HEART DISEASE

Each year, heart disease kills a staggering number of American women -- some 240,000 in all. But in many cases, heart disease can be prevented, or its progression halted, so we can lead healthier and longer lives.

Coronary heart disease refers to a buildup of fatty material which clogs our heart's delicate coronary arteries. Although research on exactly how heart disease affects women is scarce, we do know many important things about how to reduce our risk. Not so coincidentally, if you do have heart disease, these are the same measures you should take to improve your cardiac health. Remember: If you are a heart patient or have other health problems, always consult your physician before making changes.

Several risk factors have been linked to heart disease. These include unchangeable factors such as an early family history of heart disease. If a family member developed heart disease relatively young -- before 50 -- your risk is increased. Usually, however, heart disease is more likely to strike a woman after menopause.

Certain medical conditions play key roles. High blood pressure increases your risk of both heart attack and stroke, so controlling it is very important. Diabetes also increases your risk of developing heart disease, especially in women. Unfortunately, many diabetic women have a nerve disorder which makes them less sensitive to pain, so they might miss the heart attack warning sign of chest pain.

Keep in mind that lifestyle plays a crucial role. Smoking and fatal heart disease go hand-in-hand. If you smoke, quit. Oral contraceptives used by smokers might cause trouble, too, so if you smoke and take the pill,might you might be in greater danger of having a heart attack than someone who doesn't. Obesity and a sedentary "couch potato" outlook also add to your risk.

What counts is not how many risk factors you have, but what you do to change them. Maintain a lean weight and good blood cholesterol level. Cut the fat content from your food. Eat less meat and chicken. Bulk up on vegetables and fruits. You'll be eating healthier -- maybe you'll lose weight!

Most importantly, exercise! This is critical to good health. Too often, we say we don't have time. Make time. Put yourself -- your total self -- first and work out, even if you have to schedule it into your appointment book.

For years, we were told women didn't have to worry about heart disease. Now that we know the truth, we must all make the changes needed in the name of healthier -- and happier -- hearts.

Heart health risks:

• Family history of heart disease
• High blood pressure
• Smoking
• Oral contraceptives when used by smokers
• Obesity
• Sedentary lifestyle
• Diabetes

One afternoon shortly after her 40th birthday, Charlotte Libov learned she had been born with a hole in her heart.

Libov was shocked. "Only old people have heart problems, right?" she wondered to herself. After leaving the cardiologist's office, she followed her instincts as a medical journalist and sped to the nearest bookstore for more information.

"All the books seemed to be written for 55-year-old men who were undergoing coronary bypass surgery," she observes. "There was no information for women, even though a quarter of a million females die from heart disease every year."

Libov made that information available by teaming up with Fredric J. Pashkow, M.D., director of cardiology at the Cleveland Clinic, to produce a primer on heart disease for women.

As a result, Libov has become a popular speaker on women’s health topics. A contributor to the New York Times and other national publications and a frequent guest on television and radio shows, including the Jim Bohannon Show, Libov is the author of four books on health and also helped develp the PBS special, "Women's Hearts at Risk."

A final word: Remember to check with your doctor before getting started, especially if you haven't been exercising lately or have health problems. But if you follow these resolutions, come next year, when the topic of New Year's Resolutions comes up, you'll feel only pride.

If you're like most people, you probably have only a sketchy idea of why your relatives died.

It's not pleasant to dwell on, but as researchers learn more about the relationship between genetics and disease, it's vitally important to map your family health tree.

But misconceptions are common. For example, if your mother had a heart attack at 70, does that mean you have a family history of heart disease? Not necessarily. If that heart attack was your mother's first indication of a problem, then chalk it up to old age. If, on the other hand, she's been grappling with heart disease for 30 years, that does indicate a family history.

Remember, though, that biology is not always destiny! Even if you have a bad family history, you can offset your odds by reducing your own risk factors for heart disease.

Most people think that the warning sign of a heart attack is always chest pain, but that is not always so, particularly in women.

True, a heart attack can make itself felt with chest pain that comes on suddenly and radiates into your jaw, your back, or down your left arm. But sometimes symptoms are not so clear cut.

Chest pressure, especially accompanied by sweatiness or nausea; shortness of breath; even a feeling of doom can be indicators.

If you believe you might be having a heart attack, get immediate help. Don?t take chances.

If you have chest pain, does that always mean you have a heart problem? Not necessarily.

Doctors report that women tend to suffer chest pain not related to the heart more often than do men. Pain which is felt in the chest may be "referred" pain, which means it's actually from another part of the body. For example, one woman with chest pain worried she had a heart problem until the doctor identified the real source of trouble -- a pinched nerve.

Osteoarthritis of the neck can cause chest pain, as can problems with the esophagus, gallbladder disease and even gas! It's often impossible to sort out what might or might not be heart-related, so if you're in doubt, see your doctor.

It's that time of the year when we hear warnings about the dangers of shoveling snow if we're not in peak physical condition. While usually directed at the male snow remover, these warnings should be considered by women as well.

If you are older, smoke, are diabetic or otherwise at risk of heart disease and you experience chest pain or shortness of breath while walking or being active outdoors in cold weather, talk to your doctor. Your heart works harder in cold weather, so you may experience symptoms of heart disease this time of the year that you otherwise might not notice.

If you're a woman who has just been diagnosed with heart disease or has suffered a heart attack, you probably have a lot to learn.

To help, I teamed with Dr. Fredric J. Pashkow, medical director of cardiac rehabilitation at the Cleveland Clinic, to formulate a plan that people newly diagnosed with heart disease -- as well as cardiac veterans -- can use to map personal action plans. It's showcased in our book, 50 Essential Things to Do When the Doctor Says It's Heart Disease (Plume).

Although the book is written for both genders, here are five "essential" steps from the book tailored particularly with women in mind.

• Empower yourself. Back in the old days, when you went to a doctor, you expected to be taken care of. Times have changed. Now you are expected to work with your doctor as a team. This is especially important when it comes to heart disease because lifestyle changes, such as quitting smoking, eating right and exercising, play such an important role. Recognize that your doctor can help, but a large part of your recovery and future health depends on you.
  
  
• Quit smoking. Many women do not realize how deadly cigarette smoke is to the female heart. If you have heart disease, smoking not only makes your problem worse, it increases your risk of heart attack or stroke. If you're considering a smoking cessation program, look for one that will teach you how to cope with stress without overeating or lighting up.
  
  
• Trim the fat. Saturated fat not only adds pounds but can also contribute to higher blood cholesterol readings. Purchase a fat-gram counter to keep track of what you eat. Look for "hidden fat" as well, in chicken skin, marbled steaks and salad dressing.
  
  
• Consider cardiac rehab. Exercise is now seen as the route to vibrant health for heart patients. But exercising on your own, at least initially, may be dangerous. Cardiac rehabilitation is designed specifically for people with heart problems. Unfortunately, these classes have attracted fewer women. Take the initiative and ask your doctor if cardiac rehab is right for you. Your progress might surprise you!
  
  
• Laugh at least once a day. Doctors now realize that laughter not only lifts the spirits, but it's good for your health -- and your heart as well. If humor doesn't come easily to you, work on it! Cover your refrigerator with your favorite cartoons. Tape your favorite comedy shows and replay them. Learn one new joke every day and share it with friends. Before you know it, you'll have a brighter outlook!

Not so long ago, about the only difference considered worth mentioning between a man's heart and a woman's was that the woman's heart is slightly smaller.

Since then, we've learned this isn't the only difference. Far from it. When it comes to heart disease, there are important disparities that can mean the difference between life and death.

This fall I've been traveling around the country with a team of cardiologists on The Difference in a Woman's Heart Medical Advisory Board, part of the Women's Heart Health Initiative. It's a nationwide program educating women and their doctors about the important differences in a woman's heart.

As I've spoken in New York City, Phoenix and San Diego, I've been overwhelmed by the response from women. One said her mother had been disabled by a stroke resulting from heart disease, although no one had ever mentioned this risk. Another gave me an angel pin and a third sent me a set of her poems as a thank you for spreading my message.

No thanks are needed -- the risk of heart disease in women has been overlooked far too long.

Here's a recap of some of the important differences discussed in the campaign:

Risk Factors: Although many heart disease risk factors are familiar to both men and women -- obesity, lack of exercise, and blood cholesterol -- there are differences. Menopause increases a woman's risk and diabetes may be more dangerous to women's hearts than to men's.

Warning Signs: A woman may experience the type of crushing chest pain associated with heart disease in men, but sometimes womens' warning symptoms are more subtle. These may include difficulty breathing, nausea or indigestion-like symptoms, and fatigue, including a general weakness or lack of energy. There can be other reasons for these symptoms so a woman should see her doctor when experiencing any of these.

Diagnostic Differences: Procedures to diagnose heart disease developed on men may have drawbacks for women. For example, the common "treadmill" test is less accurate in evaluating heart disease in women. However, this procedure can be made more accurate if a similar technique known as "cardiac perfusion imaging" is used.

Hormonal Differences: Women do develop heart disease later than men, apparently because of the hormone estrogen. For some women, hormone replacement therapy may be useful in reducing the risk of heart disease. The risks and benefits should be weighed, however.

The Women's Heart Health Initiative is supported by the American Heart Association, the American Medical Women's Association, and The Difference in a Woman's Heart Campaign. It is underwritten by an educational grant from Dupont Radiopharmaceuticals.

Over the past several years, it's become overwhelmingly obvious how serious a problem heart disease is in women -- and how much it's been overlooked. Some progress is being made in making both women and their doctors aware of this, but, by and large, that progress has been slow.

Surveys still show the vast majority of women -- four out of five -- do not recognize that heart disease is their biggest killer. What's more, one out of three primary care physicians don't know either.

As these figures clearly show, awareness of heart disease in women must be elevated to a national goal .

A national campaign would be a major effort. Is heart disease in women a massive enough problem to warrant it? Look at the numbers.

About 240,000 women die annually from coronary artery disease. That's more than five times the number of women who die of breast cancer. If you add in other cardiovascular diseases such as stroke, the tally is nearly 500,000. That's almost twice the number of women who die of all forms of cancer combined.

There is a need for a campaign because the public's understanding of heart disease is riddled with myths. Here are a few:

Myth: Heart disease is a major problem for men, not women.

Reality: Heart disease is an equal opportunity killer.

Myth: Only old women get heart disease.

Reality: About 21,000 women younger than 65 die from heart disease each year.

Myth: Since we all have to die of "something" it's somehow better to get heart disease than cancer.

Reality: Not necessarily. Heart disease kills prematurely, disables and leads to devastating complications, including stroke.

A national campaign makes sense because women can do something now to reduce their risk of heart disease -- as long as they know they should. Cardiac experts estimate that 50 percent of their heart disease cases are due to controllable risk factors such as smoking, obesity and high blood pressure. If more women knew they were at risk, they would be motivated to change their behavior.

A national campaign would also bring a call for more research on heart disease in women. We still don't know what we can do to diagnose heart disease in women earlier -- and we should.

Finally, a campaign on women and heart disease is only fair since public health campaigns over the past 50 have focused on men. Although well-intended, they have given women the mistaken impression that their hearts are not vulnerable.

We need a national effort to raise awareness about heart disease in women. Now is the time to do it!

Efforts to raise awareness of heart disease in women got an important boost when a landmark bill targeting $140 million for the cause was submitted to Congress.

The bill, which may be the first of its kind, calls for expanded efforts to help fight heart disease, the number one killer of American women.

"Cardiovascular diseases have claimed the lives of more females than all forms of cancer combined, yet research funding for heart disease is scarce," said Congresswoman Maxine Waters, a California Democrat who submitted the bill.

Waters noted that nearly a half-million American women die from cardiovascular diseases each year, almost double the number that die of all forms of cancer and five times as many that breast cancer kills.

"For many years, women and minorities have been underrepresented in heart and stroke research. Tests for detection and equipment to treat these diseases are largely based on studies of men; not all collected data is applicable to women. Better tests and equipment are needed to diagnose the disease," she said.

Furthermore, the bill would provide funding for educational outreach programs for women and their doctors about how to prevent cardiovascular disease. "This bill could help us try to save or extend the lives of thousands of our mothers, grandmothers, sisters, aunts and daughters," she said.

Waters also noted that heart disease in women is of major concern to the minority community. She noted that African-American women are the most likely to die after suffering a heart attack, and are twice as likely to die between the ages of 35 and 74 than white female heart attack victims are.

The first hurdle for the bill is to win approval from the U.S. House of Representatives Subcommittee on Health and Environment, which is part of the Commerce Committee. Most believe the bill faces an uphill battle. Still, simply its submission represents a giant step forward in focusing public attention on this important issue.

The bill is part of a package of measures known as the Women's Health Equity Act of 1996 which seeks to improve research and health care services for American women.

When Waters first reviewed the package, none of the bills addressed the issue of heart disease in women. It was a situation she changed quickly.

The very lack of bills on this important measure further underscored how sorely heart disease in women is overlooked and motivated Waters to submit the bill.

I was recently a guest on radio talk show host Rhoda Daum’s program to discuss heart disease in women.

A few days later, the station called. Rhoda had died of a massive heart attack.

Ironic? Yes. Surprising? No. After all, heart disease is the biggest killer of American women. Yet we seldom hear about it.

Rhoda's death made me think about some of the comments I've heard as I travel the country, hoping to create awareness of this killer. Usually, I'm well-received. But occasionally, someone suggests I champion another cause. Here are some of the reasons I've been given for "switching:"

Women should concentrate on raising funds for breast cancer research because it’s a more devastating disease. Tell that to the Diabetes Foundation, the National Leukemia Society and several breast cancer groups, for which Rhoda was a tireless fundraiser.

We should concentrate on sharing information about newer threats, such as AIDS. Tell that to Rhoda's colleagues at the station. She knew AIDS was important; she concentrated on spreading the word about many important public issues.

Heart disease isn't a major problem because it afflicts mostly elderly women who have lived long, full lives anyway. Tell that to Rhoda's husband, her children and grandchildren, who expected to enjoy Rhoda for years more.

I've been told all these things, but I don't buy it. At 66, Rhoda Daum was youthful, energetic and health conscious. There was no "apparent" reason for her heart disease, yet, she's dead.

We need more publicity, more research, and more dollars spent on heart disease. We need to learn what could have saved Rhoda — and others — from losing their life to heart disease, the top killer of American women.

Me? Stop talking about women and heart disease? Don’t worry, Rhoda. I’m just getting started.

At 37, Rebecca was a successful, urban-based businesswoman. Just 28, Linda was married and a busy writer. In her 40s, Dora worked for a cardiac rehabilitation office.

None of these women fit the stereotype of a heart attack victim. Yet they all suffered heart attacks, decades earlier than would be "expected."

Educating Americans that heart disease can strike such young women is one purpose of Women’s Heart Health Day. Observed on February 1, it focuses on women who suffer from or are at risk of heart disease, regardless of age.

Such thinking is new. For most of this century, two myths concerning woman and heart disease were promulgated. First, medical school students were taught that women were largely "immune" to heart disease. Second, if a woman did suffer a heart attack, she must be elderly, for certainly heart disease did not afflict young women.

Both are false. To begin with, heart disease is the biggest killer of American women (240,000 annually). In addition, even though heart disease generally afflicts older women, about 21,000 women die from it before the age of 65. Dr. Marianne Legato, associate professor of clinical medicine at the Columbia College of Physicians and Surgeons in New York, says it’s higher, estimating that 100,000 women die "prematurely" of heart disease each year.

Why do some women develop heart disease so early? Nobody knows why either gender develops heart disease at all. However, research shows that it occurs most often in women with one or more of the following risk factors:

• age (past menopause)
• family history of early heart disease
• high blood pressure
• diabetes
• smoking
• abnormal cholesterol levels
• obesity
• sedentary lifestyle
• oral contraceptives (if you smoke)

Generally, some of these risk factors are evident in young women with heart trouble. For example, Linda's mother was diagnosed with heart disease at 36; Linda herself was a three-pack-a-day smoker. Dora, who is diabetic, suffered her heart attack the day after burying her mother, who had died of heart disease. As an African-American, she's even more likely to develop heart disease young. Rebecca lacked risk factors, but not all cases of heart disease can be explained.

Heart disease is the biggest killer of American women. If you find that surprising, you’re not alone. ABC newscaster Peter Jennings revealed results of a new Gallup survey showing that 50 percent of internists don't know it either.

The survey of 256 internists revealed these alarming facts:

Most of those polled remain unaware of the prevalence, severity and symptoms of heart disease in women.

Nearly two-thirds didn’t know women often show symptoms and warning signs that are different from men's.

Half didn't know that heart disease is the biggest health threat to women over 50.

Only 39 percent of those polled had extensive medical training in diagnosing heart disease in women, compared to 69 percent who had such training to recognize it in men.

The results of the survey, commissioned by the Washington Hospital Center, point out the need to raise awareness of heart disease in women. One event doing so is National Women’s Heart Health Day on February 1, founded by heart patient and medical author Charlotte Libov. She hopes events addressing women’s heart health will continue throughout February, which is also American Heart Month.

Here are some of Libov's suggestions for how to observe National Women's Heart Health Day:

• Invite an expert to talk about women and heart disease at your group or association meeting.
  
  
• Contact a local hospital to schedule special screening programs for women focusing on heart disease. Set up blood pressure and cholesterol checks. Distribute materials about other risk factors, including diabetes, obesity and a sedentary lifestyle.
  
  
• Sponsor a special cooking demonstration featuring delicious low-fat foods. The local chapter of the American Heart Association (AHA) or the American Dietetic Association can help.
  
  
• Plan a special event, such as a walkathon or luncheon fashion show with clothing modeled by heart patients.
  
  
• Ask your local affiliate of the American Lung Association or AHA for free materials on cigarette smoking as a major risk factor for women's hearts. Enlist the staff of a health club to distribute materials about women’s heart health.

Heart attack is the biggest killer of American women, but a new study reports that health care professionals might be overlooking a simple, low-cost, preventative.

The study, published in the Archives of Internal Medicine, found that women are less likely than men to be taking aspirin daily to help prevent heart attack.

With heart disease posing such a risk to women, this study indicates that more still may need to be done to make certain women are getting the right care for their hearts.

The study's results highlighted three major concerns:

• Women were less likely to take aspirin as a heart disease preventative.

• The health of the women declined during the study, although not to a major degree.

• Even though women were more likely to report chest pain, they were less likely to receive standard cardiac diagnostic tests, including treadmill testing or angiography.

The study was done on 677 Canadians older than 45 who had been hospitalized for one or more heart attacks. Researchers interviewed each patient twice, about 16 and 25 months after the first heart attack. Approximately one-third of the patients were women.

In an interview, Lisa M. Schwartz, M.D., the study's author, said that although the study was done in Canada, the findings should apply to the United States as well.

"This is very consistent with other studies in the United States," said Dr. Schwartz of the Veterans Affairs Medical Center in White River Junction, Vt.

More research is needed

Studies still must be done to find out whether women were being undertested, since "no one knows what the right level of testing is,” she noted.

Dr. Schwartz added that, for her, "the important message is about aspirin. Aspirin is proven to prevent death from heart attack. In people with known heart disease, taking aspirin is very beneficial. So the fact that only slightly more than half of the women were taking aspirin is significant," she said.

The use of aspirin for women is still being researched, but it appears to be beneficial. The Nurses' Health Study found that low-dose aspirin reduces the risk of first heart attack in women by about 30 percent. An Israeli study published in 1996, which analyzed data on 2,418 women with heart disease, found a similar benefit.

More research needs to be done to provide a conclusive picture, but, as an article in the March 1997 issue of the Harvard Heart Letter notes, the information thusfar "provides compelling evidence that women with coronary disease are also likely to benefit from aspirin."

Before taking aspirin on a daily basis, women should talk to their doctors to make sure they're not at risk for side effects because of ulcer or bleeding problems.

Sometimes, a heart attack strikes a woman with the same severe, crushing chest pain that has come to be associated with those dreaded words: "heart attack." But not always.

Roberta, for example, remembers vividly the day her husband suffered his heart attack. "He was standing in front of me and just keeled over. It was like something you see in movies." But, some years later, when Roberta was stricken, it didn't happen that way at all.

"I hadn't been feeling well for weeks. I felt like I had a flu I couldn't shake. But one night, I just couldn't seem to catch my breath. I got up and paced on the front porch all night, but that feeling of breathlessness wouldn't go way."

Roberta finally fell into a fitful sleep. The next morning she arose, went into the kitchen, and passed out. She was rushed to the hospital, where she learned she'd suffered a heart attack.

"I couldn't believe it. It wasn't anything like what my husband had suffered," she said.

Although researchers don't know why, it appears that heart attack symptoms in women sometimes differ from that which occur in men. But that poses a big problem.

"Because heart attacks were always associated with men, we've come to associate the classic male heart attack symptoms - crushing chest pain, sometimes radiating down the arm - as the only ones that count," says Charlotte Libov, founder of National Women's Heart Health Day and co-author of two award-winning books on heart disease.

According to the American Heart Association, the following warning symptoms may occur in both women and men:

• Uncomfortable pressure, fullness, squeezing or pain in the center of the chest that lasts more than a few minutes, or goes away and comes back.

• Pain that spreads to the shoulders, neck or arms.

• Chest discomfort with lightheadedness, fainting, sweating, nausea or shortness of breath.

However, women sometimes experience different warning signs, which are often more subtle. These symptoms include:

• Atypical chest pain, stomach or abdominal pain.

• Nausea or dizziness.

• Shortness of breath and difficulty breathing.

• Unexplained anxiety, weakness or fatigue.

• Palpitations, cold sweat or paleness.

"Because these symptoms can be vague, they can easily be mistaken for other ailments," notes Libov.

In many cases, the problem may not be heart-related. But if it is, it could be too easily overlooked. Recently, a Gallup survey of 256 internists found that nearly two-thirds didn't know that women often show different symptoms or warning signs of heart disease, she noted.

The American Heart Association has added obesity to the list of major risk factors that cause heart disease, the biggest killer of American women.

This shouldn't come as a surprise; being overweight has long been listed as a contributing factor. But it is surprising that, despite our apparent national obsession with losing weight and exercise, we are, as a country, getting fatter.

Most of us equate the problem with eating fattening foods and that certainly plays a role. But putting on weight has a lot to do with what we're not doing, and that's exercising. Despite all the media attention paid to getting fit, a government survey found that only 27 percent of all women exercise regularly.

Why do women find it so difficult to do this? When asked, most women say they don't have time. True, most women lead very busy lives. But you can fit exercise into your life - if you make it a priority. Once you do, you'll be amazed at the many different ways you can become more active.

Here are some tips:

• Make an appointment with yourself to exercise. Schedule regular activity periods in your daily calender.

• Determine the best time of the day to exercise. Some like first thing in the morning, others, after dinner.

• Choose only activities that you really like to do.

• Sneak exercise into your schedule. If you drop the kids off at school for soccer practice, walk around the track while waiting for them. Instead of meeting friends for coffee, take a group walk.

• Exercise where you feel comfortable. Many women like to go a health club, but others would rather swim at a YWCA or school pool.

• Recognize that you're in this for the long haul. It's fine to exercise to lose weight for an upcoming special event, but if you stop afterwards, the weight will pile back on. Consider exercise a way of life.