Health and Fitness

Ladies, heart attacks are your primary killer, yet 82% of your heart disease is self-induced by bad habits, and thus avoidable. Four magic bullets - discipline, smoking, exercise, diet - are your keys to extra years or even decades of fun and productivity. Use the first key to avoid the second key and to improve the final two keys and you're much more likely to watch your great grandchildren grow up and achieve your life's dreams.

Even 20-something marathon runners, especially females, need baseline medical tests. A fasting lipid profile gleaned from a few ounces of blood will provide your physician the cholesterol and triglyceride data s/he needs to make a rough first estimate of your cardiovascular health. S/he'll also look at the sugar content of that blood sample (a glucose reading, plus maybe a hemoglobin A1c measurement) to assess your risk of insulin dependence (aka syndrome X, metabolic syndrome, or prediabetes, discussed in this column in August 2000) and full-fledged diabetes. People with these often self-induced (by obesity) disorders may actually benefit from low-carb diets; the rest of the low-carb lemmings are being duped by PR and by not reading the low-carb books closely enough to recognize their stated, specific target audience: insulin-dependent people.

Blood pressure checks are also important, because high BP combined with cardiovascular inflammation (as determined by a C-reactive protein (CRP) test on that same blood sample) can raise women's heart attack or stroke risks by up to 800%, far more than in men. CRP is gaining ground as a better cardiovascular health gauge than cholesterol, but it's not sufficiently well calibrated yet to raise a yellow or red flag by itself. So far it's better used as additional data when better-understood flags surface in a lipids check. Add high triglycerides to that BP/CRP pair and you're a walking bomb with a short, lighted fuse.

Does salt raise our blood pressure? Probably not; the high salt intake statistically associated with high BP was likely just an indicator of the real culprit - a poor diet low in minerals such as the calcium, potassium, and magnesium found in fruits and vegetables ... CARBOHYDRATES. Lowering your BP may help reduce inflammation, while aspirin will. Its reduction in cardiovascular inflammation is believed to outweigh its risk of pancreatic cancer, but it should be taken regularly only under medical supervision and only by women known to have a high risk of heart attack.

If the results of your blood chemistry and pressure tests are alarming, or if you have some of the cardiovascular symptoms described last month, you should ask a cardiovascular specialist about additional tests. Examples range from a treadmill stress test at the sweaty end of the spectrum to several lie-down-and-snooze exams involving innocuous external whiz-bang gadgets such as ultrasound wands, MRIs, or sensors taped to your torso.

If your HMO is too shortsighted to pay for advanced tests given alarming blood tests or heart disease symptoms, consider paying for carefully chosen tests yourself (some tests, such as standalone CRP tests or full-body scans, are still inconclusive and false-alarming). If you need more tests but are unwilling to pay for them with your own money, you may pay with something far more precious than money.

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.

Uninformed doctors can contribute to women's heart disease death rate, but even that contribution is controllable because we can choose our own doctors (unless the notorious, socialist Clinton Health Plan is adopted, in which case choosing our own doctor becomes a federal offense with a prison sentence for both doctor and patient). Women whose physicians understand women's cardiovascular disease and heart attack symptoms and who urge them to pursue necessary lifestyle changes, medication, surgery, and/or cardiac rehab have far higher recovery rates than women who choose less informed, assertive doctors. On the other hand, women's smaller blood vessels do complicate surgery, so there are valid reasons for some gender differences.

Make sure your doctor knows that postmenopausal women heart patients are severely under-treated with medicines known to prevent additional cardiac events, including the newer SSRI-type anti-depressants which help prevent second heart attacks with far lesser side effects. Women having heart attacks are also less likely than men to be put in intensive care, and a recent study showed that only 33% of women were given beta blockers, 18% given ACE inhibitors, and 53% given cholesterol-lowering drugs. In fact, the most-ill, highest risk women were the least likely to receive these medications, often because their doctors are not following the latest research and treatment guidelines. Women who received aggressive treatment, such as automatic catheterization after a mild heart attack, were less likely to have a repeat heart attack, need re-hospitalization, or die. It's up to you to choose your physician based on knowledge and practices rather than just on bedside manner.

So what should women do to significantly cut their risk of premature, unnecessary, often preventable heart disease? Oddly enough, this list happened to hit 12 steps:

  1. Learn women's unique heart disease and attack symptoms.
  2. Find a doctor who knows them and treats them and their female cardiovascular patients aggressively with the proper tests, lifestyle changes, meds, and procedures.
  3. Dump self-induced high blood pressure, diabetes, cholesterol, and triglycerides by dumping excess weight through exercise and a proper diet such as Mediterranean or South Beach . . . maybe the far more stringent Pritikin or Ornish diets if you already have advanced heart disease.
  4. Non-diabetics should dump that stupid low-carb, high-fat diet before it harms them. Whole grain cereals and breads are vital to the prevention of obesity, diabetes, and cardiovascular disease because they provide important nutrients and discourage over-eating.
  5. Stop smoking or breathing others' smoke.
  6. Match men’s willingness to improve their lifestyles.
  7. Get off HRT estrogen unless your menopausal hot flashes are intolerable.
  8. If you have high cholesterol, diabetes, or heart disease, you probably need statin drugs. They do great thing for our health, including unblocking clogged heart valves to prevent open-heart surgery, reducing CRP, and increasing bone density to reduce the risk of fractures.
  9. Eat plenty of catfish, clams, orange roughy, oysters, salmon, sardines, shrimp, or tilapia. Other fish are less healthy, with shark and swordfish particularly risky.
  10. A little chocolate strengthens heart muscle and relieves heart pain. A lot is still too much fat.
  11. Before your bypass surgery, make sure your husband watches a video that presents an optimistic view, not the full pros and cons, of the recovery process. Wives whose husbands do this return to the hospital 25% less often and have fewer complications.
  12. For the future, tests are under way to evaluate synthetic HDL and drug treatments for the heart-harming FLAP gene, and heart stem cell discovery and research may lead to heart muscle regeneration.

All these steps except the four magic bullets we opened with are simple to follow. Those four magic bullets may require real effort, but millions manage them just fine, and so can you. The motivation for that effort comes from the realization that women with significant heart disease risk are much more likely to lose their quality of life, quite likely life itself, far earlier if they ignore those magic bullets.

Ladies, the vast majority of your heart attacks and strokes are optional. Enlist and accept the help of your family and a good physician in choosing another, far later, way to leave this earth.

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