Get a Hold On Your Heart

A sleek, sultry women in her 40s or 50s glides from the door of her limo over the red carpet entrance – only to trip and stumble embarassingly in front of her adoring crowd. The message of this advertising campaign from a few years back: even a person’s shining outward appearance can belie some uglier inner truths (in this case, the truth was high cholesterol.)

But really – once we got over the schadenfreude, that feeling of secret happiness in someone else’s folly – did we go from watching the lovely lady tumble to making health-promoting changes in our lifestyles? For younger women especially, high cholesterol and other elements of heart disease seem primarily a problem for older women, obese women, and just generally someone else.

The stats – phenomenally powerful facts, though they are — can be eye-glazing:

• Heart disease is the Number 1 killer of American women

• One in four women dies of heart disease

• Some heart disease risk factors have greater impact on women than men

• Women are more likely than men to die from heart disease

Pamela Morris, MD, Director of Preventive Cardiology and Co-director of Women’s Heart Care at the Medical University of South Carolina, says that waking audiences up has been a big part of her job as a physician, public speaker, and Assistant Professor of Medicine.

“It’s really hard to time and time again make some of these messages fresh and interesting. It’s interesting to me what a remarkable job the breast cancer research campaigns have done in capturing the minds of women. Not that breast cancer isn’t important, but you’re ten times as likely to die from heart disease as you are from breast cancer.”

In fact, one 2005 survey by the Society for Women’s Health Research revealed that while increasing numbers of women are starting to be concerned about their risk of heart disease, most still fear cancers (of the breast, ovaries, and lungs, respectively) more than heart disease.

Dr. Morris offers this quote from women’s health advocate Nanette Wenger, MD, Chief of Cardiology at Grady Memorial Hospital, Emory University School of Medicine: “The community has viewed women’s health almost with a ‘bikini approach’, looking essentially at the breasts and reproductive system, and almost ignoring the rest of the woman as part of women’s health.”

Suzanne Steinbaum, D.O., Director of Women and Heart Disease of the Heart and Vascular Institute of Lenox Hill Hospital in New York City, ventures, “I don’t believe people need to get sick from heart disease.  There are so many ways to prevent it. You can make changes before there’s muscle damage to the heart. This is a lifestyle management issue that can be addressed holistically.”

In most cases, you don’t just wake up one day with a full-blown case of disease, whether it’s cancer or heart disease. Plaque build-up, or atherosclerosis, has formed in our arteries – and this can be one of those points of information that depresses readers into shrugging with resignation – by our late teen years. The process from there to symptoms – whether that’s high blood pressure, chest pains, or heart attack – generally takes a long slow route.

Studies are now showing us numerous connections between young women and heart disease. Deaths from coronary heart disease among women ages 35 to 44 have been rising each year, to the point that experts are tremendously worried. Very few of us have no risk factors.

Dr. Steinbaum reports, “It’s so common to think of heart disease as a condition of older women, but I see women in their 30’s.”

So if you’re in your 40’s or older now, looking back on your average life filled with fast food, severely limited physical activity, or cigarette smoking, is it time to simply hang it up and hope for the best while waiting for the worst?

No. Dr. Steinbaum asserts, “We know that 80 percent of the time people have developed heart disease due to modifiable risk factors – high blood pressure, high cholesterol, diabetes, or smoking. These things are generally under our control. It’s the number one killer, but if you’re proactive and do things differently, can not have it.”

That includes those of us who might think it’s too late to modify. Frankly, heart attacks rarely occur in someone who does not have adverse cholesterol, high blood pressure, smoking, or diabetes.

Dr. Morris explains, “It’s like the old cholesterol myth; we once didn’t start people on medication for high cholesterol when they were in their 70’s. Now we have indications that their benefits from treatment can sometimes even be more pronounced than in younger people.”

Steinbaum brings in the single woman link – something that she feels is particularly timely because of recent research findings. More women than men are dying of heart disease, and women are being diagnosed with the condition younger.

Most recently, a large study revealed that oral contraceptives (OC) appear to be a major cause of significantly increased levels of C-reactive protein (a strong indicator of higher heart disease risk) and more prevalent atherosclerosis in otherwise healthy young women. While some experts say that it’s not quite time to toss out your birth control pills – earlier study subjects were using much higher dosages OC, plus pregnancy has its own health consequences – they do agree that this information should give gynecologists and primary care doctors an opportunity to talk about how their patient’s choices today will affect their tomorrows.

Another note that single women need to hear – a British study published in 2007 added to the growing body of reports that bad relationships can boost your heart disease risk. Specifically, “people who experienced negative aspects of a close relationship had a 34% higher risk of incident coronary events than those who did not.” The connection is believed to be between emotional effects and changes in the neuroendocrine, inflammatory, and immunomodulatory systems.

“We know that stress is a huge part of this,” Steinbaum says, “as we look at how women’s roles have changed drastically over time, and parallel that with the Framingham Risk Analysis long-term survey that began decades ago to look at factors leading to heart disease.”

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