Maintaining Your Health on Mackinac
One of Every Three Women Will Be Affected by Heart Disease
By Yvan Silva, M.D.

Breast cancer is the disease most women fear. The statistic that one in every eight women will develop breast cancer in her lifetime has become fixed ominously in the lexicon of women's health issues. But a significant spate of recent scientific studies has modified this perception. Indeed, heart disease kills more women every year than breast cancer, ovarian or uterine cancer, stroke, and HIV combined. The statistics are staggering. Heart disease strikes one out of every three women; more than 500,000 women die in the United States each year of cardiovascular disease, while 40,000 do so from breast cancer. Yet the public's perception continues to thrive that heart disease strikes men predominantly.

The American Heart Association recently found that over the past two decades, the number of men who succumbed to heart disease fell from 510,000 to 440,000, presumably owing to better prevention, diagnosis, and treatment methods, while the number of women who died annually

rose from 490,000 to 510,000. It is estimated that 6.4 million women in the U.S. have heart disease. In a recent study, 58% of women who were dissatisfied with their medical care blamed their doctors for not knowing the significance of this issue. Indeed, in a 1999 national survey of doctors, only 55% correctly identified heart disease as the greatest health risk for women older than 50.

The differences between women and men, in this regard, are rapidly emerging, and require emphasis. It is not entirely true that hormones play a protective role in premenopausal women, although women are usually affected in their 60s, while men first develop symptoms a decade earlier. Heart attacks strike 9,000 women younger than 45 each year. For reasons that are not clear, cardiovascular disease is more fatal in women than men, leaving women more severely disabled with congestive heart failure and stroke. Studies are underway to define the subtle differences in how women's cardiovascular systems respond to stress, hormones, excess dietary fat, and cholesterol control, and the ill effects from smoking and alcohol consumption. Pre-menopausal women do not often have heart attacks, while postmenopausal women become more vulnerable than men. Smoking is believed to increase the risk of heart disease more significantly than men. The signs of an oncoming heart attack may differ between the sexes. The common symptoms of chest pain, a crushing sensation in the chest and shortness of breath, do occur in women as well as in men; however, atypical symptoms of nausea, dizziness, and pressure between the shoulder blades may occur more frequently in women. In many women, the first heart attack is fatal because previous symptoms and risk factors were ignored.

The current initiative is to educate women that, as in men, lifestyle modifications of a healthy diet, regular physical exercise, management of high blood pressure, and cholesterol lowering drugs are vital. Smoking is the most dangerous killer for both sexes; diabetes, high blood pressure, high cholesterol, excess weight, and inactivity relate to both sexes. Women are more often overweight than men, appear to be affected more adversely by stress, and are less likely to exercise.

The National Heart, Lung and Blood Institute has solicited the help of several well known individuals. First Lady Laura Bush has been quoted as saying, "Women take care of all the people in the family - their children, their husbands - but they sometimes don't take care of themselves." The goals of a recent campaign are to make sure that women know that heart disease is the No. 1 killer for their gender, and that they can change their lifestyles to prevent it.

To summarize: Only 8% of women in the U.S. know that heart disease is their No. 1 killer, a greater threat than any cancer. A women has a 50% chance of dying from her first heart event, while the chance for a man is 30%. Of the women who survive the first heart attack, 38% will die within a year, compared with 25% of men. Heart failure disables 46% of women after a heart attack, and 22% of men.

The practical aspects gained from this information? See your doctor regularly and discuss the issues relating to high risks for heart disease. Do not use tobacco. Maintain a healthy weight balanced with a program of regular exercise, 30 minutes a day for most days of the week. Eat a healthy diet with at least five servings of fruits and vegetables a day. Maintain compliance with your management of diabetes, high blood pressure, and high cholesterol. While this appears daunting, the fact remains that heart disease in women can be prevented, and that attention to the possibility of heart attack by early recognition and treatment is very effective, especially with the latest technological advances.

Dr. Silva is a professor of surgery at Wayne State University and a resident of Woodbluff on Mackinac Island.