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Articles / 2008

Steinberg: Taking No. 1 killer of women seriously

By Alon Steinberg
Ventura County Star
Wednesday, February 6, 2008

Do you know what the greatest health problem facing women today is? Most women answer cancer, specifically breast cancer. Only about 20 percent of women identified heart disease as their main health threat, yet it is the No. 1 killer of American women today. One in three dies of heart disease, while one in 30 dies of breast cancer.

It is a myth that heart disease is a man's disease. In fact, 50,000 more women die of heart disease than men every year. Additionally, 38 percent of women die within the first year of a heart attack versus 25 percent of men. Also, 63 percent of women die suddenly from heart disease without a warning symptom versus 48 percent of men.

That is why Community Memorial Health System is holding an important symposium focusing on heart disease. "Heart Disease — the Prevention, Detection and Treatment" is Saturday at the Spanish Hills Country Club in Camarillo. It is free to the public and will run from 8 a.m. to 1 p.m.

Women just don't take their risk of heart disease seriously. Unfortunately, healthcare professionals also don't always take their female patients' risks and symptoms seriously either. Underdiagnosis and undertreatment likely contribute to excess deaths in women. The American Heart Association — "Go Red" — and the National Heart, Lung and Blood Institute — "The Heart Truth"— have launched campaigns to raise awareness about women and heart disease. The Red Dress is the symbol of the campaign and is there to remind and inspire women to take action against this epidemic.

Women, there is much you can do to prevent heart disease. First you need to educate yourself on what heart disease is. You then need to understand your risk factors and start working on modifying them. If you have heart disease already, you and your doctor need to work harder to prevent recurrent problems.

When we are talking about heart disease, we are mostly concentrating on atherosclerosis or coronary artery disease. The coronary arteries are the blood vessels on top of the heart that supply circulation to the heart muscle. Atherosclerosis, or coronary artery disease, is the accumulation of plaque in these blood vessels. These plaques can grow and eventually obstruct blood flow to the heart muscle, causing chest pain or angina. These plaques also can rupture, causing a blood clot that can completely cut off flow down the blood vessel. When there is poor flow, the heart muscle can die, causing a heart attack or a myocardial infarction.

Atherosclerosis growth is usually gradual; thus it is important to prevent progression early in life. You can do this by modifying your risk factors. The major risks are high blood pressure, diabetes, smoking, inactivity, obesity, high sensitivity C-reactive protein (CRP), high levels of low-density lipoprotein (LDL, or bad cholesterol), low levels of high-density lipoprotein (HDL, or good cholesterol), high triglycerides, family history of heart disease and age.

It is very important to know your risks and what you can do to modify them. First is hypertension, or high blood pressure, which affects three out of four women over the age of 65. It is called the "silent killer," since you don't always feel that your blood pressure is high. Pre-hypertension is any pressure over 120/80, and hypertension is pressure over 140/90.

If you are diabetic or have kidney disease, your blood pressure needs to be under 130/80. Hypertension is not curable and you will usually need to be on medication. Also, if you have hypertension, it is important to buy a blood-pressure cuff for home and check your pressure on a regular basis and report results to your doctor regularly.

Second is high LDL, or bad cholesterol. If you have two other risk factors, your level should be under 130. If you have diabetes or blockages in any artery in your body, your LDL should be under 100, and if you have heart disease, we are now recommending that your LDL be under 70. Ask your doctor what your goal LDL should be and what you need to do about it. You may need to take medications for cholesterol that have been shown to be safe and effective in slowing the progression of arthrosclerosis as well as preventing heart attacks and strokes.

Third is diabetes, a very serious condition when your sugar levels in your bloodstream increase. Diabetes increases women's risk for heart disease sevenfold, and two out of three women with diabetes die of heart disease. One way of preventing diabetes is by keeping your weight down. If you have diabetes, management is very important. A blood test called hemoglobin AIC monitors your treatment; make sure it is under 7.

Women may have fewer or different symptoms of heart disease than men do, symptoms that are often undetectable until the disease is well-advanced, thus leaving less time for treatment. Women are also more likely to have painless progression of heart disease, and the pain and symptoms that they do feel — fatigue, nausea, heartburn, indigestion and shortness of breath — are those that many women often fail to associate with heart disease. This can lead women and their doctors to be misled. You should talk to your doctor about receiving diagnostic testing if you have any symptoms.

February is National Heart Month, and it is especially important for women to know how to identify, manage and prevent heart disease. What better time, then, to sit down with your healthcare provider to discuss your risks and what you can do to modify your lifestyle and decrease your risk of heart disease?

— Alon Steinberg, M.D., is a member of Cardiology Associates, Inc, based in Ventura and Oxnard. He practices at Community Memorial Hospital.