I was asked last year by a large U.S. publisher to review a new book written by a woman who had recently become a heart patient. I enjoyed reading the first chapter or two until I came to the New York author’s dramatic story of the actual cardiac event itself. The part that left me gobsmacked was not the event, but her abject shock and disbelief that she (of all people!) could be experiencing a heart attack at all. The pervasive “Why me? Why me?” focus in this chapter clearly ignored a reality that the author had somehow chosen to gloss over: she’d been a heavy smoker for several decades.
Don’t get me wrong. Any cardiac event is indeed a traumatic occurrence no matter who and when it strikes. Sometimes, we truly have no hint about the cause of said event. And my immediate gut reaction was not meant to mock this author, or minimize her experience (which was awful).
But I felt honestly surprised that she was surprised. Here was an intelligent, educated woman who’d been actively and relentlessly engaged year after year after year in one of the most well-known and downright dangerous risk factors for cardiovascular disease out there – yet she’s surprised?
Cigarette smoking is considered the most important preventable cause of premature death in North America. So how is it even possible she would not know this? How is it possible that she would have no clue that her heavy smoking was damaging her heart?
This basic disconnect between awareness of cause and effect turns out to be surprisingly common. And, as a recent Australian study reported, there are even more surprises to be found among heart attack survivors and what they believe caused their heart attack.(1)
Australia’s National Heart Foundation (NHF) had launched a “Warning Signs of Heart Attack” multi-media campaign. This campaign ran across the entire country for four years from 2008 to 2012 to help raise awareness of heart attack symptoms in an attempt to reduce deadly treatment-seeking delay.
But in fact, this follow-up study found there was virtually no significant difference in the median pre-hospital delay time between patients who had encountered the NHF awareness campaign ads and those who had not (133 minutes vs. 137 minutes). Only 26% of patients studied recognized that they were actually having a heart attack. In just 34% of cases, an ambulance was called.
So four years of flooding the public with consistent awareness messages had resulted in barely a blip of improved personal response to heart attack symptoms. The study authors blamed a number of possible factors for this failure to recognize and respond.
But here’s the one reason identified in this study that may help to explain the New York author’s reaction of profound disbelief:
“Most patients have a limited understanding of heart attack risk factors and causes.”
And as the NHF study authors explained:
“Lack of insight into one’s own personal cardiac risk factors appears to be another important barrier to the recognition of a potential heart attack
“In fact, only 22% of patients in this study could identify all of their own cardiac risk factors. Even well-known cardiac risk factors such as cigarette smoking, hypertension, diabetes or obesity were poorly recognized.”
But wait. It gets worse.
A study of women over 40 called the LIPSTICK Survey done by The Federation of Medical Women of Canada reported that only 10% of women surveyed knew all of their personal cardiac risk factors, versus 64% of the same group who know how much they weighed in high school.
In another recent study of female heart attack survivors, Yale University researchers found that many of the women were so unaware of their personal risk of heart disease that when their heart attack symptoms did hit, women invariably blamed them on non-cardiac causes.(2) For example:
“When asked to reflect on their health before their myocardial infarction (heart attack), participants acknowledged that they had not recognized their personal risk of heart disease. This lack of awareness occurred even among women who had a family history of heart disease or multiple known risk factors.
“Participants did not consider heart disease as the potential underlying cause of their common heart attack symptoms.”
We know that we can significantly reduce the risk of about 80% of all heart disease.
And as I like to tell my women’s heart health presentation audiences, there is simply no downside to start living your life in a heart-smart cardioprotective way – just as if you already knew that you’re at very high risk for developing heart disease.
Yet far too many of us continue to waltz through life refusing to pay attention to smoking, junk food diet, inactivity, high blood pressure, chronic stress, impaired sleep and other important risk factors that we know significantly impact our chances of becoming a heart patient someday.
Worse, studies like the ones cited above continue to show that most of us simply have no clue what those cardiac risk factors even are.
For this reason, I’m completely onside with my heart sister Jen Thorson (who blogs at My Life in Red). She wrote recently:
“I have little patience with willful ignorance of cardiac risk factors (just as I do for ‘being embarrassed’ as the reason someone won’t seek care)..I’ve done this survivor/writer/speaker thing long enough and heard enough stories to just be over that..“I get it, I do, but ladies, we need to get beyond it. We need to take control of our health and care..“No one else is going to do it for us.”
Sadly, our medical care model in coronary artery disease is built entirely around opening blockages after the fact in patients with late-stage heart disease – which may relieve symptoms but, ironically, does not reduce the risk of heart attack. See also: The Cure Myth
And when cardiologists employ invasive procedures for coronary artery blockages by stenting or bypassing, they address only that specific area of the heart – not what caused the problem in the first place (likely decades earlier).
Risk reduction strategies, however, can improve not only heart health but our overall general health as well.
Yet risk reduction, except among a small but notable group of physicians (Dr. Gina Lundberg, Dr. Rainer Hambrecht, Dr. John Mandrola, Dr. James Beckerman, or Walk With a Doc‘s Dr. David Sabgir, for starters) is barely mentioned.
Apparently – as noted in the Australian study’s results – even flooding people with heart health public awareness messages is not making us any more aware. It’s why I so admire doctors like Beckerman and Sabgir who actually lace up their own shoes and accompany the public out on regular walks or runs.
Dr. Hambrecht, professor of medicine at Universität Leipzig in Germany, has presented the results of his ongoing cardiac research at European Congress of Cardiology meetings. Both his original and follow-up studies five years later compare the surprising outcomes of two groups of similar heart patients:
- those who have had angioplasty/stents to reopen their coronary artery blockages
- those who were put on a regime of regular exercise instead (in his case, cycling)
His surprising findings continue to confirm his earlier results: regular exercise training is superior to angioplasty at reducing the risk of subsequent cardiovascular events.(3) See also: Did You Really Need that Coronary Stent?
But as Dr. Hambrecht himself acknowledged:
“It’s difficult to convince people to exercise instead of having an angioplasty – but it works.
“For one, patients are not motivated to take responsibility for improving their own cardiovascular health – even if it means better event-free survival.
“For another, encouraging exercising is financially less appealing for hospitals. That was my feeling – that hospitals were reluctant to participate in this study, because they derive revenue from revascularization procedures in their cath labs.”
It’s also important to remember that, particularly in women, sometimes a serious cardiac event strikes those who seem to have no obvious risk factors that could be modifiable by lifestyle improvements.
Jen Thorson, for example, was a healthy 37-year old marathon runner when she suffered the first of two heart attacks. She now suspects that her own cardiac events are linked to a pregnancy complication years earlier called HELLP syndrome (considered a severe form of preeclampsia). We know that pregnancy complications like this can raise a woman’s risk of future heart disease by 2-3 fold.
Spontaneous Coronary Artery Dissection (SCAD) is another type of heart attack – often fatal – that most often strikes young healthy women with few if any cardiac risk factors.
And speaking of cardiac risk factors, how many on this list do you have?
How to address your cardiac risk factors
♥ Stop smoking – all smoking (especially important if you are also on birth control pills). Learn more about the effect of those public smoking bans on our health.
♥ Maintain a healthy weight (waist measurement <35″ for women)
♥ Exercise! We know that 150 minutes of physical activity per week (that’s just 30 minutes a day for at least five days a week) is the minimum for good health. What the heck – why not aim for 30 minutes of physical activity every single day? Yes, EVERY day! The human body was meant to move – not to sit around. See also: “Heart Disease is a Sitting Disease“. And as Dr. John Mandrola likes to say:
“You only need to exercise on the days you plan to eat!”
♥ Do other activities that can improve heart health all throughout your day – not just during a specific exercise period: gardening, walking to work, stair climbing – even doing housework. Just DO something. MOVE something.
♥ Get a good night’s sleep! Sleep problems have been linked to increased cardiovascular risk.
♥ Talk to your doctor about screening tests for heart disease if you have a family history (Mum or sister under age 65, Dad or brother under age 55 when they had a cardiac event) or if you’ve ever had pregnancy complications like Jen Thorson and I each had.
♥ Educate yourself about your own heart health. If you have already been diagnosed with heart disease, your only job now is to become the world expert in your diagnosis. Knowledge is power. Be a survivor, not a helpless victim. If you haven’t already done so, subscribe free to get Heart Sisters email updates about emerging news on women’s heart health and each new weekly post about women’s heart health published here (simply look at this page sidebar to your right and click Follow Heart Sisters, or click the Twitter icon to follow me there). See also: “Listen Up, Ladies: 16 Things I’ve Been Meaning to Tell You”
♥ Stop being what we call a Type E-personality: “Everything to Everybody!” This is especially true for women, who are often the nurturers and caretakers of both friends and family members, sometimes at the expense of their own health needs. See also: Are You a Priority in your Own Life?
(1) Tummala, Shrikar R. et al. Patients’ Understanding of their Heart Attack and the Impact of Exposure to a Media Campaign on Pre-Hospital Time. Heart, Lung and Circulation , Volume 24, Issue 1 , 4 – 10. January 2015.
(2) Judith H. Lichtman et al. Symptom Recognition and Healthcare Experiences of Young Women With Acute Myocardial Infarction. Circulation: Cardiovascular Quality and Outcomes. OUTCOMES.114.001612
(3) Hambrecht, Rainer et al. Percutaneous Coronary Angioplasty Compared With Exercise Training in Patients With Stable Coronary Artery Disease: A Randomized Trial. Circulation. 2004; 109: 1371-1378. March
Q: Why do you think we’re just not getting it?
- Yet another cardiac risk calculator? My response in the British Medical Journal
- Why you’ll listen to me – but not to your doctor
- Squishing, burning and implanting your heart troubles away
- Why female shift workers may be at risk for heart disease
- What other diagnosis doubles your risk of having a heart attack?
- Heart disease is a sitting disease
- The cure myth
- Why are heart patients who smoke leaving hospital still smoking