The leading killer of women isn't breast cancer or any other kind of cancer, but heart disease, which kills nearly twice as many women each year as die from all forms of cancer combined.
During February, which is American Heart Month, many groups focus on women's heart health with screenings and the American Heart Association's ``Go Red'' movement to raise awareness.
There was a time when women didn't respond well to treatment such as heart bypasses and stents, but that is changing, says Dr. Stratego ``Stacey'' Castanes, an interventional cardiologist who has been active in Miami-Dade heart health awareness events.
``One of the reasons we're doing better is patient education, women being advocates for themselves,'' says Castanes, who is in private practice and is also associated with the South Miami Heart Center.
We talked to Castanes about women and heart disease. Her answers have been edited for space.
Q: How is heart disease different in women than in men?
A: The biggest difference is the symptoms, especially of heart attacks. The things that we classically describe to patients -- chest discomfort like an elephant sitting on the chest, radiation to the jaw and down the arm -- aren't quite the symptoms women feel. We still don't know how to describe the classic symptoms women feel. I've had women who were having a massive heart attack and they just felt as if all they needed to do was burp and it would get better. It fools everyone. My recommendation to women is if you're feeling bad enough to think that something's wrong and it's persistent and it continues to make you feel worse -- women still feel some kind of chest discomfort and some type of shortness of breath -- you should go to the emergency room.
Q: What is the most important thing women can do to protect their hearts?
A: The most important thing is exercise. Exercise can decrease your risk for breast cancer, treat depression, prevent heart attacks and strokes, control blood pressure, prevent adult-onset diabetes. The other important thing is having the same due diligence that women have for seeing their ob-gyn to seeing a cardiologist to determine their risk.
Q: What are the risk factors for women?
A: Smoking brings on heart disease, 10 to 20 years earlier. Strong family history of heart disease is a risk factor. Post-menopausal for women is a strong risk factor. Diabetes. High blood pressure. High cholesterol. The risk factors are basically the same for men.
Q: Who needs cholesterol-lowering medication?
A: There was an interesting study done in 2007 where they used criteria to determine if someone was low risk, intermediate risk or high risk for heart disease. Then they looked at patients who had reported a heart attack or stroke. The scariest part of the study was that 80 percent of the people, before their event, were considered low risk. Cholesterol is one of those things where there is no such thing as normal. Depending on the risk factors, you have to make the decision of whether to treat cholesterol. A cholesterol of 130 might be OK for one person but for another person who has a family risk of heart disease and is a smoker, that's not OK and that cholesterol needs to be treated.
Q: Should women take a daily aspirin to lower their risk of heart disease?
A: We have gone back and forth and been very confused throughout the years about what to recommend. For men it's very clear-cut. If you're in your 40s you should be on aspirin to prevent heart attack and stroke. Women tend to get heart disease later in life and there's an increased risk of bleeding with the aspirin. We initially didn't have clear-cut guidelines. Now the guidelines say if you're above 60 with one risk factor for coronary disease you should consider aspirin. If you have two risk factors, you should definitely be on aspirin.
Q: What is the link between diabetes and heart disease?
A: Basically we consider diabetes equivalent to heart disease. Diabetics are three to five times more likely to have coronary disease than their counterparts with all the same problems but not diabetes. Blood pressure needs to be very tightly controlled, even tighter than usual. Cholesterol needs to be tightly controlled. It seems that a lot of heart disease is linked to an inflammatory process. Diabetes is a constant inflammatory process. The endothelium, the tissue in the lining of the arteries, needs to work a certain way for the heart to function normally. Inflammatory states such as diabetes cause dysfunction of that endothelium, which results in coronary artery disease.
Q: Why is blood pressure important?
A: Blood pressure is important because it's so closely linked to increased risk of heart attack or stroke. On a very basic level, the endothelium gets pounded with these high blood pressures all day, which results in inflammation and damage to the endothelium.
Q: What's your advice about diet?
A: Physicians are always asked about diet, and the sad thing is we take less of a month of it in medical school. Nutritionists know this much better. One of the simplest things is that you should have as much color on your plate as possible. Yellow all over the plate -- pasta, corn, potatoes -- is not good.
Posted on Tue, Feb. 09, 2010
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