Smidt Heart Institute cardiologist Janet Wei, MD, is one of the authors of a maternal health report from the National Academies of Sciences, Engineering, and Medicine, a nonprofit organization that reviews published research and provides advice to the U.S. government. Wei, associate professor of Cardiology and Biomedical Sciences, sat down with the Cedars-Sinai Newsroom to explain how pregnancy affects women’s hearts.   

How does pregnancy increase cardiovascular risk?

Pregnancy acts as a stress test for the heart and can uncover, or even worsen, problems like high blood pressure and diabetes. During pregnancy, the heart must work harder to support a growing fetus, and cardiac stress often continues after delivery.

Cardiovascular disease is the leading cause of pregnancy-related death in the U.S., yet most of these deaths are preventable. The National Academies of Sciences, Engineering, and Medicine report on maternal health highlights that although 57% of cardiovascular-related deaths occur between seven days and one year postpartum, preventive care is often focused on the prenatal and immediate postpartum period.

What are two takeaways from the report?

The committee reviewed published medical research and gathered input from a wide range of stakeholders, including clinicians, professional societies, advocacy organizations and patients.

Several takeaways became clear. The report recommends, for example, that clinicians treat pregnant women with chronic hypertension so that their blood pressure is reduced to less than 140/90 millimeters of mercury.  This is because consistently elevated blood pressure during pregnancy can cause pregnancy complications and increase a woman’s risk for developing cardiovascular disease.

The new guidelines also recommended that clinicians caring for patients with postpartum hypertension or other hypertensive disorders give their patients home blood pressure monitors and use a program that allows the patients to report their readings. This way, clinicians can adjust treatment and set clear thresholds for action. 

Cedars-Sinai is already doing this through a postpartum blood pressure monitoring program that sends patients home with a blood pressure cuff and allows them to transmit readings to their care teams. (Kimberly Gregory, MD, MPH, director of the Division of Maternal-Fetal Medicine at Cedars-Sinai, served as an adviser to the National Academies committee that created the maternal health report.)

How often should women visit a doctor in the year after giving birth?

How frequently a woman should see her doctor during the postpartum period depends on her cardiovascular risk. 

Not every woman can easily see a doctor or health specialist—especially in rural areas or when cost is a concern. Therefore, the National Academies report recommends the Health Resources and Services Administration use its telehealth, rural health and maternal health programs to reduce geographic, financial and system barriers to preventive cardiovascular services.

What can pregnant women do to protect heart health?

The National Academies created a resource for women that includes the following advice:

Share your history. Tell your healthcare team your family history of heart disease, especially early heart attacks or strokes, and your pregnancy history, including any past complications.

Keep postpartum follow-up appointments on your calendar. It’s important not to miss these appointments because risk for complications continues through the first year after delivery.

Take warning signs seriously—trust your instincts. If something feels wrong during pregnancy or after birth, seek care right away and tell providers that you’re pregnant or that you gave birth recently.

Read more from Cedars-Sinai Stories and Insights: High Blood Pressure—What Women Need to Know

“To see this level of investment in women’s heart health is remarkable,” said Arthur J. Ochoa, JD, senior vice president of Advancement and chief advancement officer at Cedars-Sinai. “Philanthropists like Erika Glazer are changing the face of healthcare and bringing advanced care to so many of our patients.”

Glazer’s journey into heart care began in 2013, when she established the Erika J. Glazer Chair in Women’s Heart Health. The funds generated by the chair’s endowment supported the work of Jennifer Van Eyk, PhD, an expert in the study of proteins whose research focuses on sex differences in heart disease. Van Eyk is director of Basic Science Research in the Barbra Streisand Women’s Heart Center in the Smidt Heart Institute at Cedars-Sinai, director of the Advanced Clinical Biosystems Institute and professor of Cardiology, Biomedical Sciences and Pathology and Laboratory Medicine.

“Science is an uncharted territory,” said Glazer. “I wanted to help ensure that women were not left behind when it comes to heart health and research.”

Glazer further widened her philanthropic focus in 2016 when she established the Erika J. Glazer Chair in Women’s Cardiovascular Health and Population Science, currently occupied by Susan Cheng, MD, MPH, MMSc, director of the Institute for Research on Healthy Aging and division director of Population Health Sciences in the Smidt Heart Institute at Cedars-Sinai.

Then in 2023, Glazer funded her third chair at Cedars-Sinai—the Erika J. Glazer Chair in Women’s Cardiovascular Research, Education and Innovation. The inaugural chairholder is Janet Wei, MD, FACC, associate medical director of Cedars-Sinai’s Biomedical Imaging Research Institute, director of the Cardiovascular Disease Fellowship program in the Smidt Heart Institute, and associate professor of Cardiology and Biomedical Sciences at Cedars-Sinai. 

Righting a Wrong

Glazer’s philanthropic inspiration was sparked by her growing awareness of the underrepresentation of women in heart research, coupled with the need for greater gender equity in the United States.

“Women’s heart disease impacts everyone, in that all of us have a mother, a sister, a daughter, and/or a wife,” said Glazer, who at age 16 spent time interning at Cedars-Sinai—known then as Cedars of Lebanon—in the cardiology laboratories. “We must do more, we must do better, and we must do it now.”

While she considered a career in healthcare, Glazer opted to join her father, Guilford Glazer, in real estate development.

Glazer has made a name for herself in the male-dominated fields of construction and sports. A successful equity investor, she currently is a co-owner of the NBA’s Golden State Warriors.

“If it’s your passion, nothing should stand in your way,” Glazer said.

In addition to aiding Cedars-Sinai’s mission to attract and retain exceptional investigators, in 2016, Glazer also pledged $7.2 million for the Erika J. Glazer Women’s Heart Research Initiative at the Barbra Streisand Women’s Heart Center to support investigations into heart failure with preserved ejection fraction (HFpEF), a type of heart failure that primarily affects women.

“We are increasingly thankful to Erika Glazer—our colleague, our friend and our partner—for helping us to uncover the secrets of women’s heart health and disease,” said C. Noel Bairey Merz, MD, FACC, director of the Barbra Streisand Women’s Heart Center, and the Irwin and Sheila Allen Chair in Women’s Heart Research. “She is a doer, and she is changing the face of heart disease for women and men.”

A Champion for Women

Wei, the newest chairholder supported by Glazer, is awed by the woman behind its creation.

“I’m honored to join an inspiring group of women leaders who have benefited from the vision and generosity of Erika Glazer,” Wei said. “She is a champion for women’s heart health and is providing opportunities for my colleagues and me to advance the research, education and innovations that will save lives.”

 Read more from Discoveries: Women’s Health and Sex Differences—Research Update

Triglycerides are the most common type of fat in the blood. Wei told HealthCentral that triglyceride levels often increase when an individual’s “bad” cholesterol is high and their “good” cholesterol is low.

“High triglycerides increase our risk of plaque buildup in our blood vessels, called atherosclerosis, which leads to heart attacks and strokes,” said Wei, who also is the Erika J. Glazer Chair in Women's Cardiovascular Research, Education and Innovation at Cedars-Sinai.

Wei told HealthCentral that fruits, vegetables, beans, whole grains and fish—which are part of a Mediterranean-style diet and the Dietary Approaches to Stop Hypertension (DASH) diet—can help keep the heart healthy.

She also spoke with HealthCentral about how heart attacks can be different for men and women.

“While both women and men can have heart attacks and angina as a result of blocked arteries from cholesterol plaque, we now understand that compared to men, women are more likely to experience heart attacks and angina in the absence of these big blockages,” Wei said.

She told HealthCentral that men and women also can have different heart attack symptoms.

“Women are more likely than men to have other symptoms [than chest pain], such as shortness of breath, nausea, profound fatigue, and back, jaw and neck pain,” Wei said. “Importantly, women may be more likely to use a different description of ‘pain’ when describing their chest discomfort, such as ‘pressure,’ ‘squeezing,’ or ‘burning.’”

Click here and here to read the complete articles from HealthCentral.

Heart disease is the leading cause of death among women in the U.S., and a type of heart attack called myocardial infarction with non-obstructive coronary arteries (MINOCA), which predominantly affects women, is garnering increased attention.

In observance of American Heart Month in February and Cedars-Sinai’s 18th annual National Wear Red Day event on Feb. 3 to raise awareness of women’s heart health, the Cedars-Sinai Newsroom sat down with Janet Wei, MD, and Noel Bairey Merz, MD, cardiologists in the Smidt Heart Institute at Cedars-Sinai, to learn more about MINOCA.

Wei is associate medical director of the Biomedical Imaging Research Institute at Cedars-Sinai and co-director of the Stress Echocardiography Lab at the Smidt Heart Institute. Bairey Merz is director of the Barbra Streisand Women’s Heart Center and director of the Linda Joy Pollin Women’s Heart Health Program at the Smidt Heart Institute.

What is MINOCA?

MINOCA is a heart attack caused by poor blood flow to the heart, despite no evidence of major blockage in the arteries. A troubling aspect of MINOCA is that often when we diagnose a heart attack, we rely on a single imaging method—invasive coronary angiogram—to tell us if there’s a big blockage in the coronary arteries. With MINOCA, the angiogram can look normal because we don’t see a blocked artery, and then patients don’t know why they had a heart attack.  

MINOCA primarily affects women—tell us more about this. 

Compared to heart attacks with obstructive coronary artery disease, MINOCA patients are more likely to be female and younger, and they’re also more likely to be Black or Hispanic/Latino. Prior studies have shown that Black or Hispanic patients—in particular, young Black women—have a lower prevalence of obstructive coronary artery disease than white/non-Hispanic patients when they come to us with chest pain or are being evaluated for heart attack. It’s unclear if this difference is due to disparities in healthcare referral patterns for testing or racial/ethnic differences.

What causes MINOCA? 

There can be different causes. Even with no obstructive coronary arteries, MINOCA can still occur because of atherosclerosis (plaque buildup). But instead of the plaque rupturing and blocking the whole artery, with MINOCA, it’s due to an erosion rather than a rupture. So, the surface of the plaque may be disrupted, but there’s no big clot blocking the blood vessel and therefore, we can’t see it on routine angiography.

There are other causes of MINOCA that are more common in women than men. These include coronary artery spasms, which cause poor blood flow to the heart. Also, a spontaneous coronary artery dissection, which is when the blood vessel tears. This is the most common cause of heart attacks in pregnant and postpartum women.

What are the symptoms and risk factors?

The signs and symptoms are the same as a heart attack in someone who has blocked arteries—chest discomfort (pain, pressure, tightness), shortness of breath, nausea, lightheadedness. There are some shared risk factors—high blood pressure, high cholesterol, diabetes, smoking—but they are less frequent in MINOCA patients than in patients who’ve had heart attacks with obstructive coronary disease. We’re still trying to understand what contributes to MINOCA, mainly because it could be caused by many different things—spasm, dissection or even an embolism.  

How is MINOCA treated? 

The same way as other heart attacks: antiplatelet therapy, statins, ACE-inhibitors/angiotensin receptor blockers and beta-blockers. However, we think these therapies should be tailored in patients with MINOCA, particularly in those without atherosclerosis. Large trials are needed to help us determine how to best treat MINOCA patients.

What research is underway to better understand MINOCA?

We previously participated in the Heart Attack Research Program, supported by the American Heart Association, in which advanced imaging techniques were tested to help us better understand MINOCA in women. We found that a combination of imaging techniques allowed us to diagnose the cause of MINOCA in over 80% of cases. The study has since expanded to include men.

We need more research into treatments. Because we don’t fully understand why MINOCA may have happened, we can’t tailor our treatment. The Women’s Heart Center at Cedars-Sinai is currently leading the WARRIOR clinical trial (designed by Bairey Merz), testing whether standard therapy used for obstructive coronary artery disease is effective for women with chest pain and no obstructions. Some of the women enrolled have experienced MINOCA.

What do you wish more people knew about MINOCA?

That heart attacks can occur for a variety of reasons, and the absence of obstructive coronary artery disease does not mean it’s not a heart attack.

Read more on the Cedars-Sinai Blog: Finding the Right Care for a Racing Heart