How to Save Your Heart: Cardiovascular disease in women with Dr Sara Moscatelli
Episode Introduction
Cardiovascular disease is the leading cause of death in women worldwide, and yet for decades it has been studied and treated as though women are simply smaller men. The symptoms we are most likely to experience are still labelled atypical, despite the fact that women are half of the population. We tend to get disease within the smallest vessels of the heart, where a standard angiogram shows nothing at all. And the risk calculators used to decide who gets treated do not account for female specific or predominant disease like preeclampsia, gestational diabetes, preterm birth, autoimmune disease or menopause.
In this episode I sit down with cardiologist Dr Sara Moscatelli to separate what is really important to know how about to look after your heart. We cover how heart disease actually presents in women, which tests find it and which miss it, what statins do and do not do, where hormone therapy currently sits, and how much exercise your heart really needs. Most importantly, we talk about what you can start doing straight away because for too many women, the biggest risk factor is that we put ourselves last.
Guest Bio
Dr Sara Moscatelli is a cardiologist with specialist expertise in paediatric cardiology, women's health and cardiovascular imaging. Originally from Italy, she moved to London to train in cardiovascular magnetic resonance at the Royal Brompton Hospital. She is now undertaking a PhD at University College London and Great Ormond Street Hospital, investigating arrhythmogenic cardiomyopathies in children. Alongside her clinical and translational research, she writes and speaks internationally on sex differences in cardiovascular medicine, including diagnostic bias in cardiovascular imaging in women.
What We Cover
[00:02:50] The awareness gap, and what it costs women
• Why so few women know that cardiovascular disease is their leading cause of death
• The measurable consequences: longer delays, fewer cardiology referrals, worse outcomes
[00:05:30] The risk factors standard calculators leave out
• Pregnancy complications, autoimmune disease and menopause as cardiovascular risk factors
• Why the risk scores your doctor uses still cannot account for any of them
[00:07:32] What a heart attack actually feels like in a woman
• Breathlessness, profound fatigue and upper abdominal pain, and why calling these symptoms atypical is part of the problem
• The case from a colleague that changed how Sara listens
[00:10:32] Small vessels, invisible disease, and the tests that find it
• Why men’s disease sits in the large arteries and ours in vessels too small to stent
• What a clear angiogram really means, and how cardiac MRI has changed the picture
[00:19:34] Statins: the evidence versus the algorithm
• A viral social media clip on statins, taken apart claim by claim
• Whether the dementia claim survives scrutiny, and what actually drives cognitive risk
[00:25:14] Blood pressure, the silent killer
• When to start measuring, how often, and what to do with a high reading
• Where home monitors and wearables genuinely help, and where they do not
[00:27:43] How much exercise your heart actually needs
• Walking, running, HIIT, VO2 max and lifting: what to prioritise and in what order
• Why the three month mark matters more than finding the perfect programme
[00:32:20] Heart attacks in younger women
• Coronary artery dissection, and why chest pain in your thirties should never be dismissed
• The other cause of heart attacks in young people that rarely gets discussed
[00:34:56] Menopause, hormone therapy and the heart
• Why losing oestrogen changes cardiovascular risk, and what HRT may or may not do about it
• Where the evidence currently sits, and what Sara is waiting for
[00:38:08] Why heart failure looks different in women
• Diastolic dysfunction, and how a heart that pumps normally can still be failing
• What decades of sex bias in clinical trials has meant for the way women are treated
What You Will Learn
• What are the symptoms of a heart attack in women?
• Why are women’s heart attack symptoms described as atypical?
• What is coronary microvascular disease?
• Why is my angiogram normal when I still have chest pain?
• What are MINOCA and INOCA?
• Does preeclampsia increase your risk of heart disease later in life?
• Do cardiovascular risk calculators work for women?
• Do statins cause dementia or memory loss?
• Do statins work as well in women as they do in men?
• At what age should women start checking their blood pressure?
• How much exercise do I need for heart health?
• Is walking enough exercise for your heart?
• Do I need to know my VO2 max?
• Does HRT protect the heart?
• Can you have a heart attack in your thirties?
• What is spontaneous coronary artery dissection (SCAD)?
• What is heart failure with preserved ejection fraction?
Key Takeaways
• Your symptoms may not look like the ones in the textbook. Unusual exhaustion, breathlessness and pain around your stomach can all be cardiac.
• A clear angiogram does not always mean a healthy heart. If you have ongoing symptoms and no explanation, ask whether microvascular disease has been considered.
• Your obstetric history is cardiac history. Preeclampsia, gestational diabetes and preterm birth belong on the list every time your risk is assessed. Mention these risk factors yourself if you have not been asked directly.
• Start small and start now. Walking counts. Three months of a habit you actually keep will do more for your heart than a programme you abandon in a fortnight.
Further Resources and Support
Heart health information and support
• World Heart Federation. Global alliance of heart foundations, with campaigns and links to national member organisations
• Go Red for Women. The American Heart Association’s women’s heart health initiative, including symptom guidance and survivor stories
• British Heart Foundation. Patient information, risk checkers and a cardiac nurse helpline
Microvascular disease, SCAD and less common presentations
• Beat SCAD. Support, information and community for people affected by spontaneous coronary artery dissection
• SCAD Alliance. International patient-centred organisation advancing SCAD research and awareness
• Cardiomyopathy UK. Support line and information for people living with inherited heart muscle conditions
Heart failure
• Pumping Marvellous Foundation. Patient-led heart failure charity offering peer support and practical day to day information
• Global Heart Hub. International alliance of heart patient organisations, including heart failure advocacy
Cholesterol and blood pressure
• HEART UK. Cholesterol charity with a helpline and clear information on statins and inherited high cholesterol
• Blood Pressure UK. Practical guidance on measuring your blood pressure accurately at home
• World Hypertension League. International blood pressure awareness resources and links to national societies
Pregnancy-related cardiovascular risk
• Preeclampsia Foundation. Information on preeclampsia and the long-term cardiovascular follow-up that should follow it
• Action on Pre-eclampsia. Support and information for women who have had a hypertensive pregnancy
Physical activity
• World Health Organization physical activity guidance. Global recommendations on how much activity is needed at each stage of life
Disclaimer
The content of this episode and these show notes is provided for general information and education. It does not constitute medical advice and is not a substitute for an individual assessment by your own doctor or healthcare professional. If you are experiencing chest pain, breathlessness, or any symptom that concerns you, seek urgent medical attention. Always discuss changes to medication, hormone therapy, diet or exercise with a qualified clinician who knows your medical history.
