Let's Talk Heart Health: Dr. Nicole Harkin Shares What Every Woman Must Know About Cardiology
“The good news is that up to 80% of heart disease is preventable!” Today’s woman dreamer, Dr. Nicole Harkin, is the founder of Whole Heart Cardiology, and a fellow at the American College of Cardiology. For Women’s Health Wednesday, she shares her actionable tips and expertise on all things heart health: Top 3 Super Foods, Impacts of Menopause, Exercise & Strength Training, the risk factors and symptoms to look out for, and the right questions to ask your doctor. A Helpful Guide to a Healthy Heart!
1) Tell us about your journey and what brought you to private practice in San Francisco?
I completed all of my training on the East Coast and began practicing cardiology in a traditional private practice after my cardiology fellowship. Throughout my training, I always had a special interest in the prevention of cardiovascular disease, particularly with the use of lifestyle and plant based nutrition approaches. I worked with the NYU Prevention Department closely during my fellowship, and became the first general cardiology fellow to become board certified in clinical lipidology. After several years in private practice cardiology in Manhattan, I moved to San Francisco with my family over the summer for my husband's work transition. Rather than join another existing private practice, I decided to launch Whole Heart Cardiology - a preventive telecardiology practice dedicated to optimizing heart health with the use of precision and lifestyle medicine. In this direct care model, I'm able to spend the time that patients deserve discussing their unique risk factors and work together to create an actionable plan.
2) What does cardiac disease look like for women and what are signs to look out for?
Heart disease is the number one cause of death in women, beating out all cancers combined. While women typically experience their first heart attack later in life than men, they are also more likely to die from it. This is due to less knowledge in the general public that women can and do experience heart disease, but also because of historic underdiagnosis and undertreatment in the medical community. While the most common presentation of a heart attack in women is still chest pain, they are more likely than men to also have symptoms such as shortness of breath, extreme fatigue, or nausea. Chest pain is not always present, or may be in the neck or upper abdomen.
3) What are the top 3 foods that you recommend for good heart health?
The good news is that up to 80% of heart disease is preventable! At the cornerstone of this is a heart healthy diet. This includes a plant based or plant predominant approach, with an abundance of vegetables, fruits, legumes (beans), whole grains, nuts, and seeds. While I always recommend a wide variety of plant foods, there are indeed several that have emerged in the literature as being cardioprotective. First, green leafy vegetables are consistently linked to decreased risk of heart disease, likely due to their anti-inflammatory and blood pressure lowering qualities. Secondly, berries have been associated with a lower risk of heart attacks as well as improved insulin resistance. Lastly, nuts are a great source of heart health fats, fiber, plant protein, and polyphenols. In a large randomized controlled trial, a handful of nuts was found to decrease cardiovascular risk by 30%.
4) How do HIIT, LISS or strength training affect women's cardiac health? What are your recommendations for exercise for women?
Exercise is a great way to reduce cardiovascular risk. Major guidelines recommend about 150 minutes of moderate intensity exercise per week or 75 minutes of vigorous activity. Examples of moderate intensity exercise include brisk walking or active yoga, while vigorous activity includes things like running, biking, and singles tennis. While there is a graded relationship between exercise and heart disease risk, meaning the more exercise someone does the better, even just incorporating small amounts of exercise from a sedentary lifestyle has been found to be beneficial. There is evidence that high-intensity interval training (HIIT) improves cardiometabolic health and may be superior to traditional continuous exercise. In addition to regular aerobic activity, incorporating strength training may confer additional benefits, particularly with regards to body composition, glucose regulation, and lowering blood pressure.
5) What are some questions / symptoms related to heart health to discuss at one's next yearly physical and when should one get a cardiology referral?
This is a great question! It's so important to ask your doctor, "What do you think my risk for heart disease is?" Be sure you have a good conversation with them about your risk factors, and which, if any, aren't optimally controlled. The main risk factors for heart disease that we have control over include high blood pressure, high cholesterol, smoking, increased weight, insulin resistance/diabetes, diet, and exercise - be sure to know your numbers, and ask your doctor for a game plan if they aren't in optimal range. Additionally, be aware of nontraditional risk factors that increase your risk - for women, this includes things like early menopause, pregnancy complications such as gestational diabetes or preeclampsia, and PCOS. Be sure your doctor takes these into account when discussing your risk for heart disease. It's a good idea to see a cardiologist if you have any symptoms that are concerning for heart disease, like chest pain, shortness of breath, or any symptoms with exercise. It's also a great idea to see a preventive cardiologist if you have multiple risk factors that aren't well controlled or want to have an in-depth discussion about how to optimize your heart health.
6) The following are some conditions that might affect heart disease: Menopause & Hormone Replacement, Can you talk about the correlation between these and heart disease?
Estrogen has many important functions in our body that tend to protect us from heart disease. As a result, women typically develop heart disease about 10 years later than men do. Women who experience menopause early, typically defined as before the age of 40, are at increased risk for heart disease due to the early decrease in the protective effects of estrogen. Interestingly, hormone replacement therapy (HRT) has a complicated history. It was thought that, because estrogen has these protective effects, that the administration of HRT would result in heart health benefit. Unfortunately, a large trial did not demonstrate a heart health benefit and instead suggested harm, however this finding was driven by HRT administration at older ages (>60 years of age) and at a greater time from menopause. Leading major societies support the use of HRT in recently menopausal women with appropriate indications, such as vasomotor symptoms like hot flashes.
7) As a dreamcatchers platform we have to ask, what is your next personal or professional dream?
I'm currently focused on growing my telecardiology practice Whole Heart Cardiology. I would like to see it expand and grow in order to help more patients optimize their heart health. I'm also extremely interested in digital health applications to help individuals manage and prevent heart disease, and hope to get more involved in the health tech space in the near future.
Thank you Nicole for sharing your expertise with us! We are excited to have you in our empowered women’s network!
Bio: Nicole Harkin, MD, FACC is a preventive cardiologist board certified in Internal Medicine, Cardiology, Echocardiography, Nuclear Cardiology, and Clinical Lipidology. After graduating from Boston University School of Medicine, she attended Columbia University for Internal Medicine residency and New York University for Cardiology fellowship. Following 5 years of traditional private practice cardiology in New York City, she founded Whole Heart Cardiology, a preventive telecardiology practice that provides cardiac optimization through precision and lifestyle medicine. She is passionate about preventing heart disease through healthful, sustainable lifestyle changes. She is a fellow of the American College of Cardiology, as well as a member of the National Lipid Association and American Society for Preventive Cardiology. She currently lives with her family in San Francisco, CA. When not doctoring, she spends the majority of her time with her three young children. She also enjoys cooking, yoga, Peloton-ing, hiking, and traveling.
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