Early Referral Catches Heart Disease Before Symptoms Start, Especially for Women

Heart disease is the leading cause of death worldwide. But not every patient with heart disease gets the same symptoms. Presentations can be subtle, risk factors can fall outside the standard checklist, and the result is that women and other groups with presentations outside of the norm are too often reassured rather than referred.

Nisha Hosadurg, MD, a preventive cardiologist and advanced cardiac imaging specialist at UVA Health, is working to change that. With a focus on women's cardiovascular health, tailored risk assessment, and emerging programs in South Asian cardiovascular health, she partners with referring providers to identify and address heart disease earlier, often before patients have symptoms.

"I'm particularly motivated by the opportunity to identify and manage cardiovascular risk before disease progresses, and to provide patients, regardless of background or gender, with clarity in often complex or unclear diagnostic situations."

Here, she shares what every referring provider should know about recognizing cardiovascular risk in these groups, and when to bring in a specialist.

How Can Providers Support Early Heart Disease Detection and Diagnosis?

Referring providers are absolutely essential in the early detection of heart disease, particularly for women or certain populations known to be prone to premature disease (such as South Asians) that present with nontraditional symptoms and risk profiles.

Keeping in mind those ‘risk enhancers’ that fall outside the traditional spectrum of cardiovascular risks is essential, such as:

• Women with a history of pregnancy related complications (like hypertensive disorders and gestational diabetes, which are often overlooked)
• Autoimmune disease
• HIV
• Family history of early CAD

Assessing risks with typical measures (like lipid panels or A1Cs), even if not traditionally recommended per guidelines in such patients, is always helpful. From there, we can always help with more tailored risk stratification.

We’re also seeing more and more cardiovascular disease in younger patients. Risk often begins silently in ones 30s and 40s. Having prevention on your radar, even this early on, makes a big difference down the line.

When Should Providers Refer a Patient to UVA Health for Early Heart Disease Care?

I would also say it’s never too early to refer patients to us! We can even add value at the ‘is it cardiac or not’ stage. We have incredible tools to detect silent or subclinical disease early, especially in women where presentations can be atypical. Early referrals can improve patient outcomes and provide clarity and support. Having the tools and experience to see beyond the surface makes a big difference.

I welcome both women and men with general cardiology concerns, with a particular interest in South Asian (individuals with ancestry from India, Pakistan, Bangladesh, Sri Lanka, Nepal) cardiovascular health. As a South Asian clinician, I’ve seen firsthand the rise in premature coronary disease in our communities. I am building a South Asian cardiovascular health program focused on nuanced risk assessment and culturally sensitive lifestyle interventions.

Patients who may benefit from any of these specialized approaches should be referred ideally sooner rather than later, as early engagement can meaningfully change long-term outcomes. Providers are encouraged to refer patients early and without hesitation, especially when there are concerns that may benefit from a more tailored, preventive, or nuanced cardiovascular evaluation.