The Five and One Issue #12: The Grey Zone of Women’s Heart Risk

Why The Five & One?

Healthcare doesn’t fail women because we lack information. It fails because systems are slow to change and rarely built around women’s bodies, lives, or timelines. The Five & One exists to make those systems visible.

To wrap up Women’s Heart Health Month and build on our recent webinar with cardiologist and Advisory Board Member Dr. Suzanne Steinbaum, we have a different kind of long-form edition of The Five & One. We believe that education matters deeply, which is why our webinars are a core pillar of member benefits.

And what also matters are the personal stories that humanize what it means to actually live with research gaps, outdated protocols and reimbursement policies, fragmented care, and all the ways the system doesn’t work for women we talk about.

Our Chief Design and Impact Officer, Kristin James, has been on a mission to tackle what she calls the “grey zone” in her own cardiac risk: the information that lives between a risk being identified, and a life-threatening event actually happening. For her this meant putting her father’s medical history in context, connecting multiple dots across her own health, and going outside traditional care models to feel more well-informed and empowered.

As stated in the webinar, 80% of heart disease is preventable. In sharing this first-person account in addition to the webinar, we hope to inspire more women to take whatever first step forward that makes sense. We’ve included lots of information and resources to help you do just that.

Join us here!

Last year, something in me shifted.

I was in the ER having the expected debate with a physician: is this anxiety or is this a cardiac episode? I was fighting to have my symptoms and family history taken more seriously, to reinforce how women experience heart attacks compared to men. That’s when I realized that I was the same age my father was when he had his first heart attack. 

Until that night, the years between risk and an actual event had felt long and theoretical. But suddenly, already in a hospital gown fearing the worst, my age took on a whole new gravity.

I had consoled myself knowing that my father didn’t curb his own risk by smoking for years and drinking nearly every day. I’m not repeating those behaviors. But biology doesn’t always negotiate, and family history doesn’t disappear because you behave differently.

In terms of that ER visit, my cardiac panel and vitals didn’t show an imminent threat. Imminent being the key word. A temporary relief. 

I still found myself absorbing my father’s timeline, beginning to measure myself against it, and feeling like I haven’t just inherited genetics - I’ve inherited an arc with a foregone conclusion.

And as a woman in midlife, the risk equation isn’t static. I’ve lived through PTSD and the long physiological aftermath of trauma. I manage an autoimmune condition, which means inflammation is never entirely abstract. And I have officially entered menopause, when cardioprotective estrogen declines sharply (PMID: 29065927). Research shows these, and other factors, can all amplify risk.

For the first time I felt helpless, and I did not like it. So, I decided to take the steps to know my own heart much better. Not as a standalone organ and through the lens of one specialty, and not in theory, but as something happening in my own body.

Heart disease is commonly evaluated through risk calculators and standard labs. Cholesterol totals. Blood pressure. Your reported family history. Potentially a stress test. The first step is usually to manage the numbers through lifestyle before medicine is introduced. For women, this normally comes with a healthy dose of body shaming. Many of you have been there, done that.

Having been through this cycle a few times myself, here’s what never happens, but should:
I’ve never been asked about the non-cardiac factors that amplify risk in women.
Additional panels that test for critical markers and how they are behaving are skipped.
A scan which would actually visualize the presence of plaque is not suggested.

This is like knowing there’s a risk of fire but not bothering with other conditions that make a dangerous fire happen. Like, is there fuel accumulating? (This is what additional panels answer). And has a spark already caught somewhere? (What a scan helps you see).

It didn’t help me much to keep answering “is there a risk of fire?” I already have ten years of that data. What I really wanted to know, in deeply human terms, is if the trajectory I feared most was already quietly in motion.

To do that, I needed more than what’s considered standard.

Instead of marching straight to my cardiologist, I opted for a more extensive and integrated option as a first step (through Function Health). Not because I distrust physicians. I wanted this information all in one place alongside other important markers beyond a cardiac panel, where retesting within the year is standard without having to advocate for it, and I could easily track multiple metrics over time.

Another consideration: because my father also developed Alzheimer’s and those two risks are connected, it felt wise to test for the ApoE4 variant at the same time. 

In our recent webinar, Dr. Steinbaum identified these additional panels and scans as vital to really appreciate cardiac health and risk:

Choosing a path with more integrated testing meant going out-of-pocket, which I’m fortunate to be able to do. But it doesn’t sit easily with me that these prevention-oriented tests are more readily accessible through private platforms than through standard care - a financially gated luxury, which is another way the system fails us.

The process required a lot of emotional regulation and restraint. The bloodwork is extensive and requires a few visits. I’m not an easy blood draw so this was an ongoing anxiety spike. And advanced testing means more data coming in sporadically. And that pacing can tempt you into catastrophizing single values before patterns emerge. 

But once the full picture came into focus, I had a degree of clarity I’ve never had, and instead of feeling more scared, I felt calmer.

I now know where genetic markers play a role.
I see which cardioprotective markers are doing their job.
I see how menopause impacted my results since last year.
My arteries are no longer a full-fledged mystery.

No, I don’t know how to pull this all together on my own and put a pin along the continuum that lives between cholesterol results and an ER visit. But I can sit with my physicians to appreciate where I’m really at, what it means, ask better questions, and make appropriate adjustments. I’m no longer waiting for the worst-case scenario to come and find me.

This has also inspired me to take advantage of our 15% member discount at CONNEQT Health on their device called the CONNEQT Pulse, an FDA-cleared at-home arterial health monitor delivering personalized cardiology insights. Having another benchmark for my cardiac health as I become more deliberate about managing my risk will build in valuable extra peace of mind. (Members must long into the member-pages to find the discount code.)

If there’s one thing I hope people take away from sharing my personal story it’s this. The psychological shift from the dread of perceived borrowed time to well-informed time is hard to overstate.

Our healthcare system is built for responding to rupture: heart attacks, strokes, acute events. It is less structured around mapping the long arc before rupture.

Insurance follows that logic. Referrals follow that logic. Care often fragments under that logic, even when clinicians are doing their best.

Women feel this gap acutely. We are navigating bodies that do not always reflect the default models on which much cardiovascular research was historically built. Hormonal shifts, pregnancy, autoimmune prevalence, trauma exposure and mental health in general, these layers complicate the picture in ways risk calculators rarely capture fully.

Preventive insight should not be a luxury add-on. It should not require extraordinary advocacy or the investigative prowess of an FBI agent. And it should not depend on whether someone can pay out of pocket to access a broader panel or a scan.

But until awareness, incentives, and care settings evolve (something Dr. Steinbaum is passionate about working on) many women will continue doing what I did: assembling a more complete picture of themselves and then bringing it back into the traditional system for next steps.

Knowing you carry risk is heavy. Advanced testing does not guarantee safety but living indefinitely in uncertainty - the grey zone - isn’t a strategy either.

That’s why we developed this guide, from our webinar with Dr. Steinbaum, to help you have conversations with your own doctors. It outlines the tests you should ask for and why, which scans are most accurate, what symptoms to look out for, and most importantly some scripts to use to advocate for yourself. 

My first step was what made sense for me. Yours might look different. But any understanding of where you stand has the power to change how you move forward. You don’t have to wait until you’re in the ER to start asking more questions.