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Tailor education on heart disease to women
Teach prevention and how to advocate for good care
A one-size-fits-all education about heart disease is not a good strategy, according to Holly Andersen, MD, director of education and outreach at the Ronald O. Perelman Heart Center at New York-Presbyterian Hospital Weill Cornell Medical Center in New York City.
Lessons for women should be different from those for men, because certain information is unique to females, she explains.
While heart disease is the number-one cause of death for both men and women in the United States, every year since 1984, more women have died of cardiovascular health problems than men, according to statistics tracked by the American Heart Association.
Heart disease is more deadly in women, says Andersen. Once a woman is diagnosed, she will be more likely to die from the disease than a man, she adds. Many factors contribute to this. Women are often diagnosed and treated later in the disease process. In addition, treatment methods have been proven in men but may not be as effective in women, she says. Women are treated less aggressively as well, she adds.
To help change the statistics, women need information about prevention; about risk factors that contribute to the development of heart disease; and about how to advocate for the best medical treatment.
"We are pretty good at treating heart attacks but pretty bad as a profession about helping patients in our community practice prevention, which is so important," says Andersen.
Women usually go to gynecologists when they are of childbearing age and get their health care from this specialist. Therefore, Andersen, who is a cardiologist, is working to have gynecologists educate women about screening and prevention of cardiac disease. For example, one in two Hispanic girls will develop diabetes, which can lead to heart disease. So, when they reach child-bearining age, they need to be taught about physical activity and diet, says Andersen. Learning ways to reduce stress and get enough sleep is also important.
"If you educate a woman about prevention, you educate a family," she adds.
In addition, heart disease can be addressed by pediatricians. Just because some young people look fine in spite of a poor diet doesn't mean their food choices are not doing damage, says Andersen.
She recommends that education go beyond the description of a good diet and teach people how to actually put the recommendations into practice. For example, a busy mother not only finds dinner at a fast food restaurant convenient, but inexpensive as well. Women need a solution to this predicament.
Teach risk factors
There are other factors that increase the risk of heart disease in addition to a poor diet, lack of exercise, and stress. Obesity and being overweight increase risk, as does smoking, high cholesterol, and diabetes.
Genetics can play a role, as well. It's important for women to know their family history and how that impacts their risk for heart disease. For example, risk is increased if there is a history of heart disease at a young age within a family, says Andersen.
Although genetics is important, lifestyle changes can improve risk factors. Those who smoke should stop; good, wholesome food should be consumed at mealtime; and physical activity should become a habit. Andersen says that studies show 20 minutes of exercise, five days a week, reduces premature death rates by 50% in both men and women.
Several risk factors are unique to women. For example, certain complications during pregnancy can be an indicator of future cardiovascular disease. Women who have had preeclampsia or gestational diabetes or hypertension should aggressively manage all risk factors for heart disease, says Andersen.
Smoking greatly increases the risk of heart attack for women under the age of 45. The combination of smoking and birth control pills increases a woman's risk by at least twenty-fold, she adds.
Women must become knowledgeable patients, tracking their cholesterol level, blood pressure, glucose level, sleep, and stress. Also, they must know their waist measurement, because a waistline is a good predictor of cardiovascular risk. The fat around the waist is metabolically active and will make a person more insulin resistant, which leads to diabetes. Ideally, women should have a waistline of 29 inches or less, but 33 or 34 inches is OK, says Andersen.
Some women should test for a "silent heart attack." This is a heart attack without pain, but it can cause permanent damage if it causes a long-term shortage of blood and oxygen flow to the heart. Women who are post-menopausal and have at least three risk factors for heart disease should ask their physician for a cardiac stress test, says Andersen.
It's also important for women to learn the warning signs of a heart attack, as well as symptoms leading up to one. Chest pain is the most common symptom for women, but only about 45% experience it. Other symptoms include jaw pain, back pain, sudden fatigue, perspiration, nausea, and indigestion. "The symptoms aren't really that subtle; you know something is going on. I would much rather have someone come in thinking they had a heart attack, and they had a bad case of indigestion, than miss a heart attack," says Andersen.
Yet often women do not call 911 right away when they think they are having a heart attack. In a survey conducted by the American Heart Association, 53% of women who think they are experiencing a heart attack call 911, which means that 47% do not make the call. Yet 88% of the women in the survey said they would call 911 if they thought someone else was having a heart attack.
Typically, people experience warning signs prior to their heart attack, such as a little tightness in the chest while climbing stairs, or feeling winded or more fatigued. Symptoms that come with exertion and go away with rest are heart disease until ruled out, says Andersen.
If a woman is taken by ambulance to the emergency department because she thinks she is having a heart attack, she should ask for an EKG test or an enzyme blood test to check for a heart attack if the medical team does not order one.
Women need to be active in their care, says Andersen. Medical professionals can miss heart attacks in women, so it is important that women know they can make their voice heard and get checked out, she says.
For more information, contact:
Holly Andersen, MD, Director of education and outreach at the Ronald O. Perelman Heart Center at New York-Presbyterian Hospital Weill Cornell Medical Center, New York City. Telephone: (212) 628-6100. E-mail: email@example.com.