January/February 2005

But I Feel Fine

Heart disease kills women, too—even young ones

by Karen Haywood Queen

Quick: what’s the number one killer of women? Nope, not breast cancer. What many women don’t know is that it’s trouble with the heart beating behind those 36-Cs that’s more likely to kill us.

Heart disease, at 192 deaths per 100,000, is the leading cause of death among women. That’s compared to all cancers, at 168 deaths per 100,000, and breast cancer at about 27 deaths per 100,000, according to the women’s Health and Mortality Chart Book developed by the Centers for Disease Control and Prevention and the U.S. Department of Health and Human Services Office on Women’s Health. The death rates from heart disease among Virginia women were in line with the national rates at about 200 deaths per 100,000.

“A lot of women are under the impression that breast cancer is the number one killer, but really it’s cardiovascular disease,” says Terrina Thomas, director of community health and prevention at Sentara Health Care.

Heart attacks aren’t the only problems caused by heart disease. Hardening of the arteries, medically called atherosclerosis, occurs when the inner walls of the arteries become narrower due to a build up of cholesterol plaque. The constricted arteries allow less blood to get through, which can lead to heart attacks, strokes and pain in parts of the body that aren’t getting enough oxygen. A heart attack happens when a blood clot blocks an artery feeding the heart. A stroke happens when a blood vessel that feeds the brain gets clogged or bursts. Heart failure means the heart continues to work but isn’t pumping blood as well as it should.

Many women feel protected from heart disease, erroneously believing it’s just a man’s problem, says Dr. Carl Hartman of Cardiovascular Associates in Chesapeake. They make sure their husbands get checked, but don’t worry about themselves.

It’s true that women are less likely to suffer from heart disease or stroke before menopause, possibly because of natural estrogen released until then. In fact, coronary heart disease rates in women of the same age are two to three times higher for those who have gone through menopause. But none of us are in the clear. Even though women are at a higher risk of heart disease after menopause, young women are at risk too. Be aware of the risk factors, warning signs and the lifestyle issues you can control. Even if you’re already had a heart attack, it’s not too late to start decreasing the risk of the next one.

“It used to be when I was going through training, they used to say pre-menopausal women were not at risk,” says Keith Newby, M.D. of Cardiology and Arrhythmia Consultants in Norfolk. “I’m seeing women younger and younger now with heart problems. I’ve had women as young as 30 year old with major heart attacks. A lot of women just die. They’re not discovered to have heart disease because they’re not looking for it.”

Says Hartman, “It tends to be more delayed in women. It shows up about 10 years later than it does in men. But that doesn’t mean, however, that it can’t show up in younger women. We see that fairly frequently.”

The word is finally starting to get out, Newby says.

“What I’ve found is that the groups of women who are slightly more educated will typically have their situations evaluated earlier,” Newby says. “They are listening to the news and hearing about it. Unfortunately, the people who are a little less educated may not be as aggressive to get themselves evaluated sooner. It’s hard to get them that information. Where do you begin to start to try to educate them? I’ve done a lot of talks at local churches.”

A heart attack doesn’t always happen like it appears on television for men or women.

“On television, you see people grab their chest,” Thomas says.

But symptoms of a heart attack may include trouble breathing, getting tired when you do something that used to be easy, heartburn or nausea not associated with something you’ve eaten, or persistent chest pain. The pain could be in the upper abdomen—not the chest. Women are more likely than men to have atypical heart attack symptoms such as shoulder pain, abdominal pain, nausea and vomiting, fatigue and shortness of breath, according to the website medicinenet.com.

“If any of those things go on for more than 10 minutes, you need to call 911,” Thomas says.

Who’s especially at risk?

• Those who have a family history of heart disease
• People who have high blood pressure (hypertension)
• Those who have high blood cholesterol
• Smokers
• People who are overweight
• Those who don’t exercise more than three times a week

Diabetes poses a significant risk. One study found that diabetics were as likely to have a heart attack as were people who had already suffered a heart attack. Diabetics also are likely to already have several of the risk factors listed above such as high blood pressure, high blood cholesterol and obesity.

Other risks include taking birth control pills, drinking more than one drink every day and using illegal drugs, according to the American Heart Association (www.americanheart.org).

Controlling your risks is the key to getting better. And not everything can be fixed with medication or a visit to the doctor.

“The biggest thing is, it has to start with the patient,” Newby says. “They have to know they can’t lead a lifestyle that most of them lead. Obesity is a major problem in this country and in this area. That by itself leads to significant incidence of heart disease and stroke. People need to eat properly, keep their weight down, and make their doctors’ appointments. Those to me are the main things to really convey. It has to boil down to prevention. Once the disease has taken hold, yes, you can improve situations, but why wait till the horse is out of the barn? If you can prevent it, that saves heart muscle, which subsequently equates to a longer, healthier life.”

Waiting until you feel bad may be too late. Heart disease is often a silent killer with few symptoms.

“When people feel fine, they don’t want to have things evaluated,” Newby says. “[People think] ÔI know I’m overweight. I know I have hypertension. I’m diabetic, but I feel fine.’ When people feel fine, they don’t have any urgency to do anything. They don’t understand that feeling OK doesn’t mean everything. It takes a fair amount of artery blockage for symptoms to occur. You’re going to be walking around with 50—60 or 70 percent blockages and not know you have it.”

Sentara conducts health screenings for its own employees and at other sites such as the Portsmouth Community Center and many people are surprised at the results, Thomas says.

“A lot of times they don’t know if their blood pressure is at a dangerous level until they sit down in one of our chairs,” Thomas says. “When we sit down with people and say ÔYou have this going on,’ their jaw goes down. They call it the silent killer and that’s why. By the time you have symptoms, you have some really serious disease going on. These hypertension folks, they’re the scariest of all. They woke up that morning and wee going about their business and they’re just a heart attack or a stroke waiting to happen. Sometimes we’ve gotten on the phone and made arrangements right then and there, had their husbands come and pick them up and take them to the hospital.”

Many women already schedule their annual mammogram on their birthdays so they won’t forget, Thomas says. She recommends they schedule a physical then, too, so that the physician can evaluate their risks and give them the lifestyle changes lecture they need to improve their health, Newby says.

People over 55 with two or more of the risk factors should have a stress test as part of their physical, Hartman says. “If you pass your first one, maybe you don’t need another one for five years,” he says.

Physicians are better educated now about women and heart disease, but some still may not recognize a women is having a heart attack or may cling to the notion that women aren’t at significant risk. In medical terms, that’s called an index of suspicion. That’s when women need to speak up—whether they are in the emergency room with chest pains or at their physician’s office for that annual physical.

“That patient empowerment—the woman knowing and insisting on treatment when she’s in the physician’s office or in the ER—that’s one of the strong things women need to be doing,” Thomas says.

Says Hartman, “Because the index of suspicion in women is lower, particularly younger women, people tend to look for other reasons for that discomfort. The index of suspicion needs to be raised because traditionally people have felt both in the medical profession and the public that it was unlikely for women to develop heart disease.”

Physicians were happy to provide success stories—patients who have changed their lives after being diagnosed with heart trouble. But not enough people heed the lecture from their physician. Of course, some don’t see their physician at all.

“Unfortunately, I have more failures than I have successes,” Newby says. “No matter how many heart attacks they have, they just don’t get it. That’s the scary thing—when you continue to do the things that got you in the pickle in the first place and you haven’t learned anything. That’s the unfortunate reality. A lot of people don’t take responsibility for their own health care and then get mad at us when we do. I can’t police what you eat every day. I can’t do it all. I can just tell you the tools you need to improve your own health.”

Symptoms of a heart attack: If you have one or more of these symptoms, don’t wait more than five minutes before calling 911:

• Chest pain
• Fullness and/or squeezing sensation in the chest
• Pain or discomfort in one or both arms, back, new, jaw or stomach
• Shortness of breath
• Nausea, vomiting and/or upper abdominal discomfort
• Sweating
• Heartburn and/or indigestion

Heart attacks can occur at any time, but most occur between 4 a.m. and 10 a.m. because adrenaline levels in the blood are higher then.

What is a heart attack?

• A heart attack—in medical terms, myocardial infarction—is the death of heart muscle that occurs when a blood clot suddenly blocks a coronary artery.

Symptoms of heart failure

• Swelling in the feet, ankles and legs
• Fluid buildup in the lungs

Women, Hormones and Heart Disease

It’s true that women are less likely to suffer from heart disease or stroke before menopause. When looking at coronary heart disease rates in women of the same age, those who have gone through menopause have rates two to three times higher than those who have yet to experience the joys of hot flashes. That may be because of the loss of natural estrogen as women age, the American Heart Association says. But taking hormone replacement therapy doesn’t help. In 2002, the National Heart, Lung and Blood Institute stopped a study of post-menopausal hormone replacement therapy after the trial showed that estrogen plus progestin increased the risk of breast cancer and blood clots and, instead of protecting women from heart attack and stroke, actually led to a higher risk of heart attack and stroke.

The Lowdown on Blood Pressure

You’d think someone who worked in a hospital would know better.

But Anita Mozgai, a registered nurse and coordinator of the Health Edge screening program for employees at Sentara Nursing Center-Currituck N.C., was just as surprised at her blood pressure results as someone walking in off the street might be.

“I had been coordinator of the program for about a year and it was almost offhand—ÔLet’s do mine now,’” Mozgai says. “I had no symptoms. The nurse took my blood pressure and she kind of looked at me and asked me if I had high blood pressure. I said, ÔI have very low blood pressure.’”

She did recall having her blood pressure taken at her previous job, a high stress medical facility in New Jersey, and being told it was high.

“I had gotten promoted to this horrible job and I think it was a combination of the stress from that position,” Mozgai says. “I spent a lot of years working, raising a family and going to school. The last important item on my agenda was me. I certainly made sure my husband went every year. But it had been a couple of years since I had gone [to a doctor].”

She just pooh-poohed the numbers that day in New Jersey because she had been running around a lot. And after all, she knew her blood pressure was low, say 110 over 70.

Not anymore.

She couldn’t ignore it this time. Her reading at the screening in Currituck was 140 or 150 over 100. Her blood pressure registered high again in a follow-up visit to her physician. Those readings reflect stage one hypertension—high blood pressure. Normal blood pressure is equal to or less than 120 over 80.

“It was like a kick in the stomach. ÔThat can’t possibly be me,’” she thought. “When you have high blood pressure, you have no symptoms, you feel fine. I have no idea how long it was up.”

It’s not up now. Mozgai takes daily medication to lower her blood pressure and she’s doing fine.

Untreated, high blood pressure can lead to heart disease, stroke, heart attack, retinal disease, heart failure and/or kidney failure, says Keith Newby, M.D., of Cardiology and Arrhythmia Consultants in Norfolk.

“Don’t you think I should know better?” Mozgai asks. Now she does.

-K.H.Q.

Scared Skinnier (Not Stiff)

Margaret Sivels’ doctor didn’t have to tell her to lose weight. She knew 290 pounds was way too much for her four-foot-five-inch frame. She suffers from congestive heart failure, angina, high blood pressure, asthma, diabetes and numbness in her hands and toes from diabetes. About five years ago, her heart and lungs collapsed and she went into cardiac arrest. Since then, she’s had several mild heart attacks. Then there’s the stress of raising six of her grandchildren (her daughter died in 2001) ages 6 to 20 in a three-bedroom home. She’s been trying to get help to get a bigger home, but so far no luck.

At 54, she could check off several of the heart attack risk factors—prior heart attacks, diabetic, high blood pressure, obesity and stress. She’s been on disability since the cardiac arrest.

“He didn’t have to tell me; I knew I needed to lose weight,” says Sivels, who lives in Norfolk. “At night time, I had to sit up. I couldn’t lay down. I was having a lot of problems with my heart. I had to use a cane to go everywhere. I was just going to the store, buying all chocolates—just eating a lot of stuff I shouldn’t be. I said ÔDoctor Newby, I have to do something.’ I had tried that stomach stapling when it first came out, but it didn’t help.”

Her doctor started to tell her about the Atkins diet and the South Beach diet. Mrs. Sivels didn’t care much for those ideas—she knew what she needed to do.

“I’ve always been a little heavy,” she says. “At one time, I just went overboard eating sweets and chocolates. Now, it’s no bread, no sugar, no starch and no fried food. I don’t eat sweets or chocolates—not unless my sugar gets real low. I stopped drinking sodas; I was consuming four or five sodas a day. I went full-fledged without eating bread and starch. I don’t mess with any bread.”

Asked about her favorite food and the twinkle in her eyes even comes across the phone line. “You know what it was—fried chicken,” she says. “And I’m a cook, too.”

But she was willing to give up her favorite foods for a higher cause—improving her heart and overall health so she raise her grandchildren.

“My purpose from God is to raise these children and I was willing to give up all that so I can,” she says. “I am going to continue eating like I am now. I’m not going back to frying a lot of food every day and eating lots of sweets. The more sweets you eat, the more insulin you have in your body.”

The result? She lost at least 30 pounds, and counting, in 2004. Now she can walk without a cane and has begun a walking circuit in her home to keep fit. Her blood sugar levels have dropped by about half—a good sign. She doesn’t get out of breath so easily, nor does she have to take as many home asthma treatments. Her blood pressure is down as is her dress size. Her goal is to lose 40 to 45 pounds by her birthday, Jan. 8.

“I was wearing a dress size that was 38 or 40,” she says. “Everything I bought was real big. I can get into a size 22 now and I’m working to get into an 18 or a 20. I can tell I’ve lost weight because my clothes are hanging off my shoulders.”

Buying new clothes one day will be a nice treat, but the important thing is her health, she says.

“All I know is, it’s better for me,” she says simply.

-K.H.Q.