Phreak Klass
Advances in science, medicine, technology and information-sharing continue to happen at an accelerated pace. Join elite athlete, Phaidra Knight as she chronicles her personal health, wellness and peak-performance journey with personal accounts and interviews with leading doctors, scientists, entreprenuers and wellness professionals. Each episode contains powerful information to help you live your best life.
Phreak Klass
Heart Health Revolution: Redefining Women's Cardiac Care
Phaidra's guest this epsiode is Dr. Suzanne Steinbaum. You'll discover why standard risk assessments fail women by ignoring crucial factors like pregnancy complications, autoimmune diseases, and depression. Dr. Steinbaum reveals how even family history—perhaps the most obvious risk indicator—isn't included in standard cardiac evaluations. Most importantly, she offers hope: 80% of heart disease is preventable with the right approach.
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This is Freak Class and I'm your host, phaedra Knight. Now. I've wanted to do a podcast for a long time and I'm really glad that I finally took that leap. I've been on this podcast for a long time and I'm really glad that I finally took that leap. As I wind down this first season, I have to say that I'm feeling pretty comfortable in front of the mic. I've enjoyed introducing you to people who are all in on pushing the. You go back and listen to the other episodes this season. Even though I knew all of the guests and research prior to shows, I learned something new and very valuable each episode. I am so very excited to present today's guest.
Speaker 1:In my experience in sports, the most dynamic and important people are those who innovate. They excel at the game as it is, but see new ways to improve the game and take it to the next level. Robert F Kennedy famously said Some men see things as they are and ask why. I dream things that never were and ask why not. My next guest is a third generation doctor, but when she finally put on the white coat herself as a cardiologist, she saw that there were gaps in the standard of care for women, that there were gaps in the standard of care for women. With leading hospital experience and a thriving private practice, she could have just stayed the course. She was on to seniority and career success, but she opted instead to follow her convictions and step out on faith. She is now a tech entrepreneur with a potential solution to improving the standard of care for women everywhere with her company Adesso. Dr Suzanne, welcome to the podcast.
Speaker 2:Thank you so much for having me, Frasier. It's great being here with you.
Speaker 1:It's so awesome being here with you and having you on. You know we've been working together for a while now and to have you on the podcast and finishing off this first season is a real pleasure. Thank you, absolutely, absolutely. Now I'm going to be tempted the entire show to jump ahead, but I really want people to know who you are and get a feel for the statistics and the issues prior to delving into your tech. Can you first tell us about yourself coming from a line of doctors and your education journey?
Speaker 2:Sure, you know I always make the joke that I've never spent a day on this planet without knowing or being involved with patients. My grandfather was a primary care doctor and his office was connected to the house, so I used to hang out at their house all the time and run through this door. That led to this magic space of patients and healthcare, and my earliest memory really is doing eye exams with my grandfather. I was so frustrated.
Speaker 2:I was very little and I was like I need to learn the alphabet to do eye exams, and my grandmother was a teacher and I went into that part of the house to learn the alphabet and the other part of the house to do the eye exam. And so that's where the story begins. My father really is an innovator in his own right. He is an oncologist and trained at Sloan Kettering, one of the most traditional research institutions in this country, and later in his career he ran a oncology center where he used Reiki and had a social worker and a psychologist and a nutritionist on his staff. And it always intrigued me that he had that Reiki master. And I would say to him well, why do you have her here? And he'd say because the patients feel better. And so I was really raised to him with this understanding that to be the best doctor you can be, you really need to focus on the patient and that the research is so important and the clinical data is so important, but that person sitting in front of you is the most important part of your job. And so, as I went through my training, I tell this story all the time, phaedra, because it was such a moment that I'll never forget.
Speaker 2:I wasn't exactly sure what I wanted to do. And I was on a rotation in the emergency room and there was a woman who was wheeled in. She was 53, really sick, sweating on a stretcher, you know kind of writhing in pain, holding her stomach and her chest. And when she was brought into the emergency room she was evaluated by the doctors there and they gave her the diagnosis of gastroenteritis and put her in the corner where she proceeded to have a heart attack in front of us.
Speaker 2:And at that moment for me everything stopped, like when Oprah talks about the aha moment, like the world just shut down. When Oprah talks about the aha moment, like the world just shut down. And there was a bright light on this woman and I just looked at everyone around me and it was like business as usual. Nobody was shocked that this happened and I said that's it, that's what I want to do. This is not the first time it happened. This wasn't the first time that a woman was neglected, ignored, misdiagnosed, put in the corner, but wasn't the first time that a woman was neglected, ignored, misdiagnosed, put in the corner. But this was the time that I said this is what.
Speaker 1:I'm going to do.
Speaker 2:And I went to the chief of cardiology and I said I want to do a fellowship in women in heart disease. He said there's no such thing. I said I want to do a preventive cardiology fellowship and he looked at me and he said there's no such thing. But I was very lucky to be in the right place at the right time. He got approved for me, through the National Medical Education Committee to do one of the first preventive cardiology fellowships in the country and I worked with him on Dean Ornish's lifestyle heart trial, which was on the West coast in San Francisco at Dean Ornish's Institute. But we were on the East coast doing that research and that research included diet, exercise, stress management in the form of yoga and group support and it was the most fascinating, interesting experience and that set my career on a trajectory that involved understanding the difference of disease states between men and women and that was in the late 90s, early 2000s, when we thought there was literally no such thing as women and heart disease.
Speaker 1:Wow.
Speaker 2:That's quite a journey.
Speaker 1:And I'm just curious. Going back to the lady who was put in the corner when she went into cardiac arrest, was she able to be saved? Was there an intervention?
Speaker 2:Yeah, she was actively having a heart attack and so immediately, you know we know what to do under emergencies. You know everyone's got a down pat the IV goes in, the central line goes in you know which medications blood thinners bring her up to the cath lab. All of that medications, blood thinners bring her up to the cath lab, all of that. But it it is a representation of the medical system which is we're a disease treatment kind of medical system. Right, we're gonna wait till that person gets sick and then we're gonna treat them. And and that was it for me. What are we waiting for? Yeah, reactive why don't?
Speaker 2:we, yeah, what are we waiting for?
Speaker 2:let's prevent this, that's right and we really do understand and this is a powerful statistic 80 percent of the time heart disease is preventable, 80 percent of the time, one of the most. And we're talking about a great time because just this past monday night I gave a talk to a group of primary care doctors and gynecologists and I really spent an exorbitant amount of time reviewing all the research again and all the data and I don't get to do that very often right now as a CEO of a tech company, and it was great just being in that academic space of a tech company and it was great just being in that academic space. And I was reminded by an intense article. It was a pivotal trial that was released in 1999. It was called the WISE trial and what it showed was that heart disease was fundamentally different in men and women, fundamentally different in men and women.
Speaker 2:And every single tool we had that we were using to diagnose heart disease did not pick up disease in women, it only picked it up in men. And I said, oh my God, like this is what I've got to do. How is this possible? And it's been, you know, a 30 year journey and, um, we haven't made that much. We've done a lot. You know there's, there's been some progress, but not enough, really not enough right.
Speaker 1:Well, I mean so much in the prevention of heart disease. I mean beyond, obviously, 20 the%. That's inevitable is lifestyle and what we call epigenetically driven right, it's lifestyle driven, would you agree?
Speaker 2:A hundred percent. I agree with that. Let's talk about epigenetics, because it's a super interesting concept. There are genes that when you have them, we know you're going to get the disease, and the best example of that is the BRCA gene for breast cancer. You got it. You know this is an issue You're going to get breast cancer.
Speaker 2:We don't have it quite like that when it comes to coronary artery disease. We know that coronary artery disease happens most often from lifestyle. But what happens with lifestyle is you tend to get these risk factors. So if you don't eat healthy and you don't exercise and you live on fast food and sugar, then your blood pressure is going to go up, your cholesterol is going to go up, your sugars are going to go up, your waist circumference is going to go up, your cholesterol is going to go up, your sugars are going to go up, your waist circumference is going to go up, your weight is going to go up, and those risk factors are the major risk factors for heart disease. So how you choose to live has an incredible impact on the lining of your arteries, and when that lining of your arteries becomes stiff and damaged, that is when plaque develops and it begins with those risk factors.
Speaker 1:Yeah, that lifestyle.
Speaker 2:Lifestyle, Exactly exactly.
Speaker 1:That's, you know, and I think you know, what comes with the lifestyle piece, especially now, is a much stronger approach to the education right of our country, of our world, but it's also, I think, the availability of sound, good choices right, availability of good options right as it concerns food and things of that nature. So that's in our hands, folks, it's in our hands.
Speaker 2:What becomes fascinating right now is that you can find out anything you want to find out, because we have AI, we have chat GPT. You just type it in and it'll tell you exactly what to eat. You know what I?
Speaker 1:mean.
Speaker 2:That's right, but you have to make that effort. So there's like all these stages you can be educated, but you can be educated and you can dismiss it, or you can be educated and you can do something about it. And here's the interesting piece of that If you don't turn on a gene, that gene does not express itself. So when people come in my office and they say one of two things my father, there's family history of heart disease, so I'm gonna get it. Or they say the opposite there's no history of heart disease, so there's no way I'm gonna get it right and on either side of those, you're missing the whole story which is.
Speaker 2:it's in your hands. You just got to take control of it 1000%, 1000%.
Speaker 1:Now let's shift a bit. Let's talk about your early medical career and what you saw in the statistics and in the actual practice that led you to your desire to do something. You talked a little bit about it a short while ago, but let's go in.
Speaker 2:I think one of the most profound things that really had an impact. And I mentioned that one trial and I'm going to dovetail off of that because it was the beginning of my career and during that time this is when stenting became a really big deal. So people were getting stents all day long, constantly, for every blockage in the artery. And what we know is that when you have plaque in the artery it's a diffuse disease. It is not disease in one location. A stent is put in one location, in the location where the plaque is building up, but the disease process is happening throughout the artery. But the disease process is happening throughout the artery. And so when you really look back at this early data, we know that plaque rupture is the most common form of heart attacks. When a plaque breaks apart, the body responds by sending platelets to that area to kind of patch up the area that erupted. But the arteries are narrow, so when all those platelets go to heal and fix it, there is no blood flow through that area and blood carries oxygen, and when there's no oxygen delivery, that heart muscle dies. Well, it turns out that most of those ruptures happen when the plaque is 30 to 50%, yet stents are put in when the blockage is 70% or greater.
Speaker 2:When the blockage is 70% or greater, and so I can't quite understand exactly what we were doing, because people were getting stents and they would leave and be like I've been saved, I've been cured, and I would think to myself what they just began, this is the beginning of their story, and there was no connection between that stent and what was going to happen to that patient when they left.
Speaker 2:And I thought, oh my god, like this is what I got to do. Nobody's really understanding this. And and I think because I did this preventive fellowship and I got to meet some of those most brilliant minds in the country who were doing things and and about high blood pressure, about lipidology, about nutrition and vitamins and diet, and I think of some of these teachers that that I found, who found me, who talked to me about the autonomic nervous system and inflammation. I mean, these are concepts now that sound more familiar to you, but back in the day nobody was talking about this. And so when I realized the gap that there was, not only in education for the patient but in the education for the doctor, that was it. That's what I decided I was going to do. Let me tell you, fadria, it was a tough road.
Speaker 2:I was up there talking about diet and exercise and people were rolling their eyes in the audience like who is this flaky doctor? What is she talking about? They wanted to talk about sense. They thought that what I was saying didn't make any sense. And it is interesting to cut to all these decades later when, finally, what we were talking about then is now mainstream and people understand that food is medicine and that we have to exercise. But could you imagine that research was done 30 plus years ago and it's not part of mainstream medicine quite exactly yet? It's a conversation, yeah, but it's much more nuanced than that when you actually get into the research.
Speaker 1:It's so insane and it's I think it's. You know I this is not necessarily it's, it's neurology when I'm what I'm about to talk about or or mention, but you know it's interesting. My mom was working with a neurologist down in Georgia. She was in a clinical trial for mild cognitive impairment, slash early stage Alzheimer's and in my initial meeting with this doctor this neurologist you know I brought up, like you know, one of the things around the lifestyle is her diet, how she eats, and it's literally proven right and what correlates with what you're saying. You know you're talking about diet and nutrition, you know 30 years ago and but you still have doctors now in different, different silos who this, this doctor was absolutely like I'm not going to tell your mom not to eat what she wants to eat, because there's no correlation. And I'm like, yes, what are you reading? You're a neurologist running a clinical trial, like, what are you talking about?
Speaker 2:So it's insane.
Speaker 1:It's insane.
Speaker 2:But I think you know that's what I'm really saying that when you look at medical education, when I was going to medical school, when my colleagues were going to medical school, we really did not learn about diet. But what's so insane? When you talk to that neurologist, there is a gene, the ApoE gene, that is associated not only with Alzheimer's but early heart disease, because it's an abnormality with actually processing cholesterol and fat and when the body can't process and get rid of them, those fats lie inside the lining of the artery and if they do that in the heart it leads to coronary artery disease. If it happens in the brain, it leads to dementia and Alzheimer's. And so the treatment for somebody with an ApoE 3, 4 or 4, 4 gene is early, early prevention with cholesterol lowering and a low fat, low saturated fat diet early on.
Speaker 2:Let's talk about epigenetics. Your grandma had Alzheimer's. I think you should be mostly vegetarian from the time you're 20 years old. I think you should be mostly vegetarian from the time you're 20 years old and that's going to change your outcome. And so how we use these genes it's again it's not just a suggestion go eat well, it's actually tailored to a genetic and metabolic individualized state and that's the difference between a neurologist saying I don't know what to say because you don't know, that's on you you know, what I mean.
Speaker 2:And so we're in a position, I believe, where, as you brought up, we're able to become educated. We have access to every piece of information out there, and what I think has become really important is that patients need to become educated, because sometimes the doctors just don't know and everyone is a little different and healthcare different, and healthcare has been created on this notion of more of a public health idea. So we have several hundreds of thousands of patients. They were part of this trial and this trial outcomes showed X, y and Z. Well, what happens if you're not, if you're a person who doesn't fit into that trial? What happens if it's a bunch of 50 to 65 year old white guys? Well, I don't know. Like that's not you, right, that's not me, that's right.
Speaker 2:So it becomes important to understand that there is personalized prevention, there's personalized treatment. We have in the oncology space. You know there's ways that treatment is given based on the genetic codes of a tumor. You know we have to do that for every aspect of our care. Who am I, treat me, and? And that takes a little bit of self-education. And once you become educated, you know what the coolest thing is when you can become your own self advocate because you're knowledgeable enough and I've watched you do that multiple times really becoming that person that can say I've read everything.
Speaker 2:This is who I am, and this is what I need.
Speaker 1:Right, that's right. You know you said it. It's a personalized care and you said you alluded to this it's. People have to take those reins and your doctor is certainly an expert, or you would hope that your doctor is an expert in that given area. But you must quarterback your own health and in doing that you absolutely must know your as much as you can know, right, your genetic makeup, what your genetic predispositions are, and you just have to take an interest in your health. There's nothing more important. Really. There isn't like you have your job, but like if you don't have your health and you, you can't work your job, you can't be a mom, you can't be a dad, you know you can't be a giving person in society. So reprioritizing your health and then quarterbacking that, you know, with the best team that you can actually put together, is an ideal approach to healthcare, in my opinion. So, absolutely.
Speaker 2:You have to find someone and this is a word that I keep using lately whoever you work with needs to be curious enough to find out what they don't know. Yes, little bit of what has made me a little unique in the technology space I'm a doctor, like I know how to practice medicine, so I know how to take information in and integrate it into the whole physiology of the body to create an outcome that makes sense. And what sometimes happens and I see this in the tech world is that someone's going to build technology but they don't understand the clinical implications or they don't understand how that needs to be done. And I think what you need to do as a patient is find somebody who's a doctor, who can integrate new information along with you to be able to give you the best options based on what they know.
Speaker 1:Do you know what I'm saying? Absolutely, absolutely. It's constantly changing right. Yes, it's ever expanding. It's constantly changing right, it's ever expanding. It's a practice and, as we know, like you know, I'm a, I'm a lawyer in training. So, even with, with, with that, right, you're, you're in the practice of medicine, you're in a, I'm in a practice or was in a practice of law, right, but you're constantly evolving. And if you can't evolve, especially as a doctor I think that's one of the key things If you can't evolve as a doctor, what are, how are you? How are you doing no harm? Right, that's it. It's almost like a direct violation of the, of the, of the Hippocratic oath. You must evolve as as the, the, the horizon changes and it's changing every day with the amount of research and advancements that are occurring in the medical space. It's fascinating.
Speaker 2:It's so dynamic and I want to make a point that I think is interesting to understand Especially. Let me just talk about cardiology and that world. We have scientific statements, we have guidelines that are published and they're they're based on tons of people. I mean, these are large studies, they're meta analysis not they could be meta analysis, but they're also multi-centered, so they're happening all over the country at different locations. There's cohorts of patients from all over and there's a standard research protocol that is standardized for all of these different places, becomes a scientific statement or eventually becomes our method or our algorithm of how we practice medicine. It takes a solid 20 years from that to go from research to clinical practice.
Speaker 2:By the time that statement is out or that research is published, there's a whole lot of other stuff that happens that can really have an impact on that, and I think what I have found so dynamic in sort of the technology space is that things happen faster. There is an understanding that you can pivot when something maybe doesn't prove to be right, you can shift, and I think in medicine it's harder. We need research, we really need that data to prove certain assumptions or hypotheses, prove certain assumptions, our hypothesis, but what we also need to be able to do simultaneously is evolve, iterate, be curious, learn more about all those little trials that are going on all over the world. That might just be interesting, that might just have an impact on that statement or that protocol or the algorithm, and, and if you're not looking at those little things, you're missing them both.
Speaker 2:You know that's what you need to do every day it's like you read the newspaper every day or on your phone, whatever you are, you are consuming information on a daily basis because it changes, and that's what you need to do in healthcare as well.
Speaker 1:Yeah, I 1000% agree, 1000%.
Speaker 2:So and you can't learn everything. That's the other thing.
Speaker 1:That's right, that's right, that's right. But when you have a movement of people who are learning and learning different things, it's still. It certainly broadens the perspective and yields a lot of information, a lot of new information on a regular basis, like you say, in a dynamic fashion. Right yeah, fashion, right yeah.
Speaker 2:So now, we let's get to the story of Adesso. All right, how did it come about and why do you believe Adesso is the solution?
Speaker 2:I spent a career in hospital systems and I also, when I started and I joke around, it was the beginning of Go Red for Women, which is under the American Heart Association and its focus is on education, research, advocacy for women and heart disease, and it now started 22 years ago, and so that's when I was, you know, really getting started in my career and I said I got to get involved with this, this is what I want to do, and I became one of the first national spokespeople for Go Red for Women, and I laugh about it because it wasn't like I was invited.
Speaker 2:They had no choice. I just talked a lot. You know, I kept showing up and saying I gotta do this, I gotta do this, and so they couldn't get rid of me and um, and I and I and I just became one of those people that went to every company I could in New York, every women's group. I was explaining how important it was to use the right language when you go to the emergency room so you get care. Study was done.
Speaker 2:Well, many years after that, showing that women actually get a delay in care when they go to the emergency room compared to men, even when they present with a heart attack. That there is a delay. But I knew that because I was in the emergency room and I saw it happening. So without that research at that time, I'm giving this talk and I told everyone to write down and translate into Spanish, from Spanish to English, I learned how to say it in Spanish. Basically, I think I'm having a heart attack. If you don't take care of me right now, I'm calling my lawyer. It was like how can I threaten you to take care of me so I don't get a delay in care because it was happening right and I and I thought so that was the beginning.
Speaker 2:And now I often walk around New York City where I I practice and live and and I'll just point to buildings I'm like I lecture there, I lecture there, I lecture there. I can just walk, walk down um Park Avenue in the 50s and the 40s and all over, because it was so important to me to educate. Well, after doing that for 20 years in the hospital system then, I wrote a book and I did a lot of television.
Speaker 2:From the time I started, I kept saying one in three women die of heart disease more than all cancers combined. Twenty years later, I'm sitting in one of the best hospitals in the country and I'm saying the same thing One in three women die of heart disease more than all cancers combined. Oh my God, what am I doing? What am I doing? If I'm really going to make an impact, I can't sit here. I got to do this and so I left, and what was interesting is that I went into private practice, wasn't quite sure exactly how this was going to work out, but COVID happened Two months later after I opened the practice.
Speaker 2:Things were going okay. I had a plan of attack and now we have to shut down and it's March 13th, on a Friday, and I basically had to leave my practice and I left New York and went to New Jersey and moved in with my parents in the country and it was the first time in 20 years I actually had a stop and I sat down and wrote a 90 page manual how how to Prevent Heart Disease in Women, using all the data, all the research, all the evidence-based data, and then my data superimposed. It was very funny. My parents kept saying can't you watch Netflix like the rest of the people? I'm like nope, nope, nope, I'm changing heart disease for women.
Speaker 2:Leave me alone. That's right, and I got that manual done and I had the biggest academic critic read it my father and I said go through this, you know, really make sure this makes sense.
Speaker 2:And it took me about two months to write it and I got it. I submitted it to the Library of Congress and got it copyrighted by the Library of Congress, found a technology company, put it on a technology platform and it made sense to me Because now, if I use technology, this is access, this is equity of care. This could be anywhere in the world of care, this could be anywhere in the world and people could be getting the same care that I know they deserve. That I was practicing in my office and put on a technology platform that primary care doctors can run in their office and it was all that same work that I was doing and it took us on that technology platform. Well it it took me about five hours to write it on we. We covered the walls with white paper and had a big sharpie marker and I just kept drawing and drawing and all the algorithms and all the arrows in different colors to explain this sort of three-dimensional approach. I had to treatment based on research that was not yet considered standard of care and should be, and to have that technology build. It took a really long time and to see it work. We're saving lives.
Speaker 2:I have a story of a 51-year-old woman who was adopted. She didn't know her family history, overweight, complaining of shortness of breath to the primary care doctor and they kept telling her just got to lose weight, got to go exercise, got to lose weight for three months. They kept telling her this. Well, odessa was in the clinic it was our first pilot and I get a call from the doctor there that Odessa diagnosed that she had a major cardiac problem and needed to see a cardiologist as soon as possible. Well, the cardiologist the nearest one was three and a half hours away, but across the street they had a CAT scan angiogram. So they sent her right over there and they saw that there was greater than 70% blockage in the artery and they weren't sure how bad it was. And she went right to the hospital three and a half hours away she had a 99% blockage in the main artery of her heart. This is a woman who would have gone to sleep and never woken up.
Speaker 2:Wow, and I have to tell you that was this moment of oh my God, I think I did it. Wow, able to say to people you don't have to get sick and to say to doctors primary doctors you can keep your patients healthy. This is how you do it and it's easy and you just got to do it. That has been incredibly powerful. I told you that my grandfather was a primary care doctor. Well, so were my two uncles and cousins, and I used them as a focus group. My cousins were my focus group and I said would you use this, how would you use this? What would you want from this? And understanding how much those patients relied more on their primary care doctors and gynecologists. They didn't go to cardiologists. You know you go to a cardiologist when you're sick, but who do you go to when you just are getting a checkup?
Speaker 2:to that doctor and really putting the power in those doctors' hands meant a lot to me and we're seeing it work.
Speaker 1:Wow, yeah, that's pretty profound, and I mean, for this reason alone, you're grateful for COVID. Right Like this is some great things.
Speaker 2:I feel guilty saying that I'm not going to say that I know, I know, I know, you know, I think the message of that, though honestly, because I think about it now often there are so many people that I speak to as a doctor over these years and even now, who are running themselves ragged and including myself, sometimes, most of the time, quite honestly, and sometimes that is not the most powerful way to be that our most creative, our most dynamic and sometimes really the way that we can kind of get ahead and do better and do more is when we go outside and we're in nature and we're barefoot, or we're just sitting and being calm, whether it's meditating or just breathing.
Speaker 2:It's the time that you allow your sympathetic nervous system to calm down. That's right. Those are the times that you actually can do more. That's right, and I think it was a moment that I think about often to say to myself just stop, just breathe, for a minute. And I think that's something that, um, we all have to remember. It's really and really important to recover that recovery on a daily basis, whether it's sleep, meditation, exercise. It is critical to not only your health but your overall well-being and productivity.
Speaker 1:Ultimately, One thousand percent. Like you know, it's parasympathetic. You know activation, if you will, is so critical. I spend every day dedicating time to it, and it was you know it kind of leads into the my my own personal story and how I came to know you.
Speaker 1:You know, um, it was actually sent to you, uh, by Dr Pamela Hopps, uh, my primary care physician in New York city. And you know, I remember, you know, getting some blood work done, um, you know, and seeing that this thing called lp little a was just elevated, and I didn't understand it, and then I got a calcium score that was higher than it should have been. I'm just like what is happening, you know, um, have a, you know there's a have a family history of heart disease, and my dad has heart disease, my grandfather had heart disease, my grandmother had heart, I mean, like everyone essentially, had developed heart disease. And so I'm like I'm, I gotta stop the site, you know, to break the cycle. And so she, she said, you know, you, the person you need to go see is Dr Suzanne. She'll take a look at every artery in your body and um, and then you know, be able to help you provide, create some solutions.
Speaker 1:And so you know it's, it's so true, but a big part of my, you know, activation, if you will, uh, of of that gene, that gene it was just I wasn't, I was too stressed all the time I was not. You know, I think a big part of a big contributor is not in parasympathetic mode. You know I was constantly going. I wasn't taking the time to breathe and walk barefoot in nature. And you know I, although I don't get a ton of time to do that now during the week, I do have the moments of you know, now during the week, I do have the moments of, you know, checking in and going to motion every day, you know, and getting that parasympathetic time. So it's so true, right, it's so important to stop and to breathe and to relax and to connect with nature and to heal, because that's the time when you rest, digest and you heal. It's so true.
Speaker 2:It's so true I think one, go ahead, go ahead. One of the foundations of disease, every disease, is inflammation and inflammation. And inflammation happens for multiple different reasons, but it continues with the triggering of the sympathetic nervous system, the fight or flight part of the nervous system, and if we don't shut that off and actually give it a rest, any little thing is going to get exacerbated. And you all know this from like. Let's think back when you're in school or during a stressful time. You go through that really, really stressful time and it's over. When that sympathetic nervous system is triggered for a period of time, your immune system drops, inflammation goes up and you're done.
Speaker 2:So it's the covid for me. I mean, there was multiple terrible things that happened, right, but one of the things that reminded me of was we gotta stop every so often. We just got to stop, and that every so often should probably be every day, and you know this about me. I am exercising every day. There is you cannot take that away from me, because I know the importance of that and the other side of it is the side of sitting and breathing and meditating and really just checking in to shut off that sympathetic nervous system. It is critical.
Speaker 1:Yeah, very critical. Well, we touched on a couple of points that I wanted to bring up at this segue of this episode, but I want to talk a little bit in general about women's heart health, or I want to have you talk about that a little bit more. Let's have that discussion as it relates to Adesso, but just a bit more about women's heart health and where we are and where we're going with that women's heart health and where we are and where we're going with that.
Speaker 2:So I think where we really need to start with is something that is just the basics. The basics of disease we don't know. It wasn't until 1993 that the Office of Women's Health opened up and the Women's Health Initiative about hormone replacement, which was a really terrible trial that really scared doctors and patients that they were going to get breast cancer and colostomy and heart disease and it was just a poorly structured trial.
Speaker 2:And that was the beginning of research in women and heart disease. It was only in 1993 that that started. Talk about 30 years, that's it, you know 32. And so we have missed out on the basics, and one of the biggest basics is who's at risk for heart disease? Well, believe it or not, there is no risk analysis that's actually tailored for women, and the standard risk analysis that we use misses women about 50% of the time, especially women less than 65 years old. We have an increase in heart disease for women less than 55 years old, and there is no risk analysis that will say to a woman who walks in the door hey, we should check your LP little a and your calcium score. Nothing, there's nothing. Lp little a and your calcium score Nothing, there's nothing.
Speaker 2:And so the first thing that I did with a death, though, is ask the right question, and, believe it or not, the ASCVD risk analysis that is the standard of care does not ask about family history. It does not ask you to check your LP little a. It does not ask questions that pertain more to women, things like adverse outcomes of pregnancy, if you had preeclampsia, or gestational diabetes, or multiple miscarriages, low birth weight, I mean, I can go on. All of those things increases your risk of heart disease as early as 10 years after you deliver. So that's the first thing. Autoimmune diseases, which happen more frequently in women. It doesn't ask that question, you know, are you living with this baseline inflammatory state? Because if you are, it increases your risk of heart disease. Things like depression two to fourfold increase in heart disease for women compared to men. So all of these different things that matters more to women. Obviously, pregnancy only happens to women. Autoimmune is more often happens to women.
Speaker 2:But without asking those questions you can't really assess who is at risk. And if you can't assess who is at risk, then you don't know who to have further testing on, further diagnostic strategies on and who to treat to prevent heart disease. And so we started with the Adesso Heart Square, which is asking the right question. The next part of the story I alluded to earlier, which is that the way we diagnose heart disease does not pick it up in women. So when a woman goes into the emergency room with chest pain and it looks like she probably has a blockage in the artery because they sent her to the cath lab the invasive procedure that's when they put the stents in she goes to the cath lab to have dye injected in her arteries to see if there is a blockage.
Speaker 2:66% of the time there will be no blockage and the reason is because in women disease is diffuse, so the entire artery looks normal, even though there might be plaque on both sides. But the way these tests are done is it compares abnormal to normal and if the entire artery is abnormal you cannot make the distinction because there's nothing to compare it to. So 66% of the time that woman is told she's fine and she gets discharged from the hospital. The most common thing that happens to that woman is she has sudden cardiac death in her home, and whoever's there doesn't know CPR. That's the story. And so when we look at that we have to realize that so much needs to change. And so not only does ADACO risk stratify, but we use diagnostic testing that looks at vascular health so we can determine if that woman has that diffuse disease pattern in the small arteries called microvascular disease. We test for things like LP, little a, that it is not standard of care, right now.
Speaker 2:And that is a genetic marker that increases your risk of heart disease earlier in life. It takes an LDL particle and makes it incredibly sticky and more likely to stick together and cause plaque and cause heart attack. And so we check for things metabolically hemoglobin A1C, we look at particles and test an apolipoprotein B. We do a cardiopulmonary exercise test to look for vascular health. We put all this together in the engine. That took all that time for me to write down and create a diagnosis that is relevant to that women's heart state. So right now, diagnosis of microvascular disease is in that cath lab. When you go to have your arteries looked at, you're now injected with a medication and if your arteries spasm instead of dilate, that's how microvascular disease is diagnosed. Who is going to get that test? Is that practical?
Speaker 1:Does that make?
Speaker 2:sense it doesn't, and so the research is very, very slow. It's taking a long time for standard of care. I mentioned hundreds of thousands of women over a period of time. I'm not sure when that new data is coming out. There are guidelines around the prevention of heart disease in women. First ones were written in 2004. Another set was written again in 2011 that really updated those original guidelines, talking about those risk factors. In 2019, there were some updates, but there was not a new sort of compilation of information or data that had a huge impact. Information or data that had a huge impact, just a little scientific statements and updates, things like pregnancy during high blood pressure during pregnancy, but it did not give us anything new, and that was 2011 when those last guidelines were written. So it's very slow, very slow, and we're working on putting a death into a space that we don't have answers to and those two spaces.
Speaker 2:What do we do with women who are really sick during pregnancy? How do we manage them so they don't die the next time they get pregnant? Paternal mortality in this country is insane. It's ridiculous, and so we're targeting that population and the next population. What do we do with perimenopausal and menopausal women? How do we risk stratify them to make sure they're okay to go on hormone replacement therapy? How do we take care of their arteries? We spend 40% of our lives in menopause and 70% of us will have some form of heart disease. When you think of that, how is it possible? We don't know how to risk, stratify or treat women, or who's safe to get hormone replacement therapy.
Speaker 1:Right.
Speaker 2:And that's what we're doing with ADESA.
Speaker 1:Well, it sounds like you should probably join forces with the likes of Halle Berry and a few other of these advocates for menopause and perimenopause, or perimenopause, menopause and postmenopause right, menopause, right. Because I think that that's a very interesting correlation and crossroad and how it, how these phases in life overlap into cardiovascular health and it's all. It's all interwoven, right. It's all very important to consider in this interesting constellation that you've kind of alluded to.
Speaker 2:Absolutely. Estrogen is one of the most powerful, powerful hormones. It is so protective to the lining of the arteries, so much so that, as it decreases, everything changes. Everything changes and your risk for cardiovascular disease goes up. As your metabolism changes, as your endothelium, your lining of your artery becomes stiff as it doesn't dilate as well and we can't regulate our temperature. And now we're sweating, we can't brain fog right, yeah I mean estrogen is potent it is, and so it becomes really important to understand do we all get it?
Speaker 2:what part of that women's health initiative should we really pay attention to right? And so there's some guidelines that say you know, you can have hormones within the first 10 years. It's pretty much safe. I'm gonna tell you that. Remember I said, for women less than 55, the risk of heart disease has gone up. I think it becomes really important for us to not just give a blanket statement on anything.
Speaker 1:Absolutely.
Speaker 2:Because one size does not fit all, as we said earlier, but that there is precision, prevention. And when we talk about hormone replacement right now although for many and most people it is the best thing for you, but not for everybody and whether you take it orally or it's a patch or a gel, it matters- it makes a difference, and the formulations of all these hormones are very different.
Speaker 2:And so I love the conversation is out there. Let's take it one step, one more step and really bring in this heart disease story. But let's take it one step, one more step and really bring in this heart disease story, but let's bring it in the right way. And so let's get checked and really let's make sure we're safe, because at that point in your life, longevity is one thing, but if you're going to live long, you better figure out how to deal with vitality, and that's what cardiovascular prevention is all about. But if you're going to live long, you better figure out how to deal with vitality, and that's what cardiovascular prevention is all about Right, Absolutely Well.
Speaker 1:That brings me to my last question for you.
Speaker 2:How can we help Odessa. There are several things from my perspective, and I say this from a place of being on this journey for 30 years. I don't say this as somebody who's a founder and CEO of a tech company today. That's where I am today. I think it's interesting when people look at the end game, and I'm sure this is with you. People look at the end game and I'm sure this is with you. It's not about what you did in that fight that day. It's every single minute of the years that you put in to get there right. And so when I think about this moment, I think about the 30 years and every little step it took to get one step further along this process.
Speaker 2:Without people who are willing to connect, invest, get it out into clinics to wellness facilities, prevention places, women's clinics, gynecology clinics, doctors across the country that whoever is listening. You know someone who has a women's group and you want me to give the speech and tell the story and you want to set this up and have women tested and understand. Let me know Wherever we have women who are now coming together to have an impact. This needs to be a part of the story and I'm hoping that we get it out there. The sooner we get this out to the world, the sooner that healthcare for women will change. And before I'm done with this journey, I want to, and believe we can, change the statistics that I keep saying. One in three women die of heart disease, more than all cancers combined. When you look at some data, it says one in four. One in four women die of heart disease. Well, I really believe, considering 80% of the time, it's preventable that it should be what? One in a thousand?
Speaker 2:Wouldn't that be amazing. Right what one in a thousand? Yeah, would that be amazing? Right, and so let's, as a collective group, let's change the statistics around women and heart disease. Let's change the standard of care to precision personalized health care that is focused on cardiovascular health for women, specifically designed for that individual.
Speaker 1:Well, you've definitely got an advocate in me and a supporter in me. Dr Suzanne, I want to thank you so much for joining us today and ask if you have any final thoughts you would like to leave with us and how people can reach you, support you.
Speaker 2:I want to leave with one final thought. Okay, and I think one of the most powerful studies I ever really kind of internalized was that for those people who actually live life with passion and purpose, they actually live longer, healthier lives. And I feel that on this journey, we all have to find what our passion and purpose is. And I think when you look at the concept of community, when you look at the concept of community when we all come together to help each other, we actually all excel and succeed together. And so come on the journey with me and find me On LinkedIn or Instagram. I have a website, drsuzannesteinbaum or adessohealth A-B-E-S-S-O, and it would be great to connect. If you have again, invest, connect, want to grow, help me grow, want to help me scale, I would welcome any conversations around that.
Speaker 1:Well, you've heard it here, folks, you've heard how to support, you've heard how to contact and you've heard what's needed. So thank you again, dr Suzanne. This has been wonderful, wonderful and very enlightening.
Speaker 2:Thank you, phaedra, it's so great talking to you likewise.
Speaker 1:I'm phaedra knight and this has been freak class. If you enjoyed it, please subscribe and let your friends know about it. Freak class is available on apple and spotify or wherever you get your podcasts.