cardiac HEALTH ON TIME
SPRING 2017
Heart to Heart
MANY WOMEN ARE UNAWARE OF HEART DISEASE RISK FACTORS
ONE 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. One out of 4 women dies of cardiovascular disease — making it the leading cause of death in women. Public health campaigns like the American Heart Association’s (AHA) Go Red for Women are raising awareness of the danger. Donations fund heart checkups for women, as well as informational campaigns aimed at educating women about their risks for heart disease and stroke. 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 56 percent, says a recent AHA survey. 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 belief that many heart attacks strike out of the blue, without warning. In fact, 75 percent of women ages 40 to 60 have one or more risk factors for heart disease. Being aware of your risk factors is important, because almost two-thirds of women who die suddenly from heart disease had no previous symptoms. 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 25 percent, for example. 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.
WOMEN’S HEART HEALTH MILESTONES
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 Almost 50 percent of young adults are not vigorously active on a regular basis. About 25 percent of high-school-age youth report using tobacco. A low percentage of women taking oral contraceptives have a small increase in blood pressure; it’s not clear if this contributes to heart disease.
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MIDDLE-AGED WOMEN Cholesterol levels tend to rise for all adults as they age. About 34 percent of women aged 45–54 have high blood pressure. More than 10 percent of adults between 45–64 have been diagnosed with diabetes.
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OLDER WOMEN Most women over age 65 have diagnosed heart disease or “silent” atherosclerosis (“hardening of the arteries”). Heart disease and stroke kill about 25 percent of American women. After menopause, women are more likely to have high blood pressure than men.
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IF YOU SUSPECT YOU ARE HAVING A HEART ATTACK, call 911 immediately. Otherwise, to request a same-day appointment, call 706-721-2426.
The ‘one-in-a-million girl’: Anna’s story of healing from heart disease JULY 15, 2002: Anna Vincent put her newborn and 2-year-old sons down for a nap and let out a sigh of relief. Not only did she have this parenting thing down, but she was also getting the hang of being a mother of two, just nine days after giving birth to her second child, Connor, who’s now 15. But then she felt a throbbing pain in her arm and chest — two telltale signs of a heart attack — except
it was in her right arm and not her left. Vincent’s mind bounced back and forth between concern and denial regarding what she was experiencing. Her mother, who was with her at the time, hurriedly called 911. Upon arrival to her then-local hospital’s emergency room, the staff dismissed her heart-attack symptoms as a postpartum panic attack. But within two minutes of conducting an electrocardiogram, 20 people in scrubs suddenly surrounded her. “I call myself the one-in-a-million girl,” Vincent said. “I’m an otherwise healthy woman with no family history of heart disease who experienced a heart attack. And nine days earlier, there had been two knots in Connor’s umbilical cord, and it was wrapped around his neck.” Vincent was admitted to the cardiac intensive care unit, where she remained for
three weeks. At one point during her stay, her husband, Shawn, brought in Connor. “I’ll never forget how I felt as I struggled to hold him,” Vincent Anna and Shawn Vincent and their said. “The doctor sons Connor and Patrick told me that I’d need a nanny all my life and that I’d never walk around Disney World.” But Vincent had other plans. When Patrick, Vincent’s eldest son (now 17), was 4 years old and Connor was 2, the family traveled to Disney World. “We did everything we wanted to do,” Vincent said, “and I continued to get better and better and better.” (CONTINUED ON PAGE 2)
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HOW HEART DISEASE DIF Coronary heart disease — No. 1 killer of both men and women in the United States PRESENTATION, DIAGNOSIS, TREATMENT AND PROGNOSIS VARY WIDELY BETWEEN THE SEXES
Symptoms 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 years on average, compared with about 65 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 list at right). 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 Average age for first heart attack single vessel heart disease, a condition that is more common Men Women in women than in men, may go 64.5 70.3 undetected on routine treadmill testing. years years Treatment and prognosis The difference in treatment between men and women may be due to the lack of information about women and heart disease — women are generally underrepresented when it comes to heart disease studies. 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: A recent study found that women are equally as likely as men to benefit from advanced therapies such as left ventricular assist devices, but are less likely than men to be referred for these types of procedures. In addition, women may derive less symptomatic relief than men from some procedures, such as angioplasty and bypass surgery. Plus, 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.
The ‘one-in-a-million girl’: Anna’s story of healing from heart disease (CONTINUED FROM PAGE 1)
Symptoms of Heart Disease
l l Excessive sweating l Unexplained anxiety, weakness l Dizziness, nausea l Pain in jaw or teeth l l Pain that spreads to neck l l Chest pain l l Shortness of breath l l Pain that spreads to shoulder l l Pain that spreads to arms l Pain in stomach l Pain in back l WOMEN l MEN
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%
Vincent had been feeling well for about 14 years, until she suddenly began experiencing speech and memory problems and fainting. “I was on a maintenance plan but wasn’t seeking care at an academic health center, which keeps up with the latest advances in medicine,” she said. Vincent decided to seek care from Dr. Ned Pruitt with Augusta University Neurosciences Center of Excellence, as well as from Dr. Sean Javaheri with Augusta University Heart and Cardiovascular Services, in April 2016. “Dr. Javaheri couldn’t believe how well I was functioning,” Vincent said, “but within six months, he had me all fixed up with new medication. If I was experiencing something that Dr. Javaheri didn’t understand, he would keep looking, and he’d figure it out. He never gave up on me. “He explained things that no one had ever told me before,” said Vincent, “and now I am fully educated about what had happened to me. I never realized how empowering that would feel. I finally had answers to questions that I had been asking for 15 years.” Despite the challenges that Vincent faced with her health, she learned a lot and maintained a positive outlook. “Heart disease isn’t what we think it is,” she said. “There are people here who can help you. I don’t think that my health would’ve gotten better in the long run if it didn’t get so bad that I’d have to come to an academic health center,” Vincent said.
To read the full story, and for more patient stories like Anna’s, visit augustahealth.org/stories.
FERS: WOMEN VS. MEN HEART-HEALTHY GOALS FOR WOMEN
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 cholesterol and triglycerides, smoking, physical inactivity, and being overweight or obese. The American Heart Association (AHA) has established the following specific goals for women: AHA Goals Blood pressure: less than 120/80 mm Hg Total cholesterol: less than 200 mg/dL HDL (good) cholesterol: 50 mg/dL or higher 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
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34 seconds, someone in Every
America has a heart attack.
For more information, talk to your doctor.
TIME IS MUSCLE
Only medical tests can confirm a heart attack. That’s why it’s important to get emergency assistance as quickly as possible. If you think you might be having a heart attack, call immediately for help. Calling 911 can 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. Treatment for a heart attack works best when it is given within one hour of the initial symptoms.
GUIDELINES FOR GREAT HEART HEALTH 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.
Get moving. In 2015, only 49 percent of American adults met the Centers for Disease Control’s recommended guidelines for physical activity.
Don’t smoke. Studies show cigarette smokers reduce their risk for coronary heart disease by 50 percent or more after quitting smoking.
Watch your weight. Obesity rates are on the rise, especially among women of color. More than 50 percent of African-American women are obese.
Fit physical activity into your everyday life. Take a walk, ride your bike, enjoy a game of tennis or a round of golf.
Get tested for diabetes. Over 13 million women in America have diabetes, and more than 25 percent of those women don’t know they have it.
Check your cholesterol. By age 55, more women than men have cholesterol levels that are borderline high or higher.
Comply with your physician’s treatment and medication directions.
As the region’s only academic health center, we offer you a remarkable advantage when it comes to your health care. To learn more, visit auhealthadvantage.com.
BYPASSING FAMILY HISTORY ANNA’S STORY ON OVERCOMING FAMILIAL HIGH CHOLESTEROL IF YOU WERE MEETING ANNA OLLIFF FOR THE FIRST TIME, you’d see an attractive, physically fit young woman. You’d soon find out that she has been married for 28 years, is a mother of three and works as a media specialist at Evans High School. It wouldn’t surprise you to learn that she enjoys activities like reading, gardening, walking and kayaking. But what you can’t tell as easily is that Olliff’s grandfather died of a heart attack at 43. Her mother
ASK THE EXPERTS ABOUT IMPORTANT HEALTH ISSUES
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. In addition, prior to menopause, a woman’s uterus also produces chemicals called prostaglandins, which widen blood vessels, lessening the chances that a blood clot will form and block an artery. After menopause, circulating estrogen and prostaglandin levels taper off — 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. HOW MUCH WEIGHT DO I NEED TO LOSE TO LOWER MY HEART DISEASE RISK? Not much. Dropping just a few pounds, even if you are seriously overweight, will reduce your 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. 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.
HOW ESTROGEN PROTECTS
• Estrogen is believed to
increase levels of highdensity lipoprotein (“good” cholesterol) and reduce levels of low-density lipoprotein (“bad” cholesterol).
• Estrogen also boosts
levels of a chemical called tissue plasminogen activator, or TPA, which dissolves blood clots.
By taking preventive measures to safeguard her heart, Anna Olliff is able to keep up with the students at the Evans High School media center. HDL helps reduce excess cholesterol Plaque
Clot
Restricted artery
After menopause, heart disease rates are 2–3 times higher. For a 200-pound woman, losing just 6.5% of her body weight can have a positive impact on heart health.
HEALTHY NEWS CLOSE YOUR MOUTH A simpler version of CPR — one that skips mouth-tomouth resuscitation — might be just as effective as standard CPR, according to recent studies. According to the American Heart Association, less than one-third 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.
ARE YOU HIP? 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 (where the thigh meets the pelvis). 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 risk for heart disease.
It was this thought that motivated her to see her doctor, even though she had been symptom-free and taking cholesterol-lowering medication since her early 30s. He referred her to another doctor, who introduced her to a different cholesterollowering medication, which was expensive and required a very restrictive diet. Olliff’s concerns led her to Dr. Neal Weintraub with Augusta University Heart and Cardiovascular Services, for a second opinion. Due to the severity of Olliff’s blood test results, Weintraub prescribed a combination of medications followed by more testing, which showed improvement. Nevertheless, he conducted a stress echo study, which led to a cardiac CT scan. To Weintraub’s surprise, this showed a severe buildup of calcium salts in her coronary arteries, despite her young age, and identified several potential blockages. Cardiac catheterization confirmed the presence of several blocked arteries, which led to bypass surgery. Just days before Christmas, Olliff found herself in the shoes of her father, mother, uncle and brother: preparing to undergo bypass surgery, a very serious procedure — but one that could save her life. Since her surgery, Olliff has focused on eating clean and taking her medication to keep the cholesterol from building up. She is back to doing the activities she has always enjoyed.
Meet Our New Chief Dr. Adam E. Berman
Chief, Division of Cardiology Director, Cardiac Arrhythmia Ablation Services
Board Certifications: • Clinical Cardiac Electrophysiology • Cardiovascular Disease • Internal Medicine
Be proactive about your health! Visit us online at augustahealth.org/cardio, or call 706-721-2426.
Copyright © 2017 GLC, Skokie, IL 60077 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.
Q&A
suffered a heart attack in her early 60s and underwent triple bypass surgery 12 years later, as did her uncle. More recently, her younger brother underwent triple bypass surgery in May 2015. While Olliff doesn’t match the profile for what most of us think heart disease looks like and she didn’t experience any symptoms of a heart condition, she did know one thing: “If this can happen to [my brother], then it certainly can happen to me.”