Oral (Birth) Control Pills?

My heart attack received much speculation in regards to oral contraceptives.  Normally this is a topic I would relegate to my private blog, but it seems that somehow many people outside of my immediate friends/own mother knew about my method of birth control.  That being said, my blood pressure was regularly monitored because of a different medication I was taking in addition to the oral birth control pill.  My blood pressure was always at a healthy range.  The day I was taken to the emergency room my cholesterol levels were also at healthy levels (as in previous testings).  Despite my weight gain over the last several years my blood pressure and cholesterol have been and remain extremely good.  As for the cause of my blood clot's and subsequent heart attack, the cardiologist and oncologist who ran extensive tests were unable to come to a conclusion.  When pressed, my cardiologist has told us that I had 'bad luck and a tremendous amount of stress'.  Lastly, I had an EKG just a few months prior to my heart attack in preparation for surgery unrelated to my heart.  It is very difficult not having a diagnosis; not knowing exactly what to avoid (as if I could control the situation in any way).  It's the ultimate fear of the unknown (and I am the type of person who likes to know).

Nonetheless, here is an article regarding the same, very serious subject, oral contraceptives:

Is There Any Risk For Heart Disease With Birth Control Pills?


Sharonne Hayes, M.D., Director, Women's Heart Clinic; Associate Professor of Medicine;
Mayo Clinic, Rochester, Minnesota
February 6, 2008

Question: As A 30-Year-Old Woman, Should I Be Concerned About Taking Oral Contraceptive Pills And Is There Any Risk For Heart Disease With These Pills?

Answer: Oral contraceptives are some of the most effective birth control methods. And so, if you have chosen to be on oral contraceptives, presumably you're trying to prevent pregnancy. Where oral contraceptives got a bad rap, in a sense, was the first generation of oral contraceptives, which were 10 to 20 times higher doses of estrogen and progesterone than currently available oral contraceptives. So the oral contraceptives we're using today are much safer.

That said, even today's oral contraceptives, many of them can slightly increase blood pressure, they can adversely affect your cholesterol -- particularly by lowering the good cholesterol -- and they can slightly increase the risk of blood clots. So all of these things need to be taken into consideration.

There is no evidence that taking oral contraceptives today increases your risk of having a heart attack down the road after you stopped it as an older person. So that's very reassuring. If you choose to be on oral contraceptives, because that's the best method, one thing you should know, is that the risk, the cardiac risk of going through a completed pregnancy is actually much higher than taking oral contraceptives. So that's important to compare those risks. Taking care of yourself and reducing your cardiac risk factors, making sure your blood pressure is under control after you start, is a good way to reduce that risk.

The other thing is there are a number of newer oral contraceptives, and ones in development, that may actually reduce cardiac risk. Several that contain drospironone, which actually can lower blood pressure and has some other beneficial effects, are available now.

And so, we recommend you take the lowest dose for the time that you need it for oral contraception, but the cardiac risk shouldn't weigh too heavily when you make that decision.

Are Heart Attacks More Deadly for Women?

Age or Illness May Cause the Gender Gap in Heart Attack Survival Rates, Study Shows

By LAUREN COX and COURTNEY HUTCHINSON

ABC News Medical Unit

Aug. 26, 2009—

Doctors have long known that women are nearly twice as likely as men to die in the first month after a heart attack. But a new study published in the Journal of the American Medical Association looked behind this statistic to discover that gender may not directly influence survival outcomes after a heart attack heart attack outcomes.

Theresa Volpe, 40, barely survived a massive heart attack two years ago. She said despite ongoing symptoms of dizziness and fatigue, when her chest pains struck, many people thought she had indigestion.

"I was so dizzy and light headed -- my arms felt heavy and weighed down," said Volpe. "The paramedics came and looked me over and said, well your heart rate is not so high maybe it's just anxiety."

But once a cardiologist saw her, she was immediately airlifted to a specialist center where it was discovered one of Volpe's major arteries was 90 percent blocked by plaque.

"I was lucky because a lot of women don't survive a heart attack," said Volpe, who is now a spokeswoman for the Go Red for Women campaign of the American Heart Association.

Investigating Why Women and Men's Heart Attacks Differ

To discover more about the difference in heart attack survival rates between the sexes, Dr. Jeffrey Berger and his colleagues at the New York University School of Medicine analyzed the medical records of more than 130,000 heart attack patients (72 percent men and 28 percent women) that were part of 11 international studies between 1993 and 2006.

Among all the studies, women died at a 9.6 percent rate compared with a 5.3 percent rate for men in the first month after a heart attack. Yet the study pointed out key differences between men and women in these statistics.

Women were having heart attacks at an older age than the men. Women were also more likely to have diabetes, high blood pressure and heart failure while men were more likely to smoke, to have had a previous heart attack and have a previous bypass surgery.

Once the researchers compared men and women of the same age and health status, then the gender difference in survival rate disappeared.

How Gender May Not Matter in Heart Attack Survival

"[In our study] you see that women have almost a twofold increase risk for death after 30 days, which was found before, but the beauty of our study is we're able to look at reasons why this is," said Berger. "If you account for age, clinical risk factors that differ like hypertension, high cholesterol and numbers of arteries are blocked, there is not a difference."

"It's not being a man or woman that puts you at higher risk, it's these other factors," said Berger. Rather than focus on treating men and differently, Berger hoped doctors would start looking at treating older heart attack victims with specific health complications differently than other heart attack victims.

Indeed, Berger's study led some cardiologists to wonder if some of the differences between men and women in heart disease have been overblown.

Gender Differences in Heart Attacks

"The so-called 'gender differences' in heart disease have been hyped to a large extent," said Dr. Steven Nissen, director of the Joseph J. Jacobs Center for Thrombosis and Vascular Biology at the Cleveland Clinic Foundation in Cleveland, Ohio.

"The primary conclusion of this study is that there is not a higher mortality in women than men following a heart attack (when adjusted for severity of disease and co-morbidities)," said Nissen. "Accordingly, the study does not suggest a different strategy in women with heart attack. It appears that 'what is good for the goose is also good for the gander.'"

Yet other doctors point out that the study couldn't explain why women had their heart attacks at an older age, and in worse health in the first place. Moreover, doctors wondered whether there are still important differences to note about men and women leading up to the heart attack, if not in the 30 days that follow.

"This study tells us that even in this era of highly sophisticated diagnostic and treatment modalities for heart attack that women's heart disease is different from that seen in men and that women still fare worse," said Dr. Malissa Wood, of the cardiac unit of Massachusetts General Hospital in Boston.

Sex Differences in Heart Attack Symptoms Still Exist

"I believe that the big differences start before the heart attack ever happens," said Wood. "Once a woman presents with a heart attack and is of advanced age with diabetes and high blood pressure and their associated complications (blood vessel disease, kidney disease) the horse is out of the barn."

Volpe was only 38 when she had a heart attack. Despite her young age, she experienced some of the worst troubles that seem to affect women who have heart disease. First nobody could recognize her symptoms, and then nobody believed it when she had a heart attack.

"I was very tired, I was very fatigued. I was so tired I thought I was pregnant," said Volpe.

Volpe also occasionally went into dizzy spells, she got out of breath and she would experience chest pain. Her primary care doctor performed some tests -- an EKG and an echocardiography -- but when those came up normal Volpe's doctor suggested anti-anxiety medication.

"She had thought that I was suffering from a generalized anxiety disorder -- I was thinking the only thing that I'm anxious about is that I'm having chest pains," said Volpe.

Another round of tests at a gastrointestinal specialist couldn't explain her chest pains, so Volpe tried to relax with the occasional chest pain.

Then, on March 31, 2007 at a family birthday party she had a heart attack.

"At the ER, the cardiologist said we need to get to her out of here, she's having a massive heart attack and my husband said 'are you kidding,'" said Volpe.

Volpe now lives with four stents and must take a variety of medications for life.

"I wish I had the guts to say I want to see a cardiologist earlier," said Volpe, a mother of two school-age children. "Being so young, I was afraid to say I'd like to see a cardiologist."

More, Volpe wishes she had taken better care of herself.

"That's the huge thing. I really wish that I had taken better care of myself. You always think you have time. I don't have to worry about that until I'm older, but you're back pedaling," she said. "Every time I get on the treadmill I think I don't feel like it but this is what I have to do."

Copyright © 2009 ABC News Internet Ventures

How Does Stress Affect A Cardiac Condition After A Heart Attack?

Question: How does stress affect my cardiac condition, is it dangerous when I have angina, and how about stress after a heart attack?

Answer: There has been an awful lot of research documenting that if you already have heart disease -- if you already had a heart attack or have been diagnosed with heart disease by angiography or other tests -- that stress puts you at a higher risk for having some bad events happen to you.

People who've had a heart attack, who have low levels of social support, are more likely to die in the next few years. People who meet criteria for depression following a heart attack are actually four to five times more likely to die in the next six months following the heart attack. People who have chronic stress at work -- high demands, low control over how you meet those demands -- when they're followed up over two to four years, are about twice as likely to die as people whose jobs do not impose that kind of stress.

So once you have heart disease, I'm afraid I have to tell you that the stress story is even more dire than before you develop heart disease.

Redford Williams, M.D., Professor of Medicine and Director, Behavioral Medicine Research Center, Duke University Medical Center

Copyright © 2009 ABC News Internet Ventures

We're Signed Up!

In keeping with the overall idea of the American Heart Association's Start! movement  philosophy of becoming/remaining active, I registered us both for a fall cycling event.  Ultimately our ultimate goal of course is to achieve a healthy lifestyle change.  I'm especially excited since the event is sponsored by a group of cardiac survivors.

I began participating in cycling events shortly before I met my husband.  We since participated together once (we did a half century).  He was awesome (climbing steep rolling hills in 100 degree plus weather; me not so much!!).  So, I am excited to try cycling again since running isn't recommended for me.   

Likewise, the upcoming ride supports several cardiac efforts also.  What better way to make sure we're working out regularly other than shelling out some money forcing us to prepare for the ride (yes, I admit, I need motivation as the days begin to grow shorter and I still try to find a routine that is both intersting and challenging).  I am not doing the full century since there is no way I am physically able yet.  My husband is signed up for the longer ride (the metric century)!  Time to put up or shut up!!