Asking for a Friend - Health, Fitness & Personal Growth Tips for Women in Midlife

Ep.123 Women's Cardiovascular Health: Dr. Odayme Quesada on Heart and Stroke Risk, Weight Loss, and Sustainable Health Practices

• Michele Henning Folan • Episode 123

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Joining me is Dr. Odayme Quesada, esteemed director of the Christ Hospital Women's Heart Center, who brings invaluable insight into women's heart health. Discover the often-overlooked symptoms of heart attacks in women—like jaw pain and nausea—and understand the distinct risk factors that make women's cardiovascular health unique. 

Dr. Quesada shares her extensive expertise on how conditions like preeclampsia, early menopause, and genetic predispositions can impact long-term heart health, offering a comprehensive view of women's cardiovascular risks and the essential need for specialized care.

Explore the powerful benefits of GLP-1 drugs for significant weight loss and cardiovascular risk reduction, alongside practical dietary recommendations such as the Mediterranean and DASH diets. Learn the critical differences between heart attacks and strokes, including the importance of recognizing transient ischemic attacks (TIAs) as early warning signs. 

Odayme calls on women, particularly those with a history of cardiovascular risk, to participate in vital health studies, stressing how diverse representation in research is key to advancing women's health. Join us for an episode that not only informs but compels action toward better health outcomes for women everywhere.

You can find Odayme Quesda, MD at:
https://www.thechristhospital.com/services/heart/specialized-care-and-treatment/womens-heart-disease

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Michele Folan:

I believe my family and friends thought it was a little crazy for me to leave my secure corporate job to pursue fitness and nutrition coaching, and I will say that I would likely not have done this even four years ago. But this podcast has opened my eyes to the multifaceted challenges of women's midlife health that even my 26 years in the health industry didn't teach me. I am much like you. Maybe you've been through menopause and now you're trying to figure out how you're going to ensure your longevity and mobility for the next 30 plus years. My mission wasn't to look like my 24-year-old self again, but I wanted to have energy, sleep well, feel comfortable in my clothes and not be a burden to my children when I'm older. I want to control what I can control. I wanted to find a program that met me where I was and one that would undo all that diet culture had thrown at me. And guess what? You can lose weight, that belly fat and feel amazing in your 50s and beyond. Are you ready to make a commitment to your future self? Shoot me an email or reach out on social media. We can chat about your goals and see if my program will suit your needs. Health, wellness, fitness and everything in between. We're removing the taboo from what really matters in midlife.

Michele Folan:

I'm your host, Michele Folan, and this is Asking for a Friend. Heart disease is the number one cause of death in women and men, but how does the risk of stroke factor into the equation and what are the symptoms and why are women different than men in overall stroke risk? Way back in 2022, in episode 10, Dr Odayme Quesada was a guest on the Asking for a Friend podcast and we both realized, after a very robust conversation about heart disease, we never really had time to dive into the topic of stroke. Dr Quesada is the director of the Christ Hospital Women's Heart Center in Cincinnati, Ohio, which is one of the few dedicated centers in the world solely focused on women's heart health. Welcome back to Asking for a Friend on women's heart health. Welcome back to Asking for a Friend, Odayme Quesada.

Odayme Quesada, MD:

Thank you for having me. How exciting. I can't believe it's been two years I know it's flown.

Michele Folan:

I had to get this together because I really wanted to talk. First of all, go back and talk about heart disease in women, because that's what you do, and then also touch on stroke, because there are some commonalities between the two in terms of risk factors. But first, before we get started, I gave a little bit of an introduction of you, but if you want to tell the audience a little bit about, like, where you went to school and kind of your career path, that would be wonderful, absolutely.

Odayme Quesada, MD:

So I am Cuban, originally from Miami, and somehow ended up in Cincinnati, Ohio, to build the first women's heart center in the region. But my training essentially was long as it is for many of us. I started at the University of Florida where I got my undergraduate degree in chemistry. I went on to Yale Medical School where I got my MD and a Master's of Health Science. That's where I started doing clinical research. Then I went on to San Francisco to finish my residency in internal medicine and then finally did my cardiology fellowship in the Barbra Streisand Women's Heart Center at Cedars-Sinai, where I also did a research fellowship. And that's how I got recruited to Christ to start the Women's Heart Center.

Michele Folan:

I would love for you to talk a little bit about the Women's Heart Center, because it is a unique institution within not just this area but really the country. Can you talk a little bit about your mission there? Absolutely.

Odayme Quesada, MD:

So we started the Women's Heart Center and we're very happy that we've seen this happen throughout the country. We actually are helping other centers throughout the country build women's heart centers. But it's really because of this need for specialized care for women with cardiovascular disease. We know that women are unfortunately not underdiagnosed when it comes to cardiovascular disease, undertreated, and therefore it's not surprising that actually a woman with heart disease has worse outcomes than a man with the same heart disease. And again, that's because of there's differences, biases, etc. So that's why these women's heart centers, that's why we build our women's heart center because we want to close that gap. We want to make sure that men and women receive the same care and that we are able to change outcomes in women, moving forward you talk about some of the disparities and biases with men and women and how they're treated, and biases with men and women and how they're treated.

Michele Folan:

Would you discuss a little bit about the symptoms and the signs of heart attack and heart disease and why that may play a role there?

Odayme Quesada, MD:

You know, I think there's a lot of different things that are different when we look at sex differences, and one of them is what you're pointing out, which is what are the symptoms of presentation of different heart diseases, and my heart attacks is one of the ones that we often have to talk about, because we want to make sure that people know, you know the warning signs if they're, if they're having these symptoms.

Odayme Quesada, MD:

So you know the classic. The classic symptoms of a heart attack is chest pain that sometimes radiates up the neck or down the arm, some shortness of breath, nausea, sometimes even vomiting, that occurs suddenly or when someone is doing some kind of exertion, and so those are the typical warning signs. But what we've learned is that, even though women also get similar presentations, they also have a lot of what we call associated symptoms that many times are not thought to be a heart attack. For instance, they may have just a jaw pain, they may have just nausea or more like epigastric pain, which they think is more GI related. They may have like sudden malaise or not feeling well, and that may be the way that they are presenting with their heart attack. So it's not always that classic. You know, chest pain that you can ignore. In women, they may have more of those subtle symptoms, so you just have to be more aware.

Michele Folan:

What about some of the risk factors?

Odayme Quesada, MD:

Yeah, risk factors is a great question and it actually links nicely with stroke, which I know you want to also discuss today. But when we talk about risk factors, you know the typical cardiovascular risk factors are smoking, high blood pressure, diabetes, physical inactivity. Those are all key risk factors for both cardiovascular disease, heart attacks and for for strokes. And if you actually look at differences in the sexes, we actually find that these risk factors women with these risk factors are at a higher risk of having the heart attack or the stroke compared to men. And then we have to think about, when we talk about risk factors, the women specific risk factors that we're starting to recognize, like pregnancy, like complications of pregnancy, like preeclampsia, preterm delivery, gestational diabetes. These are all now recognized as women specific risk factors or things like early menopause. So it's important, when we're thinking about risk factors and sex differences, that we think about the ones that are more specific to women, like pregnancy related or menopause related.

Michele Folan:

So with the risk factor of preeclampsia. Didn't you do a study on that at one time?

Odayme Quesada, MD:

Yeah, we're still doing our study on that.

Odayme Quesada, MD:

It's actually starting to come to an end. Study on that is actually starting to come to an end. So our study was to try to understand why it is that women with preeclampsia end up having up to a threefold higher risk of heart disease later in life and actually develop heart disease at a younger age than women who have had just normal pregnancies. And so, yeah, this is a study that we're still working on and we're trying to understand why they're at this higher risk, that high blood pressure that then essentially doesn't just completely resolve but lingers all the way until their later in life 40s, 50s to really start showing the signs of the heart disease. But they go silent, unfortunately, and that's why these women think that they're okay, but they're really at a higher risk, especially of high blood pressure. So that's why it's so important for women with these blood pressure issues in pregnancy to know that they're at a much higher risk of developing high blood pressure, that sometimes it's just silent and never you know, and undiagnosed for lots of years.

Michele Folan:

Yeah, because you could have high blood pressure and not even know it right?

Odayme Quesada, MD:

It's the silent killer. I mean they really call hypertension or high blood pressure the silent killer, because you can have it and not know it for so many years and that's what leads to really high risk of heart attacks, strokes, heart failures. I mean you name it.

Michele Folan:

Dr Quesada, does heredity play a role in any of this?

Odayme Quesada, MD:

Absolutely. We can't forget that there are certain risk factors that are hereditary. For instance, there's familial hyperlipidemia, which is a genetic disorder where there's really high cholesterol. These are families where, unfortunately, they're having heart attacks and strokes in their 30s and 40s really high cholesterol levels. There's also a lot of familial and genetic cardiac diseases that we're starting to learn about. Different cardiomyopathies, which are issues of the muscle, the heart, like hypertrophic cardiomyopathy, is just one example.

Michele Folan:

So, yes, we're learning more and more that there is that there are a lot of diseases that do have a genetic link well, you know what and I've had this conversation with another doctor that you know there's the genetic heredity and then there's the lifestyle heredity. That's true, Some of those lifestyle maybe sometimes not so great habits that we adopt from our parents. So there's that too, Absolutely. You made a comment about early menopause and the prevalence of heart disease in those women. Was it because of the lower amount of estrogen at that point? Do we think there's a correlation there? There probably is.

Odayme Quesada, MD:

So we know that early menopause increases the risk of cardiovascular disease and that's actually now made it into as one of the risk enhancers in our guidelines. When we're looking, when we're trying to risk stratify someone for future cardiovascular disease, we use the ASCVD risk score the atherosclerotic cardiovascular disease risk score and essentially we take different we put it in a calculator different measures age, blood pressure, different risk factors and we're actually able to get a percentage and then we're able to risk stratify patients by that percentage. But then we have these risk enhancers which help us know, in addition to the percentage percentage, what things make this person a higher risk.

Michele Folan:

And what we've recognized and what we've learned from from lots of work that's been done is that early menopause does increase a woman's risk of having cardiovascular disease compared to someone that has menopause during, you know, normal timing so with the women's health initiative and you and I touched on this before we started recording would you be so kind as to, from a cardiovascular doctor, explain a little bit about the Women's Health Initiative and kind of the stance on HRT now, yeah, so the Women's Health Initiative was a fantastic study that was part of the wave of early studies to try to understand cardiovascular risk and cardiovascular disease, and the reason that made sense was because, to your point, when we see that women go through menopause and they lose estrogen, their risk increases significantly.

Odayme Quesada, MD:

So of course, it made sense like, wait, what if we replace it right? Would we reduce this women's cardiovascular risk? But what they actually found which was not what they expected and the reason the study got cut off early they actually found that there was an increased risk of cardiovascular events in the women that were taking the hormone replacement therapy. So that's why hormone replacement therapy for cardiovascular prevention is a big no-no, since that study publishes results. Big no-no, since that study publishes results. Now, the reality is that currently, our HRTs that we're using have a much lower content of estrogen, and so what we need is new studies to help us understand what is the risk of the current hormone replacement therapy that we're using, and there's a lot of great work that's being done right now, and I have colleagues doing this kind of work, but the guidelines are really based on the data that we do have.

Odayme Quesada, MD:

So, right now, the data that we do have tells us that if the ASCVD risk of someone is less than 5% and they've had recent menopause and they have low risk for cardiovascular disease, then they should, then no problem, Green light when it comes to being on HRT. If someone has an ASCVD risk score between five and 7% and then they have other other risk factors like diabetes, smoking, hypertension that's not controlled obesity, et cetera, then they are in this yellow. You know, they usually usually think about the different lights. Then they're like kind of on that, Um, there is risk, but you have to have a conversation. Maybe this is someone that that we shouldn't consider being on HRT. Maybe we should consider progesterone only if we're talking about, um, not so much hormone replacement therapy but more like for birth control. And then the red light people that we really shouldn't be using, you know, birth control that contains estrogen or HRT are patients that have an ASVD risk greater than 7.5 or anyone that actually has known cardiovascular disease. So right now, these are our guidelines.

Michele Folan:

So since it's been two years since we spoke, I was wondering if you had any new data to share on cardiovascular risk in women.

Odayme Quesada, MD:

We've had a very busy two years I'm very excited to share.

Odayme Quesada, MD:

We had a publication in Hypertension Journal this past year and this was in Latina women, from the study of Latinos which showed that women with preeclampsia were at a higher risk of having abnormalities in their heart structure and function, and so again this alludes to what we talked about earlier, which is that preeclampsia is an important risk factor for future cardiovascular disease and actually affects the heart structure and function even in asymptomatic women.

Odayme Quesada, MD:

So that was a very exciting study. We had another really exciting publication where we looked at heart attacks with open arteries, and we actually found that patients with heart attacks and open arteries actually have the same risk of death at five years than patients who have heart attacks with obstructive disease, meaning blockage of the large arteries that requires a stent. Historically, we've thought that if someone has a heart attack with open arteries, that's a much lower risk heart attack. We don't have to really worry about it, and this actually happens more commonly in women, and so this was a really exciting publication in the last few months that showed that no, we need to worry about these heart attacks too.

Michele Folan:

Wow. So I mean, that seems very counterintuitive. So what are you thinking? Why?

Odayme Quesada, MD:

is it that these patients? Well, it turns out that patients can have heart attacks and have open arteries and that's from. It could be a number of things that can cause that. It can be because they had a plaque, that that caused a blockage, but by the time they go looking it went downstream, so the damage is still being done. It can be from a dissection of the coronary artery that's not observed initially. It can be from spasmsection of the coronary artery that's not observed initially. It can be from spasm of the coronary arteries. So there's a lot of other issues that happen that can cause a heart attack, even when there's absence of blockage that requires a stent.

Michele Folan:

Okay, my audience is mostly, I would say, 50 years old and plus. In regard to risk, how does risk go up year over year? When it comes to heart attack risk in women?

Odayme Quesada, MD:

Yeah, so there's a lot of changes that happen as women and men get older and unfortunately, you know, blood pressure goes up, especially after menopause, which is an important risk factor. The incidence of other risk factors diabetes, obesity in a physical activity, I mean all the things that that are risk factors start going up with age, which is why we see that increase in the risk and the increase in these events happening as people get older. So I would say that's, that's the problem, or that's that's the reason. Now I think the more important piece is how do you, you know, how do we prevent this? How do we, how do we keep ourselves cardiovascularly young? How do we keep ourselves cardiovascularly young or cardiovascularly healthy right, and it really has to do a lot with.

Odayme Quesada, MD:

And one thing that I am always, always talking to all of my patients about and I take the extra five minutes of every visit is to talk about the importance of exercise.

Odayme Quesada, MD:

I can't emphasize enough how important that is and, as you know, as people get older, that's where the knee problems come into play and all the joint problems start coming into play, and I always say, well, if you need that knee surgery so you can be able to do my 30 minutes a day, five days a week, then I approve that knee surgery right. So it's all about, I think, making sure I'm staying physically active. It doesn't have to mean going to a gym, it doesn't have to mean anything fancy, but staying active, doing true cardiovascular exercise, some weight training, especially for people that are losing a lot of weights. On these new agents, these fantastic new agents, the GOP ones that are making a lot of people lose weight, people can't forget that they have to do the muscle training because they lose a lot of fat, a lot of muscle mass with these agents. So again, just for so many reasons, physical activity with a mixture of cardiovascular and, ideally, some weight training, I think is the way to stay cardiovascular, young, you know.

Michele Folan:

I wasn't going to talk about the GLP-1s, but since you brought it up, I do have a question Are there reductions in cardiovascular risk with those drugs?

Odayme Quesada, MD:

Absolutely yes. There are more and more studies are coming out that are showing that these new drugs that were originally approved for diabetes and then found to reduce, you know, be significant weight loss drugs and are now getting approved just for weight loss, even in patients without diabetes. More and more studies are coming out showing their different cardiovascular benefits.

Michele Folan:

And I guess it goes hand in hand with if you lose weight, that can lower your risk, If you lower your metabolic syndrome, whatever right.

Odayme Quesada, MD:

And blood pressure, for instance. I mean, we know that when people lose weight I've been having to down titrate hypertension medications, I've been having to down titrate hypertension medications and then of course, all the cardiometabolic components, the sugar levels all of that goes down too. So, yes, that's why we see a lot of those benefits that go beyond just the glycemic effects of the drugs.

Michele Folan:

So you counsel your patients on exercise. What kind of diet counseling do they get? Yeah, in terms of diet.

Odayme Quesada, MD:

The diet that I recommend is the diet that has the most data, which is the Mediterranean diet and the low salt diet. Essentially, the DASH diet and the Mediterranean diet, especially in combination, is what's recommended by the majority of us cardiologists, just because it has been shown to reduce cardiovascular risk factors and even events.

Michele Folan:

Okay, I do want to talk a little bit about stroke and kind of the risk factors of stroke and how and, if it, if there's any correlation between heart attack risk.

Odayme Quesada, MD:

Yeah, I mean the reason that there's so much overlap and many times when we say cardiovascular disease, strokes are added to the mix. So many times that fits under that umbrella. Sometimes it doesn't, but it's really because the risk factors are essentially the same. I mean it's high blood pressure, hypertension is the number one risk factor. Sm mean it's high blood pressure, hypertension is the number one risk factor. Smoking, diabetes, obesity again all of very similar, again very similar to what I just said before about the risk factors for heart attacks. And so that's why there's so many similarities.

Odayme Quesada, MD:

And if you think about what's happening in a heart attack and what's happening in a heart attack and what's happening in a stroke, again there's a lot of similarities. So in a heart attack, what happens many times is that there is plaque in the coronary arteries that essentially dislodges and or think of it as a pimple that pops and then closes off that vessel. Right there's a clotting cascade. That happens and forms a clot and that clot pretty much doesn't allow blood flow to go down the coronary artery. The heart doesn't get any blood and those cells die and that's what a heart attack is. The most common cause of stroke is very similar. You have a plaque that dislodges from the artery in the neck or somewhere in that vascular tree and then essentially, that clot dislodges. It causes inability of the blood to go up to the brain, so then that part of the brain dies and that's a stroke. So very similar things happen in both disease processes.

Michele Folan:

Would you talk about the transient ischemic attack, tia and what happens there versus like the big one, like when you have a real stroke stroke?

Odayme Quesada, MD:

Yeah, no for sure. And that's important because a lot of times they call like a TIA that transient ischemic attack, like the warning before the stroke. And the reason that they do that is actually because a lot of patients like one in three patients who have a TIA will have a stroke later on. So that's why they call it a warning sign and actually about half the patients who had a TIA they'll develop a stroke that same year. So again, you don't want to ignore a TIA or just say, oh, I just had a TIA. So what is a TIA? Essentially, what it means is that there is blood flow to the brain that gets stopped before a transient amount of time and therefore it doesn't lead to any longstanding damage or longstanding disability. That's a TIA versus a stroke. That clot goes up or something causes disruption of blood flow, but it's permanent. So then that causes death of whatever area was fed by that artery and then that causes what we call the full-blown stroke. Are there?

Michele Folan:

risk factors that are different with men and women with stroke.

Odayme Quesada, MD:

Similar top risk factors. It's just about similar to what I said in heart attacks. It's just the risk factors just increase the risk for women more than men.

Michele Folan:

Okay, and did you say it's because?

Odayme Quesada, MD:

because you said this before we got on the call that women tend to live longer and so our risk is higher. Is that part of it, of strokes? It's higher in women compared to men just because women usually live longer. So when we talk about you know stroke has a greater percentage of deaths in women than men. That's in the life, you know, over the lifespan. But for instance, if you look at younger patients, actually men have strokes at like a three point higher rate than women do, if you're looking at like, let's say, young patients. But overall, you know we have to understand stroke is the third cause of death in women. So that's why we're talking about it.

Odayme Quesada, MD:

Heart disease is the number one cause of death. Stroke is the number three cause of death. So this is a real problem. What's number two? Actually, it is cancer. It is cancer, but it's all cancers combined. That's why sometimes they separate the cancers. But when you combine all of the cancers is yeah, okay. And I guess one thing that I also wanted to mention again, just to kind of bring the context of of how prevalent this is, you know we always talk about one in three women will have a cardiac event. I mean, for strokes is one in five, so it's not that much lower Okay.

Michele Folan:

All right, and then are there any early warning signs for stroke?

Odayme Quesada, MD:

So I would say the TIA is definitely a warning sign you don't want to ignore. I would say that's probably the main warning sign per se. The people that have a TIA that then you know are at a higher risk of having that stroke that same year or overall. That is probably the best warning sign that someone can get for that. So again, don't ignore it just because it goes away, Because usually the stroke, like symptoms for a TIA, are very similar, Just just.

Odayme Quesada, MD:

I don't think we talked about that. We didn't talk about, like, the signs and symptoms of a stroke, but essentially, essentially, an acronym that the AHA uses a lot is called FAST. So it's face drooping, arm weakness, speech difficulty and time to call 911. That's really, you know what they want to make sure that we all remember. But when we're talking about stroke, they want to make sure that we all remember.

Odayme Quesada, MD:

But when we're talking about stroke, essentially there are some differences. Usually we think of stroke, as I said face drooping, arm weakness, speech difficulty, vision problems, trouble walking, severe headache. These are all the warning signs and symptoms of a stroke. In women they can have these, but they can also have, as we talked about, with heart attacks. They can also have more subtle signs and symptoms. So they can have like general weakness, disorientation, fatigue, nausea, vomiting, and that may be their stroke-like presentation. So again, for women, you just have to be very aware If you don't feel right, go get checked out. It could be the way you're presenting, with a heart attack or a stroke, Both of which are permanently damaging.

Michele Folan:

That's really interesting that the signs and symptoms are very similar for women, for stroke and for heart attack. How will they treat TIA? Because I know they put some preventative measures in place right, so that you don't have an actual stroke, of course. Okay, like the anti-platelet type of drug?

Odayme Quesada, MD:

or oh, so you're asking for the actual treatment. Yes, so the treatment is TPA. So, essentially, if someone presents with a stroke, the first thing that they do is they get a CT to confirm that the person's having a stroke and that there's no bleeding, and then, essentially, they give a very potent anticoagulation, anti-clot medication called TPA, so that they can lyse the clot and return blood flow to the brain to reduce the damage of that stroke. That's exactly what they do, okay.

Michele Folan:

Are there things that the patient can do to facilitate recovery from a stroke?

Odayme Quesada, MD:

Absolutely so. One of the well, I guess the most important thing that I just want to reemphasize one more time is recognizing those symptoms, presenting right away, because for both heart attacks and stroke, time means muscle or time means brain cells, and so if someone's having these symptoms, or even these other non-specific symptoms, and you just don't feel right, it is really critical to go present, call 911 right away, act fast. That's why the acronym is FAST. You want to be as fast as possible. So that's the key.

Odayme Quesada, MD:

But of course, if someone has had an event, I guess the other part of the question you're asking how do they recover from this? And that requires a lot of good physical therapy. So the journey to recovery depends, of course, and what is the impairment as a result of the stroke? Right? And so a lot of often what happens is the therapy is very much targeted to whatever the deficit is as a result of that stroke. But I can't emphasize enough how critical it is to do therapy the same way we send patients to cardiac rehab after they've had a heart attack.

Michele Folan:

So you've been working in this arena for how many years now?

Odayme Quesada, MD:

I guess overall maybe 10 now between training and being a cardiologist.

Michele Folan:

So in that 10 years, how has your lifestyle and how you take care of yourself changed? That's a good question.

Odayme Quesada, MD:

That's actually. You know, I really have tried to do what I preach. I have been very adamant, despite my busy schedule and a lot of competing things for my time, that I do dedicate those 30 minutes to myself. You know, I tell people get a dog. If you need an excuse to walk, do whatever it takes. It's not so much about, it's about commitment when it comes to physical activity and exercise. It's not about waiting until you're feeling inspired. And so when I moved to Cincinnati, california, it was very easy to stay active all year round. But when I moved to Cincinnati and then I had to deal with winters, I bought a Peloton, I bought a machine to be able to stay active throughout the winter. And so again, whatever it is that people need to help them stay active throughout the year.

Odayme Quesada, MD:

I think it's important, and even my diet has changed. I am Cuban, so my diet is definitely not Mediterranean or dash in any shape, way or form, but I have learned that you know that's Cuban food is for my sheep days, meaning the weekends and during the week. I really try to adhere to that Mediterranean diet and a lot of what I tell my patients I try to adhere to it eat as many fruits and vegetables as possible, reducing the carbs and the red meats. So I really have tried and I wasn't like this. This has not been my lifestyle always, but I feel like over the years I've learned to adapt because it's so important to stay, you know, healthy from a cardiovascular standpoint.

Michele Folan:

You know, my husband and I were in Miami and we went to a Cuban restaurant for breakfast oh my God, maybe one of the best breakfasts I've ever had and the Cuban coffee is lights out Right. Oh my God, I can see why it would be hard to take your whole upbringing of food and your culture and say Nope, not eating it, sorry, because it would be really, really difficult.

Odayme Quesada, MD:

Yeah, exactly, so that's why weekends exist.

Michele Folan:

Do you have any other pillars of self-care that are important to you?

Odayme Quesada, MD:

I would say different things work for different people. I value a lot of my vacation time, so for me I find that very helpful. It's very difficult. I think the whole idea of like balancing is just very hard. The reality is we just have to prioritize different things at different times in our lives or at different weeks or different months, and so what I find very helpful is taking some time away every so often just to recharge and kind of be able to do it all over again.

Michele Folan:

Yeah, that's great advice, that is. We all need to be better at that, I think. Dr Otamai Kasada, I would love for you to tell the audience where they can find you and the Women's Heart.

Odayme Quesada, MD:

Center? Yeah, absolutely so I would say the easiest way to do it is if you just Google Christ Hospital Women's Heart Center, it should easily come up on your search engine. Otherwise, I can share the website with you to share with your audience. We essentially have on our website a lot of really good information on, even educational materials on risk factors in women the different diseases that I specialize in that are more common in women, like the heart attacks with open arteries or chest pain with open arteries. So a lot of good information there too. And we actually have a Facebook group that we started recently. I don't think we had it when we had our first podcast two years ago, but we found that our patients really wanted a form to be able to support each other. So we do have the Christ Hospital Women's Heart Center Facebook group now for patients.

Michele Folan:

Oh, that's fantastic. I love that. And then are you recruiting for any studies right now that you need help with?

Odayme Quesada, MD:

Actually we are. We're always recruiting for studies. Yes, our preeclampsia studies still recruiting, meaning if women are in there within 10 years of a pregnancy, whether they had preeclampsia or even normal pregnancies within the last 10 years, we're still actively recruiting for that study. We do compensate women for their time. So please contact us if you would be interested. It's really important us as women, and especially minority women, to be represented in research because otherwise studies will not reflect us, they will reflect other people, and so I really encourage us to. If we can be part of research studies, we really should do that so that in the future we can really help close those gaps in knowledge.

Michele Folan:

Thank you for saying that I think that's important. Dr Quesada, I want to thank you for being here today and fitting me into your very busy schedule Anytime.

Odayme Quesada, MD:

I look forward to doing this again.

Michele Folan:

Oh, wonderful Be careful what you wish for Right. I am so grateful for the ratings and reviews from our listeners. Did you know that your reviews help other people find Asking for a Friend? If you like what you hear, won't you please leave a review on Spotify or Apple? Thank you from the bottom of my heart.