HEALTH MATTERS

LOVE YOUR HEART

By: Allison Van Heusen

Ladies, are you at risk for heart disease? Here’s what you need to know.

Lub-dub, lub-dub. Our hearts inconspicuously beat every day circulating our blood, which carries oxygen and nutrients to our cells and carries waste away. But, how often do we really stop and think about our heart and its health? Hopefully, now, at least once a year. February, if you didn’t already know, is American Heart Month. During February, the American Heart Association’s goal is to raise funds for research and education, and to pass along information about heart disease and stroke. We here at Max Sports & Fitness are doing our part to share valuable information about heart disease and its prevention, especially in women.

We typically think of men having heart attacks, but heart disease is the leading cause of death in both men and women in the United States. In fact, women are more likely than men to die when they experience a heart attack. To learn more, I sat down with Dr. Eugenia Carroll, MD, Director of the Women’s Heart Disease Clinic at the University of Colorado Hospital and Fellow of the American College of Cardiology.

I started by asking Dr. Carroll, what exactly is heart disease? She explains, “There are many types of heart disease; some common, some less frequent. If we think in broad categories, we might categorize them in this way: 1). Disease of the arteries of the heart (coronary arteries), called atherosclerosis, which can cause angina (chest pain), and can lead to a heart attack. 2). Electrical conduction issues, which can cause irregular heart rhythms. 3). Heart valve problems, such as mitral valve prolapse. 4). Heart muscle problems, such as congestive heart failure and cardiomyopathy. 5). Congenital, meaning a heart defect you are born with, like a hole between the heart chambers.”

If you are surprised at the amount of conditions included in heart disease, you are not alone. Dr. Carroll has found that, “When most people think of heart disease and how they might improve their cardiac health, they are thinking of preventing atherosclerosis, which affects the coronary arteries and can lead to a heart attack.”

When I ask about heart disease being the leading cause of death in America, Dr. Carroll says, “In industrialized nations most people eventually die from cardiovascular disease or cancer, whereas those living in underdeveloped nations are most likely to die from infectious diseases or childbirth.” So, why then do we hear so much about breast cancer and not heart disease? According to Dr. Carroll, “This is likely because cancer is the major cause of death in women aged 35 to 55, and we tend to think of death in younger people as more tragic than those who are elderly, rightly or not. Only after age 55, do we reach a crossover in causes of death and more women begin to die due to heart disease. Also, an important but less well known fact is that the leading cause of cancer death in women is actually lung cancer, not breast cancer.”

Then perhaps women ages 35 to 55 don’t need to worry as much about heart disease? “Not true,” says Dr. Carroll. “Atherosclerosis (the build up of fat and plaque in the arteries) is a disease that begins in the pediatric age. Plaque gets worse over decades and by the time an artery is 70 percent blocked, that’s when we often see symptoms. People begin to develop fatty plaque and streaks in their arteries as young as their teens, especially if they are smokers. These fatty blockages worsen over the decades and eventually may lead to heart attack.”

So, what can we do to slow this progressive build up and prevent heart disease? Dr. Carroll says, “Know your risk factors and STOP SMOKING IMMEDIATELY.” She is very serious about smoking, and explains why. “Smoking one cigarette per day doubles to quadruples your risk of having a heart attack.” The good news is that if you are, or have been a smoker, you are not forever doomed to have a heart attack. According to Dr. Carroll, “Three years after a person stops smoking they have nearly the same risk of having a coronary event as a non-smoker.” Unfortunately the possibility of getting lung cancer isn’t as easily remedied, but as Dr. Carroll wisely states, “that’s a whole other article.”

Smoking lecture completed, we return to the topic of risk factors. “Knowing your risk for heart disease is the first step you can take in taking charge of your cardiac health,” states Dr. Carroll. She brought with her a quiz anyone can take to asses their heart disease risk from the Women’s Heart Foundation Web site, www.womensheart.org. Dr. Carroll highlights the first bullet point on the page which states, “Over 60 percent of women believe their biggest health threat is breast cancer but heart disease kills six times as many women as breast cancer.”

Let’s take a look at these very important risk factors, as detailed by Dr. Carroll.

Positive Family History: Dr. Carroll explains that this does not mean your grandpa who died of a heart attack at age 75. “We are looking for a history of premature coronary disease. A male relative who had their first coronary event in their 40s or a female relative having her first coronary event in her 50s.”

Hypertension: This means your blood pressure is over 135/85 mmHg or your healthcare provider has told you that you have high blood pressure. Optimal blood pressure is 120/80 mmHg. After age 45, 60 percent of Caucasian women and 79 percent of African-American women have high blood pressure. Dr. Carroll calls hypertension “the silent killer” as you don’t really feel your blood pressure going up. Hypertension is a risk factor for heart disease because it makes the heart work harder to pump against a high resistance (hypertensive) circulation, which can damage the heart muscle over time.

Smoking: If you smoke or are exposed daily to secondhand smoke.

Older age: Women who are older than 55 or postmenopausal.

Sedentary lifestyle: You do not exercise for at least 30 minutes of moderate-intensity physical activity, like taking a brisk walk, on most days.

Diabetes: You have been told you have diabetes by your healthcare provider or take medicine to help control your blood sugar. After age 45, diabetes affects many more women than men. And, in case you’re wondering why high blood sugar is harmful, it’s because sugar particles are very large and like so many bowling balls bouncing against drywall, they poke holes in your veins and arteries.

Elevated cholesterol levels: Your bad cholesterol, LDL, is too high as determined by your physician. And, your good cholesterol, HDL, is less than 50mg/dL. LDL goals are varied and dependent on risk, so talk to your doctor about what level is right for you.

Overweight: You are 20 pounds or more overweight. More than 1/3 of American women are more than 20 pounds overweight.

Additional risk factors: beyond the major risk factors detailed by Dr. Carroll, included on the Women’s Heart Foundation quiz include: metabolic syndrome; premature menopause, either natural or through surgery before the age of 40; birth control pills, when combined with regular exposure to cigarette smoke; unhealthy diet and stress.

If you answered yes to two or more of these risk factors, consult your health care provider and ask for a complete risk assessment.

What about the risk factors we can’t do anything about, like age? Unfortunately, aging means the progression of both predisposing genetic factors and lifestyle decisions which eventually cause organ systems, including the heart, to become critically damaged or fail. In this regard, our bodies are similar to automobiles. Regardless of how well the car was built and how carefully it may (or may not) have been maintained, eventually something wears out and it stops running.

Well, as long as our engines are still running on all cylinders, we should know how to tell when something is wrong, right? So, I asked Dr. Carroll how a woman might know she is having a coronary event. She begins by explaining that heart attacks usually present in three different ways: “In almost 50 percent of people, the initial presentation of coronary heart disease is sudden cardiac death; 30 percent have symptoms of angina (chest pain), nausea and heaviness in the chest; and 20 percent present with a silent heart attack.” That means that half of the time, the person had no prior symptoms and has a cardiac arrest and dies without warning! Thirty percent of the time a person has symptoms as a warning that they are at risk of having a heart attack. And, 20 percent have a silent heart attack (no clinical symptoms) and never know they had one. Now, knowing that 50 percent statistic, don’t you want to take a cardiac risk assessment, and discuss the results with your health care provider? Moving on…

“Women can experience a coronary event, like a heart attack, differently from men,” Dr. Carroll continues. “Men usually experience very typical chest pain or chest heaviness (often described as an elephant sitting on their chest), which may radiate down the left arm or right arm or into the neck or jaw. While a woman may certainly have these same experiences, more often their symptoms are more subtle and vague, especially as they get older. Women may feel a vague fullness in the chest, be short of breath, nauseated or fatigued.” Dr. Carroll goes on to say, “I may have a patient tell me she used to be able to go the grocery store, load groceries in and out of her car, then carry them into the house, with no problems. But now, the patent says she experiences shortness of breath, vague fullness in her chest, and nausea when doing activities she normally did before without difficulty.” Dr. Carroll would then need to determine if this patient is indeed at risk for having a coronary event. The type of evaluation and testing needed will depend on that patient’s symptoms and risk factors.

Dr. Carroll also explained that there are multiple reasons why women are more likely to die from a heart attack compared to men. First, women are less likely to recognize that their symptoms may be due to a heart attack. This causes them to delay getting to an emergency room, and thus delay getting critically needed care in a timely fashion. The longer you wait for treatment, the more likely you are to have heart muscle damage, and “time is muscle.” Secondly, women are often older than men at the time they experience their first heart attack. This means they are more likely to have additional major medical problems, which can worsen their outcome. All in all, “If a person is experiencing chest pain, they need to get to the emergency room, especially if they have risk factors,” says Dr. Carroll.

And what if you already have heart disease? Knowledge is key according to Dr. Carroll. “Patients have to know about their disease because they can’t take optimal care of themselves otherwise. For example, if a patient has high blood pressure, I typically have them take daily blood pressure readings at home. They know then if the medications are working. They also need to know whether they are eating right, and if they are following the plan we’ve designed for their cardiovascular health.” She suggests that anyone educating themselves about heart disease or stroke, look for the American Heart Association (www.americanheart.org ) and their affiliated Web sites. This is the best way to get medically accurate, up-to-date information.

And, finally, what about supplements? “Currently, the only supplement with sufficient evidence from randomized, controlled, clinical trials is fish oil (omega 3 fatty acids), which have a positive affect on lipid levels.

Please ladies, don’t forget to pay attention to that miracle of muscle beating in your chest. Find out about your heart disease risk, discuss it with your physician, follow through on your heart health plan, and pay attention to even subtle symptoms of a coronary event. It may just save your life, or prolong it at the very least. Lub-dub. Lub-dub, take good care so the beat goes on…. MS&F