Laura and Sarah 2021

Photo by Dr. Laura McLain

The author, Dr. Laura McLain, left, is pictured with her late sister, Sarah Rogers, at White Sands National Park in 2021. She dedicates this article to Sarah's memory.

In veterinary medicine, we're acutely aware of the risk of heart disease in our patients. Maine Coon cat? Doberman with ventricular premature contractions? Elderly mini poodle that has been coughing for three months? All of these set alarm bells dinging in our brains. But what about our own risk of heart disease?

I recently learned the hard way that heart disease is the No. 1 killer for both men and women worldwide. We should all be aware of the risk for ourselves, our families, our staffs and our colleagues.

My younger sister, Sarah, died a year ago of a heart attack at age 49. She left behind a husband and two teenage sons. She didn't have elevated cholesterol or hypertension. She walked the dogs daily, ate well and didn't drink or smoke.

She spent most of her career doing theatrical costuming and had recently begun working for a NASA contractor, making spacesuits for the upcoming Artemis missions. She was ecstatic for the future — to see her work walk on the moon.

The week before Sarah died, she felt tired and thought she was coming down with a cold. The morning she died, she took the dogs to the park like usual. At home, she complained that she felt dizzy and asked her husband to take her to the hospital. In the time it took for him to put on his shoes, she had collapsed. Within two hours, she was dead.

An autopsy revealed a clot in her left coronary artery. I was devastated by her loss and confounded. Neither Sarah nor I had been concerned about heart disease, as our parents were in their 80s with no heart problems. Our maternal grandfather died of a heart attack when we were very young, but our family attributed that to his devotion to cigarettes and red meat.

Sarah's death prompted me to start reading about heart attacks among younger, seemingly healthy people, especially women. What I learned changed how I understood my own risk and that of my staff and fellow veterinary professionals. In my sister's honor, I would like to share what I gleaned.

According to the American Heart Association, there were nearly 418,000 sudden cardiac arrest deaths in the United States in 2022. Cardiovascular disease caused more than 19 million deaths globally in 2021. Hospitalizations and deaths from myocardial infarction are increasing among younger people (ages 35-54), especially women, a study published in 2018 reported. This isn't just an American phenomenon. A separate review paper in 2023 documented the trend around the world, including in China, Southeast Asia and sub-Saharan Africa. The U.S. Centers for Disease Control and Prevention reports that 44% of women in the U.S. live with some form of heart disease, and that heart disease caused one in five female deaths in 2021.

This is important with respect to our colleagues' heart attack risk because veterinary medicine in the U.S. has been majority female since 2009. Women represent 68% of the profession and 83% of veterinary school students, according to figures from the American Veterinary Medical Association and the American Association for Veterinary Medical Colleges. The great majority of veterinary technicians are women, as well.

Heart attack symptoms can present differently in women from men. We know the classic signs: pain in the chest and left arm, as demonstrated by the television actor dramatically clutching his chest while his face reddens. But those signs are not all-inclusive, especially for women. My sister thought she was coming down with a cold. In women, heart attack symptoms include jaw pain, abdominal pain, nausea and vomiting. (When I say "women," I include everyone who was born female.)

Women also face more predisposing factors than men. The "traditional" factors that affect both sexes include diabetes, obesity, hypertension and smoking. In women, further risk factors are: more prevalent autoimmune disease (lupus, rheumatoid arthritis, psoriasis), higher likelihood of major depression, onset of menstruation or menopause at an early age, endometriosis and polycystic ovaries.

There's also an association with a host of pregnancy-related complications, as described in the previously cited 2023 review paper: hypertension, gestational diabetes, preeclampsia or eclampsia, ectopic pregnancy, stillbirth, preterm birth, placental abruption and a small-for-gestational-age infant. Importantly, pregnancy-related complications could increase the risk of myocardial infarction years or decades later.

The nontraditional risk factors aren't as well-studied as the traditional risk factors, but if you have any, please discuss them with your physician.

While I don't know of any studies looking at the heart disease risk among veterinary professionals, a review published in ScienceDirect in 2023 reports that cardiovascular disease is increasing among health care providers. With our colleagues in human medicine, we share risk factors including long hours, shift work, high stress, anxiety and the nature of the work (such as surgeons standing in place for extended periods).

In a survey in 2021 for the Merck Veterinary Wellbeing Study III, 92% of veterinarians reported increased stress levels and 30.5% reported high levels of burnout. Burnout contributes to chronic low-grade systemic inflammation, autonomic dysregulation, coronary heart disease, hypertension, diabetes, immunodeficiency and premature death, according to a review article published in Frontiers in Veterinary Science in 2023. The same article notes that the risk of cardiovascular events associated with burnout was at least equal to the more well-known risk factors of smoking, obesity and hypertension.

(I hope reading these long lists of risk factors didn't increase your stress level!)

What can you do to assess your personal risk? Your primary care physician might ask if you have a family history of heart attacks, check your blood pressure and run a lipid panel. If you have hypercholesterolemia or hypertension, you will probably be referred for additional diagnostics, but otherwise, you probably won't.

As patients, we are commonly educated about the risks of various cancers and strongly encouraged to have colonoscopies, mammograms, prostate exams, PSA blood tests, Pap smears and dermatological exams. But consider this: In 2022, more people in the United States died of heart disease and stroke than all forms of cancer and chronic lower respiratory disease combined, according to the American Heart Association.

We must advocate for ourselves. If you have risk factors such as family history, autoimmune disease or previous pregnancy complications, I urge you to discuss them with your primary care physician and ask for a cardiology referral if appropriate.

In Sarah's case, the only risk factor I can identify in hindsight is family history: our cigarette-smoking grandfather. I wish we had been more cognizant of his heart attack when we were little. Perhaps if Sarah had discussed our grandfather's death with her physician, she might have been referred for a cardiac workup. After Sarah died, I talked to my doctor and was referred to a cardiologist for a stress echocardiogram and PET myocardial perfusion scan and was prescribed a cholesterol-lowering statin.

When considering your own risk factors, don't discount anything, and look back a few generations for family risk. I also urge you to educate staff members about cardiovascular disease. I've spoken at a staff meeting to raise awareness among our (mostly young, mostly female) staff. We had an excellent discussion, with several staff members sharing personal stories of heart disease, early diagnoses and treatment, along with cardiologist contact information. I even donned my teaching hat to educate Sarah's friends and coworkers at her memorial service!

My sister didn't know she had heart disease, and her first heart attack was fatal. Please find out your risk, because your family, your staff and this profession need you.

Laura McLain received her DVM in 1997 from the University of Wisconsin. She lives in Salt Lake City, Utah, with her husband, daughters, mother, a courageous Labrador retriever, and a sassy Pembroke Welsh corgi. She works general practice and emergency/urgent care relief. She especially loves working K9 medicine, surgery and dentistry and is a certified Working Dog Practitioner through the University of Pennsylvania School of Veterinary Medicine's Working Dog Center.