Podcast Summary: The Thyroid Fixer, Episode 592

"The Female Heart Crisis No One Warned You About"

Host: Dr. Amie Hornaman
Guest: Dr. Sanjay, Interventional & Functional Cardiologist
Date: January 2, 2026

Episode Overview

This powerful episode tackles a topic often overshadowed in women’s health—cardiovascular disease as the #1 killer of women. Dr. Amie Hornaman and guest Dr. Sanjay deliver a frank, nuanced discussion on the silent progression of heart disease, its links to female hormones, thyroid health, and how conventional paradigms often fail women. They break down real-life symptoms, overlooked diagnostic tools, the importance of prevention, and how personalized, root-cause medicine can empower women to take control of heart health before a crisis hits.

Key Discussion Points & Insights

1. The Silent Threat of Cardiovascular Disease in Women

• Cardiovascular disease is the #1 killer of women but rarely discussed in personalized, preventative terms.

• The progression is silent—by the time symptoms appear, disease is typically advanced.

  "When it comes to cardiovascular disease, the problem is that it builds up in silence. You don’t necessarily feel a problem until it’s too late. ... The best way to manage a heart attack is to manage to never get one in the first place."
  —Dr. Sanjay (00:00 & 09:23)

• Many women mistakenly believe breast cancer, accidents, or COVID are greater threats due to public perception (09:32).

2. Why Women's Heart Attacks are Missed

• Atypical symptoms: Most women do not have the classic "elephant on chest" chest pain seen in men.

• Presentations can be misleading: toothaches, indigestion, anxiety, shortness of breath, “just feeling off.”

  "The most typical presentation for women is an atypical presentation. ... I’ve had one woman who had a chronic toothache...turns out she had a 90% blockage."
  —Dr. Sanjay (13:03)

• Medical gaslighting is common: Women are often told it's just anxiety or stress (15:10).

3. The Overlap: Hormones, Thyroid, and Heart

• Perimenopause and menopause trigger increased risk due to dropping estrogen—previously "protective" against heart disease.

• Declining estrogen leads to higher blood pressure, rising LDL cholesterol, and insulin resistance (18:21).

  "Your blood vessels now start to become less reactive and more like a guy’s...piling up plaque."
  —Dr. Sanjay (19:06)

• Thyroid dysfunction (especially hypothyroidism) can cause high cholesterol, heart muscle weakening, swelling, and overall higher risk (21:12).

  "Hormone health is really cardiovascular health."
  —Dr. Sanjay (21:11)

• Symptoms of hormone imbalance and thyroid issues (fatigue, brain fog, anxiety, weight gain) often mask heart problems or are mistaken for routine aging (22:44).

4. Danger of "Normal" Labs & Band-Aid Prescriptions

• Many women are dismissed by both endocrinologists and cardiologists, told their labs are normal while underlying risk continues unchecked (22:44).

  "Women will just accept the fact that their doctors are telling them they're normal. ... We can't ignore the damage that is occurring year after year as you sit in that non-optimized hypothyroid state."
  —Dr. Amie (22:44)

• Usual response: handed a statin or blood pressure med instead of hormone or thyroid optimization.

5. Prevention & Real-World Screening Tools

• Mammogram as a dual-purpose test (10:00): Not only detects tumors, but can reveal calcification in breast arteries—a sign of vascular disease often overlooked.

  "On mammography, we can actually see calcifications within the arteries that supply the breast. ... We're not using that test for its full power."
  —Dr. Sanjay (10:40)

• Call for women (and doctors) to recognize symptoms, push for proper cardiac evaluation, and not settle for being "dismissed." (16:31)

6. Labs, Cholesterol, and Statins—What Women Should Know

• Standard cholesterol panels (LDL, HDL, triglycerides, total cholesterol) only tell part of the story.

• Advanced markers: ApoB and Lp(a) far more predictive.

  "If you've got your notebook, [ApoB] is really, I think, the test most people can run...It tells us the entire population of these atherogenic cholesterol particles."
  —Dr. Sanjay (39:50)

• Low LDL is not always best—statins are overprescribed, especially to women, sometimes with little impact on actual risk if root causes are not addressed.

  "I do think we overuse [statins]. ... If you treat the thyroid disorder and that fixes cholesterol, everyone's happy."
  —Dr. Sanjay (31:51)

• Optimal LDL for prevention: 70–110 mg/dL, but decisions should be based on the bigger picture—history, genetics, imaging, not just one number (42:10).

• Nutrition: Red meat, egg yolks, and dietary cholesterol are not culprits for most unless genetic or other metabolic issues exist (52:48, 54:35).

7. The Power and Safety of Hormone Optimization

• Replacing lost estrogen, progesterone, and testosterone (for men and women) can deliver cardiovascular, cognitive, and quality-of-life benefits.

  "I call it this menopause machismo—some women say, 'I don’t need hormone therapy, I’ll just tough through it.' ... Why?"
  —Dr. Sanjay (35:00)

• Many wrongly view hormone therapy as “just another pill”—but for many, it’s the key to regaining health and preventing chronic disease (34:22).

8. Insulin Resistance, Weight Gain, and Cardiometabolic Fire

• Insulin resistance drives visceral fat buildup, cholesterol oxidation, and inflammation—the real “spark” for cardiovascular events, not red meat or “high” cholesterol alone (47:24).
• Testosterone replacement is under-used, especially for women; supports metabolic and cardiac health, muscle mass, and better outcomes (50:13).

9. Actionable Takeaways

• Get advanced lipid panels including ApoB and Lp(a), esp. if traditional cholesterol is “normal” but risk factors/symptoms persist.
• Take hormone and thyroid optimization seriously—don’t let fear or stigma prevent you from replacing what your body is lacking.
• If something feels “off” (even vague), persist until you get the right workup. Demand more than generic advice and "normal" labs.
• Support cell health and metabolism with appropriate lifestyle, nutrition, and supplements.

Memorable Quotes & Moments

• On the reality of restless symptoms:

  "The most typical presentation for women is an atypical presentation...the abnormal thing is what's really normal."
  —Dr. Sanjay (13:03)

• On doctors not connecting dots:

  "It just gets me so angry. ... They told her, ‘Why don’t you just go home and have a glass of wine—it’s probably anxiety.’"
  —Dr. Sanjay, on ER dismissal and near-fatal outcome (15:10)

• Regarding attitude toward hormone therapy:

  "I call it this menopause machismo...Why would you need to do that?"
  —Dr. Sanjay (35:00)

• On root-cause medicine:

  "I don’t see blood pressure as a disease state...I see it as a warning sign of imbalance, your body’s cry for help."
  —Dr. Sanjay (28:48)

• On cholesterol goals:

  "For me, if you haven’t had a cardiovascular event, living in that LDL cholesterol range of 70 to 110—you’re in a good spot."
  —Dr. Sanjay (42:10)

Notable Segments & Timestamps

• [09:23] – Dr. Sanjay’s introduction & re-framing the #1 killer of women
• [13:03] – Why women’s heart attack symptoms are different, “atypical,” and often dangerous when dismissed
• [18:21] – How perimenopause and menopause elevate risk (hormonal changes, LDL bump, blood vessel changes)
• [21:12] – Thyroid-hormone/heart health connection & why we must optimize, not just medicate
• [31:51] – When statins are appropriate vs overused; why treating root cause matters more
• [39:50] – Advanced lipid panel, ApoB, and Lp(a): why they matter
• [42:10] – Dr. Sanjay's take on optimal LDL ranges and cholesterol therapy
• [47:24] – The real story behind cholesterol, statins, male testosterone, and modern health
• [50:13] – The importance of testosterone in women as well as men, and its cardiac/metabolic links
• [52:48] – The myth of dietary cholesterol/red meat, and the truth about insulin resistance

Where to Find the Guest

• Instagram: @drsanjmd
• Practice: Laguna Institute of Functional Medicine (Southern California & telehealth)
• Program: Cardio-metabolic online program "Well12" ([details on site])

Final Thoughts

This episode challenges women to take heart disease risk seriously—especially if you’re in your 30s, 40s, or beyond—and to seek truly personalized, root-cause answers instead of following "one-pill-fits-all" advice. The connections among hormones, thyroid, and heart are real and profound. Don't accept being dismissed or told you’re “fine” if you know you’re not.

"If you can imagine your best life, that is absolutely possible for you." —Dr. Amie (01:25)

For Women: If your heart, hormones, or thyroid don't feel right, keep pressing, keep asking, and seek a provider who will look deeper and walk with you to prevention and real health.

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