Did you know that Heart disease is the leading cause of death for men and women in the United States? Every single year, 1 in 4 deaths are caused by heart disease. The good news is that heart disease can often be prevented when people make healthy choices and properly manage their health conditions. Because February is American Heart Month and because I happen to closely know one of the leaders in cardiac and pulmonary rehabilitation in NYC and beyond, I thought we would dedicate this week’s blog to a question and answer session on matters of the heart (health).


Meet my husband Dr. Jonathan Whiteson. He is Medical Director of Cardiac and Pulmonary Rehabilitation at NYU Langone Health, Assistant Professor of Rehabilitation Medicine and Vice Chair of Clinical Operations at Rusk Rehabilitation, NYU Langone Health.   I sat down with Jonathan to discuss heart disease, how in particular it effects women and how we can better take care of ourselves and prevent this disease from effecting us and those that we love.

Q: February is heart health month. Since the majority of my readers are women, I thought we should open up by asking how women’s heart disease is different than men’s heart disease.

A: Heart disease is caused by narrowing of the coronary arteries–atherosclerosis – and is the number one cause of disability and death in women. One in four women die from cardio-vascular disease! Women are typically ‘protected’ from this kind of heart disease until the postmenopausal years. 10 years post-menopause and risk of heart disease is the same as in men. While the typical central chest pressure and pain can indicate heart disease in women, shortness of breath and generalized fatigue are a far more common presenting complaint in women than men – a fact that has been overlooked by the medical community.


Q: Are there any female-specific disorders that increase a women’s risk of heart disease?

A: Women have the same risk factors for cardiovascular heart disease as men: obesity, high cholesterol, high blood pressure, diabetes, smoking, physical inactivity are the major risk factors. But, the impact of diabetes, smoking, physical inactivity and emotional stress have been shown to be more significant in contributing to heart disease in women than men. Women can develop a heart muscle disorder, or cardiomyopathy related to pregnancy. While often reversible sometimes this can persist and lead to heart failure over a number of years. And recently, increasing data identifies women treated for breast cancer at increased risk of heart disease – a consequence of toxic effects of some chemotherapies on the heart muscle, as well as radiation directly damaging the coronary arteries.


Q:  In general, what is the most common cause of heart disease?

A: The most common cause of heart disease is atherosclerosis – hardening or thickening of the arteries by buildup of fatty plaques within the wall of the coronary artery. Risk factors – as above – cause this build up. This kind of heart disease causes the narrowing of the coronary arteries. Reduced blood flow to the heart muscle and can cause angina – typically experienced as chest tightness on increased activity but in women shortness of breath, excessive fatigue may be more typical features. If a fatty plaque ruptures this will cause a blood clot within the coronary artery and suddenly block all blood flow to the muscle causing a heart attack – sudden severe chest pains, severe shortness of breath, nausea, sweating and at times collapse and sudden death. Other causes of heart disease include tightness (stenosis) or leakiness (regurgitation) of the heart chamber valves, and abnormalities of the electrical conducting system within the heart. Rarely, the heart muscle itself might weaken.


Q: Is heart disease preventable? What can we be doing in terms of taking care of our bodies that will prevent this disease?

 A: Atherosclerosis is in nearly all instances related to lifestyle risk factors and so absolutely preventable. A ‘heart healthy lifestyle’ implies not smoking, frequent exercise, maintaining ideal body weight and composition, a healthy nutritious diet rich in fruits and vegetables and low in saturated fats and the maintenance of normal blood pressure, blood cholesterol and blood sugar. Stress management and control of anxiety and depression, as well as refreshing sleep – at least 6-8 hours nightly, round off the heart healthy lifestyle. Alcohol in my opinion is not heart healthy – it is not ‘medicinal’ as many would like to believe and it should be limited to small quantities at celebrations only. Alcohol is in fact a heart muscle toxin and can impair heart function as well as make heart and other medications less effective.


Q: Which is more important in preventing heart disease? Diet or Exercise?  If exercise, is there a certain exercise or exercise trend that you see most effective in preventing this disease?

A: Air or water? We cannot ‘live’ without either! A poor diet undoes the benefit of exercise, and sedentary lifestyles negate healthy diets. Heart healthy lifestyles require the correct combination of both. Janine can tell you the heart healthy diet – I can tell you it is delicious, we live it and I crave it! I prescribe aerobic exercise for heart health – the scientific literature has confirmed its benefit. And it is a prescription – exercise is medicine and so we must all exercise according to our own specific needs. In general, we should all be doing 60 minutes of aerobic exercise most days (4 to 5 days a week) at an intensity that feels somewhat hard to us. This ‘intensity’ is key – too light and easy and the heart protective benefit is not gained. Too heavy and intense and the heart can be put under undue strain. High intensity interval training where short bursts (45-60 seconds)  of higher intensity exercise is safe for everyone and can boost the heart protective benefits of aerobic exercise. In addition, 3-4 times a week we should be doing light to moderate resistance exercise for muscle tone and strength. And remember, the heart healthy lifestyle combining good nutrition and prescriptive exercise is lifelong – lifelong for a long, and healthy / productive life!


Today we’ve just scratched the surface. We’ve got lots more to cover and Jonathan is happy to help. Check back here next week–same time, same place. Jonathan will be back to answer five more questions regarding heart health including signs that women must never ignore regarding their health.

In the meantime, read up on my heart (Jonathan) below.

Dr. Jonathan Whiteson works at Rusk Rehabilitation, NYU Langone Health where he has dedicated his practice to helping people with heart disease recover and improve their health and well-being. By teaching his patients how to manage their risk factors for heart disease and through a specific exercise prescription and nutrition guidance he has helped thousands recover and then thrive again following heart attacks and other cardiac events. Dr. Whiteson is also the host of “The Rehab Show” on Doctor Radio, Sirius XM channel 110 where he discusses his ideas on heart healthy lifestyles with his guests. Catch him every Monday morning, 6-8 am EST (and later replayed on both Sirius XM and online).