August / September 2004

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NOT FOR MEN ONLY
Women and Heart Disease
by Bruno Cortis

INTRODUCTION

As a cardiologist, I have treated women with heart disease for thirty years. My interest in prevention prompted me to write this article in the hope that women will become aware of heart disease, learn that the symptoms may be atypical, and most important, that there is help available to those who seek health. In this article, current statistics will be described, who is at risk, and how to preserve health.

HEART FACTS FOR WOMEN

Women suffer heart attacks and heart disease just like men. Here are the facts, as provided by the American Heart Association, 2002.

Each day, 2,600 individuals die in the United States from cardiovascular disease—an average of one death every 33 seconds. This represents about 60% of the total deaths in the U.S. In 1999, 445,871 males died of cardiovascular causes (46.5 percent), compared to 512,904 female deaths (53.5 percent). Other major causes of death recorded for 1999 were cancer (549,838), accidents 97,860, and AIDS (14,802), with breast cancer deaths totaling 41,144 and lung cancer deaths at 62,703. The tobacco industry targets women by exploiting the association of having a slender figure and smoking.

Although the above statistics don’t bear it up—one in 30 female deaths in 1999 was from breast cancer—but one in 2.4 was from cardiovascular disease. Nevertheless, most women fear breast cancer more than cardiovascular disease.

6 TYPES OF WOMEN AT RISK FOR HEART DISEASE Dr. Marianne J. Legato, M.D., author of The Female Heart, describes the categories of women at risk like this: 1. Type A Woman — who hides her anger and frustration and learns to smile. 2. Nice Girl — who can’t say “no,” because she wants to be liked. 3. Doormat — who has a subordinate, passive nature but hides a lot of hostility. You might find her in a high-performance job with low pay. 4. Neglected Caregiver — who makes sure everyone in the family gets a checkup, for example, but forgets herself. 5. Overloaded Woman — who is continually under stress because she’s handling two or three jobs at a time at home and at work. 6. Isolated Woman — One in five women will lose their husband between age 55 and 64, and the resulting social isolation promotes illness.

SOLUTIONS FOR WOMEN

What’s a woman to do? Dr. Marianne Legato advises women to not be on call 24 hours a day, but to find a place where they can rest, identify what makes them happy, begin a sport activity, exercise regularly, and spend at least an hour a day just for themselves. Women, obviously, juggle multiple roles— as homemakers, as wage earners, as family caretakers, mothers, and wives. They are the ones who experience the conflicts when a child is sick or injured and they are at work. Women tend to have many more necessary activities than men—shopping, preparing meals, cleaning, and childcare—and of their total workload, some work is paid and some is not.

OVERLOADED LIFE OVERLOADED HEART

Wives report feeling responsible, even for their husbands. Unwinding at the end of the day is more difficult for them. A study performed on the blood pressure and stress level of both genders reports that after 5 p.m. men’s blood pressure and hormone levels drop, while they remained elevated in women.

Also, given women’s coping strategies, the stress of work may be increased because of tendencies toward more weight, less physical activity, more anger, more smoking. And while men have cut down smoking by 20%, women have cut down by only 6%. One in three women of childbearing age is still a smoker. The average age of a first heart attack in men is 65.8 and in women is 70.4. The coronary heart disease rates after menopause are two to three times greater than prior to menopause.

Myocardial infarctions without pain, so-called silent heart attacks, are statistically more common in women than men: 35% versus 28%. According to the Framingham Heart Study, 50% of men and 60% of women who die suddenly of coronary disease have no previous symptoms of heart disease.

The major risk for women after menopause is a change in their lipid values, with an increase in LDL (low-density lipoproteins), called bad cholesterol because it forms deposits in the arterial walls, and a lowering of the HDL (highdensity lipoproteins), named good cholesterol because it keeps the arteries free of plaque. Smoking also lowers the HDL and increases the risk of death 30%.

DIFFERENT SYMPTOMS

Women who suffer from coronary heart disease experience different symptoms than men do. They have more shortness of breath and nausea, and more atypical symptoms, such as more back pain and jaw pain, but they have less chest pain and sweating. If a man goes to an emergency room with chest pain, he is hospitalized and undergoes many tests. In sharp contrast, when a woman goes to the emergency room, she is more likely to be viewed by physicians as “emotional,” and she undergoes fewer tests.

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SAVE YOUR HEALTH, SAVE YOUR LIFE

Females are usually affected by heart disease at an older age, but they tend to have more co- morbidities, such as diabetes, hypertension, and obesity. The diagnosis tends to be made late. And there is less intervention and less rehabilitation. In terms of diagnosing coronary heart disease in women, the treadmill gives false-positive results about 50% of the time, so physicians rely more on stress-echo and thallium tests.

HEART PROBLEMS ARE FAMILY PROBLEMS

A common denominator of paramount importance for men and women who suffer from heart disease is their families. The heart problem becomes a family problem. Everyone in the family is affected. It is like an emotional earthquake in the life of many persons. So think of the daily consequences: The total number of heart-related deaths each day is 2,600; this represents 2,600 families deeply affected by this tragic event, and for their lifetimes.

WOMEN LIVE LONGER On the positive side, longevity is a feminine attribute. In fact, 90% of the people who live to 100 years old are women!

CONCLUSION Health is the most precious gift we have. Maintaining our health is our responsibility. Good information may add years to your life and love to your heart.

BRUNO CORTIS, M.D., is a cardiologist with a major interest in spirituality and medicine. He is the author of The Spiritual Heart and Heart & Soul. He delivers speeches and seminars across North America. Dr. Cortis created the Exceptional Heart Patients Program. www.brunocortis. com; dr.cortis@brunocortis.com, (708) 366-0117.

Cover Story

SUICIDE BY LIFESTYLE
And Failure in the American Healthcare System
— Stan Charnofsky