Women and Heart Attacks---Make the Call!
Posted by on March 28, 2011 - 8:37am

A woman suffers a heart attack every 90 seconds in the United States. Yet according to a 2009 American Heart Association survey only half of women indicated they would call 9-1-1 if they thought they were having a heart attack and few were aware of the most common heart attack symptoms.

The Make the Call. Don't Miss a Beat. campaign is a national public education campaign that aims to educate, engage, and empower women and their families to learn the seven most common symptoms of a heart attack and encourage them to call 9-1-1 as soon as those symptoms arise.

The first step toward surviving a heart attack is learning to recognize the symptoms. The campaign, developed by the U.S. Department of Health and Human Services' Office on Women's Health, encourages woman to make the call to 9-1-1 immediately if they experience one or more of the heart attack symptoms listed below. The most common signs of heart attack in both women and men are:

Unusually heavy pressure on the chest, like there's a ton of weight on you
Most heart attacks involve chest pain or discomfort in the center or left side of the chest. It usually lasts for more than a few minutes or goes away and comes back. It can feel like uncomfortable pressure, squeezing, fullness, or pain. It may even feel like heartburn or indigestion.

Sharp upper body pain in the neck, back, and jaw
This symptom can include pain or discomfort in one or both arms, the back, shoulders, neck, jaw, or upper part of stomach (not below the belly button). Pain in the back, neck, or jaw is a more common heart attack symptom for women than it is for men.

Severe shortness of breath
This symptom can come on suddenly. It may occur while you are at rest or with minimal physical activity. You may struggle to breathe or try taking deep breaths. Shortness of breath may start before or at the same time as chest pain or discomfort, and can even be your only symptom.

Cold sweats, and you know it's not menopause
Unexplained or excessive sweating, or breaking out into a "cold sweat," can be a sign of heart attack.

Unusual or unexplained fatigue (tiredness)
Sudden and unusual tiredness or lack of energy is one of the most common symptoms of heart attack in women, and one of the easiest to ignore. It can come on suddenly or be present for days. More than half of women having a heart attack experience muscle tiredness or weakness that is not related to exercise.

Unfamiliar dizziness or light-headedness
Unlike in the movies, most heart attacks do not make you pass out right away. Instead, you may suddenly feel dizzy or light-headed.

Unexplained nausea (feeling sick to the stomach) or vomiting
Women are twice as likely as men to experience nausea, vomiting, or indigestion during their heart attack. These feelings are often written off as having a less serious cause. Remember, nausea and vomiting may be signs that something is seriously wrong, especially if you have other symptoms.

If you have any one of these symptoms and it lasts for more than five minutes, call 9-1-1 for emergency medical care. Even if your symptoms go away in less than five minutes, call your doctor right away—it could be a sign that a heart attack is coming soon. Don't waste time trying home remedies or waiting for the feelings to pass on their own. Remember, quick treatment can save your life.

 

Peripheral Artery Disease Harder on Women
Posted by on February 7, 2011 - 5:46pm

Women with peripheral artery disease (PAD)  lose ability to walk short distances and climb stairs sooner than men.

Peripheral arterial disease occurs when plaque  builds up in the arteries that carry blood to your head, organs, and limbs. Plaque is made up of fat, cholesterol, calcium, fibrous tissue, and other substances in the blood.When plaque builds up in arteries, the condition is called atherosclerosis. Over time, plaque can harden and narrow the arteries. This limits the flow of oxygen-rich blood to your organs and other parts of your body.  PAD usually affects the legs, but also can affect the arteries that carry blood from your heart to your head, arms, kidneys, and stomach. This article focuses on PAD that blocks arteries going to or in the legs.

Small calf muscles may be a feminine trait, but for women with PAD they’re a major disadvantage. Researchers at Northwestern Medicine point to the smaller calf muscles of women as a gender difference that may cause women with PAD to experience problems walking and climbing stairs sooner and faster than men with the disease.   The study was published in the February 2011 issue of the Journal of the American College of Cardiology.

Peripheral artery disease affects eight million men and women in the United States. The disease causes blockages in leg arteries, and patients with PAD are at an increased risk of having a heart attack or stroke, said Mary McDermott, M.D., professor of medicine and of preventive medicine at Northwestern University Feinberg School of Medicine and physician at Northwestern Memorial Hospital.

McDermott and a team of researchers observed 380 men and women with PAD for four years, measuring their calf muscle characteristics and leg strength every year. Oxygen is needed to fuel calf muscles, and blockages in leg arteries prevent oxygen from reaching the calf muscles of people with PAD.

The researchers also tracked whether or not the patients could walk for six minutes without stopping and climb up and down a flight of stairs without assistance every year.

“After four years, women with PAD were more likely to become unable to walk for six minutes continuously and more likely to develop a mobility disability compared to men with the disease,” said McDermott, lead author of the study. “When we took into account that the women had less calf muscle than men at the beginning of the study, that seemed to explain at least some of the gender difference.”

Interestingly, men in this study experienced a greater loss of calf muscle annually than the women. But the men had more lower extremity muscle reserve than the women. That may have protected men against the more rapid functional decline women experienced.   “We know that supervised treadmill exercise can prevent decline, so it’s especially important for women with PAD to get the diagnosis and engage in walking exercise to try and protect against decline,” McDermott said.

Source:   Erin White, Northwestern NewCenter

February is Women's Heart Month
Posted by on February 6, 2011 - 3:45pm

In celebration of  Women's Heart Month, the Institute for Women's Health Research featured heart disease in women in its February E-newsletter.    To view this free newsletter, click Heart Disease in Women Enewsletter.

High Power Jobs Can Stress Women's Hearts
Posted by on December 20, 2010 - 2:51pm

Women who report having high job strain have a 40 percent increased risk of cardiovascular disease, including heart attacks and the need for procedures to open blocked arteries, compared to those with low job strain, according to research presented at the American Heart Association's Scientific Sessions 2010.

In addition, job insecurity -- fear of losing one's job -- was associated with risk factors for cardiovascular disease such as high blood pressure, increased cholesterol and excess body weight. However, it's not directly associated with heart attacks, stroke, invasive heart procedures or cardiovascular death, researchers said.    Job strain, a form of psychological stress, is defined as having a demanding job, but little to no decision-making authority or opportunities to use one's creative or individual skills.

"Our study indicates that there are both immediate and long-term clinically documented cardiovascular health effects of job strain in women," said Michelle A. Albert, M.D., M.P.H., the study's senior author and associate physician at Brigham and Women's Hospital, Boston, Mass. "Your job can positively and negatively affect health, making it important to pay attention to the stresses of your job as part of your total health package."

Researchers analyzed job strain in 17,415 healthy women who participated in the landmark Women's Health Study. The women were primarily Caucasian health professionals, average age 57 who provided information about heart disease risk factors, job strain and job insecurity. They were followed for more than 10 years to track the development of cardiovascular disease. Researchers used a standard questionnaire to evaluate job strain and job insecurity with statements such as: "My job requires working very fast." "My job requires working very hard." "I am free from competing demands that others make."

The 40 percent higher risks for women who reported high job strain included heart attacks, ischemic strokes, coronary artery bypass surgery or balloon angioplasty and death. The increased risk of heart attack was about 88 percent, while the risk of bypass surgery or invasive procedure was about 43 percent.

"Women in jobs characterized by high demands and low control, as well as jobs with high demands but a high sense of control are at higher risk for heart disease long term," said Natalie Slopen, Sc.D., lead researcher and a postdoctoral research fellow at Harvard University Center on the Developing Child in Boston.

Previous research on the effects of job strain has focused on men and had a more restricted set of cardiovascular conditions. "From a public health perspective, it's crucial for employers, potential patients, as well as government and hospitals entities to monitor perceived employee job strain and initiate programs to alleviate job strain and perhaps positively impact prevention of heart disease," Albert said.

Source:   American Heart Association (2010, November 15). ScienceDaily.

The Chemistry and Mystery of Red Wine
Posted by on November 29, 2010 - 1:01pm

Two scientific articles in the July 2010 issue of American Journal of Clinical Nutrition shed more insight on the chemistry of red wine that may explain why more doctors are suggesting that a little red wine may be heart-healthy.  Both articles focus on resveratrol, a chemical compound found in certain plants. It is called a phytoalexin because plants naturally produce it as an antibiotic substance to fight both bacteria and fungi. Plants containing resveratrol include the grapes and skins of grapes that produce wine, raspberries, mulberries, blueberries and cranberries.  There is growing evidence that resveratrol plays a role in plaque development, fatty tissue growth, and other biological mechanisms that impact the cardiovascular system.

In the first article by Fischer-Posovszky et al reported that resveratrol influences adipose (fatty) tissue mass.   Laboratory tests on human cells in vitro showed that resveratrol  blocked immature fat cells from developing and differentiating affecting the fat cells' ability to function.  These findings indicate that resveratrol might interfere with obesity and other metabolic effects that  could increase the risk of cardiovascular disease.

In the second article, Hamed et al studied the effect of moderate red wine consumption on vascular endothelial function. Endothelial progenitor cells (EPC) are bone marrow-derived cells that are mobilized by the peripheral circulation when vascular repair is needed (e.g., peripheral arterial disease).  In this study, 14 volunteers consumed 250 mL (little more than 8 ounces) of red wine daily for 21 consecutive days.   The researchers reported an improvement on vascular endothelial function.

According to an editorial in the same journal, these findings may suggest that moderate wine consumption provides cardiovascular protection.  However, these findings also raise further questions about whether red wine (resveratrol) can reverse or attenuate established heart disease.    Human clinical trials are needed to substantiate these findings.

While we recognize the concerns about alcohol addiction, a surprising number of reports have come out in favor of moderate red wine drinking.  In fact, a recent report suggested that a periodic glass of wine during a normal pregnancy may be helpful to the mother.   It's hard for a layperson to determine what is hype and what is true.  I recently came upon a website run by the Institute on Lifestyles and Health at Boston University that critiques many of the studies that discuss the benefits and risks of alcohol.   It's web site can be found HERE.

Is Heart Disease Genetic Destiny or Lifestyle?
Posted by on November 22, 2010 - 11:13am
CHICAGO --- Is cardiovascular health in middle age and beyond a gift from your genes or is it earned by a healthy lifestyle and within your control?Two large studies from Northwestern Medicine confirm a healthy lifestyle has the biggest impact on cardiovascular health. One study shows the majority of people who adopted healthy lifestyle behaviors in young adulthood maintained a low cardiovascular risk profile in middle age. The five most important healthy behaviors are not smoking, low or no alcohol intake, weight control, physical activity and a healthy diet. The other study shows cardiovascular health is due primarily to lifestyle factors and healthy behavior, not heredity.

“Health behaviors can trump a lot of your genetics,” said Donald Lloyd-Jones, M.D., chair and professor of preventive medicine at Northwestern University Feinberg School of Medicine and a staff cardiologist at Northwestern Memorial Hospital. “This research shows people have control over their heart health. The earlier they start making healthy choices, the more likely they are to maintain a low-risk profile for heart disease.”

Why Many Healthy Young Adults Become High Risk

The first Northwestern Medicine study investigated why most young adults, who have a low-risk profile for heart disease, often tip into the high-risk category by middle age with high blood pressure, high cholesterol and excess weight.  The unhealthy shift is the result of lifestyle, the study found. More than half of the young adults who followed the five healthy lifestyle factors for 20 years were able to maintain their low-risk profile for heart disease though middle age. (The five healthy lifestyle factors are not smoking, low or no alcohol intake, weight control, physical activity and a healthy diet.)

“This means it is very important to adopt a healthy lifestyle at a younger age, because it will impact you later on,” said Kiang Liu, lead author of the study and a professor of preventive medicine at the Feinberg School.

There are big benefits to reaching middle age with a low-risk profile for heart disease. These individuals will live much longer, have a better quality of life and generate lower Medicare bills. A low-risk profile means low cholesterol, low blood pressure, no smoking, no diabetes, regular physical activity, a healthy diet and not overweight.

The study followed 2,336 black and white participants, ages 18 to 30 at baseline, for 20 years. Researchers tracked participants’ diet, physical activity, alcohol consumption, smoking, weight, blood pressure and glucose levels at the baseline year, year seven and year 20. The participants are part of the CARDIA (Coronary Artery Risk Development in Young Adults) multi-center longitudinal study sponsored by the National Heart, Lung and Blood Institute.

After 20 years, the prevalence of a low-risk profile was 60 percent for participants who followed all five healthy lifestyle factors, 37 percent for four factors, 30 percent for three factors, 17 percent for two and 6 percent for one or zero. The results were similar for men only, women only, black only and white only.

“From a public health point of view, this shows we should put more emphasis on promoting a healthy lifestyle in young adulthood,” Liu said. “We need to educate and encourage younger people to do this now, so they’ll benefit when they get older.”

Tracking Three Generations of Families for Cardiovascular Health

The second Northwestern Medicine study examined three generations of families from the Framingham Heart Study to determine the heritability of cardiovascular health. Heritability includes a combination of genetic factors and the effects of a shared environment such as the types of foods that are served in a family.  Only a small percentage of the United States population – 8 percent -- has ideal levels of all the risk factors for cardiovascular health at middle age.

The study found that only a small proportion of cardiovascular health is passed from parent to child; instead, it appears that the majority of cardiovascular health is due to lifestyle and healthy behaviors.

“What you do and how you live is going to have a larger impact on whether you are in ideal cardiovascular health than your genes or how you were raised,“ said Norrina Allen, the lead study author and a postdoctoral fellow in preventive medicine at the Feinberg School.

The Northwestern Medicine study looked at three generations of families including 7,535 people at age 40 and a separate group of 8,920 people at age 50. The goal was to see who was in ideal cardiovascular health at these two critical periods in middle age.

“We really need to encourage individuals to improve their behavior and lifestyle and create a public health environment so people can make healthy choices,” Lloyd-Jones said. “We need to make it possible for people to walk more and safely in their neighborhoods and buy fresh affordable fruit and vegetables in the local grocery store. We need physical activity back in schools, widely applied indoor smoking bans and reduced sodium content in the processed foods we eat. We also need to educate people to reduce their calorie intake. It’s a partnership between individuals making behavior changes but also public health changes that will improve the environment and allow people to make those healthy choices.”

Marla Paul is the health sciences editor. Contact her at marla-paul@northwestern.edu

Stroke Survival Greater for Men than Women after Hospital Treatment
Posted by on November 8, 2010 - 2:52pm

Between 2000 and 2007, the death rate of men treated in hospitals for stroke tumbled by 29 percent compared to a 24 percent decline for women, according to the latest News and Numbers from the Agency for Healthcare Research and Quality (AHRQ).

Men's faster decline in death rate widened the death rate disparity even more. Men's death rate for every 1,000 admissions for stroke went from 123 in 2000 to 87 in 2009, compared with women's 127 deaths in 2000 to 96 deaths per 1,000 admissions in 2007.

The Federal agency found other gender variations in hospital deaths rates during the period as well:

  • Men's heart failure death rate fell by 52 percent compared with women's 46 percent. But men were about as likely to die from heart failure in 2007 as women—28 deaths versus 29 deaths, respectively, per 1,000 admissions.
  • Conversely, women's heart attack death rate fell slightly more than men's—39 percent versus 37 percent. But by 2007, women hospitalized for heart attack were still more likely than men to die—77 deaths versus men's 58 death per 1,000 heart attack admissions.
  • Regardless of gender, people who had private insurance experienced decreases in heart attack and heart failure death rates of 32 percent and 41 percent, respectively while Medicaid patients experienced declines of 27 percent and 34 percent for the same conditions. Medicare patients' death rates fell by 38 percent and 51 percent—the most for both conditions.

This AHRQ News and Numbers is based on data in Trends in Hospital Risk-Adjusted Mortality for Selected Diagnoses by Patient Subgroups, 2000-2007.

Sex Hormones Influence Heart Function
Posted by on October 29, 2010 - 1:05pm

In the largest human study to date on the topic, researchers have uncovered evidence of the possible influence of human sex hormones on the structure and function of the right ventricle (RV) of the heart.

The researchers found that in women receiving hormone therapy, higher estrogen levels were associated with higher RV ejection fraction (ejection refers to the amount of blood pumped out during a contraction; fraction refers to the residue left in the ventricle after the contraction)  with each heart beat and lower RV end-systolic volume — both measures of the RV’s blood-pumping efficiency — but not in women who were not on hormone therapy, nor in men. Conversely, higher testosterone levels were associated with greater RV mass and larger volumes in men, but not in women, and DHEA, an androgen which improves survival in animal models of pulmonary hypertension, was associated with greater RV mass and volumes in women, similar to the findings with testosterone in men.

“This study highlights how little is known about the effects of sex hormones on RV function. It is critical from both research and clinical standpoints to begin to answer these questions,” said Steven Kawut, M.D., M.S.,  director of the Pulmonary Vascular Disease Program at the University of Pennsylvania School of Medicine in Philadelphia.

The study was published online ahead of the print edition of the American Thoracic Society’s American Journal of Respiratory and Critical Care Medicine.

Study participants were part of The MESA-Right Ventricle Study (or MESA-RV), an extension of the Multi-Ethnic Study of Atherosclerosis (MESA), a large, NHLBI-supported cohort focused on finding early signs of heart, lung and blood diseases before symptoms appear. Using blood samples and magnetic resonance imaging (MRI) of the heart, researchers measured sex hormones and RV structure and function in 1957 men and 1738 post-menopausal women. Because the MESA population is ethnically mixed and covers a broad age range of apparently healthy people, the results may be widely applicable to the general U.S. population.

“One of the most interesting things about this research is that we are focusing on individuals without clinical cardiovascular disease so that we may learn about determinants of RV morphology before there is frank RV dysfunction, which is an end-stage complication of many heart and lung diseases,” said Dr. Kawut. “When we study people who already have RV failure from long-standing conditions, the horse has already left the barn. We are trying to assess markers that could one day help us identify and intervene in individuals at risk for RV dysfunction before they get really sick.”

Because the RV plays a critical role in supplying blood to the lungs and the rest of the body, RV function is closely tied to clinical outcomes in many diseases where both the heart and lungs are involved, such as pulmonary hypertension, COPD and congestive heart failure. However, the RV is more difficult to study and image than the left ventricle and comparatively little is known about its structure and function and how to treat or prevent right heart failure.

Corey E. Ventetuolo, M.D., lead author of the study from  Columbia University College of Physicians and Surgeons, reported,  “Our results have generated some interesting questions about RV response to the hormonal milieu. For example, the finding that higher levels of testosterone (and DHEA) were associated with greater RV mass would first appear to have adverse clinical consequences, since increasing cardiac mass is traditionally thought to be maladaptive. However, another study from MESA-RV has shown that higher levels of physical activity are also linked to greater RV mass, which would suggest an adaptive effect. So, whether the increased RV mass seen with higher hormone levels is helpful or harmful is not yet clear. The sex-specific nature of the associations we found was unexpected and reflect the complexity of the actions of sex hormones.”

Sex hormone levels could help explain a key paradox in pulmonary arterial hypertension (PAH), where the RV response is an important determinant of survival.  While women are far more likely to develop PAH, they also have better RV function and may have a better survival than men. “It is possible that hormone balance could predispose them to developing PAH, but confer a protective benefit in terms of RV adaptation,” explained Dr. Kawut.

The ultimate goal would be strategies to treat or prevent RV failure in those at high risk.

Source:   American Thoracic Society

Aspirin for Heart Disease and Stroke Reduction: Men vs. Women
Posted by on October 18, 2010 - 3:47pm

Aspirin therapy to prevent heart attack may have different benefits and harms in men and women.

Cardiovascular disease (CVD) is the leading cause of death in the U.S., contributing to approximately 58% of deaths.  The epidemiology of CVD events is different for men and women.   Men have a higher risk for coronary heart disease and tend to have these events at a younger age than women.

Although incidence rates of stroke are higher among men than women, more women die of stroke than men because of their longer life expectancy.

Back in 2002, the US Preventive Services Task Force (USPSTF) strongly recommended that clinicians discuss aspirin with adults who are at increased risk for coronary heart disease. This preventive measure was based on 5 randomized controlled trials that showed a 28% reduction in myocardial infarctions (heart attack) with aspirin use.   Only 2 of 5 studies included women!   At that time it was not clear if the earlier recommendation base on mainly male dominated studies was valid for women. In 2005, the large Women's Health Initiative (WHI) provided some new data about the benefits of aspirin in women but confusion continued.

In March 2009, the U.S. Preventive Services Task Force reviewed new evidence from NIH's Women's Health Study and other recent research and found good evidence that aspirin decreases first heart attacks in men and first strokes in women. The Task Force has issued a recommendation that women between the ages of 55 and 70 should use aspirin to reduce their risk for ischemic stroke (lack of blood and oxygen due to a clot or other disease process) when the benefits outweigh the harms for potential gastrointestinal bleeding.

In summary, as of March 2009, the USPSTF recommends:

  • The use of aspirin for men age 45-79 years when the potential benefit due to reduction in myocardial infarctions outweigh the potential harm due to an in increase in GI bleeding.
  • The use of aspirin for women age 55-79 when the potential benefit of a reduction in ischemic strokes outweighs the potential harm of an increase in GI bleeding.
  • The current evidence is insufficient to assess the balance of benefits and harms of aspirin for cardiovascular disease prevention in men and women 80 years or older.
  • Against the use of aspirin for stroke prevention in women younger than 55 years and for myocardial infarction prevention in men younger than 45 years.

The new report does conclude that aspirin increases the risk for major bleeding events, primarily GI bleeding in both men and women.   There is also limited evidence that hemorrhagic strokes are significantly increased among men but not women.

As with other studies we have cited on this blog, recommendations are always subject to change as new research is completed.   It is wise to discuss your individual concerns with your physician because other health factors could influence your decisions.    The entire discussion above also reinforces the need for ALL research to look at sex and gender differences even in the most basic trials so that when we want to apply  findings to humans, we already know if there are sex differences --- as we are finding out about aspirin therapy.

The recommendation and other materials are available at Exit Disclaimer U.S. Preventive Services Task Force, Ann Intern Med 150(6):396-404, 2009 (AHRQ supports the Task Force). See also Optowsky, McWilliams, and Cannon, J Gen Intern Med 22:55-61, 2007 (AHRQ grant T32 HS00020).

National Institutes of Health Celebrates Women's Health
Posted by on September 13, 2010 - 2:28pm

The National Institutes of Health Office of Research on Women's Health (ORWH) will celebrate its 20th anniversary with a day-long symposium on Monday, Sept. 27, in Bethesda, Maryland.  Discussed will be highlights of early accomplishments in women's health research, as well as a preview of the next decade A Vision for the Year 2020. Many of the advances involve medical differences between women and men, and implications for sex/gender — appropriate clinical care and personalized medicine.

A keynote speaker will be former NIH Director Bernadine Healy, M.D., who launched the Women's Health Initiative (WHI), a $625-million effort to study the causes, prevention, and cures of diseases that affect women at midlife and beyond. The WHI study continues to uncover critical information, including recent evidence that combined hormone replacement therapy carries a greater risk for heart attack and stroke than previously thought, particularly in older women.

The scientific keynoter will be Linda G. Griffith, Ph.D., professor and chair of MIT's Biological and Mechanical Engineering Department. She will discuss the integration of tissue engineering and systems biology in women's health research.   A scheduled guest speaker in the afternoon is actress Cicely Tyson, who won three Emmy Awards and was nominated for an Academy Award for her portrayals of strong, positive African-American women. Her women's medical research interests include high blood pressure, heart disease and stroke, especially in minority patients. Her acting career, begun in 1957, remains active. This will be her first visit to the NIH campus.

The free and open symposium will conclude with a reception honoring many of the women and men who are heroes of women's health research. For more details, visit http://orwh.od.nih.gov or call ORWH at 301-402-1770.

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