Have a heart for women’s health

More women die from heart disease, stroke and other cardiovascular diseases than men — half a million women every year in the United States alone

By: John D. Passalaris, M.D.
   The American Heart Association’s (AHA) release of updated guidelines on women and heart disease reflect sweeping changes in the way women and their physicians are being compelled to think about the No. 1 killer of women in the United States.
   The guidelines, just released last week, include new paradigms for risk assessment and new directions for using aspirin, hormone therapy and vitamin and mineral supplements to prevent heart disease and stroke. They focus on a woman’s lifetime heart disease risk, not just short-term, and emphasize changes in lifestyle factors that can improve chances for survival.
   The updated guidelines were based on research in virtually every field of women’s health — cardiology, epidemiology, gynecology, family medicine, neurology, public health and surgery — and illustrate just how far research and attitudes about women and heart health have progressed in the last few years.
   For years, cardiovascular disease has been perceived largely as a threat to men’s health. That perception has resulted in treatment disparities, with women less likely to receive aggressive treatment for heart disease and stroke. Research traditionally has been focused on men. And yet, more women die from heart disease, stroke and other cardiovascular diseases than men — half a million women every year in the United States alone.
   While awareness of the serious threat of breast cancer has grown, many women underestimate the even greater threat of death caused by heart disease. The reality is that 1 in 8 women will be affected by breast cancer, but an astounding 1 in 3 women will be stricken with heart disease. And — contrary to the widely held belief that heart problems don’t affect pre-menopausal women — heart attacks strike 9,000 women under the age of 45 each year.
   The 2007 Guidelines for Preventing Cardiovascular Disease in Women are published in a special issue of an AHA publication called Circulation: Journal of the American Heart Association that is devoted to women’s heart health. The guidelines offer concrete ways that women and physicians can work together to improve overall heart health over a lifetime. There are many new recommendations.
   For example, smoking cessation has long been recognized as a good way to cut the No. 1 risk factor for heart disease in both men and women. The 2007 guidelines now add specific recommendations for counseling, nicotine replacement or other forms of therapy to quit smoking.
   Daily aspirin is again recommended for women at high risk for heart disease. The new guidelines now recommend that in these high-risk patients, there should be a consideration for dosages of up to 325 mg. There is also a new recommendation that low-dose aspirin may be considered for younger low-risk patients for modest benefit. This benefit must be weighed against the increased risk of bleeding, so aspirin therapy should always be started under physician guidance and with caution.
   As for nutrition and supplements, in addition to the existing emphasis on eating lots of fresh fruit and vegetables and low-fat dairy products, the updated AHA guidelines offer specific guidance on the intake of omega-3 fatty acids and recommend the consumption of oily fish like salmon at least two times a week.
   Hormone replacement therapy, selective estrogen receptor modulators such as tamoxifen, vitamin E, vitamin C and folic acid, once thought to be helpful, are no longer recommended, as several recent large trials have shown that these supplements have no demonstrable effect to reduce the risk of heart disease.
   There is an increasing recognition of the fact that while hormones may help protect against heart disease in women who have not yet reached menopause, they may merely delay the onset of heart disease later in life, rather than preventing it entirely.
   The role of exercise in preventing heart disease received a boost. The AHA recommends 30 minutes of moderately intense exercise on most, but preferably all days of the week. For women who need to lose weight or to maintain weight loss, that recommendation is now 60 to 90 minutes.
   Reducing the threat posed by heart disease to women also requires an ongoing re-conditioning of the way we think about the issue and a more open discussion of its causes and symptoms.
   For example, if a man were to experience shortness of breath, extreme fatigue or a bad case of indigestion, he may immediately think he is experiencing a heart attack. Women might experience the same symptoms and shrug them off as a passing affliction, with the possibility of a cardiac event never entering their thoughts.
   With updated guidelines like these and more education and research, both the medical community and health care consumers are starting to adapt their thinking and behavior to the realities of women and heart disease in today’s world.
   The encouraging news is that the vast majority of heart attacks in women can be prevented with a combination of medication and healthy changes in behavior and lifestyle. That includes eating high-quality foods with more fresh fruits and vegetables and less fat, increasing activity levels, and putting aside the cigarettes once and for all.
   That also means keeping an eye on other factors that greatly increase the risk of heart disease — diabetes, high blood pressure, high cholesterol levels and stress.
   There is no doubt that women today tend to take care of everyone else in their family first and put themselves and their health needs on the back burner. But the best way they can ensure a better quality of life for themselves and for their families is to take early and easy steps to thwart heart disease and to protect themselves from a proven killer.
   More information on women and heart disease and the updated guidelines from the American Heart Association can be found at www.americanheart.org.
To find a physician with Princeton HealthCare System, call (888) 742-7496 or go to www.princetonhcs.org.