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Questions for your doctor: Cardiovascular risk

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The short answer

What should I ask my doctor about cardiovascular risk? Heart disease kills more women than all cancers combined, and risk accelerates sharply at menopause. Standard "average risk woman" screening often understates risk in women. Insist on a thorough evaluation, particularly if you have a family history.

Why this conversation matters

Heart disease kills more women than all cancers combined, and risk accelerates sharply at menopause. Standard "average risk woman" screening often understates risk in women. Insist on a thorough evaluation, particularly if you have a family history.

6 questions to ask

  • What's my calculated 10-year ASCVD risk? — The pooled cohort equation gives a baseline risk number. Anything over 7.5% warrants statin discussion; under 5% is generally low-risk.
  • Should we order an advanced lipid panel — ApoB, Lp(a), particle size? — Standard cholesterol misses ~30% of women at risk. ApoB is more predictive than LDL alone. Lp(a) is genetic — once is enough.
  • Am I a candidate for a coronary calcium (CAC) scan? — CAC directly measures plaque burden. Useful when borderline risk; gives concrete information for treatment decisions.
  • How does menopause change my risk, and how should we adjust monitoring? — Estrogen is cardioprotective. Its loss accelerates atherosclerosis. Post-menopause is when prevention matters most.
  • What's my blood pressure goal, and how often should we check? — Target should be under 130/80 for most women. Home monitoring is more accurate than office readings.
  • Could HRT (especially started near menopause) reduce my cardiovascular risk? — The "timing hypothesis" suggests HRT started within 10 years of menopause reduces CV risk. Worth discussing if eligible.

What to bring

  • Symptom log — at least 2 weeks of daily entries (severity, time of day, triggers)
  • List of current medications and supplements with doses
  • Family history of relevant conditions
  • Recent lab results, if any (especially hormones, thyroid, vitamin D, lipids)
  • A written list of questions — easy to forget under time pressure

Red flags to escalate

  • Chest pressure, jaw or arm pain — particularly with exertion
  • Sudden severe shortness of breath
  • Unexplained fatigue or palpitations
  • Swelling in legs

If they dismiss you

Cardiac symptoms in women are dramatically more often dismissed than in men. If you have chest discomfort, do not accept "anxiety" without thorough cardiac workup — including ECG and troponins.

Let Mira walk through these questions with you first

She knows your symptoms and helps you prepare for the conversation.

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Frequently asked

Depends on your 10-year risk, ApoB, and CAC score. Decision should be shared, not unilateral. Side effects matter — but so does heart attack risk.

Less than previously thought. ApoB is now considered more important than HDL. Don't over-celebrate a "good" HDL.

Both help. Recent research shows strength training has comparable cardiovascular mortality reduction to aerobic, with better outcomes for muscle preservation. Do both.

Key takeaways

  1. What's my calculated 10-year ASCVD risk?
  2. Bring a 2-week symptom log to the visit
  3. Insist on testing if your concerns are dismissed
  4. A second opinion is reasonable for ongoing dismissal