During the 1980s, the American Heart Association launched an advertising campaign that asked: “If your husband had a heart attack in bed tonight, would you know what to do?” Even the AHA thought heart disease was strictly a man’s problem back then.
Offering this valuable historical perspective, Kansas City cardiologist Dr. Tracy Stevens reminds us that physicians are still practicing medicine based on cardiac studies performed mostly on white, middle-aged men.
Dr. Stevens, a Scientific Advisory Council member at WomenHeart: The National Coalition For Women With Heart Disease, recently used an online webinar format to update training for graduates of the annual WomenHeart Science & Leadership Symposium at Mayo Clinic. I attended the 2008 Symposium – a life-altering experience for me as the first Canadian ever invited to participate in this world-class training opportunity. Five intensive days of cardiac lectures were presented by prestigious specialists described as the “rock stars” of cardiology, those whose work focuses specifically on women and heart disease.
Dr. Stevens’ webinar training program (one of an ongoing continuing ed series provided to Mayo ‘grads’) updated us on what health care providers are now learning about the diagnosis and treatment of women’s heart disease, and how women can take control of their heart health.
Dr. Steven also advised women to pay attention to their risk factors and to be proactive, adding:
“We’ve not had enough time yet to do research and assess the results and then change the behavior of health care providers and physicians. We can prevent 85% of heart attacks and stroke simply by being on top of basic risk factors. Common risk factors include smoking, hypertension, diabetes, high LDL (bad) cholesterol, waist circumference above 35 inches, stress, sedentary lifestyle, menopause and family history.”
Here are some other key points offered to us by Dr. Stevens:
- Although women are the number one health care decision makers in North American households, they are also less likely to take care of their own health, instead choosing to put children and other family members at the forefront.
- Dr. Stevens says that men are “more compliant” when it comes to following treatments prescribed by their physicians.
- Only one third of women will fill a new prescription for blood pressure or cholesterol-lowering medications.
- Of those, just one third will bother to have the prescription refilled, a real concern in a culture where women are already undertreated for risk factors.
Items that Dr. Stevens thinks should be found in every household include a blood pressure cuff and a measuring tape, allowing women to monitor their blood pressure and keep track of increasing waist size, both accurate predictors of heart disease. It’s also a great idea to check your blood pressure before and after exercising — the results can be dramatic and may help women to recognize what a positive difference exercise can make in reducing blood pressure.
Coronary artery plaque is an insidious foe, which a colleague of Dr. Stevens has likened to a “pimple on the artery” because of its tendency to become inflamed and then rupture, causing a scab or blood clot to form at the ruptured site, thus blocking blood flow to the heart muscle which can cause a heart attack unless immediately treated.
Women with autoimmune disorders such as lupus or arthritis should be mindful that flare-ups related to those conditions are often associated with an increase of plaque ruptures or “cracks” in the artery. She added:
“I like to tell people that it’s not the plaque but the crack that causes the heart attack.”
Many women are aware that plaque clogging their coronary arteries is a bad thing, but seldom make the connection between that kind of plaque and the kind caused by inflammation inside the mouth. Dr. Stevens explained:
“There’s a definite relationship between oral health and coronary artery disease, and post-menopausal women are more likely to have gingivitis as they lose estrogen.”
A major factor in the lack of heart studies on women in the recent past has been the frequent hormonal changes that women go through each month, which physicians feared would complicate studies. It turns out that the female hormone estrogen is very important to heart function – the heart contains estrogen receptors which bind estrogen to them and help to release nitric oxide, which regulates blood flow. As women approach menopause, estrogen production slows, reducing nitric oxide and allowing the heart muscle to stiffen.
“Even normally healthy women will find they get shortness of breath with quick exertion like running up the steps with something in their arms. Women who generally have no trouble with regular exercise but find this type of occasional shortness of breath should look into getting an echocardiogram to measure diastolic function.”
Hormonal cycles may also cause heart palpitations in younger or perimenopausal women, according to Dr. Stevens, who wondered, “Is there a cyclic pattern?” Turned out there is. Women experience skipped heart beats during the week before their periods. Palpitations can also be related to stress, which raises adrenaline. She explained to us:
“Women have very dense adrenaline receptors on their heart muscle, and it makes them more prone to these skips. It can be frightening, but we can check it out with an ultrasound or echocardiogram.”
When questioned about the controversial use of hormone replacement therapy (HRT) for menopausal women, Dr. Stevens said that she and her colleagues are not pulling women off HRT if they are already on it, but they are also not starting women on HRT either, as there is still “muddiness” when it comes to HRT’s currently known effects on the heart.
Dr. Stevens especially cautioned women who both smoke and have heart disease to stay away from HRT because it can be a deadly combination. See also: Why Are Gynecologists Still Prescribing HRT Despite Known Risks?
Risk of heart attack and stroke from birth control pills is constantly being weighed by cardiologists, especially with the newer American College of Obstetricians and Gynecologists guidelines permitting the prescription of birth control pills through to menopause. Currently, death from cardiovascular disease is rising in the age group of women from 35 to 45 years of age. Dr. Stevens was unsure of how the newer birth control pill guidelines may impact cardiovascular risks in this age group, but insisted:
“We’re concerned about the age group of women between 35 and 45 years of age (who are more likely to be on birth control pills) that we’ll see a rise in premature coronary artery disease.”
Learn more about women and heart disease, and about applying to attend the WomenHeart Science & Leadership Symposium at Mayo Clinic every fall.
♥ This post was included in Grand Rounds on July 19, 2011
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