find a healthy balance of knowing your good resources knowing what resources to trust, but also just being aware.

There's so much bad information out there and really trying to walk that fine line of, you certainly want to be informed, but I think you want to be informed from reliable sources.

So Google itself, you know, it might lead you to one good source, but five bad sources.

So I think realistically, we live in a world of information where it's so accessible, but you really have to say, I don't trust everything on the internet.

Where can I go to get that information reliably?

>> So when we come back from only break, I've got some questions from listeners related to what we've been talking about, that our expert guests are going to be able to help us understand, and there's plenty of time if you want to use the email Connections at wxxi.org.

As always, you can join the chat.

If you're watching on YouTube.

So we've got a number of those, which we'll get on the other side here.

And we'll talk a little bit more about this new study that we saw this week.

you know, why does menopause have a bearing on heart disease?

How do we understand you know, why premature menopause is leading to higher cardiovascular risk and related issues.

We're talking to Dr.

Rebecca Schallek, who is assistant professor of clinical medicine in the Division of Cardiology, and a cardiologist with a Cardiac Care Women's Heart Program at UR Medicine.

Dr.

Amanda Coniglio, an advanced heart failure and transplant physician at Rochester Regional Health and Jessica Driffill here telling her story.

We're coming right back on Connections.

Coming up in our second hour, we sit down with Barry Silverstein at the University of Rochester.

He is the former chief technology officer of Optics and Display at meta.

He reported to Mark Zuckerberg annually his big part of what meta was doing with AR glasses, augmented reality glasses.

Do you know anybody who has AR glasses?

Are they the future?

Barry Silverstein joins us to talk about what could be coming next in our tech world.

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Believing an informed public makes for a stronger community.

Proud supporter of Connections with Evan Dawson focused on the news, issues and trends that shape the lives of listeners in the Rochester and Finger Lakes regions.

Bobjohnsonautogroup.com.

>> This is Connections.

I'm Evan Dawson Sarah wants to know when should menopause start?

When is it considered early and what's the difference between early and perimenopause?

As related to this conversation?

Okay, doctor Coniglio looked across the table.

Dr.

Schallek you want to hit that one?

>> so that's a great question.

I'm technically officially not an Ob-Gyn, but in the study that I think we're all referring to, we talk about premature menopause.

I believe it's before the age of 40.

So we're talking about early detection of heart disease because premature menopause can lead to increased risk of heart disease.

So the study considered premature onset of natural menopause for women before the age of 40.

>> Okay.

Before the age of 40.

>> I forgot the second part of the question.

>> The difference between perimenopause and premature menopause.

>> Perimenopause is typically the few years before, during and after.

So we kind of consider there's perimenopausal symptoms that can hint at you maybe approaching menopause.

There's formal testing that you can do with your OB GYNs, but it's, it's essentially the before, during and after.

>> Would you like to endorse the idea that Sarah can also consult her OB with those kinds of questions?

>> Absolutely.

>> Okay.

>> Sure.

>> Our doctors here are focused on the heart.

They're doing their best.

But it's this is all related to the study here.

So I understand why people are asking.

Jerry Lynn wants to know if if this is any of this is obesity related.

So doctor, doctor Coniglio you want to start there.

>> Obesity is certainly a risk factor for coronary disease.

for hypertension and can be for some types of heart failure.

So we always recommend that people control their weight.

Obviously we have a lot of great options now to help patients lose weight.

Diet and exercise we all know can be challenging.

We have a whole class of medications now that can help people lose weight, which we have clearly seen has a reduction in cardiovascular events, including heart attack and heart failure.

>> and anything you want to add on that part of it.

>> Yeah, I agree with Dr.

Coniglio.

I think that obesity leads to other problems.

Things like high blood pressure, higher cholesterol numbers, higher risk for diabetes.

So it all goes hand in hand.

And when you lower the risk of obesity, you lower the risk of all of those things.

>> Can I ask both of you?

I mean, I don't know how much this is in your professional sphere, but are you comfortable with GLP-1s?

And what we're seeing in society?

Dr.

Coniglio.

>> All day, every day.

>> Yes.

Okay.

Tell me more about that.

>> I mean, so many of our patients are overweight and are suffering from cardiovascular complications because of that.

And so we I think cardiologists are probably very big prescribers of GLP-1 medications to help our patients lose weight.

Unfortunately, when somebody gains enough weight, it can become very challenging to be able to exercise.

And so even if somebody becomes more motivated, it is challenging.

And so these medications really help slow the transit, the transit of food through your gut.

They keep people feeling full longer.

So they just by nature of the medication, eat less.

And so we can get people to lose a very significant amount of weight if needed.

and people feel remarkably better, their blood pressure gets better, their cholesterol gets better.

I've seen people's heart failure get better.

their risk of coronary disease goes down.

So they're really, really remarkable medications.

And I think our cardiology division as a whole uses them quite a bit.

>> Dr.

Schallek.

>> I think I'm cautiously optimistic.

I'm always, I think a big believer in the conservative make sure people are exercising and maintaining a healthy weight.

And then when we hit the point where we're unable to lose weight or we're really struggling with comorbidities and other diseases due to obesity, they're a great tool.

I very much counsel patients about all weight loss options.

And I keep healthy eating a part of that.

I've seen a lot of great success for people who've really struggled to lose weight, finally achieve that when they start the GLP-1s.

But I do know a lot of patients have side effects.

So it's really a risk benefit conversation.

there's certainly side effects that some people can't tolerate them.

So I think it's absolutely part of the tool set, but I think I'm still a big believer in that exercise.

Healthy eating, they all go together.

>> Okay.

And maybe one other question related to that, to that point from from Jerry Lin's question on obesity this is casting no moral judgment on size, weight, et cetera.

You know, I mean, I, I feel very fortunate.

I've always had a pretty good metabolism and it's easy for me to make judgments.

I'm not trying to make any judgment, but I will say that roughly a decade ago on this program, when we would talk about obesity related health, I would get more feedback.

That was pretty sharp.

That would say, you know, you can't talk that way healthy at any size.

You know, don't be shaming.

And certainly the goal is never to shame.

I hear that less today.

I hear more of a direct approach that says, generally speaking, not individual to individual, but in general populations.

Obesity can be concerning, it can be a threat, and it's okay to say so, and it's okay to try to counsel people on starting with diet and exercise.

Perhaps the GLP-1s have have has the tenor of things changed, do you think in about this question on health at any size, obesity, et cetera.?

Have you seen anything there?

Dr.

Coniglio.

>> I feel like this comes up every couple of years about how we as physicians should describe patients.

You know, obviously, as you said, we don't ever want to make someone feel ashamed, but there is so much data that clearly shows that if you are overweight that you are at much higher risk of diabetes, hypertension, heart failure, coronary disease, et cetera.

And we know that if we can get people to lose weight, then they will be healthier.

>> Okay, anything to add doctor?

Schallek?

>> No, I completely agree.

Obesity is a risk factor and it's absolutely something that we I consider it multifactorial.

It's genetics, it's lifestyle, it's age.

It's all of the things catching up and the more options we have to treat it, the better.

>> speaking of genetics, listener named Jane wanted to know if the issues you're talking about today are related to genetics.

>> Specifically the risk of heart disease.

There's absolutely some genetic component to things like peripartum, cardiomyopathy, cardiomyopathy.

I really consider it a pie chart of multifactorial.

So genetics is one part of it.

If I have a patient in front of me who says both of my parents had heart disease, my grandparents all had heart disease, my I'm already like, oh, I'm very concerned about a genetic component of heart disease.

there's also certainly lifestyle risk factors, things like smoking and other things.

So it's not one thing in particular.

It's all of the above.

>> And Jessica, I know nothing about your family.

I'm just giving you a hypothetical.

So if you meet a patient like Jessica, everything she's gone through, the surprise, the shock that she's all the treatment she's needed doing okay, thank goodness.

But then you find out she's got a sister.

Is there an additional risk?

Is anything someone related to Jessica would would want to think about based on her experience?

>> There is.

There's.

And Dr.

Coniglio can also speak to this as advanced heart failure, but there are genetic screens that we do for first degree relatives.

So siblings, parents, children who would who would often want to undergo genetic testing at some point.

And certainly as long as I've been in practice, we've learned more and more genes.

So I think genetic testing is a great way forward to find out more.

>> Okay, anything you want to add, doctor Coniglio.

>> I agree wholeheartedly.

>> Okay.

Do you have any any siblings over there?

>> yeah, I have three siblings, but I had my genetic tested and my genetics and there should be no negative.

>> Yeah, I think it's hard.

we are still learning a lot about genetics.

So this is really exploding as a field probably really in the last 5 or 10 years.

and so for somebody with heart failure, the rate of finding a clear genetic cause for that is still only about 30 to 40%.

Now, that doesn't mean that that other 60% of people absolutely doesn't have a genetic predisposition.

It just means we don't know what it is yet.

And so there's still a lot of work to be done.

I highly encourage patients to seek out genetic counseling and genetic testing if they're interested or have a high family risk.

Specifically, when we talk about coronary disease, there actually isn't a specific genetic test or predisposition for coronary disease.

But we all see patients that have a very significant family history of coronary disease, and that actually just the family history alone, independent of genetic testing, is taken into account when we are calculating a patient's risk for disease.

And family history puts you at higher risk.

And you should be on treatment for that to help prevent that.

>> Jessica, has this changed how you eat, how you exercise, how you go through the world?

>> the only reason why I eat differently is because I was also diagnosed with celiac disease.

So now I have to eat gluten free.

I do not work out because I don't want to.

It hurts.

It hurts to do it.

I know it sounds weird, but I, I can only do I can walk the dog.

I can play with Jackson, I do, I keep myself busy and but I don't stress my body more than I have to.

>> And do you find yourself more aware of when you start to feel kind of overloaded?

>> Oh yeah, I can.

I know my body and I know when things are getting wonky.

>> before I go back to emails, we've got several more here.

so if you've emailed, we'll get to these in just a second, but let me just talk a little bit more about your long term, because you mentioned that, you know, your story is that Jackson was born eight years ago.

and you had the, again, the, the term is the Lvad.

Yeah.

Put in five years ago.

and it's, you know, it's been pretty good, but you've had some tough times at times.

You missed a Christmas, you know, with health issues, as you say.

>> Yeah, I had a stroke as well.

Oh, from getting the from having the Lvad, it produced a clot and I had a stroke.

>> So what do you expect for your health in the future?

>> Well, my long term goal right now is to get a transplant.

I would like that to happen.

Eventually.

My doctor suggest I stay on stay with the Lvad as long as possible because it's doing its job, and there are a lot of complications that can come with a transplant.

So that's my goal right now.

I'm just living day by day, having fun and being a mom, doing what I can, staying healthy.

>> so Dr.

Coniglio, when it comes to transplant.

>> Jessica's got, you know, a future that's uncertain on how long, you know, she kind of tolerates the Lvad and what happens here?

How do you talk to patients about this?

And how do you how do you sort of consider the hierarchy of treatment and where does transplant tend to come in here?

>> It's a it's a big question.

obviously, you know, a lot of people consider transplant to be a gold standard because the Lvad that Jessica described earlier is connected to battery.

So Jessica is carrying two large batteries with her right now.

And those go into her are connected to her via a drive.

>> If you're watching on YouTube, she's, she's holding them up right now.

You carry these around.

Yeah.

All the time.

Yeah.

And they're connected to you.

Yeah.

There you go.

>> So they last for about 8 to 10 hours.

So, you know, she can go about her day playing with Jackson and doing whatever she needs to do and not really worry about the Lvad.

But that line that goes into her is called a driveline.

And so that connects the pump that's in her heart to these batteries and keeps it going.

And so Jessica has already experienced some of the complications of lvads, which include infection.

You know, anytime we have something abnormal or plastic hanging out of our skin, I mean, that's certainly a risk factor for having an infection.

and then stroke is a lower risk with the newer pumps, but still certainly exist.

Jessica has to be on blood thinners because of this device as well.

So there's certainly some things about the Lvad that are not ideal.

she is doing great with it now.

she's not in the hospital constantly.

She's not filling up with fluid.

She's able to do what she needs to on a daily basis.

And so that puts her lower on the list for transplant because there are people, the people that are in the hospital and can't get out of the hospital are much higher.

On the list for transplant.

And so oftentimes when we have young, healthy people who are doing very well, the counseling is that we should continue with the Lvad because the Lvad will never run out or die.

And we've had people 12, 18 years out on the Lvad.

And so people can go a very, very long time with this.

obviously there is some waiting that we have to do for the correct organ when it's time, but you, you do need to become sicker to be able to be eligible for transplant.

>> Okay let's get back to email here.

Wendy in the city of Rochester said I had a friend whose identical twin had heart trouble that would have killed her and required an abortion.

My friend got tested, had the same condition, and was counseled not to conceive and therefore did not have to go through the experience of aborting a wanted child.

She ended up being a wonderful adoptive mother.

I had an anti-abortion friend tell me recently that with modern medicine, there is no such thing as an abortion, because the mother's life is threatened.

I told her about the twins case.

Has it gotten to the point where heart problems never indicate the need for an abortion to save a mother's life?

I'm wondering about this now.

Here.

>> Absolutely not.

>> Can you elaborate there?

>> Yeah.

There's still lots of instances where if we, for instance, we don't know about somebody's heart trouble ahead of time and they start presenting with heart troubles in pregnancy, sometimes we do have to counsel patients on abortion.

Obviously, no one wants to do that.

If we can get to a point of delivery, we will deliver as early as we can.

Obviously, there's more risk.

The sooner you deliver.

but there are still diseases that if we know about ahead of time, we would counsel patients that they should not undergo pregnancy.

>> Okay, so whatever Wendy's hearing was incorrect.

Correct.

Okay.

I don't know how often that I mean, is that a common experience?

Not common, but not impossible.

>> Correct.

I mean, most 20 and 30 year old women are healthy.

>> Yeah, yeah.

Anything you add, doctor Schallek.

>> No, there, there I guess.

Yes, there, there are a few things where pregnancy is considered contraindicated from a cardiac standpoint, and they're rare.

like Dr.

Coniglio pointed out.

But, but there, there are things that I think especially young women generally don't have to worry about them, but there are a couple of situations.

The first that comes to mind is something called pulmonary hypertension, which is part cardiovascular but also part pulmonary where women would be very at risk to continue a full pregnancy.

putting both herself and baby at risk.

So there are certainly situations where pregnancy is contraindicated.

I think that especially here in New York State, we, we have the option to counsel women about all the risks of continuing the pregnancy versus termination.

And that is something where it really comes down to a conversation between the patient, the family, the physician and the team to sort of say, these are the risks, these are what we would be up against.

>> Yeah.

Wendy, thanks for the email.

And I would also say, I mean, like, I understand this is an issue that becomes very fraught for some people.

It often becomes very political.

Our guests are not here in any sort of political fashion at all.

We're just talking about the medicine of it.

And it is not accurate to say that we've reached a point where you would never need to counsel an abortion based on health concern or risk.

We're not there yet.

It's not common, not impossible though.

Greg in San Diego says he says good morning.

Well, good afternoon, Greg, but good morning to you.

He says, I've been diagnosed with a heart problem, and I'm trying to find out the difference between systolic and diastolic congestive heart failure.

Could the doctors address this and say, which is more threatening?

Okay, doctor.

Schallek.

>> Sure.

So when we talk about blood pressure, we'll talk about the systolic blood pressure and the diastolic blood pressure.

The systolic is the number on top.

The diastolic is the number on the bottom.

There's also something called systolic heart failure and diastolic heart failure.

And I think of it as a whole spectrum.

Systolic heart failure means that the heart pump is not pumping fully normally.

And normally we we measure something called the ejection fraction.

And the ejection fraction tells us how well the heart is pumping.

When the heart is not pumping normally, that is typically what we call systolic heart failure.

Diastolic heart failure is a little bit more complicated to explain, but I think of it as if the heart is a muscle.

It's the muscle that has to contract.

Or when you see like biceps, you see the muscles will thicken, but then it also has to relax.

And that's kind of what we call diastolic.

As we get older, our heart muscle tends to have more trouble relaxing.

So the pumping part might be perfectly normal, but the relaxing is getting stiffer.

It doesn't relax as well.

And that's what we call diastolic heart failure.

They can both be very serious and they can both be very treatable.

So I think both can be sort of have a spectrum of, of treatment options, but they can also both be very significant and lead to things like having to go to the hospital.

>> Okay, anything to add there?

>> Nope, I would agree.

>> All right, Greg, I hope that helps you there.

Good luck to you.

And finally, Anne wants to know back to menopause.

What about women who are in chemical menopause under the age of 40?

>> I think that that's a great question, but it also brings up the point that I think menopause is partly I think a lot of it has to do with hormone changes.

So if you're chemically induced or if you've had a hysterectomy and now are on hormone replacement therapy, there's absolutely that sort of hormone imbalance, which can lead to things like earlier heart problems.

so, so women typically develop heart disease about ten years later than men.

And it's in part thought to be related to some of the hormone protection of things like estrogen and progesterone, which change considerably during menopause and after menopause, which is when women will catch up with the the diagnosis of heart disease.

So even chemically induced or early menopause that that can lead you to higher risk for earlier heart problems as well.

>> Okay.

and good luck to you.

Let me, we're going to finish the hour by talking a little bit about the guidance that has come from the American Heart Association, the American College of Cardiology and nine other organizations issued last week.

And then we're going to talk a little bit about what is coming next here.

Some of the guidance that I'm reading about here urges those at risk of heart disease to start lowering cholesterol as early as age 30, to try to reduce the number of fatalities reducing cholesterol.

Yes.

Doctors.

Good with that.

>> Yes, yes.

>> Okay.

Directly related to some of what we've already done.

Anything to add there?

>> New guidelines came out last week.

So I think this is a very hot topic for all cardiologists.

And so they are much more aggressive, which I think a lot of us have been treating towards for a long time and really reflect.

>> What the guidelines in general are a hot topic.

Yes.

Are they.

>> Controversial guide?

>> No they're not.

>> We're excited.

>> We love you.

Okay.

>> You're happy with.

>> The new and exciting.

>> Okay.

>> Cardiologist for this, but the changes that are noticeable in the new guidelines are that we are now treating people younger.

So oftentimes we don't put women in particular on statin therapies for cholesterol while they are trying to conceive in those pre-pregnancy or during pregnancy years.

But now the guidelines are saying that we should start treating women and everybody of every gender at much earlier ages, because we know that the longer period of time that you have elevated blood, I'm sorry, elevated cholesterol, that cholesterol is depositing in your blood vessels.

So we used to think, oh, we'll start worrying about it when you're 40 and 50.

But really, now we know that even at a young age, if you have high cholesterol that is starting to deposit in your blood vessels, so they are much more aggressive about what we should be targeting for your LDL, which is your bad cholesterol.

Oftentimes, women are protected before menopause because their HDL, the good cholesterol is very high.

And so that's where I think a lot of the issues related to menopause come in is that it really has a big effect hormonally on your cholesterol.

But we can now treat that too with our medical therapies.

>> Okay.

And in general, with the guidance, you said the cardiologists are happy about this.

We do anything else we should know about the guidance?

>> We love new guidelines.

So the newest cholesterol guidelines came out within the past month.

I think Dr.

Coniglio pointed out most of the big points.

The thing that I was sort of I thought, I think grabbed my attention was we have these things called risk factors.

But then in the new guidelines, they did point out that there's what are called enhancers.

So instead of risk factors, we're calling them risk enhancers.

And it includes things like early menopause, which comes back to the article here in in the new guidelines, they're calling early menopause less than 45 years.

also noted pre-eclampsia as a risk enhancer and gestational diabetes as a risk enhancer.

And where that really comes into is knowing your history.

If you had preeclampsia or if you had gestational diabetes, knowing that that can put you at higher risk.

And you should bring that up with your doctor down the road, because it might be a point where they would consider cholesterol medicines a little bit earlier for you.

>> Okay.

so thumbs up to the new guidance from the doctors in the studio here.

And finally Vox reported on a number of issues related to the conversation today, including this here, according to a report from the American Heart Association in McKinsey, less than 1 in 4 primary care doctors say that they feel well equipped to gauge cardiovascular disease, cardiovascular disease risk in women.

So fewer than 25% of primary docs feel where they like up to speed where they need to be on this.

Are you concerned about that?

>> Yeah, I think it's it's a common message that I've heard, you know, throughout cardiology is that we do a lot of great primary care, primary care doctors are really overburdened with taking care of a person from head to toe, and that some of the the heart disease, I think can, can really become overwhelming in terms of diagnosis because it can be quiet.

The symptoms can be different for different people, for, for men and women, the symptoms can be different.

So it is something that as much education as we try to do on a program like today, even in our medical schools, in our training programs, I think it's still an ongoing.

We need to update our programs, update our teaching.

>> Okay.

Dr.

Coniglio.

>> I agree.

I think a lot of our, if you, if a patient sees a primary care doctor, a cardiologist, oftentimes a cardiologist is going to be much more aggressive.

and so, you know, if somebody feels that they are particularly at high risk, I encourage them to talk to their primary care doctor about that.

but they can always refer to a cardiologist, a cardiologists are happy to see patients to talk about risk, even if they don't already have disease.

but we love to prevent disease we'd rather not see in the cath lab or the hospital.

>> Well, what a really powerful hour it's been.

Jessica Driffill.

Let me close with this here.

Tell me something good about Jackson here.

What's he into these days?

>> He loves golf and basketball.

Those are his two things.

He watches wrestling all the time.

And he loves his dog, Max.

>> And life is good for this eight year old.

>> Life is good.

>> And well.

Here's to continued success to you.

Thank you.

Thank you for telling your story.

I know it's for some folks.

It's not easy to tell these stories publicly.

It's really powerful.

It's very helpful for us.

Thanks for doing that.

It's good to meet you this hour.

Good to meet you.

Jessica Driffill a heart patient telling her story, and I want to thank our the professionals in the room have fielded a lot of your questions.

If we didn't get to them you know, don't just Google the answers.

It turns out there's great.

There are great professionals who can help you.

Dr.

Rebecca Schallek, assistant professor of clinical medicine in the Division of Cardiology and cardiologist with the Cardiac Care Women's Heart Program at UR Medicine.

Thank you for being here this hour, doctor Amanda Coniglio advanced heart failure and transplant physician at Rochester Regional Health.

Thank you as well from all of us at Connections.

Thanks for listening and watching.

We're right back here.

What do we got?

Oh, we have another hour.

Rob's looking at me like, what have you done for the day?

I'm not done for the day.

We have another hour coming up right now in Connections.

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Just click on the Connections link at wxxinews.org.

>> Let's have some fun.

I, someone I know pretty well Pezeshkian.

Is that the right guy with the way I heard that?

I thought the Facebook.

Yeah.

you know, from what I mean, I don't know a lot, but I think the price has fallen.

But so for the, for the standard rate bans are 299.

And then Oakley's are 3.99 and the low down display is about 799.

If you can get your hands on one because they're sold out, so there's always the one with of the 1952.54.

And you know, that was that was our that, that was, that was, you know, that was, that's a demonstration has in classes.

So those were for sale because, because they cost so 16 or $20,000 apiece to make Nolan McLean for Daniel Palencia.

One of the things that we heard about to be aware.

>> Of, right?

>> So let's.

>> See.

>> The widespread adoption.

But yeah.

Yes.

So what are you bringing the technology up?

I think.

Yeah.

So I'm in 20s here.

We come.

>> Back.