HeraSphere #25: Your Pregnancy was a Heart Test

Dear Friends,

It's February, which means we're officially in Heart Health Month. Last week, I hosted a "Vital Signs" panel for our US Capital YPO chapter, bringing together cardiologist Dr. Miriam Fishman, OB/GYN Dr. Tobie Beckerman, functional physician Dr. Denia Tapscott, and women’s psychiatrist Dr. Aeva Doomes to talk about women's health through midlife. We designed it for both women navigating these changes, the partners who want to understand and support them, and leaders who work with them.

The room was packed. Partners (including mine) raised eyebrows. Women asked questions they'd been carrying silently. And afterward, so many people said the same thing: "I had no idea."

I want to focus on today, during Heart Health Month on this key insight: your reproductive history contains critical cardiovascular intelligence. And most women have no idea.

If you’re like me, your pregnancy history is a thing of the past - it never occurred to me to mention my pregnancy symptoms to a cardiologist. Most male cardiologists would never even ask about reproductive history. However, how your body handled pregnancy is one of the best stress tests of your cardiovascular system you'll ever get.

Heart Health Is Actually Women's Health

• Heart disease is the number one killer of women. Not breast cancer. Not any other condition. Heart disease kills more women than all cancers combined. One in three women will die from cardiovascular disease. Yet we still think of it as a "men's disease."

• Women are 50% more likely to be misdiagnosed after a heart attack because many doctors have the same misconception. We're more likely to die within five years of having one. 72% of basic scientific research is done only on male animals, with the assumption that females are just smaller males.

• The risk of heart disease doubles for menopausal women compared to premenopausal women of the same age. Our cardiovascular risk changes dramatically with hormonal transitions. Our symptoms present differently. Our reproductive history gives us decades of early warning signals that too often get ignored.

• "Perimenopause is a cardiovascular risk factor. Not a gynecological footnote." was a comment by Dr. Jayne Morgan that stuck with me. Even healthy women develop metabolic syndrome during menopause.

Pregnancy: Your Cardiovascular System's First Major Stress Test

• Pregnancy is a giant stress test for your cardiovascular system. When you're pregnant, your body undergoes massive cardiovascular changes. Your blood volume increases by 40-50%. Your heart works harder than it ever has. You're growing an entirely new network of blood vessels to supply your placenta and growing baby.

• When things don't go smoothly during pregnancy, it's often because your vasculature—your blood vessels—aren't as healthy as they could be. The same blood vessels that struggled during pregnancy are the ones that will carry you through midlife and beyond.

• Heart disease is a disease of blood vessels. So is stroke. Pregnancy complications are your body's way of revealing vascular vulnerabilities long before a cardiac event occurs.

• But here's the problem: once you deliver and complete your six-week postpartum visit, that information gets filed away. The OB moves on to other patients. You move on to new parenthood. Years pass. When you finally see an internist or cardiologist in your 40s or 50s, they're not automatically asking about pregnancy complications from decades ago.

The Pregnancy Complications That Predict Future Heart Disease

• Preeclampsia is the most significant signal your body can send. Women who develop preeclampsia during pregnancy have four times the risk of developing chronic hypertension within 15 years. They also face increased risks of stroke and heart attack down the line. If you experienced preeclampsia and you haven't had cardiovascular follow-up, make that appointment.

• Gestational diabetes means your body struggled with blood sugar regulation under the stress of pregnancy. That metabolic vulnerability makes you more likely to develop Type 2 diabetes and cardiovascular disease later. If you had gestational diabetes, you should be getting your hemoglobin A1c (a three-month blood sugar average) checked regularly—not just once postpartum.

• Gestational hypertension (high blood pressure during pregnancy without full preeclampsia) also increases your risk of chronic hypertension, stroke, and heart attack. Even if your blood pressure normalized after delivery, the stress test revealed something about your vascular function.

• Preterm delivery—especially before 34 weeks—is associated with increased heart disease risk. Researchers believe many preterm births happen because blood flow to the fetus is compromised due to vascular problems. If your body made the call to deliver early (not due to infection or other clear cause), that's information about your cardiovascular health.

• PCOS (polycystic ovary syndrome) is recognized as a cardiac risk factor. Women with PCOS typically have metabolic syndrome—a cluster of conditions including insulin resistance, elevated blood pressure, high triglycerides, and abdominal obesity. These are all risk factors for heart disease.

• Needing IVF may itself be a vascular signal. The research is still emerging, but there's a chicken-and-egg question: Do some women require IVF because of underlying vascular problems that affect both fertility and cardiovascular health? Or does the IVF process impact vascular function? Either way, women who required fertility treatment should be attentive to cardiovascular risk factors.

• Premature menopause (before age 40) or surgical menopause (hysterectomy with ovary removal) means abrupt estrogen loss. Your blood vessels lose estrogen's protective effects earlier than they should, which is why early menopause is considered a cardiovascular risk factor.

• Even severe vasomotor symptoms during menopause—frequent, intense hot flashes—are increasingly linked to cardiovascular risk. These symptoms reflect what's happening with your vasculature.

• Dr. Fishman asks every female patient about their pregnancy history. She's often the first doctor to make the connection. And this information informs how she approaches their cardiovascular care.

When to See a Cardiologist (And What to Track)

You don't need to wait for chest pain or a family scare to see a cardiologist. If you had significant pregnancy complications—especially preeclampsia or gestational hypertension, or family history of heart disease—it's worth establishing preventive cardiology care. But even if you don’t see a cardiologist, make sure your primary care doctor knows your reproductive history and is monitoring the right things.

• Blood pressure: Normal is less than 120/80. If yours creeps above 130/80 consistently, pay attention. Above 140/90 typically means medication. But lifestyle changes—particularly exercise—can make a real difference. Dr. Fishman has seen patients on two blood pressure medications get off both entirely through regular exercise that includes hills or intensity.

• Lipid panel: Don't just look at total cholesterol. Your LDL (the "bad" cholesterol) matters most for heart disease risk. But there are more sophisticated markers worth knowing about:

• Lipoprotein(a) or Lp(a): This is a sticky type of cholesterol that can clog arteries. It's genetic, and if it's elevated, you need to know.

• ApoB: This measures the number of particles carrying "bad" cholesterol. It's often more predictive than LDL alone. Dr. Fishman notes that Peter Attia's discussion of ApoB in his book "Outlive" prompted many patients to start asking about it. As Dr. Jayne Morgan emphasized at the YPO wellness conference, lowering inflammation by tracking ApoB, CRP, and GGT (gamma-glutamyl transferase) through nutrition, stress regulation, and targeted interventions is key to cardiovascular aging and longevity.

• CRP (C-reactive protein): This measures inflammation in your blood vessels. Remember, heart disease is fundamentally a vascular problem, and inflammation plays a major role.

• Hemoglobin A1c: This gives you a three-month average of your blood sugar levels. If you had gestational diabetes, this isn't optional—it's essential surveillance for Type 2 diabetes risk.

• Calcium score: Think of this as a mammogram for your heart. It's a simple CT scan (same radiation as a mammogram) that looks for calcium deposits in your coronary arteries—early signs of plaque buildup. For women, it's typically recommended after 60 unless you have risk factors suggesting earlier screening. The score ranges from zero (perfect) to over 400 (time for serious intervention).

Tests to consider based on symptoms or risk: 

• A cardiac stress test watches how your heart responds to exercise. It's not for everyone, but if you have symptoms (unexplained fatigue, shortness of breath, chest discomfort) or multiple risk factors, it provides valuable information about your cardiovascular fitness.

• EKG (electrocardiogram): Dr. Morgan recommends that women get a baseline EKG every 3 years—not just when there's a problem. The reason is smart: if you do develop cardiac issues later, having a baseline from when you were healthy gives doctors something to compare against. It's like having a before picture. Without that baseline, doctors are trying to interpret results in a vacuum. This simple test gives a snapshot of your heart's electrical activity and takes just minutes.

The Breast Cancer Connection 

• Breast cancer treatment can significantly affect heart health, particularly left-sided radiation (where the heart sits) and certain chemotherapy drugs with cardiotoxic side effects. If you've had breast cancer treatment, you should be seeing a cardiologist who understands cardio-oncology. The cardiac effects can show up years or even decades after treatment.

Menopause Changes Everything

• Estrogen is protective for your blood vessels. It helps keep them flexible and healthy. When you lose estrogen during menopause, blood pressure often rises. Cholesterol climbs. Weight becomes harder to manage. Metabolism shifts. Dr. Fishman sees women whose cholesterol was perfectly fine pre-menopause suddenly have high LDL. Women with borderline blood pressure develop hypertension. The estrogen loss unmasks vulnerabilities that were there all along.

• This is why your 40s and early 50s are such a critical window. If you have borderline anything—blood pressure, cholesterol, blood sugar—menopause will likely make it worse. Getting ahead of these risk factors before menopause hits makes a huge difference.

• Women need to focus on resetting metabolism through strength training, prioritizing protein, reducing sugar, and stabilizing fasting insulin to slow cellular aging. Improving oxygen delivery and mitochondrial function through zone 2 cardio, intervals, breathwork, and muscle-building boosts longevity at the cardiovascular level.

• The good news: the old belief that hormone replacement therapy (HRT) is bad for your heart has been thoroughly debunked. That came from research that gave HRT to women who were 63 on average—already a decade past menopause, when vascular disease may already be established. When started appropriately during perimenopause or early menopause, HRT doesn't show those risks. Cardiac concerns shouldn't automatically rule out appropriate hormone therapy. It's an individual decision you should make with a knowledgeable doctor.

What Actually Protects Your Heart

• Movement matters more than almost anything else for cardiovascular health. You need at least 150 minutes of moderate exercise or 75 minutes of vigorous exercise weekly. Your heart rate needs to actually go up—a leisurely walk where you're chatting comfortably doesn't count.

• Strength training also matters. Building muscle helps with metabolism, insulin sensitivity, and overall cardiovascular fitness. Aim for at least twice a week.

• Mediterranean-style eating protects your heart. That means: plenty of olive oil, fish, chicken, whole grains, fruits and vegetables. Red meat (including pork) should be occasional, not daily. Eggs are nutritious but try to limit yolks to one every other day if you're managing cholesterol.

• Managing stress is just as important as diet and exercise. Chronic stress floods your body with cortisol and adrenaline, raising blood pressure, increasing inflammation, and even triggering irregular heart rhythms. Simple practices help: deep breathing (try 4-7-8 breathing: inhale for 4, hold for 7, exhale for 8), regular movement, time in nature, genuine laughter with people you love.

• Sleep gives your cardiovascular system essential recovery time. If you're consistently getting less than 7 hours, your heart is working harder than it should.

What to Watch Out For

Heart attack symptoms in women are often different from what we see in movies. Yes, many women get the classic chest pressure—like an elephant sitting on your chest. But some women present with:

• Unusual, profound fatigue

• Nausea that won't quit

• Jaw or neck pain

• Shortness of breath

• A sense that something is profoundly wrong

If you're experiencing severe symptoms that feel different from anything you've felt before, get it checked. You're not wasting anyone's time. Women often delay care because we're taking care of everyone else. If you're with someone experiencing possible heart attack symptoms and they don't look right—they're pale, sweating, clearly distressed—trust that observation. Our bodies tell us when something is seriously wrong.

The Bottom Line

Your reproductive history gave you intelligence about your cardiovascular system. That intelligence should inform your healthcare for the rest of your life.

If you had pregnancy complications—preeclampsia, gestational hypertension, gestational diabetes, preterm delivery, severe PCOS—make sure your current doctor knows. Document it in your active medical record. Use it to advocate for baseline testing and appropriate monitoring.

If you're approaching menopause or already there, pay attention to how your cardiovascular risk factors are shifting. This is the time to be proactive.

If you've had breast cancer treatment, make sure you're getting cardio-oncology follow-up.

And if you're reading this thinking about that pregnancy complication from 10 or 20 years ago that no one ever mentioned again—make the call. Schedule the appointment. Get your numbers checked.

This is information we all need—women and the people who love us. Forward this to someone who needs to know.

Stay heart healthy,

Lilly

P.S. If you found this helpful, please share it with a friend who might need it. We need to make sure this information doesn't stay hidden in old OB records.

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Note: While I love diving deep into research and sharing what I've learned about women's health and wellness, I want to be crystal clear: I'm a passionate health advocate and researcher, not a medical professional. Think of me as your well-informed friend who does extensive homework – but not your doctor.

Everything I share in HeraSphere comes from careful research and personal experience, but it's meant to inform and inspire, not to diagnose or treat any medical conditions. Your body is uniquely yours, and what works for one person might not work for another. Always consult your healthcare provider before making significant changes to your diet, exercise routine, or wellness practices, especially if you have underlying health conditions or take medications.

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