Are You At Risk?

Would you send a loved one out in a boat into the middle of the ocean surrounded by hungry sharks without an oar? Now imagine that one shark is labeled high cholesterol, another poor diet, and another lack of physical exercise get the picture? Are you as responsible to your loved ones as you think? The human heart beats 100,000 times a day, pumping five to six quarts of blood about 2,000 gallons a day around your body each minute. At its best, a healthy heart can expect to last over 100 years. Dr. Dean Ornish, Founder and President of the Preventive Medicine Research Institute in Sausalito, Calif. states that the fate of this vital organ rests in our hands, “Nearly everybody 95 percent plus of the population can prevent and reverse heart disease through changes in diet and exercise.” Still, more women than men die every year of cardio vascular disease (CVD), a fact largely unknown to physicians and lay people alike. So how can we take care of our amazing heart?

An American Heart Association recent study indicated up to 34 percent of women do not perceive themselves to be at risk. Health care experts cite the three main reasons many women do not seek proper heart care stems from the fact that women believe their male partners to be more at more risk than themselves, 25 percent said that their healthcare provider did not say that heart health was important, and 1 in 5 said that healthcare providers did not clearly explain how they could change their risk status.

How bad is the heart risk overall in American women?
Let’s review some sobering statistics: In the U.S., 38.2 million women (34 percent) are living with CVD and the “at risk” group is even larger. Healthcare providers are seeing an ever-expanding cross section of patients with serious heart disease due to obesity, stress, poor diet and lack of exercise. Just 20 years ago, it was unusual for doctors to view young women as being “at risk” for coronary artery disease (CAD), stroke cerebrovascular accidents (CVA), and heart attacks or myocardial infarction (MI). Back in my medical school days almost all the data was about men. I had to learn about the typical male symptoms of heart attack and survival data from men treated with various interventions for their cholesterol, their success rates from open heart surgery, etc.

Then in the 90s, the course of medicine made a radical change. All sorts of equally shocking data came out on women in regards to how we did not fare as well as men for survival. Simply put, the disease doesn’t present in the same way for women. We can have very subtle signs and yet suffer significant angina (chest pain) and have silent or atypical syndromes that go unrecognized. (Of course, we are also more complicated creatures who have the monthly balancing act of hormones to worry about.)

As we progressed in our knowledge of heart disease in women, all sorts of interesting books abounded. One of my favorites was “Women Are Not Small Men” written by cardiologist, Dr. Nieca Goldberg (Ballentine Books, 2002). Acknowledging that so many women have heart disease began to change everything from the size of instruments available for open-heart surgery, to the medications used in treatment.

Women today are more informed than ever before and I’m often asked about alternatives to prescription medications. Many prescription medications are necessary to save lives. Statin drugs such as Lipitor can decrease cholesterol by 25 to 35 percent an important reduction if you are at risk. Yet Statins can also deplete our cells of the vital energy coenzyme Q10, and LDL cholesterol can now be tested to determine if you have large particles that do no harm or small dense sticky particles that build up plaque. Preventing oxidation of LDL cholesterol is key to keeping the coronary arteries clear. A deficiency in vitamin C can lead to uncontrolled LDL oxidation. (Remember humans cannot make their own vitamin C and the American population is notoriously deficient!) A good diet can also help lower your cholesterol and, of course, a diet high in processed food can increase your cholesterol. Some supplements can help to lower cholesterol. Your healthcare professionals should discuss all of these factors with you. Yet, keeping cholesterol low is only one piece of a complicated puzzle that looks at overall lifetime heart risk.

Reviewing the most current (March 2007) guidelines for the prevention of cardiac disease in women from the American College of Cardiology (ACC), I realized that more women than ever are at high risk of developing heart attacks, coronary artery disease and stroke. These findings from the ACC’s metanalysis of over 5,000 peer reviewed articles clearly show that although more women fear getting breast cancer (lifetime risk 1 in 7) approximately 1 in 2 women die of serious heart disease or its complications. The ACC actually revised their classification system of women “at risk” and changed what were previously four separate categories into three broad ones. (See Risk Ranking for Heart Disease.) Very few women, especially as they age will be able to dodge the “at risk” category if they do not make wise choices now.  Symptoms that indicate we can be heading toward CVD aren’t always obvious. Knowing your blood pressure, having regular check ups that include an EKG and labwork that can warn you of cardiac risk factors are important for all women. Most of us are very good at having an annual GYN exam or mammogram. It’s time we get smart and look at our hearts too!