Ep. 48: “Just a Little Heart Attack”: Why and How Heart Disease Affects Women and What You Should Do About It — with Dr. Arash Bereliani, Preventive Cardiologist

Jaw pain that appeared only while climbing stairs. Blood pressure that looked normal at every office visit but rose at home. One woman had a 90% blockage in a major coronary artery; another had masked hypertension that may have contributed to a cardiomyopathy — and in both cases the warning signs were easy to miss. In this episode, Dr. Regina Druz sits down with Dr. Arash Bereliani, a Beverly Hills preventive cardiologist with three decades of experience, to explain why women’s cardiovascular disease is so often diagnosed too late — and what can catch it earlier. They unpack the pattern behind underdiagnosis in women, the atypical symptoms doctors write off as anxiety, and a condition called SCAD that disproportionately affects women in their forties and fifties. Dr. Bereliani explains how microvascular disease can cause real chest pain even when an angiogram looks clean, and how a woman’s risk shifts when estrogen drops at menopause. Dr. Druz shares a case where a simple blood pressure cuff uncovered masked hypertension despite reassuring imaging. It’s a practical, myth-busting conversation about the questions worth bringing to your next cardiology appointment. This episode is educational only and is not medical advice.

Watch on YouTube: A video version of this episode is available on the Own Your Heart Health YouTube channel. Subscribe to be notified of new episodes.

Episode Chapters

[00:00] Dr. Arash Bereliani’s Personal Path Into Cardiology
[04:19] Why End-Stage Treatment Isn’t Real Prevention
[06:11] Atherosclerosis Takes Twenty Years to Develop
[07:16] The Top Risk Factors to Manage Starting in Your Twenties
[14:53] Why Prevention Training Still Lags Behind Treatment
[16:36] How Cardiology’s Risk Models Were Built Without Women
[23:28] Risk Calculators Still Don’t Account for Women
[25:33] What Actually Makes a Woman’s Heart Different
[32:02] The Bias Behind Underdiagnosis and Late Treatment
[35:28] Pregnancy History as a Hidden Cardiovascular Risk Factor
[38:23] Dr. Bereliani’s Take on Hormone Replacement Therapy
[44:21] The Top Three Tests Every Patient Should Get
[50:01] Why a $30 Blood Pressure Cuff Can Catch What Scans Miss
[53:17] Be Your Own Advocate

Transcript

[00:00] Dr. Arash Bereliani’s Personal Path Into Cardiology

Dr. Regina Druz (00:02): Welcome to Own Your Heart Health. I’m Dr. Regina Druz, your holistic cardiologist. This week we’ll dive into common heart health concerns, uncovering root causes and unpacking scientific discoveries and controversies. The information provided does not constitute medical advice. Please contact your healthcare practitioner before making any changes that may impact your health.

Dr. Regina Druz (00:40): It’s another Friday fun day — my listeners know I love Fridays. I’m thrilled today because I’m with a colleague, Dr. Arash Bereliani. Not to demean any of the wonderful physician and non-physician guests I’ve had, but having a cardiologist on the show is always a special treat — and with Dr. Bereliani it’s more than that, because he’s a preventive cardiologist focused on women’s cardiovascular health. If you’ve listened before, you know I’ve done quite a few shows on menopause and its impact on the heart, so today we’ll dive into this rapidly expanding topic. Dr. Arash, welcome to the show.

Dr. Arash Bereliani (01:27): Thank you, Dr. Druz — it’s a pleasure to be here.

Dr. Regina Druz (01:31): I’m going to ask you the most difficult question I ask all my guests: how did you grow up to be who you are today? Give us the backstage story — and since you’re from Beverly Hills, I’ll bring in some Hollywood metaphors.

Dr. Arash Bereliani (01:49): Cardiology is very personal to me. When I was eight, my brother — two years younger and very close to me — developed rheumatic fever and was very, very sick, and seeing what he went through really affected me. My father had heart disease; he started having chest pains in his thirties, and I’d come home and see him grabbing his chest — it was terrifying, because you think you’re going to lose your dad any second. He ended up having five-vessel bypass, open-heart surgery, at age forty-nine. And when I was dating my wife, the day we signed the location for our wedding and were celebrating over lunch, we got a call that her mother had just died of a sudden heart attack at a young age. So heart disease has always been very personal to me. As a kid I felt helpless — like I couldn’t do anything about it — and I wanted to do something to fix it. Not just treat heart disease, but prevent it from happening. Ever since medical school my goal has been prevention, because by the time you see a doctor with chest pain, it’s already too late. I’ve been in practice about 30 years, and I truly believe everyone should be able to live to at least a hundred without suffering.

[04:19] Why End-Stage Treatment Isn’t Real Prevention

Dr. Regina Druz (04:19): And we want them to be centenarians.

Dr. Arash Bereliani (04:21): Exactly. In this day and age we have the capability — the technology, the knowledge — to prevent heart disease. No matter how bad your heart is, no matter how bad your genetics, heart disease is something we can control and prevent in the vast majority of patients. It comes down to two things: choosing the right doctor to do the right testing and give the right recommendations, and then the patient actually following those recommendations. Do those two things and I truly believe everyone should be able to live without heart disease until at least a hundred.

Dr. Regina Druz (05:07): I so agree. What you’re highlighting is so important, because every day I meet patients who feel that once they get a procedure — a stent, a bypass, a pacemaker, a defibrillator — that’s it, the definitive treatment. And you and I know it’s actually 180 degrees opposite. That’s not the definitive treatment of heart disease; it’s the treatment of a specific end stage of heart disease — that occlusion, that arrhythmia — the end-stage manifestation, but not the disease itself. The true treatment of heart disease would start in utero and continue through childhood, adulthood, and into our more mature years.

[06:11] Atherosclerosis Takes Twenty Years to Develop

Dr. Arash Bereliani (06:11): Absolutely correct. Heart disease isn’t just a localized problem — it’s not just one artery that got blocked and you opened it. When someone has coronary artery disease, it’s almost a systemic problem, and it takes about 20 to 30 years to develop. Someone who has a heart attack — that heart attack didn’t happen the night before; the person wasn’t perfectly healthy with wide-open arteries the day before. It takes about two decades before an artery becomes completely blocked, or accumulates so much plaque that it ruptures and causes a heart attack. So everyone has the opportunity — about twenty years — to prevent that heart attack.

Dr. Regina Druz (07:02): You’ve been warned — warned twenty years in advance.

Dr. Arash Bereliani (07:06): If you don’t do anything about it, obviously it can happen. But you have plenty of time to prevent the upcoming heart attack.

[07:16] The Top Risk Factors to Manage Starting in Your Twenties

Dr. Regina Druz (07:16): So true. So what’s in your toolbox as a preventive cardiologist? I call myself an integrative cardiologist, you call yourself a preventive cardiologist — different stripes, but we probably do a lot of things the same way. Let me narrow it down to one of heart disease’s most common entities — atherosclerosis, cardiovascular disease (there are other types, structural, arrhythmia, and so on). What do you see as the top three things we must do, ideally in early adulthood, to position ourselves for better vascular health?

Dr. Arash Bereliani (08:28): Let me first say I also consider myself an integrative cardiologist — you and I are exactly the same; integrative and preventive cardiology are almost the same thing. In my practice I integrate a lot: lifestyle first and foremost, then supplements and vitamins as needed, and medications as needed. But the most important thing is lifestyle — the foundation. That means looking for the risk factors for heart disease: the basics like smoking, diabetes, high blood pressure, and high cholesterol, but also things people don’t realize — stress (a major factor), lack of sleep, certain diseases. So the first step is concentrating, at a young age, on managing those risk factors. When we’re teenagers or in our twenties, we think we’re invincible — we can eat whatever we want. But what you do now affects you ten and fifteen years from now. A lot of research shows true prevention should start in your twenties, not at forty or fifty. Get into the habit of eating healthy, exercising, reducing stress, and sleeping well early. Now, when it comes to women, they have their own set of risk factors that unfortunately a lot of people don’t know about — the basic ones men have, plus a few more — and women need to pay attention even at a young age. We can talk about that in a moment.

Dr. Arash Bereliani (11:00): The second thing is the checkup — and it’s very important. Don’t assume that because you’re thirty you’re healthy and don’t need one. I have so many patients who come in their early thirties with very high blood pressure or very high cholesterol — and these give you no symptoms; you can walk around with very high blood pressure at thirty and not know it. So get a regular checkup at least once a year — but done by a doctor who specializes in prevention. A lot of checkups I see are very basic — a quick EKG, maybe an ultrasound, “you’re fine.” When I trained as a cardiology fellow, they taught me nothing about prevention — how to treat someone who’s already had a heart attack, what medications to give in heart failure, but zero (or very minimal) training in prevention. It’s getting a little better, but there’s still a big gap. So we need to do the right testing — go above and beyond a regular cholesterol panel. There are biomarkers everyone should check: lipoprotein(a), ApoB, and hs-CRP (a test of inflammation). And the third thing, an extension of lifestyle, is exercise — exercise, losing weight, and stress reduction are really important.

[14:53] Why Prevention Training Still Lags Behind Treatment

Dr. Regina Druz (14:53): Let me summarize what you said, because it’s so important: people often jump to the complex or complicated, but it’s the foundational things that make the most difference. Once you have that good foundation, you can build on top of it — but the foundation is critical, and starting early matters. If you’re a parent, you can start even earlier with your children; if you’re a young adult, eighteen or older, that’s your opportunity to have a preventive, cardiovascular focus on yourself. Would you agree?

Dr. Arash Bereliani (15:58): Absolutely, a hundred percent. The point about kids is important — I have two little kids, and of course they want junk food. As a parent, part of you wants to give it to them, but you know the danger. Making sure they start eating healthy and exercising at a very young age can be challenging, but it pays off as they get older.

[16:36] How Cardiology’s Risk Models Were Built Without Women

Dr. Regina Druz (16:36): Your point about how we were trained is interesting — you and I trained in the same era, and that’s exactly how it was: we were trained to deal with the acute complications of chronic heart disease — acute MI, acute heart failure, acute stroke, aortic dissection. We were trained to titrate the drips, give the drugs, do the procedures. And even our “preventive” testing was geared to finding these end-stage states — is there a blockage on the nuclear stress test? Even when cardiac CT came along, the main goal until recently was to rule out obstructive atherosclerotic disease. It’s only recently that we pivoted coronary CT angiography toward a more preventive route — with AI-based plaque quantification, and coming down the pike, fat-attenuation imaging of inflammation in the perivascular and epicardial fat. So there’s a lot of opportunity. But for generations, we as cardiologists grew up with gender treated as a risk factor for heart disease — and typically it was male gender that counted, not female. You recently wrote a book to reverse that thinking, because it can actually harm female patients. Tell us about that.

Dr. Arash Bereliani (18:41): For almost the entire history of my field, the “textbook” heart patient was a middle-aged man. The big studies, the risk factors, even the symptoms we all learned — crushing chest pain with pain down the left arm — were built largely on men. We took that template and assumed it would fit women. But it doesn’t. Heart disease is the number-one killer of women — roughly one in three women dies of heart disease worldwide, and the latest statistics I reviewed show a woman dies from heart disease every eighty seconds. Yet women tend to be under-diagnosed, under-treated, and under-referred compared to men. There’s a big gap between how common and dangerous this disease is and how well the system is built to catch it. The reason is that the studies and trials are centered mostly on men, and we extrapolate to women — but women’s hearts are different and their risk factors are different. It’s time we understand that and treat women differently.

Dr. Regina Druz (20:28): My realization about this came early. I was asked to give a presentation at a nuclear cardiology meeting — I started my career as a non-invasive cardiologist, a cardiac imager (echo, nuclear, then cardiac CT), and I still love cardiac imaging; it’s the first love that never goes away. The talk was about the classic model we’re taught — age, gender, and the character of chest pain — to estimate the likelihood of obstructive heart disease. We call it pretest probability. So I went back to the original paper that derived that neat little table embedded in our heads, and it turns out they didn’t really have female subjects. The women they included were largely those who had tragically died in childbirth and had autopsies — they simply didn’t study enough women, and certainly not in reproductive age groups. So the whole table that said, “if you’re a woman with this atypical symptom, you probably have nothing to worry about until your sixties,” was essentially made up. That “foundation” we were told to build our evaluations on. A lot has changed since — but a lot hasn’t, and we’re educating and advocating yet not really reducing cardiovascular disease’s impact on women. Why is that?

[23:28] Risk Calculators Still Don’t Account for Women

Dr. Arash Bereliani (23:28): There have been slight improvements. Our risk calculators — the tools we use to decide who’s in trouble — were mostly built on men. Recently they’ve added some metabolic risk factors, but they still haven’t added women’s specific risk factors, and I think it’ll take time before they do. The main issue is knowledge — people still aren’t knowledgeable about the differences between men and women. That’s why women remain under-tested, under-treated, and under-referred: the system needs to change — the risk calculators, the diagnostics. We’re taking very slow steps, but we have a long way to go.

[25:33] What Actually Makes a Woman’s Heart Different

Dr. Regina Druz (24:53): So what makes women different from men when it comes to cardiovascular disease? I want our listeners to know — you may be a young or older woman listening, or a man who cares about a woman in his life — what those differentiating features are, so you can get care expeditiously.

Dr. Arash Bereliani (25:33): First, a woman’s heart is a little different — more delicate, with smaller blood vessels; the structures are the same, but the heart is smaller and the vessels are smaller. Second, hormones play a major role in women’s cardiovascular status. I tell my patients: your hormone trend is your cardiovascular trend. Take estrogen — it’s protective for the heart; it keeps blood vessels flexible, lowers the bad cholesterol, and keeps inflammation at bay. That’s why fewer women get heart disease when they’re younger. But at menopause, when estrogen drops, a lot changes — blood pressure goes up, cholesterol goes up, vessels become less flexible, inflammation rises — and stress and poor sleep during menopause raise stress hormones and further affect the heart. Men don’t have this; women do. There are also certain diseases far more common in women — one I want every woman to know is SCAD (spontaneous coronary artery dissection), a tear in the coronary artery that can cause a massive heart attack and death. It’s very common in women and very uncommon in men — and the kicker is that it happens mostly in women in their forties and fifties, exactly the time we tell patients, “you’re too young and healthy, it’s not your heart, it’s anxiety.” But it could be SCAD, which is very dangerous.

Dr. Arash Bereliani (28:22): Why do these happen more in women? We don’t know exactly — some speculation is that women’s coronary arteries are thinner, making a tear easier. There are other conditions too — ANOCA and INOCA, where women come in with chest pain, we take them to the cath lab, do an angiogram, and the arteries are completely open, so we say “you’re fine, go home.” But they actually have disease — microvascular coronary disease — true chest pain coming from the small blood vessels of the heart. A lot of times it’s misdiagnosed as anxiety or “it’s in your head.” I have patients who’ve seen two or three cardiologists and were told it’s all in their mind — but they truly have heart disease. And this microvascular disease, which is largely unique to women, can increase the risk of future heart attacks by at least two-fold, so it’s critical these patients get treated. The third reason is that women’s symptoms often differ. The typical teaching is chest pain with radiation to the left arm — but in women a heart attack can present just with unusual fatigue or nausea. I had a patient six months ago whose only symptom was jaw pain that occurred only when she climbed stairs. Her primary doctor said it was nothing, probably inflammation, and gave her Motrin — but she knew something was wrong. She came to see me, and we found a 90% blockage in her LAD, the main artery of the heart. She was a walking time bomb — and thank God we fixed it. So women’s symptoms can be very different, and because of that, the right treatment often isn’t given, and the patient can develop a heart attack or die.

[32:02] The Bias Behind Underdiagnosis and Late Treatment

Dr. Regina Druz (32:02): I talk a lot with my patients about the bias physicians often have when evaluating women’s cardiovascular health. Doctors look for pattern recognition, and women tend to present atypically — shortness of breath is very prominent in women with significant coronary blockages, or atypical pain (a different side of the chest, the jaw, back, or shoulder, not really the chest). If doctors are wired to the dogma that “common things are common” — “when you hear hoofbeats, think horses, not zebras” — they allocate women to the zebra category, and zebras don’t get addressed. That’s why women historically got to the hospital later with heart attacks and, when stented, had worse outcomes than men, controlling for everything else. And as you note, there are syndromes unique to women. I’ve seen SCAD a number of times, and Takotsubo cardiomyopathy — which in my mind is the model for how hormones affect women’s cardiac health. Takotsubo — named after a Japanese octopus-catching vessel — is a “heart ballooning” syndrome: the heart balloons and it looks like a massive heart attack, but the coronary arteries usually aren’t occluded enough to cause one. Not everyone recovers, and it has this fascinating two-hit hypothesis — a psychological insult followed by a physiological manifestation. It’s almost exclusively female (about nine to one), and the prominent age group is peri- and postmenopausal. So the thread of hormonal impact on the female heart runs through everything — how we present, when we present, and how we should be treated. So here’s a tough question: what do you think is the missing piece in treating women with cardiovascular risk or disease? Are you in the HRT camp or not? And if so — transdermal estrogen, oral estradiol, or a bit of both?

[35:28] Pregnancy History as a Hidden Cardiovascular Risk Factor

Dr. Arash Bereliani (35:28): That’s one of the number-one questions I get, and I’ll answer it in a second — but quickly, back to the previous point: a lot of doctors, when they see a younger woman, automatically assume she must be healthy and can’t have heart disease. If a forty-year-old woman comes to my office for chest pain, many doctors assume it’s anxiety or stress before even talking to her. We need to change that mindset — really listen, look at the risk factors, and take a full list, not just the traditional ones but also her pregnancy history: did she have preeclampsia, hypertension during pregnancy, gestational diabetes? When did she reach menopause — was it early? Those are risk factors for heart disease that every cardiologist should ask young women about.

Dr. Regina Druz (36:51): It’s finally made it into the guidelines — the 2026 dyslipidemia guidelines finally include these pregnancy-related and metabolic conditions more prevalent in women, like PCOS (recently renamed to reflect its polyendocrine, metabolic nature).

Dr. Arash Bereliani (37:19): Finally, after all these years — but you’d be surprised how many cardiologists still aren’t following it; it’ll take time to become mainstream. Now, on hormones: I did extra training in hormonal therapy, so I understand the different types of HRT very well, and in 30 years of practice I have many patients on it. HRT is much more nuanced and complicated than we tend to think. As I said, I believe hormones are, in a way, protective of the heart — if it’s done the right way. Not all HRT is the same. If hormones are given in the right form (estradiol, estriol, bi-est), at the right time — around menopause —

Dr. Regina Druz (38:59): During the “magical window” — the ten-year window.

[38:23] Dr. Bereliani’s Take on Hormone Replacement Therapy

Dr. Arash Bereliani (39:02): Right — that time window. And if it’s given the right way — the right form, often as a patch, gel, or cream rather than oral — to the right woman, not only is it not dangerous, I believe it could be protective. However, I want to be very clear: I don’t think we’re at the stage where we should give hormones purely for cardiovascular protection. But if a patient needs it — for symptom control during menopause, for osteoporosis, or other reasons — I’m a big advocate, as long as it’s individualized: the right time, the right patient, the right form, the right amount, and carefully monitored. Done that way, patients can definitely benefit cardiovascularly.

Dr. Regina Druz (40:34): I’m with you. What bothers me about HRT is that we don’t have strong outcome studies. Some older studies showed that with oral estradiol in women without a uterus (so no synthetic progestins, which is what the Women’s Health Initiative used), there was a reduction in cardiovascular event risk — but that was a subpopulation of a much larger study where many women were older, and these happened to be younger. So we don’t necessarily have a strong outcome base, and in cardiovascular medicine it’s all about outcomes — non-fatal MI, fatal MI, total mortality. If we can’t stop a heart attack or improve total mortality, we don’t feel we’ve “done it.” But there’s real nuance, and I think we need to broaden the lens of what we consider hormone replacement — because the incretins (our GLP-1s, GIP, and soon the triple agonists) are, technically, peptides, but peptides are just hormonal fractions. In women, these appear to be even more powerful than in men, across the spectrum of cardiovascular disease — especially conditions that lean female, like heart failure with preserved ejection fraction, SCAD, and ischemia with non-obstructive coronary arteries (ANOCA). The question then is which hormonal support — it’s not only sex steroids. A lot of people think you just slap on a patch and add a progesterone pill and she’s fine. But you have to look at her adrenals, her thyroid, her incretin status, her cardiometabolic window — and then possibly bring in sex-steroid replacement. That combination is potentially what drives the benefit. So it’s 100% complex and nuanced.

Dr. Regina Druz (43:20): I’m super curious about your practice — I definitely have to come out to Beverly Hills. Although I’ve been once, and everyone seems to have to be a size two and super young, which I’m not anymore.

Dr. Arash Bereliani (43:56): That’s not true — that’s a misconception.

[44:21] The Top Three Tests Every Patient Should Get

Dr. Regina Druz (43:58): So what are your favorite tests as a preventive cardiologist — your top three, the hill you’ll die on, that every patient who comes through your door gets?

Dr. Arash Bereliani (44:21): Routinely, any patient with risk factors gets, in addition to the basic lipid profile, an advanced lipid profile with biomarkers like lipoprotein(a), homocysteine, and ApoB, plus hs-CRP. There’s a bunch of blood work that goes beyond the regular cholesterol panel and gives far more insight into future risk. But the thing that’s really revolutionized how we treat patients is the scanning — the CT calcium score, or now the CCTA (coronary CT angiogram), which shows the inside of the coronary arteries: hard and soft plaque, and the vulnerable plaques at risk of rupture. These scans aren’t for everyone — I won’t do it on a 25-year-old with no risk factors — but patients with risk factors (high cholesterol, family history, diabetes, pregnancy complications, smoking history) get either a CT calcium scan or a CCTA. That’s the most important test, I believe. Along with it, I check the carotid arteries for plaque, because carotid plaque can lead to stroke and heart plaque to heart attacks — so both a carotid ultrasound and a calcium score or CCTA. And one thing I really want viewers to take away: please be your own advocate. If your doctor isn’t doing these tests, ask for them — I see patients who’ve had a cardiologist for years and never had even one carotid ultrasound. Plus a baseline echocardiogram to make sure we’re not missing valve problems, and a full metabolic workup — insulin, hemoglobin A1c, stress levels.

Dr. Regina Druz (47:33): I’m with you. As an imager, I love CCTA — contemporary CCTA gives us plaque components, which is huge — and I love carotids, because they’re the window into the vascular universe: no contrast, no big machine, just a little ultrasound probe you can put right on the neck. We measure CIMT (carotid intima-media thickness) and follow it. Recently I’ve gone deep into blood-pressure and arterial-stiffness measurement, and honestly it’s been an eye-opener — because sometimes a simple blood pressure cuff, without any of the sophisticated tests, tells the story.

[50:01] Why a $30 Blood Pressure Cuff Can Catch What Scans Miss

Dr. Regina Druz (48:00): I have a lovely patient — a woman, 79, in fantastic shape — who since her fifties has had a non-ischemic cardiomyopathy (a mildly reduced global ejection fraction, no clinical heart failure). Her coronaries are clean, her calcium score is zero — extraordinary for a 79-year-old — no soft plaque anywhere, and her carotids are beautiful. But with monitoring we discovered she probably has masked hypertension: in the office her blood pressure was always good, but it started with her arterial-stiffness measurement, which was higher than expected for her age. We then measured central and brachial pressure — higher than she expected — and started measuring at home, and lo and behold, she’s hypertensive. So I’m now thinking: was this hypertension simply masked for decades, quietly affecting her heart until she developed a cardiomyopathy? Sometimes the most effective test is a thirty-dollar blood pressure cuff — as long as you use it.

Dr. Arash Bereliani (50:01): We have a test in our office called MaxPulse that checks arterial elasticity — every patient over fifty gets it, to look at stiffness. You brought up a very good point that a lot of people miss: masked hypertension and monitoring. I always ask my patients to keep monitoring their blood pressure, and I teach them to check it the correct way. Every new patient learns how to check it properly, checks it for seven days, and brings me the numbers so I can see where they are — and I do that once a year even for patients who don’t have high blood pressure, to make sure we’re not missing it.

Dr. Arash Bereliani (50:59): What you mentioned is absolutely the easiest, cheapest way to diagnose a major heart issue.

Dr. Regina Druz (51:09): Exactly. What we’ll struggle with going forward is that patients now have access to a lot of these modalities — they can go online and buy their own calcium score (it’s not that expensive), there are many providers, including our center, where we send testing kits so they can get their bloods at home. But at the end of the day you need a guide — someone with the experience and expertise to interpret it. And sometimes the simplest things play the biggest role. I can’t overemphasize checking blood pressure. I’m even wearing my Oura ring and learning I’m a borderline non-dipper for blood pressure, which upset me — so I need to figure out how to “dip” appropriately in the evening, because I’m in the age group where being a borderline non-dipper isn’t good.

[53:17] Be Your Own Advocate

Dr. Regina Druz (52:23): These are things now accessible to us. We encourage all our listeners — and Dr. Bereliani, maybe you’d consider being a guest speaker for us, because we have Holistic Heart University, a patient education platform. It’s easy to join — I even have a little module there on how to properly measure blood pressure. Any parting words of wisdom from Beverly Hills? I love that I’m in New York and you’re in California — it’s like we’re hugging the whole country with cardiovascular wisdom.

Dr. Arash Bereliani (53:17): If viewers take one thing from this podcast, the most important is: be your own advocate. Listen to your body. If something doesn’t feel right, it’s okay to say, “I don’t feel good — let’s check my heart.” That can save your life. Understand that a woman’s heart is different from a man’s, and discuss your hormones and your pregnancy or menopause history with your doctor. If you don’t have one, it’s really important to see a preventive cardiologist who knows how to diagnose premature, early heart disease. Do those three things and, hopefully, everyone can avoid heart disease, heart attack, and heart failure in the future.

Dr. Regina Druz (54:21): A hundred percent. I was once in a webinar with Dr. Peter Libby — so famous in cardiology, a huge proponent of the inflammatory hypothesis of atherosclerosis — related to the JUPITER study, and I asked him about focusing on lifestyle and getting people in early, which is what integrative cardiology does. He said, “Every cardiologist should be integrative.” That’s what Dr. Bereliani and I are trying to accomplish here — giving you the tools and questions to advocate for yourself, because your cardiologist may not be integrative yet, but eventually they will be. Thank you so much, Arash, for joining me — it’s been a delight. Until I see you in LA.

Dr. Arash Bereliani (55:24): Definitely. We’ll be in touch — thank you again for the opportunity.

Dr. Regina Druz (55:31): Thank you for tuning in to Own Your Heart Health with Dr. Regina Druz. This podcast is powered by Holistic Heart Centers. If you enjoyed the show, please rate and review us on your favorite podcast platform. To learn more about our services, visit holisticheartcenters.com and subscribe to our YouTube channel — the link is in the show notes. See you next week.

Frequently Asked Questions

Why is heart disease so often missed in women?

Dr. Bereliani explains that for most of cardiology’s history the “textbook” heart patient was a middle-aged man — the major studies, risk factors, and even the classic symptoms (crushing chest pain radiating down the left arm) were built largely on men, then assumed to fit women. As a result, women are often under-diagnosed, under-treated, and under-referred, and risk calculators still don’t fully account for women’s specific risk factors. Dr. Druz adds that clinician bias — treating atypical female presentations as “zebras” or as anxiety — contributes to delays. This is a general discussion of a documented gap in care, not a diagnosis; if you have concerns, seek evaluation.

What is SCAD, and who does it affect?

SCAD — spontaneous coronary artery dissection — is a tear in a coronary artery that can cause a major heart attack. Per Dr. Bereliani, it’s far more common in women than men and tends to strike women in their forties and fifties — exactly the group often told they’re “too young” for a heart problem. It’s one reason he urges women (and their doctors) not to dismiss cardiac symptoms by age alone. This is general education about a serious condition, not medical advice — anyone with concerning symptoms should seek prompt evaluation.

Can you have real chest pain with “clean” arteries?

Yes. Dr. Bereliani describes ANOCA/INOCA — angina or ischemia with non-obstructive coronary arteries — where a woman has genuine chest pain but the angiogram shows open arteries, leading to a “you’re fine, go home” (or “it’s anxiety”) message. Many of these patients actually have microvascular coronary disease affecting the small vessels of the heart, which he says can raise future heart-attack risk at least two-fold and deserves treatment. This is educational information, not a diagnosis; persistent chest symptoms warrant medical evaluation.

How does menopause change a woman’s heart risk?

Dr. Bereliani frames it simply: “your hormone trend is your cardiovascular trend.” Estrogen helps keep blood vessels flexible, lowers “bad” cholesterol, and keeps inflammation at bay — which is part of why fewer women get heart disease earlier in life. When estrogen drops at menopause, blood pressure and cholesterol tend to rise, vessels stiffen, and inflammation increases. On hormone replacement therapy (HRT), he stresses it’s highly individualized and nuanced — potentially protective for the right patient at the right time and in the right form, but not something to start purely for heart protection. Both physicians emphasize this is complex and not a one-size-fits-all recommendation; decisions should be made with your own clinician.

Which tests does Dr. Bereliani recommend?

For patients with risk factors, he goes beyond a basic cholesterol panel to an advanced lipid profile with biomarkers like lipoprotein(a), ApoB, homocysteine, and hs-CRP (inflammation). His most valued imaging is a CT calcium score or CCTA (coronary CT angiogram) to see hard, soft, and vulnerable plaque — plus a carotid ultrasound (Dr. Druz measures CIMT), a baseline echocardiogram, and a metabolic workup (insulin, A1c). These are general educational examples of a preventive workup, not a personalized prescription — talk with your own clinician about what’s appropriate for you.

What is “masked hypertension,” and why does it matter?

Masked hypertension is when blood pressure looks normal in the doctor’s office but is elevated at home or over the day. Dr. Druz shares a case of a 79-year-old with a zero calcium score and clean arteries whose masked hypertension — uncovered through arterial-stiffness measurement and home monitoring — may have quietly contributed to a cardiomyopathy over decades. Both physicians make the point that a simple, inexpensive home blood-pressure cuff, used correctly and consistently, can catch a major risk that expensive scans miss. Learn to measure your blood pressure correctly and discuss home readings with your clinician; this is general guidance, not medical advice.

Show Notes & Resources

Guest: Dr. Arash Bereliani, Preventive Cardiologist

Dr. Arash Bereliani is a Beverly Hills preventive (and self-described integrative) cardiologist with roughly three decades in practice, focused on preventing heart disease and on women’s cardiovascular health. His path into medicine was deeply personal — a younger brother’s rheumatic fever, a father who had five-vessel bypass surgery at forty-nine, and the sudden cardiac death of his future mother-in-law — experiences that convinced him prevention, not just treatment, is where the real difference is made. He pursued additional training in hormone therapy, works to catch premature and early heart disease with advanced biomarkers and imaging, and recently wrote a book to raise awareness that women’s hearts, risk factors, and symptoms differ from men’s and are too often overlooked. (The views shared are his own, offered for educational purposes.)

Topics & Resources Mentioned in This Episode

Women’s heart disease — heart disease is the #1 killer of women; Dr. Bereliani cites roughly 1 in 3 women dying of heart disease and a statistic of one death every ~80 seconds (as stated on the episode; verify before citing)
SCAD (spontaneous coronary artery dissection) — a coronary tear far more common in women, often in their 40s–50s
Microvascular disease / ANOCA & INOCA — real chest pain with non-obstructive (“clean”) arteries
Takotsubo cardiomyopathy — the “heart ballooning” syndrome, overwhelmingly female and peri/postmenopausal
Advanced biomarkers — lipoprotein(a), ApoB, homocysteine, hs-CRP
Imaging — CT coronary calcium score, CCTA (with plaque-component analysis), carotid ultrasound / CIMT, baseline echocardiogram
Blood pressure — masked hypertension, home BP monitoring, arterial-stiffness testing (MaxPulse), non-dipping
Menopause & HRT — estrogen’s protective role and the individualized, nuanced approach to hormone replacement (form, timing, monitoring)
2026 dyslipidemia guidelines — now incorporating pregnancy-related and metabolic (e.g., PCOS) risk factors more common in women
Holistic Heart University — Holistic Heart Centers’ patient education platform (includes a module on measuring blood pressure correctly)
Heartwell AI (heartwell.ai) — Holistic Heart Centers’ personalized cardiovascular-risk tool

Holistic Heart Centers

holisticheartcenters.com
HeartWell.ai — AI-powered cardiovascular risk assessment
Address: 55 Bryant Avenue, Suite #6, Roslyn, NY 11576
Phone: 877-511-5166
YouTube: @reginadruzmd
Instagram: @dr.reginadruz
Podcast: Own Your Heart Health — available on Apple Podcasts, Spotify, and all major platforms

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