Women's Health for the Long Run: I Thought I Understood Heart Disease
Understanding the process before the event.
For most of my life, I thought I understood heart disease.
My dad had his first stroke at forty-nine. Years later, he underwent a triple bypass. Heart disease was never an abstract concept in my family. It was something I had seen up close.
But looking back, I realize I didn’t actually understand heart disease at all.
I understood the event.
The stroke.
The surgery.
The blocked arteries.
I didn’t understand the decades that came before them.
I thought heart disease was something that happened one day.
I didn’t realize it was something that had been unfolding quietly for years.
When I first started taking ownership of my health, my heart wasn’t my focus.
I was trying to understand why I no longer felt like myself.
The weight gain.
The fatigue.
The brain fog.
The inflammation.
The stress fractures.
Like many women, I assumed the answers would simply be the result of years of chronic stress finally catching up with me.
As I shared in earlier essays in this series, I stopped relying solely on my annual physical and decided to order comprehensive testing. I wanted a better understanding of what was happening beneath the surface instead of waiting until something became obvious enough to investigate.
I didn’t know what to expect.
What I didn’t expect was that my cardiovascular system would become one of the biggest parts of the story.
My cholesterol had hovered just outside the normal range for years.
My cardiologist—who also happens to be my father’s cardiologist and knows our family’s history well—never felt it was time for medication.
His recommendation was always the same, which I always agreed with.
Improve my nutrition.
Exercise consistently.
Lose some weight.
Let’s continue watching it.
At the time, that felt completely reasonable.
Then I completed my Function Health testing.
Suddenly, cholesterol wasn’t just cholesterol anymore.
I wasn’t looking at a single LDL number.
I was looking at ApoB.
LDL particle number.
Inflammatory markers.
Additional testing that painted a much more complete picture of cardiovascular risk than I had ever seen before.
For the first time, my family history stopped feeling like background information.
It felt relevant.
Not because it guaranteed my future.
But because it changed the questions I wanted to ask.
One of the things that unsettled me most wasn’t that some of my cardiovascular markers were elevated.
It was realizing that I felt completely fine.
No chest pain.
No shortness of breath.
No symptoms that would have prompted me to schedule a cardiology appointment.
Apparently, that’s the point.
Our arteries don’t wait for symptoms before they begin changing.
Plaque doesn’t suddenly appear the day someone has a heart attack.
Inflammation doesn’t begin the day someone needs bypass surgery.
The cardiovascular system ages gradually.
Quietly.
Long before most of us would ever think to pay attention.
That realization changed far more than how I think about heart disease.
It changed how I think about health altogether.
I’m beginning to notice the same pattern everywhere I look.
We don’t suddenly become insulin resistant.
We don’t suddenly lose bone density.
We don’t suddenly lose muscle.
We don’t suddenly develop cognitive decline.
Most chronic disease isn’t born overnight.
It develops through countless small biological changes happening beneath the surface while life continues as usual.
The event is simply the moment we finally notice the process.
Disease often arrives in the medical record long after it has arrived in the body.
That may be the biggest lesson this entire Women’s Health series has taught me.
Like many women, my first instinct was simple.
Lose the weight.
Exercise more.
Eat better.
Surely everything else would follow.
Over the next year, I lost more than twenty pounds.
My metabolic health improved.
My insulin improved.
My blood sugar improved.
Many of the numbers I had been working toward started moving in the right direction.
I felt hopeful.
Then I repeated some of my cardiovascular testing.
Some markers improved.
The ones I cared about most barely moved.
My ApoB remained elevated.
My LDL particle number remained high.
Further testing suggested that part of what I was seeing wasn’t simply lifestyle. My liver appears to naturally produce more cholesterol than average, meaning genetics may be playing a larger role than I had initially appreciated.
I’ll be honest. That scared me.
Not in a dramatic, panic-inducing way.
In the quiet kind of way that keeps you reading research papers late at night because you’re trying to understand what your body is trying to tell you.
Around that same time, I attended the YPO Women’s Wellness Summit.
One of the sessions was led by cardiologist Dr. Jayne Morgan. She challenged the way I had been thinking about women’s cardiovascular health entirely.
One idea in particular has stayed with me.
Women’s health has largely been treated as reproductive health.
It sounds obvious now. But I couldn’t stop thinking about it.
Because so much of what we’re taught about estrogen revolves around periods.
Pregnancy.
Fertility.
Hot flashes.
Menopause.
Far less attention is given to the fact that estrogen has quietly been supporting our cardiovascular system our entire adult lives.
Our blood vessels.
Our arteries.
Our metabolism.
Our muscles.
Our brain.
As women enter perimenopause, estrogen doesn’t simply decline in a straight line. It becomes unpredictable—sometimes rising, sometimes falling—before eventually settling at much lower levels after menopause. Those hormonal shifts don’t just influence our menstrual cycles. They affect blood vessel function, cholesterol metabolism, body-fat distribution, insulin sensitivity, inflammation, sleep, and ultimately the long-term health of our cardiovascular system.
None of those systems are changing in isolation.
That explained something my own cardiologist had asked me months earlier.
The very first question he asked during one appointment wasn’t about my cholesterol.
It was: “How are your periods?”
I remember immediately bursting into tears.
Not because of the question itself.
Because only a few weeks earlier I had started learning about perimenopause for the first time. I was beginning to understand what was happening inside my body, and hearing my cardiologist ask that question made everything feel suddenly, undeniably real.
In a split second, my mind wasn’t thinking about my heart anymore.
It was thinking:
I’m aging.
Am I already too late?
Too late to protect my health?
Too late to have children?
Too late to change the trajectory?
Looking back, none of those conclusions were actually contained in his question.
He wasn’t telling me I was too late.
He was recognizing something I hadn’t yet fully accepted.
My hormones and my heart were part of the same conversation.
Suddenly, the conversations I had been having about hormones, metabolism, muscle, inflammation, visceral fat, and cardiovascular disease no longer felt like separate conversations.
They were all describing the same biological transition from different angles.
Perhaps the biggest shift wasn’t scientific.
It was psychological.
I used to think prevention meant finding disease early.
Now I think prevention means becoming curious while disease is still invisible.
Those are two very different ways of thinking.
One waits for evidence.
The other pays attention to trajectories.
One reacts.
The other observes.
If I’m honest, what frustrates me most isn’t discovering that I have cardiovascular risk factors.
It’s realizing how little I knew ten years ago.
I’ve spent my life learning.
I have multiple degrees.
I’ve built a successful business.
I’ve spent a career solving complicated problems.
Yet somehow I reached my forties before anyone explained how profoundly a woman’s hormones influence her cardiovascular health.
No one explained that heart disease often develops over decades.
No one explained that muscle, metabolic health, inflammation, sleep, stress, body composition, and estrogen were all participating in the same conversation.
It makes me wonder how many women are trying to optimize isolated pieces of their health without realizing those pieces are deeply interconnected.
I’m still figuring out what all of this means for me.
I’m still working with my physicians.
I’m still deciding whether lifestyle alone will be enough or whether medication will eventually become part of my long-term plan.
I’m still trying to build muscle after realizing how much I had lost.
I’m still working toward better sleep.
Still managing stress more intentionally.
Still trying to improve my cardiovascular fitness.
I’ve stopped thinking about my heart as an organ I’m trying to protect.
I’m thinking about it as a system I’m trying to preserve for the next forty years.
That’s a very different goal.
In my next essay, I’ll walk through exactly how that shift has changed the questions I’m asking, the testing I’m doing, the conversations I’m having with my physicians, and the decisions I’m making along the way.
One of the things I’ve come to appreciate most over the past year is that our bodies are constantly telling stories long before they become emergencies.
The challenge is that many of those stories aren’t told through symptoms.
They’re told through patterns.
Through trends.
Through biology quietly unfolding beneath the surface while life carries on as usual.
That, more than anything, is what I hope this series helps women understand.
I’m not trying to convince anyone to order the same tests I ordered.
Or make the same decisions I’m making.
I’m trying to help women ask better questions earlier.
Because that’s where prevention actually lives.
The question I’m holding:
If heart disease spends decades developing quietly, what would change if we became as curious about the health we can’t feel as we are about the symptoms we can?
xoxo 💋
Paola