Building Women's Heart Health: Interview with Dr. Connie Guttersen

For Heart Health Month, we interviewed Dr. Connie Guttersen on women's heart health.

There has been a greater focus recently on how heart disease impacts women. Unfortunately it remains the number one killer of women. Can you talk briefly about the ways that heart disease impacts women differently from men?

Women not only have more heart attacks that go unrecognized, but also have more repeat heart attacks and a greater risk of stroke after heart attack. The important issue here is that while the numbers of women who are dying of cardiovascular disease is large, few of them realize the risk. More than half of the women who die suddenly have no prior symptoms. Most of these deaths are caused by irregular heart beats. A woman’s heart attack has different symptoms than a man’s. She may not always experience the chest pain / pressure which is typical in men. The list below provides key signs and symptoms which can be different in women.

· Women tend to deny or not recognize symptoms of heart attack
· Some therapies such as thrombolytic drugs and aspirin may be less effective in women
· Psychosocial issues are different for women
· More than half of the women who die suddenly have no prior symptoms
· Pain in the upper back, shoulders, neck and jaw
· Shortness of breath without experiencing chest pains
· Nausea
· Unusual fatigue or mild cold and flu symptoms that worsen with activity, often misdiagnosed as chronic fatigue syndrome.
· Unusual feeling of anxiety, weakness, and dizziness.

By the time the typical symptoms, chest and arm pain pressure, are detected in women, the heart disease has already progressed and may actually signal a heart attack. Educating women about these early symptoms can influence proper medical, nutrition, and lifestyle treatment for better outcomes.

Women also have two to three times the risk of heart disease after menopause. After menopause, estrogen and the levels of high density lipoproteins decrease. It is also a time, where women tend to gain weight – specifically abdominal weight, which is the location that increases the risk of cardiovascular disease and diabetes.

Researchers have learned that gender differences play an important role in the prevention, diagnosis and treatment of CVD. Heart attack symptoms may present differently in women than in men and they may also respond differently to cardiac medications.

· Although chest pain is the most common heart attack warning sign in both men and women, women may be less likely than men to report chest pain during a heart attack and more likely to report other symptoms, often resulting in misdiagnosis and delays in treatment.
· Women tend to develop CVD later in life than men and their outcomes are often worse. An exception is women smokers who die of a heart attack caused by smoking earlier than men.
· Women with acute coronary syndrome are more likely to have adverse outcomes, including death, heart attack, stroke, or rehospitalization, even after adjusting for age differences.
· Previous studies and clinical trials have often been done with inadequate numbers of women in the study population, and thus their conclusions do not always apply to women. Women represent just 38 percent of subjects in NIH-funded cardiovascular studies. In addition; three-fourths of cardiovascular clinical trials do not report sex-specific results, making it difficult for researchers and clinicians to draw conclusions about their effects on women.
· Researchers have identified gender differences in response to cardiac medications. Drugs that are beneficial for men may even be harmful to women. For example, the drug digoxin which used to treat patients with heart failure was associated with an increased risk of death among women but not among men.

What information do women need to have about heart disease?

More women die from heart disease, stroke and other cardiovascular diseases (CVD) than men, yet many women do not realize they are at risk. These diseases kill more women each year than the next five causes of death combined.

How can you recognize that you may be at-risk for heart disease?

Heart attack symptoms in women may be different from those experienced by men. Many women who have a heart attack do not know it. Women tend to feel a burning sensation in their upper abdomen and may experience lightheadedness, an upset stomach, and sweating. Because they may not feel the typical pain in the left half of their chest, many women may ignore symptoms that indicate they are having a heart attack.

Are there differences in heart disease for women of different ethnicities?

· As a group, African Americans have high rates of heart disease, which includes CAD, stroke, high blood pressure, and heart failure.
· More than one quarter of Mexican Americans have some form of heart disease.
· People of South Asian descent are at high risk for heart disease, but people of Japanese descent are at low risk.

We are proponents of Health At Every Size, which focuses on creating healthy lifestyles and not on weightloss as a cure-all. What kinds of lifestyle changes can help protect women against heart disease, regardless of their size?

Women can lower their heart disease risk by as much as 82 percent, by following a healthy diet and lifestyle. These positive changes should begin early in life.

Lifestyle factors that increase heart disease risk are increasingly common among teenagers and young adults. These include smoking, excessive alcohol abuse, consumption of fast food / processed foods, smoking, and physical inactivity. Regardless of age, a healthy diet is an important part of lowering the risk for heart disease. A diet based on fruits, vegetables, whole grains, lean meats, as well as healthy fats is essential. The scientific literature continues to support the role of monounsaturated fats and omega 3 fatty acids as key factors in the overall diet and lifestyle prescription for decreasing cardiovascular disease.

Following a colorful approach to selecting a wider variety of vegetables (especially vegetables that are a vibrant dark green) is a great way to ensure the best combinations of antioxidants and phytochemicals.

What foods are best to protect people from heart disease, and how can we make these a regular part of our diets?

Key Nutrients for Women and their Protection against Risk Factors

Plant sterols, soy, soluble fiber
Reduces cholesterol · Reduces menopause symptoms

Antioxidants: Vitamin C, E, Isolfalvones, Phytochemicals
Inhibits oxidation of Low Density Lipoproteins: Decreases Coronary Heart Disease Risk · Provides a natural boost to the immune system

B Vitamins: Folate, B6, B12
Reduces homocysteine levels which are thought to promote heart attacks and dementia · Protects against colon cancer, breast cancer, and Alzheimer’s disease · Folate is essential for a healthy pregnancy

Calcium, Vitamin D, Magnesium
Maintains healthy bone mass

Flavonoids, omega 3 fatty acids
Prevents stroke and heart attack

Whole Grains and Fiber
Positive effects on blood sugar control and coronary heart disease risk factors

Monounsaturated Fats · At least 25% of total caloric intake
Provides protective role against breast cancer, heart disease, and Alzheimers · Minimize the risk of chronic inflammation: a key risk factor involved in cancer, heart disease, Alzheimer’s Disease and diabetes.

Omega 3 Fatty Acids · A varied intake from plants and seafood
Provides cardiovascular protection, essential for brain function, and provides benefit to mood disorder conditions, improved immune function and response. · These fats minimize the risk of chronic inflammation: a key risk factor involved in cancer, heart disease, Alzheimer’s Disease, stroke, and diabetes

What other health advice can you offer women during heart health month?

Focusing on keeping the waist trim to decrease abdominal fat is a good and easy way to monitor your health. Think about ways to decrease stress through meditation or yoga. These are different types of exercise which can balance higher intensity exercise as well.

Comments

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[Account Deleted]

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By the time the typical symptoms, chest and arm pain pressure, are detected in women, the heart disease has already progressed and may actually signal a heart attack.

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[Bethdjoyce]

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