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What if midlife isn't the beginning of getting old—but the beginning of something we haven't quite figured out yet?
Welcome to Second Opinion, where science meets real life in midlife.
Because the second half of life deserves a second opinion.
Hosted by Rosemarie Beltz—a cardiovascular perfusionist, Columbia-trained journalist, and former broadcast medical reporter with more than three decades inside operating rooms and high-stakes medicine.
Second Opinion brings together a career spent practicing medicine and reporting on it to explore health, longevity, reinvention, and the wonderfully complicated reality of being somewhere in the middle.
Because midlife is strange.
Some days you feel 25—curious, ambitious, optimistic, and convinced there's still so much ahead.
Other days? About 105. You're tired. Your body feels different. Your parents are getting older. Your career may not fit quite the way it once did. Relationships change. The future suddenly feels both incredibly exciting and a little more finite.
And somehow, all of those things can be true at the same time.
We're also living through an extraordinary moment. Medical discoveries, emerging technologies, and changing ideas about aging are reshaping what's possible in our 40s, 50s, 60s, and beyond.
We're talking about healthspan, hormones, metabolic health, strength, sleep, brain health, longevity, artificial intelligence, and treatments that barely existed a generation ago.
But more information doesn't always mean better answers and solutions.
After more than three decades working in medicine, Rosemarie has seen firsthand how asking another question, considering another perspective, or seeking a second opinion can change an outcome.
One expert doesn't have every answer. One approach doesn't work for everyone. And sometimes, the most important thing we can do is challenge what we've been told.
That's the philosophy behind Second Opinion.
We look beyond headlines, health trends, quick fixes, and conventional wisdom to explore what the evidence actually supports, where uncertainty remains, and what different choices might mean in real life.
And here's an even bigger question:
We may be living longer—but what are we going to do with all that extra life?
That's where the conversation gets really interesting.
Because midlife isn't just about our physical health. It's about our relationships, financial well-being, emotional health, careers, environments, changing priorities, and the lives we're still living and creating.
Through candid conversations with physicians, researchers, scientists, innovators, authors, and people with something meaningful to teach us, we explore the science, stories, decisions, and unexpected possibilities of midlife.
And sometimes Rosemarie turns the microphone on herself—sharing what she's learning from medicine, journalism, starting over, building something from scratch, and discovering that you don't necessarily become less curious about life as you get older.
Sometimes you become more curious.
What we're exploring:
- Health & longevity: Perimenopause, menopause, hormones, cardiovascular health, metabolic health, GLP-1s, sleep, strength, brain health, preventive medicine, and navigating healthcare.
- Relationships & connection: Dating after 40 and 50, love, sex, intimacy, friendships, family, and the relationships that shape our lives.
- Money, work & reinvention: Financial well-being, career transitions, entrepreneurship, confidence, changing priorities, and finding new purpose.
- Life beyond medicine: Mental and emotional well-being, beauty, technology, travel, our environments, personal growth, and finding more joy in everyday life.
This isn't about trying to be 25 again.
We can't go back. And maybe we don't want to.
We've lived. We've learned. We're not starting from scratch. We're starting with experience.
It's about taking everything we've learned, everything science is learning, and everything we still don't know—and exploring what might be possible from here.
Call it Midlife 2.0.
No perfect roadmap. No pretending we have it all figured out. Just smart conversations, good science, lived experience, a healthy dose of curiosity, and a willingness to look at things from another angle.
Because health matters. But being healthy isn't the whole point of living.
🌍 Independently created and produced in New York City, Second Opinion has reached audiences in more than 90 countries. A growing conversation for curious women and men who believe there's still so much more to discover.
And yes, Rosemarie is still figuring out what she wants to be when she grows up.
Real science. Real life. The bigger picture.
Second Opinion isn't here to tell you what to think. It's here to give you something worth thinking about!
Kim - 00:00:04:
Welcome to Second Opinion. I'm Rosemarie, and if you've ever wanted a Second Opinion on some of the trending topics in health and wellness, you're in the right place. Each episode, I sit down with experts, innovators, and even a few disruptors to bring you fresh perspectives on the issues that could change your life, from age rejuvenation and brain health to the weight loss drug revolution and how to reinvent your career. Together, we'll dig into the latest research, question what's type and what's real, and give you the insight you need to make your own choices about health and wellness. So if you're ready for a Second Opinion that's engaging, enlightening, and maybe even a little unexpected, let's get started. Today, we're talking about heart health in midlife and menopause with interventional cardiologist, Dr. Kimberly Skelding. Dr. Skelding is a trailblazer in cardiology. She is one of the first women to investigate a wide range of less invasive heart treatments and procedures that get patients back to their life faster. She's also been a fierce advocate for women, has led initiatives to improve mentorship in cardiovascular medicine, research, women's health, and patient care. But today, we're zooming in on your heart. How does menopause affect and impact cardiovascular health? Why are heart attacks so often missed in women? And what can you do right now to protect your heart health in midlife and beyond? So let's dive in. Dr. Skelding, thank you so much for taking time out of your patient's schedule to chat with us today.
Rosemarie - 00:01:51:
Thank you for having me.
Kim - 00:01:53:
Well, February is Heart Month, a time where various organizations are really encouraging people to take notice of their heart and what impacts their heart health and basically to love your health and your heart a little bit more. Why did you go into cardiology and what keeps you passionate about heart health?
Rosemarie - 00:02:13:
Great question. I... Like the combination in my career of doing procedures and taking care of patients. So it was one of the few areas where I had immediate gain. Like if I was taking care of a heart attack patient and we could immediately make them feel better. As well as the long-term relationship. So. Taking care of patients for a prolonged period of time. Helping them with their risk factors. And hoping not to meet them with a heart attack or an event.
Kim - 00:02:47:
Right, right. Exactly. Preventative. So I found this interesting. I'm going to read some stats when it came to women going into the field of cardiology, which I never realized. So according to 2020 numbers that were put out by the NIH and the American College of Cardiology, and also American Heart Association journals, even though half of all medical students and over 40% of internal medicine residents are women. Only 15% of adult cardiologists are women. And less than 5% of that number are interventional cardiologists. And cardiology is ranked 39th of 47 specialties in the percentage of women. Now, correct me if any of those numbers are wrong. If they are correct, why do you feel there are so few female cardiologists? And do you think that affects women's care at all?
Rosemarie - 00:03:44:
So I do think it affects care. So I'll say that right up front.
Kim - 00:03:48:
Okay. Okay.
Rosemarie - 00:03:50:
But I think those numbers are accurate. And I would add one more. The women who are involved in structural heart disease, which is replacing valves and fixing holes in the heart, we're less than 1%. So it gets worse as we think about people getting more subspecialized. I think there's a number of reasons why women didn't go into the field originally and why women continue to not go into the field as much. Early on, women didn't go in because of the radiation exposure in the procedural pieces of cardiology because they were worried about their health, their health of their baby, their health of themselves. And so many moons ago, we wrote a paper that showed that you could have radiation exposure and still have incredibly healthy babies and live a long life. Now, there are some caveats to it in that it is a hard field for health. With radiation exposure as well as orthopedic injuries from carrying lead. But I don't think that's any different for men and women. So I think a lot of women didn't go in originally because of the concern about radiation exposure in their childbearing years. That was one piece. The other piece is lack of mentorship. And so when you're in a room and everyone else around you is male and you can't really look at somebody and say, I know where they're going to be. I know what their life is going to be like. You don't really resonate with them. I remember the first woman interventionalist that I met. I asked her what she did when she was pregnant in the cath lab. And she said, oh, Kim, I adopted my children. And then I was like, oh, my goodness, can I not have children? And so I went into learning more about it and learning more about the field. And I realized I could have children and have a very successful interventional cardiology career.
Kim - 00:05:49:
Oh, wow. So, well, that's really interesting because I, even being a female myself working in the OR, like, yes, definitely there's risks, but are you hoping with better mentorship that, and there's awareness that you'll see more women? Are you seeing that, say currently more women going into cardiology?
Rosemarie - 00:06:08:
We are, and we're making a very conscious effort to do that. So we're reaching out to women earlier in their academic careers. So not just in medical school, but reaching out to them in college and in some cases, even reaching out to STEM programs in high school to show them that women really have no limitations in what their career looks like later in life.
Kim - 00:06:29:
Oh, wow. That's a really, I hope anybody listening, if they're interested in that, I know even my niece, she's only 12, but she says she wants to work in heart surgery. Of course, I'm definitely pro that, but it's just really exciting to hear that because we focus, yes, and still I work with a lot of men in CT surgery. So that's pretty exciting. Okay. Thank you. And with that, with men and women's health, I know as a woman, we are, let's go back to what you were talking about, even just with care. We're told as women, get a pap smear, get a mammogram, you're good, right? Especially, and even as we get into midlife, we're really pushed that the issue. Why do you think that women's health when it comes to heart is still under discussed?
Rosemarie - 00:07:16:
Well, I think there's a lot of important pieces that not everybody is as comfortable discussing and reviewing. For example, women who have a pregnancy-related complication can be up to 10% the risk. Or sorry, 10 times the risk. Of heart disease later in life than their than their female friends who had no pregnancy related complications. Let me go back and repeat that.
Kim - 00:07:43:
Of course.
Rosemarie - 00:07:45:
So I think that women are much more comfortable talking about pregnancy with other women and talking about complications of pregnancy with other women. Why is that important? Women who have a pregnancy-related complication are up to 10 times the risk of having heart disease later in life. So it's very important to gather that information. We haven't really gathered that information for many years in clinical trials. So we don't have the data that's so important to know why are men and women different in regard to heart health. And so for many years, we treated women just like small men, and we're certainly not. Um, we are different hormonally. We are different genetically. And we have different risks. So when we think about pregnancy, we think of it as a time in a woman's life where it's almost like a stress test. And so when you see cardiovascular risks occur in pregnancy, when you see vascular events, which sometimes lead to miscarriages, you think about what that says about women's cardiovascular health later in life. And I ask that every single time to every single female patient I see. And I suspect that there's not a majority of people who are asking the same questions.
Kim - 00:09:04:
Interesting. So with that, if you wouldn't mind sharing without violating any HIPAA. What are some of the frustrations that women come in with? Maybe if they've seen one cardiologist and now they're coming to you. Is there any, do they have any frustrations or?
Rosemarie - 00:09:22:
I think sometimes women don't always feel heard when they see a physician. And that goes for seeing female physicians as well as male. But generally, there is more of a connection with women, with women patients. And when men say, well, I see a lot of female patients, so I don't understand why there's a difference. Think about it this way. Think about you getting on a bus and sitting next to someone and realizing that you went to the same college. Well, all of a sudden, you're talking about the buildings. You're talking about the class. You're talking about the football games or the basketball games. And you have that immediate connection. When a woman sees a woman physician, often we can make those connections as well. And it really sort of lessens the anxiety about being at a visit and being able to be open and honest about symptoms, complications, questions, concerns.
Kim - 00:10:17:
Well, then do you feel like, because I actually had an issue in my 40s, it wound up being okay. But I went to, say, my primary and it was, oh, you're fine. Just look at me. I was going through a lot of stress, X, Y, and Z. But then I went to a female doctor. She's like, you know what? I'm going to take you seriously. You're this, this, this. So I personally also had that. She's like, I know you, the X, Y, and Z. So we're going to do a full cardiac workup. You should have one anyways. So I personally felt connected to a story like this as well. Luckily, I was okay. But who knows? She's like, you know, you should have a baseline anyway to see where you are. But she took me seriously. And it's true. I thought, well, how many women who maybe aren't in healthcare who don't even know how to press or to ask those questions kind of get swept by the wayside? And this isn't bashing any, you know, male provider. But it just personally happened to me, you know?
Rosemarie - 00:11:09:
Well, and I think that there's also a piece that we as women can do better. And when we do a lot of educating the community, we talk to women about how they share their narratives, right? Because men and women definitely have a different cadence to their speech and a different way we communicate. And so let me give you a pretty stark example. When a man comes into the office, generally we're asking the questions, do you have chest pain? Do you have this? Do you have that? And their answers are more pointed where women might say, well, I was at the grocery store and I was doing X, Y, and Z. And this happened. And then I had to pick up my daughter from school, so I was rushing. And then this happened. And so there's a lot more intermingled in the narrative. And so I try to speak to women and say, make sure that you get your symptoms across. Make sure it's not lost in the narrative. Try to be pointed, especially in the days when people don't have as much time in their office visits. But really trying to get across the real importance of your symptoms, and what's going on. And also, I think women tend to be the caregivers. And they don't like to take time out for their own health. And so we put a lot of things on the back burner. And I encourage women to make sure that they are taking care of themselves so they can be available
Kim - 00:12:31:
to
Rosemarie - 00:12:32:
take care of their families.
Kim - 00:12:34:
So you touched on something that I definitely want to hit on. Can you talk about some of the signs that you've seen that most often go overlooked when it's comparing men and women?
Rosemarie - 00:12:48:
Yeah, so one of the sort of misnomers is that women don't have chest pain. Well, when you ask people who have had heart attacks, both men and women, about 76% of both genders have chest pain as part of their symptoms. So it's not that women don't have chest pain, but it is that women may have a lot of other accompanying symptoms. So they might have chest pain and shortness of breath or chest pain and nausea or chest pain and fatigue. Fatigue, by the way, is the second most common symptom that people have with heart disease. But it can be a whole host of symptoms. And I think it gets sort of all wrapped up and it gets forgotten when maybe the shortness of breath is more problematic to the woman, but you can't deny that they don't have chest pain. And so I think it's important to get the history and to really get it right. And so we have work to do as physicians.
Kim - 00:13:44:
Okay. Well, and then also I found it interesting, and again, correct me if I'm wrong in my research, but when I was looking at evidence, according to the research I found around the mid 80s and early 2000s was when that evidence began to emerge that women as well as men are experiencing face substantial risk from heart disease beginning at a much earlier stage than life, than anticipating with the differing symptoms that you talked about. So, and we've also, I think, heard a lot of information where we're more protected earlier in life, maybe because different hormone, you know, our hormone situation. So do you think that's misleading then, that we're more protected earlier than life, that women should pay attention? Like say if someone's listening or watching and thinking, oh, that doesn't apply to me. It could.
Rosemarie - 00:14:43:
Right. So we do see people, both men and women, having heart disease much earlier. And I think it has to do with. More likely our obesity epidemic, which brings on a lot of the other risk factors like high blood pressure, diabetes, high cholesterol. So that's part of it for sure. The other thing is that you really hit it right on target. Estrogen is very protective for women. And so women tend to have heart disease about 10 years later than their male counterparts. Now, this comes into play for a lot of things because there's now data and literature that shows that women who have late menopause are actually protected to a higher degree than women that have early menopause. And so that's also vitally important. But one of the things I see with my patients fairly frequently is a woman will come into the office. She's 65 years old, and she doesn't understand why now she has high blood pressure and now she has high cholesterol when her weight hasn't changed, her diet hasn't changed, her exercise hasn't changed. And they're like, I don't understand. Now they're telling me I have high blood pressure. I've never had high blood pressure in my entire life. And then we have the menopause discussion because after menopause, a lot of women end up with hypertension or high blood pressure, high cholesterol. And these things happen as part and parcel of the estrogen starting to be removed from our bodies. And so those bring on a risk. And so it's very important for women, many of whom have their primary care with their OBGYNs. And so they have their primary care with the OBGYNs, and then they switch gears and they see an internist. When they no longer have obstetrical issues and it becomes a whole new conversation. And so then they're confused. Why did I not have high blood pressure five years ago? And now my blood pressure is through the roof. And no one's had the discussion about the hormones and menopause.
Kim - 00:16:49:
So without getting too into the science, but I feel like our listeners are a little, you know, they're curious. Can you explain that a little bit of how that happens, like break it down a little bit? Because I think when women or just people in general understand what's actually going on, it helps them make decisions better.
Rosemarie - 00:17:09:
Right.
Kim - 00:17:09:
You know?
Rosemarie - 00:17:11:
So estrogen is a naturally occurring hormone. Obviously, it's very self-protective. And it's probably a evolutionary protection, right? So women are protected through their childbearing years. And they're not having severe illnesses, cardiovascular disease, heart attack, strokes. When that estrogen slowly starts to remove from the body. The effect that the estrogen have is primarily on the lining of the blood vessels. So when the blood vessels start to lose that protection, they become more diseased. So they develop more atherosclerosis or cholesterol in them. They get a little bit more hardened. So their blood pressures are changing. All of these things happen. The reason why we get high blood pressure is because of both the heart and the kidneys. When the blood vessels to the kidneys get diseased because they're no longer protected from estrogen, they can't regulate the blood pressure as well anymore either. So all of these things, although we don't think about blood pressure as a vascular disease, it clearly is a vascular disease. And so as estrogen removes its protection from the blood vessels, all of these things come to the surface.
Kim - 00:18:29:
Thank you so much, because I even know just a lot of my girlfriends, their peers, very smart women, whether in healthcare or various backgrounds, they're healthy women. Their complaints are, I don't get this. My blood pressure's through the roof. I've got these palpitations, anxiety. So basically, is it safe to say a lot of this is related to estrogen, it sounds like?
Rosemarie - 00:18:53:
Right. So I can't speak to the anxiety. It's not in my wheelhouse. Unfortunately, there are other folks who handle this very effectively. But for sure, with the blood pressure, for sure with the cholesterol, for sure with the chest pain symptoms that come on post-menopausal, and that's predominantly because of estrogen removing the protection.
Kim - 00:19:18:
Okay. So with that, and we're talking about the symptoms and the diseases that it's causing, how does a woman differentiate between menopause symptoms and say heart attack symptoms?
Rosemarie - 00:19:34:
All right, so... Great question. Menopause has a whole host of other issues, including hot flashes and really changes in energy level, sleep patterns. When people have heart disease, it generally is a supply-demand problem. And so a woman will recognize that she can't do as much as she used to be able to do. So maybe she could walk a mile or two, walk up a hill, walk upstairs, and not have any symptoms of shortness of breath. Or chest pressure or tightness. And this becomes less and less frequent that they can do it without symptoms. So in other words, there's a change in their functional capacity. So they say nothing else has changed, but I just can't do as much as I used to be able to do because I'm limited from shortness of breath or chest tightness. And so that's because when we get a blockage in our arteries, it becomes a fixed blockage. So it's kind of like trying to drive your car. On the freeway in first gear. You just can't. Allow it. To be able to give you enough gas to do what you want to do.
Kim - 00:20:44:
Okay. Interesting. Yeah. Because it's tough when there's days you're just feeling like, I don't know, I don't have the energy. So, okay. So that's really helpful. Thank you so much. Because it's hard to tell, am I just tired? Do I need sleep? Or am I really having a bigger issue here that I need to go to get checked out? And you did mention something that I thought was kind of, well, not kind of, but was interesting. If we could just go back a little bit for people to understand, having kids. So pregnancy complications. So if you do have children, that, or say if you have children and you had, like you said, the difference between having children, a pregnancy complication. Affecting heart health later in life. And on the flip side, if you didn't have children.
Rosemarie - 00:21:34:
Right.
Kim - 00:21:34:
You could just talk a little bit about that again.
Rosemarie - 00:21:37:
And so there isn't a whole lot of data, and the data is a little bit conflicting of whether people have multiple children, one child, no children. But pregnancy-related complications are unequivocal. So if a woman has high blood pressure, or high blood sugars during her pregnancy. Also things like having very large babies, very small babies. Early labor, fatal demise or unfaithfulness. Unfortunate miscarriages, all of those things. Are risk factors for heart disease later in
Kim - 00:22:10:
life. Yeah. And I also, I did another story. It was interesting because women are having, not all women, but statistically showing a lot of women are having babies now later too. So it seems like, you know, all of my friends are like, I'm a geriatric pregnancy. We're all geriatric pregnancies. And that's even at 35. For someone who's listening, I think it doesn't apply. It could apply in your thirties. So, you know, it's, it's interesting because a lot of my friends, you know, having kids in their forties, you know? So thank you for touching on that. You mentioned, you know, every family has a CMO, a chief medical officer, and chances are statistically they are women, one in four versus one in five. Usually it's a female taking care of the family. So with that, what are some things that women say in their forties and fifties and beyond should be doing to protect their heart as opposed to also their loved ones?
Rosemarie - 00:23:06:
So I think there's a couple of things. One is making sure that they see an internist or family medicine doctor early on and having a lifelong relationship with them because you should have a check-in. Check-in every year to get your lab work done. Check-in every year to have someone talk to you about your symptoms. We do this, again, making a car analogy, but we take our cars for their regular checkups. And many of us don't go and get a regular checkup with our doctors. So very important to know your numbers, know what your blood pressure is, know what your cholesterol is, what your blood sugars are doing. So important. Also, being able to follow over time your functional capacity, what you're able to do and what you're not able to do. All those things are very important. Lifestyle modification and diet is really one of the big things that we've seen in the large heart trials like the Framingham Heart Study or the Nurses' Health Study to show that exercise 30 minutes a day most days of the week helps people live longer regardless of what else they do. Having a heart-healthy diet, meaning eating more fruits and vegetables, less meats and cheeses, very healthy. One of the more unhealthy diets is the keto diet. So it helps you lose weight, but it doesn't necessarily do good things for your heart. And so having a balanced diet, but trying to have it with more fruits and vegetables is really the way to go.
Kim - 00:24:41:
So you touched on something that I think is important. Like you said, having a good relationship with your doctor. Is there an age that maybe somebody should start checking in with a cardiologist for a baseline checkup? I know insurance is also a factor, but say if someone's listening and like, well, I'm too young to have a cardiologist. I think we associate it with older people. What's a good age to start thinking about that?
Rosemarie - 00:25:06:
I think it depends. If someone has... Any heart concerns. Palpitations, murmurs. In other words, when someone listens to your heart and they say, oh, this doesn't sound normal. They should all check in with a cardiologist, even if it's early in life. As far as lab work, everyone should have their cholesterol checked as early as 25. If you have a good internist who's paying attention, to your blood pressure and your cholesterol, your diabetes, talking to you about... Diet, exercise, your weight. Then you can put off having a cardiologist. Unless, like I said, someone hears something funny or you have symptoms, that are concerning, and I would say, The threshold to seeing a cardiologist early, it is very low.
Kim - 00:25:56:
Okay. Okay. Good to know. And thank you for talking about diets and so forth, because I know keto, fasting, the Mediterranean diet always seems to be like a solid, which just sounds like it's just like a whole food, really healthy diet. How about supplements? Do you want to go down that road? Is there anything that maybe you feel that you, maybe you want to share something you take or something that maybe is helpful for women?
Rosemarie - 00:26:24:
So supplements are important if you're not able to have a well-balanced, healthy diet. If you have a diet that's rich in fruits and vegetables and you're getting all of the vitamins that you need naturally, there's really no need for a supplement. Some of the supplements also, without getting into too many details, can really interfere with some of the medicines used to treat. Your cardiac risk factors. So it's very important that when you see a physician that you go through your list of supplements along with the medicines that they've prescribed. So they really have a good idea of everything you're taking and why. I think that there are some supplements that are useful and really can add to your health, particularly if you have some diet issues that won't allow you to have a balanced complement of foods. But I think that that conversation really needs to be with you and your physician looking at the medicines you're taking as well.
Kim - 00:27:24:
Okay. Thank you for that. And with that, I know you said anxiety is not as much your wheelhouse, but just like stress management. Do you advise your women, patients, anything along mindfulness or, and what does the, what role does stress play in a lot of this midlife health as well, heart-health?
Rosemarie - 00:27:48:
So there definitely is a heart-mind connection. And there's a lot of correlations between heart disease and your mental health. For example, a lot of people who have a cardiac event have depression. It's not necessarily a lifelong depression, but certainly will have depression around that disease process and sometimes for up to a year afterwards. So very important connection. The other thing is stress management definitely needs to be a part of the whole cadre of things when you're thinking about diet and lifestyle, because stress does increase your blood pressure. Stress does lead you to things like unhealthy diet choices, right? And so having... A plan where you can have stress reducers, whether it's... Spending time with your family or meditating on a regular basis is really important to just really bring down your blood pressure, help you make healthy choices, and also not to live in that constant stress-related state, which is not healthy for your mind or your body.
Kim - 00:28:55:
Right, right. Okay, thank you. So again, I'm of age and I get a lot of questions from friends being in healthcare and also a journalist. They want to know what everybody's doing, whether it's diet, exercise, stress management. And now I'm going to ask a question that a lot of my women friends are talking about is hormone replacement therapy. Now they did all the right things and they're like, this is not cutting it, right? So now they're going down the road of HRT. And so with that, what are your thoughts with hormone replacement therapy and its effects on the heart? Pros, cons, who's it for? Who maybe should question if you wouldn't mind sharing that?
Rosemarie - 00:29:41:
So a number of years ago, we had one of the largest trials of hormone replacement therapy for women, which turned out to really raise some concerns about hormone replacement therapy. But when you took a deeper dive into that data, there were some patients put on hormone repair, I'm sorry, hormone replacement therapy that already had heart disease, which we would never do today, right? And so what needs to happen is to continue to look. What we've been able to pull out of that data set is that women that actually had hormone replacement therapy through the early phases of menopause and continuing actually had a protective effect. Those that were a little more concerning were the women who really had stopped. Menstruating, had menopause, and then started much later in life. That was a little more concerning. Why? Because estrogen can lead to things like blood clots. And so there are some protective and some not protective pieces. Also for women who have breast cancer, you know, that's a red flag for using hormone replacement therapy. So it really needs to be a discussion, but I think it's an open conversation now. And so if a woman is starting to go through menopause, I think having that discussion with their intern as family practitioner or cardiologist, if they have one, about is this the appropriate thing for me, considering who I am as an individual, is really an important question. Because for some people, hormone replacement therapy will be protective. And for others, it's really a no-go.
Kim - 00:31:25:
Oh, that's interesting. So like you were saying, you have to look at the whole picture, one thing versus the other. So if you're right, everybody's different. If you're a relatively healthy woman, and I use that loosely because sometimes you're walking, you don't even know, like you said, high blood pressure. So basically just a comprehensive checkup before you do anything. Because I know a lot of people that are getting HRT, they're seeing a couple different doctors. So maybe is it, like you said, have a good relationship, say with your OBGYN or whoever's prescribing your hormone replacement and say your cardiologist or primary doctor. Basically, it sounds just like an open dialogue.
Rosemarie - 00:32:03:
Yes. And you have to weigh the risks and the benefits, right? So everything we do is a risk benefit ratio every day, whether it's going through a yellow light during rush hour versus at two o'clock in the morning or taking a new medication. You weigh the risks and benefits and make a decision if it's right for you.
Kim - 00:32:25:
Okay, thanks. I like the analogies. They're helpful. And with that, is there anything when it comes to women's health that excites you about women's health that maybe that's currently going on or that's coming along that's maybe not here, but something that you know inside or as a physician that you'd like to share that gives maybe us some hope?
Rosemarie - 00:32:46:
Yeah. So I think we're having the conversation now, right? And so the clinical trials in cardiovascular disease historically had only enrolled 15 or 20% women in the best trials. We are now making our conscious effort with the government, with pharma and device companies, with physicians to make sure and enroll appropriate numbers of women in clinical trials so that we can actually get the data for them. It's no longer enough to compare women to men. You have to compare women who are treated compared to women who are untreated to truly see what benefit we have for medications and procedures and devices. So it's really exciting to see this data continue to develop and attention being paid to making sure that we have all the information and all the scientific evidence to treat women how they need to be treated. Based on who they are as women, not as small men.
Kim - 00:33:52:
Right. So it sounds like, and even from what I read, we are going in the right direction. The conversations are happening. Research is opening up for women and you're seeing an improvement even with your patient population and so forth. Okay. So with that, say if someone's listening, is there something or watching, say one piece of hard advice maybe that you wish you, were given or you feel that's missing with your patients or just in midlife about protecting their heart? What would it be? If there's that one thing that maybe somebody could start doing today, what would it be?
Rosemarie - 00:34:33:
Sounds simple, but making a regular exercise appointment with yourself. We make appointments to do all sorts of other things, put it into your calendar, put it on your Outlook, put it wherever you keep your schedule, but make a regular scheduled appointment with yourself to get exercise, to have some time to decompress, doing something you enjoy, reading, watching TV, spending time with family, and trying to eat a healthy life. At 40 or 50, women don't have the same metabolism. They don't have the same risk factors as we did at 15 or 20 years old. So we really need to start paying attention to lifelong wellness. And it's very important for all of us, but particularly important for women.
Kim - 00:35:22:
Okay. So are they some of the non-negotiables you as a cardiologist make with yourself? I try my best. I try my best.
Rosemarie - 00:35:31:
So I try to get the walking in. I try to make healthy choices. I try to do the things that will keep me alive and healthy long term. I have somebody that I see and check in with and have them check my risk factors. I don't think we should be our own physicians. We should have a physician. And so I think it's really important to have someone you'll have a lifelong relationship with.
Kim - 00:35:55:
So say if somebody wants to come see you or is looking for resources, could you give any resources, share any, you know, if somebody's looking for more information when it comes to their heart health, are you seeing new patients and so forth?
Rosemarie - 00:36:11:
So yes, I do see patients in Jersey City and I do have a specialty in women's heart disease. And we have other providers who are also very interested in women's heart health as well. So very important to do. You asked me something else.
Kim - 00:36:27:
Resources for women. Like maybe, yes.
Rosemarie - 00:36:30:
And there was some, you asked for resources. You asked if I saw a patient. Oh. So also, there's a lot of information in the literature, which is important to keep up on for women who have continued chest pain and have been told, it's not your heart, we're not sure what's going on. Maybe it's in your head, or it's a GI problem. And you're still very concerned at your heart. There's very specialized testing that can be done at centers like our own in Jersey City Medical Center that can identify other things like the health of your blood vessels that may be contributing to your symptoms. So very important to look into those things. There's a microvascular network that you can find online, which does this testing. We're one of four centers in New Jersey who does this testing. And there's a lot of new data coming out that shows us that for women, there are very specific risk factors that need to be looked at.
Kim - 00:37:29:
Is there a name for that test?
Rosemarie - 00:37:31:
Yeah, it's an endothelial function testing or microvascular disease testing.
Kim - 00:37:37:
Thank you. Because you know what? That reminded me also to ask you about the calcium score.
Rosemarie - 00:37:41:
Yeah.
Kim - 00:37:42:
But the endothelial testing, I've never heard of that.
Rosemarie - 00:37:46:
Right. So calcium scores are very important, particularly as you're putting your risk factors in question. Like, should I start treating my cholesterol even though it's borderline? Should I start treating my blood pressure even though it's borderline? Or should I work on lifestyle and diet? And so when you get those calcium scores, it gives you additional information. And information is power in being able to identify what you should be treating and to what level. So that's where I feel like calcium scoring fits in. With microvascular testing, it was designed initially for women who had chest pain symptoms who would come into the hospital, sometimes even having blood work consistent with having a heart attack. And their cardiology testing is negative. They have a stress test, which doesn't show much. They might even have a catheterization that doesn't show much. But they continue to be plagued with chest pain. For those women, the answer might be to do microvascular testing. And it's very specialized. It's done at just a few centers. And we look at what the blood vessels are in regard to their health and in regard to other risk factors. And so identifying that can be life changing for women. I have women who come into my office in tears because they're plagued by chest pain and told over and over that it's not their heart. And to be able to give them an answer is so important and is just really what they're looking for. It's a gift that you can give your patients to be able to tell them definitively it isn't your heart or it is your heart. And we need to think about these things, even though the traditional tests have been negative so far.
Kim - 00:39:35:
Thank you so much. So you do practice at Jersey City Medical Center. What if somebody is, before we wrap, if somebody is watching, would love to see you, but lives outside of this area, is there a place, a database or someplace that somebody can go to find information, to find a provider who does this kind of testing?
Rosemarie - 00:39:59:
Right. So online, there is a microvascular disease network. And so you can go on there. There's a heat map of the whole United States. And you can find people that might be in your area that do this testing.
Kim - 00:40:13:
Oh, great. Thank you very much. I feel like that's going to pique the interest of a lot of our women that are tuning in. So thank you. All right. Well, again, before we wrap, is there anything we didn't mention today that you feel that's worth mentioning that I didn't ask you that you wanted to make sure you left people with?
Rosemarie - 00:40:38:
I think you've probably asked most questions. Maybe the one sort of parting comment that I would make is that it is time to start thinking about people and their unique risk factors, whether it's gender, whether it's age, whether it's socioeconomic status, and being able to really identify how best to treat patients and how to improve their outcomes. And the biggest part of it is spending time and listening. Being a good detective as a physician and identifying what the problems are and identifying a plan to move forward. The most important partnership in this is the physician and the patient being aligned with their goals and being aligned with how they want their treatment to proceed. And in the past, it used to be you went to a doctor, they told you what to do, and you went on your merry way. Well, now there's lots of options. And so having that discussion of what's best for you as an individual is so important.
Kim - 00:41:43:
Thank you so much, Dr. Skelding. That's a wrap for today's episode of Second Opinion. A huge thank you to Dr. Skelding for breaking down the critical connection between midlife, menopause, and heart health. There's a few things that we took away from this conversation. It's that your heart health is in your hands. Small changes can make a huge impact and advocating for yourself, whether at the doctor's office or in your daily life is key. If you've enjoyed today's conversation, don't forget to subscribe, rate, and leave a review. It helps others find the show. And if you have a topic you'd love for us to explore, drop us a note. We're always looking for new ideas. I'm Rosemarie Beltz. Until next time, take care of yourself, get some rest, and remember, always get a Second Opinion.