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July 2004 Issue
Women's Heart Health: Part Two
by Michael Fick
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Exercise stress tests have long been effective in determining heart disease risk in men, but it's becoming increasingly clear that their direct applicability to women is invalid as a screening test in the absence of symptoms. A robust study has shown the stress test heartbeat irregularities which can forewarn of men's heart disease are not very good markers in women except to identify the cause of specific existing symptoms.

Once a heart attack begins, men release one set of telltale blood chemistry, while female hearts tend to release their own unique blood cocktail containing CRP and brain natriuretic peptides. If your doc says, "Huh?" when you inquire about those markers common to women after your ambulance ride and/or stress test, switch doctors quickly, while there's still time. If he asks, "Where'd you hear that nonsense?", tell him "Harvard Medical School" and crawl out the door. For women, below-average fitness levels and recovery rates are far better markers of heart disease than the treadmill stress test markers used for men.

Magnetic resonance imaging (MRI) was recently found to diagnose heart attacks, severe artery blockages, and unstable angina better in the ER than EKGs, blood enzyme tests, and TIMI risk scores. MRI sometimes verified heart attacks despite normal EKGs, partly because breast tissue can distort EKG signals. MRIs or other imaging tests such as ultrasound, especially in conjunction with stress tests, may more accurately measure heart muscle health in women.. They give doctors a better view of the heart, allowing a patient to be diagnosed and ready for treatment within 40 minutes.

Watch out for doctors pushing too many tests, or wrong tests, however. Many advanced tests are overkill, maybe even misleading, if blood tests show nothing. The casual, non-specific, I-can-afford-it-so-why-not, full body scan is a classic example of too much information. Your doctor should be able and willing to explain why each test is being performed and how it fits into the escalating, justified sequence of tests.

Both the woman patient and her doctor need to recognize and compensate for the fact that women resist lifestyle changes more stubbornly than men do. Women are less likely to quit smoking or start exercising for their health, and less likely to attend cardiac rehab after bypass surgery. That's particularly dangerous because smoking and diabetes harm women twice as badly as they do men. These and other gender differences can be mitigated by extra knowledge, vigilance, and effort by both doctor and patient.

Another gender difference requiring extra management and motivation is depression. It's far more prevalent in women than in men, and depressed women, including those with no history of heart disease, have a 50% to 100% greater risk of developing or dying from heart disease than women who are not depressed. (Maybe it's because all guys need for bliss is a beer, a remote, and 200 channels.) Even women's nurturing nature can be deadly; women who spend at least nine hours a week caring for their grandchildren or for ailing husbands increase their heart disease risk by up to 55%. Resuming housework too soon after a heart attack produces similar results. If these, other obligations, or sheer inertia lead a woman with weekday heart symptoms to delay an ER visit until the weekend, and she gets a procedure such as an angioplasty, she incurs 50% greater odds of dying in the ER or having a second, often fatal, heart attack.

Women eat at least 22% more calories now than 30 years ago (compared to men's 7% increase), and it shows in cardiac wards, in diabetes-induced amputations, in clothing sizes re-definitions, and in this ill-informed, dangerous, expensive obsession with low-carb diets. Be vigilant, ladies ... portion sizes are up 200 to 500% in restaurants and cookbooks and high sat-fat diets compound that problem.

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