cardiac
health on time
TM
SPRING 2013
women: take heart! Heart disease is not just a man’s problem
O
ne of the most dangerous myths about heart disease is that it’s primarily a man’s problem. Cardiovascular disease does strike men about a decade earlier in life than women. But once women reach age 50, their risk quickly climbs. Over a lifetime, 1 out of 4 women die of cardiovascular disease—making it the leading cause of death in women. Public health campaigns like the American Heart Association’s (AHA) Wear Red Day, which is held in February, are raising awareness of the danger. At participating companies nationwide, employees can contribute $5 for heart disease research and education, in return for being allowed to wear jeans and something red. When it comes to increasing awareness, significant progress has already been made. In 1997, only 30 percent of women surveyed knew that heart disease is the leading killer of women. That number has climbed to 54 percent, according to a 2009 survey conducted by the AHA. But that still leaves almost half of women in the dark about the real danger heart disease poses. Too many women don’t realize they have risk factors like high blood pressure, elevated cholesterol or early signs of diabetes. Many women who do know they are at risk aren’t doing enough to minimize the danger. One reason may be another dangerous misconception: the widespread belief that many heart attacks strike out of the blue, without warning. In fact, 80 percent of women ages 40 to 60 have one or more risk factors for heart disease. Identifying your own risk factors and working with your doctor to modify them could save your life. A recent analysis showed that cholesterol-lowering medications called statins reduce the risk of heart attacks by a full 30 percent, for example. And two-thirds
a woman’s risk through the ages The risk for cardiovascular disease begins to climb dramatically in women after menopause. But the lifestyle habits that influence risk are formed much earlier. And their consequences become more and more serious as women age.
Younger Women
•M ore than 30 percent of young adults are physically inactive. • About 25 percent of high-school-age youth report using tobacco. • Women taking oral contraceptives have a small increase in blood pressure; it’s not clear if this contributes to CHD.
Middle-Age Women
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•B eginning at age 45, more women than men have high cholesterol levels. • About 37 percent of women aged 45–54 have high blood pressure. • More than 12 million women have diagnosed or undiagnosed diabetes.
Older Women
•O ver the age of 65, 1 in 4 women has some form of heart disease. • Heart disease and stroke kill more than 43 percent of American women. • After age 64, women are more likely to have high blood pressure than men.
of people who suffer their first stroke have blood pressure higher than 160/95. Doing something as simple as becoming more physically active will also cut your risk for cardiovascular disease significantly. Heart disease rates have fallen dramatically over the past 25 years. Today, thanks to better diagnostic tests, your doctor can assess your risk of cardiovascular disease more accurately than ever before.
Heart attacks among women Estimated heart attacks among women every year
Age 65 and older 352,000 Ages 45 to 64 74,000 Under age 45 9,000
Total 435,000
Protect your heart! To schedule an appointment with a cardiologist, call 706-721-2426. To schedule a $100 calcium scan, call 706-721-9729.
Coronary artery calcium scans What’s the score?
T
he first step in preventing heart disease is understanding your individual risks, such as high cholesterol, high blood pressure and other factors. But you may be unaware of one risk factor: specks of calcium, called calcifications, in the walls of the coronary arteries that supply blood to your heart.
“Fortunately, a test known as a coronary calcium scan can measure the calcium in the walls of these arteries,” says Sheldon Litwin, MD, a cardiologist at Georgia Regents Heart & Cardiovascular Services. “The test lets physicians calculate a score that helps estimate your heart attack risk and guide treatment options.”
Are you a candidate?
Georgia Regents University 1120 15th St., AD 1114 Augusta, GA 30912
NONPROFIT U.S. POSTAGE PAID georgia regents university gru-002
Anyone who may be at risk for developing heart disease can benefit from calcium screening. But the test is particularly beneficial in men between ages 45 and 75, and in women between ages 55 and 75. The simple, noninvasive test uses computed tomography (CT) technology to produce images from which a physician will determine your calcium score. The scan takes less than five minutes, and there’s no pain or discomfort.
Benefits of the test The test may allow your physician to detect calcifications in the early stages and develop a strategy to prevent a heart attack. It also reduces the need for more invasive and expensive tests and provides you with peace of mind. Most insurance plans do not yet cover this valuable test, but the cost of the scan and physician interpretation is just $100. You’ll be notified of the results as soon as possible after completing the test. To schedule a scan, call 706-721-9729.
men vs. women
how heart disease differs Coronary heart disease is the No. 1 killer of both men and women in the United States, yet its presentation, diagnosis, treatment and prognosis vary widely between the sexes.
Symptoms
ways women differ
Men
The timing and symptoms of heart attack, a manifestation of heart disease, differ in women and men. At the time of a first heart attack, women are usually older—70.4 years on average, compared with 65.8 years for men—and more likely to have had untreated angina or chest pain prior to the event. Both sexes may present with “classic” chest pain, but women are more likely to have atypical pain and other symptoms (see center image). Because the symptoms of heart disease vary between the sexes, some diagnostic procedures that are accurate in men may be less so in women. Exercise stress testing, for example, may produce a false-positive result in young women who are at low risk for heart disease, whereas single-vessel heart disease, a condition that is more common in women than in men, may go undetected on routine treadmill testing.
Women
65.8
Age
average age at time of attack
70.4
24%
Death
die within a year of a heart attack
42%
18%
Recovery
will have another attack within six years
35%
22%
Disability
will be disabled because of heart failure
46%
Treatment and prognosis
The lifetime risk
The difference in treatment between men and women may be due to the general lack of information about women and heart disease—only about 27 percent of participants in heart-related studies are women. Furthermore, treatment options may be more limited in women than in men, because in general, women are more ill when heart attack occurs and often have serious coexisting disorders because of older age at presentation. After a heart attack, women are less likely than men to receive aspirin, beta-blockers or angiotensin-converting enzyme inhibitors. Surgical heart procedures also are performed less often in women than in men: Women receive only 34 percent of angioplasties, stents and bypass surgeries; 26 percent of implantable defibrillators; and 36 percent of open-heart surgeries. Women may derive less symptomatic relief than men from some procedures, such as angioplasty and bypass surgery. In addition, women have an almost twofold greater risk for dying after bypass surgery than do men. Complications of heart attack, like shock, heart failure and stroke, are also more common in women. Within one year of a heart attack, women are 50 percent more likely to die than men. To protect yourself against heart disease, talk to your doctor and take preventive measures.
After age 40, the lifetime risk for developing coronary heart disease is 33 percent in women and 50 percent in men. As women age, the risk approaches that of men.
Age 40
Men 50%
Women 33%
Many of the risk factors associated with heart disease can be controlled, so identifying what constitutes a risk and how to modify it is an essential first step in empowering individuals to take charge of their health. The major controllable risk factors for heart disease in both men and women are high blood pressure, high levels of AHA Goals cholesterol and triglycerides, • Blood pressure: less than smoking, physical inactivity, 120/80 mm Hg and being overweight or • Total cholesterol: less obese. The American Heart than 200 mg/dL Association (AHA) has • HDL (good) cholesterol: established the following 50 mg/dL or higher specific goals for women: • LDL (bad) cholesterol: range of less than 100 mg/dL to less than 160 mg/dL, depending on risk factors • Triglycerides: less than 150 mg/dL • Body mass index: less than 25 • Waist circumference: less than 35 inches • Exercise: at least 30 minutes a day, all or most days of the week • Don’t smoke • Eat a balanced diet • See your doctor regularly. For more information, talk to your doctor.
• Excessive sweating • • Unexplained anxiety, weakness • • Dizziness, nausea • • Pain in jaw or teeth • • Pain that spreads to neck • • Chest pain • • Shortness of breath • • Pain that spreads to shoulder • • Pain that spreads to arms • • Pain in stomach • • Pain in back •
Heart disease accounts for
8 million
of male deaths.
women are currently living with heart disease.
Time is muscle
the risk factors of heart disease: how much do you know?
Because estrogen protects premenopausal women against cardiovascular disease, researchers had high hopes that giving women hormone replacement therapy (HRT) would help stave off heart problems. Many doctors were already prescribing it. But now, several large studies have shown an increased hazard to women taking HRT. Based on those findings, most national health groups now advise women not to start or continue taking HRT for heart disease prevention. Because hormone therapy may have other benefits, it’s important to talk to your doctor about what’s right for you.
Heart-Healthy Goals for Women
symptoms of heart disease
25%
HRT: high hopes turn to disappointment
Eat a balanced diet
Anteroseptal infarct
(The most lethal type of heart attack)
Right ventricle
1. High blood pressure ________________ A. usually has no early warning signs. B. increases the risk for heart attack, stroke, eye damage, congestive heart failure, kidney failure and atherosclerosis. C. places an extra burden on the heart, which over time causes it to enlarge and weaken. D. all of the above
Picture perfect
Left circumflex artery Only medical tests can confirm a heart attack. That’s why it’s important to get emergency assistance— the sooner the better.
2. In an adult, high blood pressure is defined as _____________ A. a systolic pressure of 140 mm Hg or more and/or a diastolic pressure of 90 mm Hg or more. B. a systolic pressure of 130 mm Hg and/or a diastolic pressure of 80 mm Hg that lasts for an extended period of time. C. a diastolic pressure of 80 mm Hg or more. D. none of the above
If you think you may be having a heart attack, call immediately for help. Calling 9-1-1 may provide lifesaving assistance. Also, chew and swallow an aspirin and drink a glass of water. Aspirin thins the blood, which will help the heart get more blood if you are having a heart attack.
Anterior descending artery
3. The American Heart Association recommends that individuals ages 20 and older have their cholesterol measured _____________ A. every six months. B. yearly. C. at least once every two years. D. at least once every five years.
Right coronary artery
4. LDL cholesterol is ________________ A. deposited in artery walls, which increases the buildup of plaque. B. the “good” cholesterol that is removed from the body by the liver. C. the most common type of fat in the body. D. both a and c are correct
People in rural areas often have limited access to advanced cardiovascular imaging such as echocardiograms and carotid ultrasounds. But Georgia Regents Heart & Cardiovascular Services is taking this equipment to them in a new Mobile Echo Unit. Staffed by a registered echocardiography technician, the unit will be making regular visits to: • Wills Memorial Hospital in Washington, Ga. • Georgia Regents Medical Associates in Lake Oconee Village, Greensboro, Ga. • Evans Urgent Care in Evans, Ga. All tests will be read by cardiologists who are board-certified in echocardiography. For more information, call 706-721-4997.
Left ventricle
Artery blocked by a thrombus (blood clot) Infarcted area—dead tissue resulting from obstructed circulation
An average of 64 percent of women, compared to 73 percent of men, were prescribed a beta-blocker after a heart attack.
ANSWER KEY: 1-d; 2-a; 3-d; 4-a If you got most or all of the answers right, you’re heart smart!
W o m e n : y o u r h e a r t- h e a lt h l i f e l i n e
0-25 years
25-40 years
Watch your weight. Obesity rates are on the rise, especially among minority women. More than 50 percent of AfricanAmerican women are obese.
Get moving. In 2006, only about 31 percent of American adults engaged in regular physical activity.
40-55 years Get tested for diabetes. Approximately 2.3 million women have the disease and don’t know it.
Learn more about HRT. Women should discuss the pros and cons of hormone replacement therapy (HRT) with their physicians.
Check your cholesterol. By age 55, more women than men have cholesterol levels that are borderline high or higher.
Don’t smoke. Cigarette smokers are 2–4 times more likely to develop heart disease than non-smokers.
diabetes
55-75 years
Grow old gracefully. Increasing age is a risk factor that cannot be changed. That’s why it’s important to focus on the risk factors you can control like smoking and inactivity.
75+ years Fit physical activity into your everyday life. Take a walk, ride your bike, enjoy a game of tennis or a round of golf.
Comply with your physician’s treatment and medication directions.
blood sugar screening every 3 years after age 45
blood pressure screening annually cholesterol screening every 5 years
screening every 3 years after age 50
heart disease
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People who have excess body fat—especially if a lot of it is in the waist area—are more likely to develop heart disease and stroke even if they have no other risk factors. If you can lose as little as 10 to 20 pounds, you can help lower your heart disease risk.
For more information about Georgia Regents Heart & Cardiovascular Services, call 706-721-2426 or visit www.gru.edu/cardio.
speedy recovery accelerate your recovery with cardiac rehab exercise plan just for you, monitor your heart as you exercise and submit monthly reports to your physician. You can also take classes about smoking cessation, stress management, nutrition, blood pressure, diabetes and cholesterol control.
What makes our Cardiac Rehabilitation Program different? • A board-certified physician who works directly in the center, something no other area cardiac rehab center offers
• An exercise physiologist who will design an individual exercise plan for you • A registered nurse specializing in cardiac care who will monitor your heart as you exercise • Advanced exercise equipment and an indoor walking track • A built-in support group of others affected by heart disease •A convenient location on the GRU campus with free street-level parking right outside the building For more information or to have a staff member contact your physician about a referral, call 706-721-9055.
Q&A Why does heart disease risk increase later in life for women than men? Women are protected by the female hormone estrogen, which is produced at high levels until women reach menopause. For more on estrogen’s healthy benefits, see “How Estrogen Protects,” at right. In addition, prior to menopause, a woman’s uterus also churns out chemicals called prostaglandins, which widen blood vessels, lessening the chances that a blood clot will form and block an artery. After menopause, levels of estrogen and prostaglandins fall—and heart disease danger increases rapidly. Among women of the same age, those who have gone through menopause have heart disease rates two to three times higher than premenopausal women, according to the National Heart, Lung and Blood Institute. For information on hormone replacement therapy, see the inside pages.
How much weight do I need to lose to lower my heart disease risk?
For appointments, please call 706-721-2426. Director of Heart and Cardiovascular Services M. Vinayak Kamath, M.D. Chief, Cardiovascular Medicine Sheldon Litwin, M.D. Chief, Pediatric Cardiology Kenneth Murdison, M.D.
Cardiovascular Electrophysiology
How Estrogen PRotects • E strogen is believed to increase levels of high-density lipoprotein (“good” cholesterol) and reduce levels of lowdensity lipoprotein (“bad” cholesterol).
Adam Berman, M.D. William Maddox, M.D. Robert Sorrentino, M.D.
Cardiovascular Imaging (Echo, MRI, CT and Nuclear Imaging) HDL helps reduce excess cholesterol
Plaque
Clot
• E strogen also boosts levels of a chemical called tissue plasmin ogen activator, or TPA, which dissolves blood clots.
Preston Conger, M.D. Sheldon Litwin, M.D. Vincent Robinson, M.B.B.S. Pascha Schafer, M.D. Gyanendra Sharma, M.D.
Cardiothoracic Surgery M. Vinayak Kamath, M.D. Vijay Patel, M.D.
Restricted artery
After menopause, heart disease rates are 2–3 times higher.
General Cardiology
Preston Conger, M.D. Chris Pallas, M.D. Vincent Robinson, M.B.B.S. Pascha Schafer, M.D. Gyanendra Sharma, M.D. John Thornton, M.D.
Interventional Cardiology
Not much. In fact, dropping just a few pounds, even if you are seriously overweight, will reduce your cardiovascular risk. A recent study found that obese women who lost just 6.5 percent of their body weight in a six-month program of exercise and diet—that’s just 13 pounds for a 200-pound woman—lowered their blood pressure, triglycerides, total cholesterol and LDL cholesterol. Because it’s not easy to lose weight, psychologists say it’s important to set a reasonable goal. Something else worth remembering: Eating a low-calorie diet rich in fruits, vegetables and whole grains, and increasing your level of physical activity will lower your heart disease risk—even if you don’t lose much weight.
For a 200-pound woman, losing just
6.5%
of her body weight can have a positive impact on heart health.
Vishal Arora, M.D. Deepak Kapoor, M.D., M.B.B.S. Mahendra Mandawat, M.D. Paul Poommipanit, M.D.
Pediatric Cardiology William Lutin, M.D. Kenneth Murdison, M.D. Henry Wiles, M.D.
Rehabilitation and Prevention Preston Conger, M.D.
Vascular Surgery Gautam Agarwal, M.D., R.P.V.I.
breaking news are you hip?
close your mouth
The size of your hips could be a predictor of your heart disease risk. A recent study showed that women with a high hip-to-waist ratio were 91 percent more likely to develop heart disease than those with a smaller ratio. To calculate your hip-to-waist ratio, divide your waist measurement by your hip measurement. Ideally, women should have a ratio of 0.8 or less. If yours is higher than 0.8, consult with your physician for an overall assessment of your heart disease risk.
A simpler version of CPR—one that skips mouthto-mouth resuscitation—may be just as effective as standard CPR, according to recent studies. According to the American Heart Association, less than onethird of out-of-hospital cardiac arrest victims receive bystander CPR, even though it can double or triple the victim’s chances of survival. Bystanders are often hesitant to perform mouthto-mouth resuscitation, but chest-compression-only CPR can be just as effective and may increase the percentage of victims who receive the lifesaving help they need.
Check out videos of our physicians and heart-healthy tips at www.gru.edu/cardio.
For more information on our heart and vascular services, visit us online at www.gru.edu/cardio.
Copyright © 2013 GLC, Northbrook, IL 60062 U.S.A. This publication is not meant to replace professional medical advice or service. Personal health problems should be brought to the attention of appropriate medical professionals.
G
eorgia Regents Cardiac Rehabilitation Center offers the safety, security and equipment you’ll need to exercise after a heart attack. The center’s professionals will design an
our heart and vascular physician team