American Heart Month: Women's heart health and imaging, with Sean Raj, MD, MBA

Cardiovascular disease remains a leading health threat to women, with data suggesting that 1 in 3 women will be affected by some form of heart disease in their lifetime. Sean Raj, MD, MBA, chief medical officer and chief innovation officer at SimonMed, emphasizes that while obstetricians and gynecologists are often the primary point of contact for women, the current rate of heart health screening remains low.

“I think the big picture here is that women’s cardiovascular health isn’t a one-type or one-input assessment,” Raj said. “Whether you look at pregnancy, contraception choices, menopause, age, estrogen supplementation, all of these are factors that influence cardiovascular health.”

Raj noted that key factors that increase lifetime cardiovascular risk include a history of gestational diabetes, preterm delivery, and hypertension, both baseline and gestational. Additionally, family history, smoking, and sleep quality serve as critical indicators.

“There are many factors that should be discussed, and family history is certainly a major component. But even certain contraceptives can influence cardiovascular risk, especially those that contain estrogen,” Raj said. “Blood pressure, specifically uncontrolled hypertension, or smoking history, can also contribute quite a bit to having a thromboembolic event, like a stroke.”

The integration of imaging into preventative health offers a visual manifestation of these risks. Raj highlighted that routine screenings, such as mammography, can serve as a dual-purpose diagnostic tool.

“From an annual mammogram, we can assess the presence of breast arterial calcifications. And we know when a patient has breast arterial calcifications, there is some sort of correlation with cardiovascular disease,” Raj noted. “Even when you’re coming in for a mammogram, for example, we’ll give a personalized report, show where there may be breast arterial calcifications, and then give patients personalized information on next steps and what to do.”

While high-end exams like coronary CT angiography or nuclear scans provide precise data, Raj argues that the clinical priority should be "opening up the funnel" to increase the sheer volume of patients screened. This starts with routine conversations during fertility, pregnancy, or menopausal care.

“If you’re going to your ob-gyn to talk about fertility, or you’re going to your ob-gyn to talk about a pregnancy you’re about to have or are having, or post-pregnancy, this should be part of the routine conversation—before symptoms, before complications, before disease becomes irreversible,” Raj said. “Ob-gyns are in a really fortunate position to be able to capture the attention of the patient, oftentimes before heart disease becomes a significant problem.”

Reference

The Facts about Women and Heart Disease. American Heart Association. Accessed February 27, 2026. https://www.goredforwomen.org/en/about-heart-disease-in-women/facts