Women struggle for parity of the heart Women struggle for parity of the heart According to recently published studies in
Circulation, the journal of the American Heart
Association, women are inadequately cared for in
terms of preventing heart disease and in diagnosing
and treating it.
One study, published in the journal in February, was
conducted online among 500 randomly selected
physicians - 300 primary care doctors, 100
obstetrician/gynecologists and 100 cardiologists.
It revealed that women at risk of developing heart
disease were more likely than men to be assigned to a
lower risk category and thus were less likely than
men to receive recommendations to change their living
habits and take medications to help prevent heart
attacks.
Earlier studies have repeatedly shown that when women
with symptoms of heart disease go to doctors, the
significance of their symptoms is often missed or
misattributed to a less serious disorder. Yet, when a
heart attack occurs, women are less likely than men
to survive it - or the postcoronary bypass surgery.
Getting over it
Even women who survive heart attacks are
underrepresented in rehabilitation programmes. A
recent study at the Mayo Clinic shows that women are
less likely than men to participate in postcoronary
exercise and health-improvement programmes.
Among 1,821 men and women studied who had heart
attacks from 1982 to 1998, the women’s participation
rate in rehabilitation programmes - 38 percent -
lagged far behind the men’s rate of 67 percent, the
study found. This in turn increased the women’s risk
of having second and often fatal heart attacks.
Thus, among the men and women who took part in
cardiac rehabilitation programmes, the survival rate
after three years was 95 percent, while the survival
rate for non-participants was only 64 percent.
For much of the 20th century, heart disease was
considered mainly a disease of men middle-aged and
older. For many, especially those who smoked, the
first symptom was sudden death from a heart attack.
Many victims were working men in their 40’s and 50’s
with families that were devastated by the loss.
Much research was done, mostly among men, to identify
risk factors and find ways to control them.
Gradually, the studies revealed that besides smoking,
a person’s risk of a heart attack was increased by
high cholesterol, high blood pressure, Type 2
diabetes and obesity, along with a diet rich in
animal fats and sedentary living.
Further studies (again, mostly among men) showed that
by controlling such factors, the risk of heart
disease and sudden cardiac death could be greatly
reduced. In fact, the era of preventive medicine was
born with the diagnosis and treatment of coronary
risk factors.
But along the way, heart disease in women was sorely
neglected, even though more women than men have died
of cardiovascular disease in the United States since
the mid-1980’s. And while the mortality rate in men
has dropped significantly since 1980, in women the
death rate from this disease has continued to rise
for most of the last quarter century.
Today, cardiovascular disease is the No. 1 killer of
American women. Half a million women die of it each
year, more than the next seven causes combined. If
these deaths were evenly distributed, every minute of
every day, a woman in USA would die of heart disease.
Heart disease in women tends to become apparent about
10 years later than in men. The risk to women
generally remains low until after menopause, a
pattern that fostered the belief, now known to be
untrue, that taking postmenopausal hormones would
continue to protect women’s hearts. By age 75 and
beyond, the percentage of women with diagnosed heart
disease exceeds that of men. The same pattern applies
to heart disease deaths.
Knowing your numbers
To Dr. Lori Mosca, director of preventive cardiology
at New York Presbyterian/Columbia hospital, these
data scream out a critically important message.
Women, she says, “must know their numbers, including
their blood pressure, cholesterol, glucose levels and
body mass index, as well as their overall risk level
for heart disease.”
She adds that women also must “take charge” and not
rely on their doctors to order the tests that can
provide them with the data that may suggest a need to
change their habits or to get protective medication.
Doctors should routinely check a patient’s blood
pressure, no matter what the reason for the medical
visit. High blood pressure is on the rise in America,
thanks to expanding waistlines. A reading of 120 over
80 or lower is ideal. Losing excess weight, reducing
dietary salt and exercising regularly can help. If
necessary, dozens of pressure-lowering prescription
drugs are available.
And no matter what kind of doctor a woman sees on an
annual basis, she can request that her blood be
completely analysed for cholesterol and
triglycerides. Women, as well as men, should strive
for a level of damaging L.D.L. cholesterol no higher
than 100 milligrams per decilitre and a level of
protective H.D.L. cholesterol of 50 or higher.
Making Good choices
A healthy triglyceride level is under 150 milligrams
per decilitre.
If adopting a diet low in saturated fats and
exercising regularly cannot by themselves achieve
these goals, medication may be in order.
A minimum of 30 minutes a day of moderately intense
physical activity on most days, and preferably all
days, is the current recommendation for those seeking
a healthy heart.
As for diet, a healthy eating pattern includes a
variety of fruits, vegetables and whole grains, along
with low-fat or non-fat dairy products, fish, dried
beans and peas (cooked, of course). Lean meats and
poultry may also be included. As much as possible,
avoid trans fats, which are found in most processed
foods that contain hydrogenated vegetable oils.
For those who will not or cannot eat fish, a
supplement of omega-3 fatty acids is considered
beneficial.
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