Women & Heart Disease: Here are the Facts

By Dr. Gail Dawson, MD, MS, FAAEP

About eight million American women live with heart disease, the #1 killer of women (and men) in the United States today!

Studies show the following:

• One in three women will die of heart disease.

• Women are less likely to survive a heart attack than men.

• About 38 percent of women will die within one year of a first recognized heart attack.

• About 35 percent of women heart attack survivors will have another heart attack within six years.

• Two thirds of women who have a heart attack fail to make a full recovery.

• Women tend to underestimate the symptoms of heart disease and are less likely to seek treatment.

• Heart disease is a lifelong condition – once you are diagnosed with it, you will always have it.

The very positive news is that women easily can change these statistics! Most risk factors of heart disease are controllable. Research shows that women can lower their heart disease risk enormously – by 82 percent – if they lead a healthy lifestyle.

What is heart disease?

The most common cause of coronary artery disease – commonly known as heart disease – is a narrowing or blockage of the coronary arteries, the blood vessels that supply blood to the heart muscle. This process happens slowly over time, and is the major reason people have acute myocardial infarction (heart attack).

What are the warning signs of a heart attack?

Heart disease often has no symptoms, however, there are a few signs to watch for, and the signs in women may be different than those men experience. Women may feel pain in the center of the chest; in the ear, jaw or neck; or in the back or shoulder area. (Men tend to have crushing pain in the center of the chest that extends down the arm.) Other signs can be unusual tiredness or sudden extreme fatigue, problems with breathing, indigestion, or anxiety.

Heart disease symptoms may be milder in women than men. About 1/3 of women experience no chest pain at all when having a heart attack, and 71 percent report flu-like symptoms for two weeks to a month prior to having more obvious signs of a heart attack.

Can I reduce my risk of heart disease?

Making relatively simple changes in your daily eating habits will pay off quickly. By following this advice, you can reduce your chance of heart disease significantly:

• Control your blood pressure. Blood pressure is considered high when it reaches 140/90.

• Stop smoking. More than half of the heart attacks in women under age 50 are related to smoking. Women who smoke are at risk of dying 19 years sooner than non-smokers. Women who stop smoking for three years have the same risk as women who have never smoked.

• Get tested for diabetes. This medical condition is considered one of the major factors contributing to heart disease. Women with diabetes are two to three times more likely to have a heart attack. Controlling sugar makes a big difference in the development of coronary artery disease, as well as renal failure and stroke.

• Control your cholesterol levels. Too much cholesterol in your blood can build up (plaque) in your arteries and cause a narrowing of the arteries, which causes heart disease. Good cholesterol (HDL above 50 for women) helps remove bad cholesterol (LDL) from the blood. LDL levels should be at least under 140 for women, and the lower the better. Eating healthy helps maintain the good levels of cholesterol in your blood.

• Eat a heart healthy diet. Keep fat calories to less than 30 percent of the total calories you eat each day, and choose foods low in saturated fats, which raise your LDL. Avoid animal meats, butter, whole milk dairy products, cheese, and tropical oils (coconut, palm). Also limit trans fats, which are found in margarine, donuts, muffins and other processed foods. Choose foods with mono or polyunsaturated fats instead. Wise food choices include vegetables, whole grain foods, and low fat or nonfat dairy products. Some processed foods – frozen dinners and canned foods – can be high in saturated fats. When in doubt, read labels. Also remember to limit sodium to no more than 2.4 grams a day.

• Maintain a healthy weight.

• Try to exercise 30 minutes a day, a minimum of three to four times a week. Remember, your heart is a muscle. It needs regular exercise to stay in shape. At midlife, women can benefit from weight-bearing activities that keep bones healthier – walking, lifting hand weights, and even carrying groceries.

• If you drink alcohol, limit it to no more than one drink (12 ounce beer, five ounce glass of wine, one shot of hard liquor) a day.

• Do not take hormone replacement therapy to prevent coronary artery disease. It actually does more harm than good. Research now shows that estrogen plus progestin therapy increases the chance of developing heart disease, stroke, blood clots and breast cancer. If you need to take hormones, use the lowest possible dose for the shortest time needed.

Only two risk factors for heart disease are not controllable – these are your family history and age. If your father or brother had a heart attack before age 55, or if your mother had one before age 65, you’re more likely to develop heart disease. This does not mean you will have a heart attack; but it means you are at a higher risk.

To protect your heart health, be aware that every risk factor counts. If you have even one risk factor, you are more likely to develop heart disease.

What tests are conducted to determine if a person has heart disease?

If you are worried that you have signs or symptoms of heart disease, check with your physician right away. A physical exam may be all that is needed, but sometimes, more testing is necessary.

Imaging studies such as a stress echo or nuclear test will show the reaction of the heart muscle under stress. Patients walk on a treadmill or receive a drug to dilate the blood vessels or make the heart beat faster. In a stress echo, the cardiologist looks for abnormal heart movement under stress. A nuclear study tracks the flow of blood. If it can’t get to the heart muscle under stress because of a blockage, the heart will appear lighter in some areas on the scan.

A CT scan and cardiac catheterization provide a view of the inside of the coronary arteries, which supply blood to the heart muscle. If there is a blockage, it will show up as a narrow part in the blood vessel. A CT scan takes X-rays very rapidly. Patients lie in a machine while dye is injected. The heart rate needs to be slow enough to obtain clear images of the coronary arteries. During a cardiac catheterization, the cardiologist injects dye through a catheter that enters the leg and goes up into the coronary arteries, and then takes pictures. If an artery is blocked, the physician can open it during the procedure. Often a stent is placed to keep the artery open. A stent looks like a skinny tube made of metallic meshwork.

What should I do if I think I am having a heart attack?

Fast treatment can limit heart damage. Get to the hospital as fast as possible. Do not drive yourself. Chew an uncoated aspirin if you have one. This can reduce damage to the heart muscle. Once you arrive at the hospital, an electrocardiogram (EKG) and blood work will be ordered to help determine if you’ve had a heart attack. Even if the EKG is normal, you still may have had a heart attack, and more testing will take place.

Remember: the good news is that women can make a lot of simple changes in their daily routine to greatly reduce their risk of heart disease. It is never too late to start making these changes!

Dr. Gail Dawson is on the medical staff at Genesys Regional Medical Center in Grand Blanc and practices at Regional Cardiology Associates.  She obtained her medical degree from the University of Michigan and earned a fellowship in Cardiology at the Detroit Medical Center through Wayne State University.  She is board certified in cardiovascular disease, internal medicine, nuclear medicine, echocardiography, and coronary CT interpretation.

Go Red. Love Your Heart

February is not just the month when the true doldrums of winter set in but it is also the month of love when Cupid draws his bow and takes an aim right at your heart – the biological one that is. This month as you walk around and notice the splashes of pinks and reds all over card and chocolate shops remember that it is also National Heart Month where you are supposed to extol the same love and adoration to your ticker as you do your loved ones, minus the 5-pound box of chocolate.

In celebration of the National Heart Month, the American Heart Association has created the Go Red for Women campaign, a national movement developed to help bring awareness to the number one killer of American women today. The campaign focuses on raising awareness of heart disease including how the disease impacts women and also offers preventive information for women of all ages.

The Red Facts

It used to be that heart disease was considered to be an exclusively male disease. But the face of heart disease has significantly changed over the years. Now, one in three American women dies of heart disease. In 2003, almost twice as many women died of cardiovascular disease, which includes both heart disease and stroke, than from all cancers combined.

Heart disease is an umbrella term for a number of heart conditions including coronary artery disease, heart failure, heart arrhythmias and other ailments.

A woman’s best defense against reducing her risk and altering these scary national figures is becoming responsible for her own lifestyle behaviors. Protecting your heart does not, and should not, wait until you’re in your forties or fifties. Most doctors now recommend women in their twenties to start looking after their heart by eating right, exercising and keeping up with routine physical examinations.

Here are the American Heart Association’s ABC’s of reducing your risk of heart disease:

• Stop smoking

• Engage in some sort of physical activity every day

• Reduce your blood cholesterol levels to under 200 mg/dL

• Keep your blood pressure at less than 120/80 mmHg

• Keep a healthy weight

• Manage your diabetes effectively

• Reduce your stress levels

• Limit alcohol

The American Heart Association encourages all women to be able to call off their cholesterol and triglyceride levels and their blood pressure and waist size as quickly as they can cite their shoe size.

Act Now

On February 1, anyone can support the fight to prevent heart disease in women. As part of the Go Red campaign, all individuals nationally and locally are encouraged to wear red on February 1, which has also been coined as Wear Red Day. A red blouse, a red tie, even a red pair of earrings will demonstrate your dedication to raising awareness of this pressing public health issue affecting women all over this country.

The Go Red for Women campaign is filled with a host of other events and activities that you can partake in. For instance, you can get a heart check up, attend a Red Around Town event, cook heart-healthy recipes for yourself and your family or sign up for the Choose To Move challenge which is a 12-week program designed to get you moving and eating the right foods for three months.

The American Heart Association has also created a line of Go Red products that are available for purchase on their website. From educational materials to cookbooks and from jewelry to tote bags, all purchases go towards supporting the fight to prevent heart disease.

To join the campaign, visit: goredforwomen.org. The registration is free and you’ll receive a free monthly e-newsletter filled with heart-healthy tips, plus invitations to events in the Detroit area, as well as access to Go Red merchandise, special programs and more.

Women & Weight Loss: Why the Difference?

With Ernest Quin of Physician Directed Hy-Tch Weight Loss

So, why do men seem to keep winning on the reality television show, “The Biggest Loser?” Well, it is not simply coincidence. In fact, men generally have an easier time losing weight than women because of their physical makeup and because of some of their dietary preferences.

It is a well-known fact that the more muscle you have, the more fat you will burn. Your metabolism will be higher, and your body will process the calories you consume much more quickly. Men tend to have a physical makeup that contains more muscle tissue than women; however, women can be very successful at losing weight using some of the same approaches as men.

According to Ernest Quin of Physician Directed Hy-Tech Weight Loss, most diets don’t work for men or women because they’re temporary. “After a person loses the weight, providing they stick to the diet, they gain the weight back because they return to their old eating habits. Weight loss programs that use meal replacements have the same problem. Once they stop purchasing the pre-packaged meals (which can get expensive), they gain the weight back,” says Quin.

Successful weight loss is truly about changing your lifestyle. There are many fad diets out there that may help you lose 2-15 pounds quickly, but many people quickly regain that weight once they stop the diet. Why does this happen? It happens because people return to their eating habits (which were generally poor) after they discontinue the diet.

Some points to consider when trying a true weight loss program is to consider how you are going to maintain your new body once you are finished with the program. If you simply have replaced your meals with meals from a program, but didn’t learn what the calorie intake and nutritional value of the meals were, you have not learned the skills to change your lifestyle when you return.

Keep in mind, exercise is important. However, if you are taking in 5000 calories a day, but only burning a fraction of those through exercise, then you are not going to lose or maintain any weight loss.

“A successful program measures a persons metabolism (which can be different from one person to the next) in order to customize a nutritional weight loss program for that individual,” says Quin.

Other considerations in choosing the right weight loss program for you:

• Program should have no meal replacement

• Program should not be a “one size fits all” weight loss program

• Program should strive toward lifestyle change for permanent weight loss

Men tend to carry their weight in different areas than women. For example, men tend to gain weight in the belly area, where women tend to put weight on in their lower body such as legs, buttocks and abdomen. No matter where your problem areas are, the process if very similar: exercise regularly, and eat properly.

A true commitment is necessary to losing and maintaining weight regardless of your program. Too many people begin a program, only to slowly fade off the regimen and never fully completing the lifestyle change necessary. This is where you see the Yo Yo dieter.

So, when you sit down and start looking at your weight loss opportunities, do the research. Take the time to find a program that meets your needs, and has the best possible outcomes for long term maintenance. You will be happy you did so.

Natural Choices for Menopause

By Laura Kovalcik, D.O., The Downing Clinic

THE CHANGE

Women want solutions that are safe and that work. Often they suffer from hot flashes, mood changes, vaginal dryness, depression, bone loss, heavy and irregular periods, tender breasts, fluid retention, fatigue, thickening waistlines, poor sex drive, mental dullness, and just not feeling like themselves. They want vigor and youthful feelings again.

Starting around age 40, women may begin to have symptoms from hormone changes. During the 50’s, periods stop and hormone levels fall. Menopause begins when there is no period for a year. It is one of life’s great transitions, a marker for the end of fecundity. Some women breeze through it while others suffer emotional and physical upheaval.

TRADITIONAL HRT

For years, physicians obligingly prescribed strong prescription hormones to help reduce symptoms. Most often Premarin and Provera were prescribed. Premarin (made from pregnant horse urine) is many times stronger than human estrogens. Provera (synthetic progesterone substitute) does not protect the breast the way natural progesterone does. When The Women’s Health Initiative study in 2004 showed increased risks of breast cancer from these hormones, many women simply stopped taking them. Often they felt wretched, but neither they nor their physicians knew there were safer options. Bio-identical hormones have been safely used since the 1980’s, and herbal phytohormones have been around for generations.

BIO-IDENTICAL HRT

Three estrogens, and one progesterone, are made by the body. The estrogens are E1, estrone; E2, estradiol; and E3, estriol. When used for hormone replacement, Mexican wild yam or soy provide ring structures that are then completed in the lab to the same identical molecules the body produces. Hence, the term bio-identical hormones.

Estriol is a weak estrogen that competes for binding sites with the two stronger estrogens; estradiol and estrone. When estriol is on a receptor, it keeps the stronger two estrogens from stimulating that receptor. During reproductive years, estrogen is balanced by progesterone in a cyclic fashion. Whereas estrogen stimulates breast and uterine tissue to proliferate, progesterone opposes these effects.

Balanced human hormones speak to receptors in harmony with nature while artificial substitutes are unbalanced and send different and often harmful messages.

MOTHER NATURE DID IT RIGHT!

Jonathan Wright, M.D. first prescribed these same-as-the-body-makes hormones in the 1980’s for treatment of menopausal symptoms. Dr. Wright used estrogens in a balanced fashion mimicking Mother Nature. He always added progesterone to oppose and balance the estrogens. Dr. Wright used these bio-identical hormones for more than 20 years, treating thousands of women, and didn’t see an increase in breast cancer among his patients.

When a woman asks her physician for bio-identical hormones, she will receive a prescription for estrogen balanced with progesterone. Many different dosage forms exist, including capsules, creams, gels, troches. Often other hormones are used, including testosterone, DHEA, and pregnenolone. There is a wide variation in proper doses and needs for individual women, and risk factors need to be evaluated whenever hormones are used.

A key part to managing hormone therapy is routine hormone testing. This helps identify when one of the many hormones is out of balance – which will present symptoms.

HERBS

Women often seek herbal options such as black cohosh, damiana, false unicorn root, vitex agnes casti, dong quai, blue cohosh, red clover, licorice root, red raspberry leaf, motherwort, maca or sage to help with menopausal symptoms. Many of these herbs are active at the estrogen and progesterone receptors, but they are much weaker than the actual hormones. Some women combine herbs with bio-identical hormones, a good choice for women in their 60’s or 70’s. Other women rely upon established homeopathic formulas such as pulsatilla or sepia to help with symptoms. Today’s women have many good choices!

Looking and feeling great also depends upon a good diet along with physical exercise and time out for stress reduction and personal reflection. Women choosing fresh foods, lots of greens, colorful fruits and vegetables, nuts, seeds, olive oil, fish, poultry, lean meat, and whole grains, will fare the best. Especially helpful are flax seed, soy foods, leafy greens and the broccoli family.

Women today can truly live the poem written by Elizabeth Barrett Browning, “Grow old along with me, the best is yet to be; the last of life for which the first was made.” The natural choices available today combined with a healthy lifestyle will reward you with a truly enjoyable time of life.

Dr. Laura Kovalcik is board-certified in internal medicine. Her work at the The Downing Clinic focuses on internal and integrative medicine and bio-identical hormones and natural menopause treatments. She graduated from Michigan State University School of Osteopathic Medicine and completed her internship and residency at Genesys Regional Medical Center.

Women’s Health: February 2007

PREVALENCE IN WOMEN

• 8,000,000 American women are currently living with heart disease – 10% of women ages 45 – 64 and 25% age 65 and over.

• 6,000,000 of women today have a history of heart attack and/or angina or both.

• 13% of women age 45 and over have had a heart attack.

• 435,000 American women have heart attacks each year; 83,000 are under age 65 and 9,000 are under age 45. Their average age is 70.4.

• 4,000,000 women suffer from angina, and 47,000 of them were hospitalized in 1999.

MORTALITY IN WOMEN

• Heart disease is the leading cause of death of American women and kills 32% of them.

• 43% of deaths in American women, or nearly 500,000, are caused by cardiovascular disease (heart disease and stroke) each year.

• 267,000 women die each year from heart attacks, which kill six times as many women as breast cancer.

• 31,837 women die each year of congestive heart failure, or 62.6% of all heart failure deaths.

WOMEN AT RISK

• The age-adjusted rate of heart disease for African American women is 72% higher than for white women, while African American women ages 55-64 are twice as likely as white women to have a heart attack and 35% more likely to suffer from coronary artery disease.

• Women who smoke risk having a heart attack 19 years earlier than nonsmoking women.

• Women with diabetes are two to three times more likely to have heart attacks.

• High blood pressure is more common in women taking oral contraceptives, especially in obese women.

• 39% of white women, 57% of black women, 57% of Hispanic women, and 49% Asian/Pacific Islander women are sedentary and get no leisure time physical activity.

• 23% of white women, 38% of black women, and 36% Mexican American women are obese.

AS COMPARED TO MEN

• 38% of women and 25% of men will die within one year of a first recognized heart attack.

• 35% of women and 18% of men heart attack survivors will have another heart attack within six years.

• 46% of women and 22% of men heart attack survivors will be disabled with heart failure within six years.

• Women are almost twice as likely as men to die after bypass surgery.

• Women are less likely than men to receive beta-blockers, ACE inhibitors or even aspirin after a heart attack.

• More women than men die of heart disease each year, yet women receive only:

• 33% of angioplasties, stents and bypass surgeries
• 28% of inplantable defibrillators and
• 36% of open-heart surgeries

• Women comprise only 25% of participants in all heart-related research studies.

Statistics complied from: National Center on Health Statistics; National Heart, Lung and Blood Institute; and American Heart Association’s 2002 Heart and Stroke Statistical Update, which may be viewed online at: www.americanheart.org

Women’s Health: Not Just an Issue for October

By Cheryl Wesen, MD

During the month of October we recognized Breast Cancer Awareness Month, heightening interest in women’s health issues. We repeatedly heard about the importance of getting mammograms annually after age 40. Does it really matter? The answer is unequivocally “Yes.” Breast cancer is the most common non-skin cancer in women and the second deadliest cancer in women (after lung cancer). If you didn’t get a mammogram in October, invest 15 minutes – the time it takes to get a complete mammogram – and possibly save your own life.

Women’s health is an issue that deserves attention all year long. Many small changes in lifestyle can result in improved health – and lower risks of breast and other cancers, as well.

Much of the following information is known, but bears repeating: don’t use tobacco, and only drink in moderation. Many women continue to use tobacco because they fear stopping could cause weight gain. However, any pounds gained after you quit can be worked off in the extra years you live once you stop!

Of course, many women diet, whether or not they smoke. A useful approach to losing weight, it’s also an approach that is rarely successful. A better approach to a healthy weight is a healthful diet. That is – diet as a life choice, not as a temporary lifestyle. Too often, altered menus and counting calories is a drastic change to your regular lifestyle, one that is artificial and too difficult to maintain. Subtle, healthful changes over time will gradually become part of a better lifestyle, resulting in permanent changes and better health.

Little changes that add up include: snacking on deeply colored fruits; increasing your intake of fresh vegetables, substituting snacks that are convenient, like chips and candy, for those equally convenient but healthful, perhaps soy crisps or a low-fat, high-fiber health bar. Many treats can be healthful and delicious, allowing you to nibble while maintaining your energy levels and a healthy weight. Eat portion-controlled snacks throughout the day to appease hunger. Soon, you will lose your preference for fats and sugars. Your body and your waistline will both thank you!

Exercise is another hurdle to a healthful lifestyle. Many women don’t like going to the gym, don’t have time to exercise, or simply don’t like it. Yet regular exercise is one of the best ways to boost your metabolism and has been proven to offer multiple health benefits. What can you do? Almost anything! A yoga class at a local center may be just the trick to get you moving. As long as your body is in motion, you are burning calories. Can’t take a 30-minute walk? Try to walk for 10 minutes three times daily. Wearing a pedometer has been shown to help people stay on target. Aim for 10,000 steps daily – about five miles. The steps add up quickly, and you’ll have the benefit of better health.

A boon to exercise and diet is that both help reduce stress. The effects of stress on the body are being studied, and early findings indicate that it’s bad for virtually every part of your body. People who live with chronic stress are more prone to many debilitating illnesses, including various cancers and increased risks of heart disease. Learning to recognize the signs and symptoms of stress so that you can regain control of your life is a critical first step in controlling the effects of stress.

Studies have shown that stress may affect migraine headaches, peptic ulcers, asthma, allergies, kidney disease and thyroid problems. Stress alone probably does not cause these disorders, but it may make them worse. In addition, stress contributes to many types of accidents through human error, fatigue, worry and haste.

There are no quick and easy answers to controlling stress in today’s fast-paced, demanding society. As impossible as it may seem, you must make time to relax. An old saying sums it up best, “If you wear out your body, where will you live?”

Taking time to relax should become a priority habit in everyone’s life. A brief, two-minute stress-break may provide enough calm to help you through the toughest moments on the busiest days. Stop what you are doing, and pay attention to your breathing. Take several deep, belly-breaths, and let them out slowly. The increased oxygen will give you a much-needed boost, as most people tend to take shallow breaths when stressed, and the pause in the day’s pace will allow you to regain some equilibrium and go forward with a more positive attitude.

Pay attention to what you are feeling, and respect what your body tells you. Are you tired all the time? Sleeping too much or not enough? Angry, irritable or upset more than normal? It may be time to assess how you really feel, or to contact a counselor for help in managing stress.

Establish self-nurturing routines and keep them as diligently as you would a date to nurture your loved ones. Women are often still the primary caregivers in many families, and may neglect themselves. Nurture you; remind yourself that you deserve it.

These are simple steps, yet will position women for a healthier life. As director of breast care for St. John Health, I emphasize that it is critical for all women over age 40 to have annual mammograms, whether digital or film. I tell all my patients, and ask that they tell all their loved ones and friends: be kind to yourself and be sure that everyone has their mammogram every year.

October was Breast Cancer Awareness Month, a great start to raise awareness of women’s health. But please remember, we need to take care of our health every day of every month. Right now, today, is the best time to start.

Dr. Wesen has practiced general surgery since 1985. She has two years of additional training in surgical oncology (cancer surgery) from the University of Minnesota. Her practice includes all areas of general surgery such as thyroid and parathyroid colorectal diseases, hernias, gallbladder and breast diseases. She has a special interest in care of cancer patients, especially breast cancer. She is board certified through the American Board of Surgery and has recently re-certified. Dr. Wesen was recognized as one of the area’s most respected general surgeons in Hour Detroit magazine’s 2004 listing of “Top Docs.”