Excerpt
The Women's Healthy Heart Program
1
Women’s Hearts Are Different
As a woman and a cardiologist, I’ve written this book to help you improve the health of the most important muscle in your body—your heart. Knowing that heart disease has taken over the lives of 8 million women in the United States, I want to show you how taking care of yourself today will help you to have a stronger heart and a healthier life for years to come. You can prevent a heart attack from happening to you—even if it runs in your family—by following the Women’s Healthy Heart Program that I present in this book. If you’ve had a heart attack already, this program will show you how to keep it from happening again. I have designed this unique cardiac prevention and treatment program specifically for women.
Until very recently, no book like this could have been written, because all the knowledge, research, and treatments concerning heart disease were based on findings in men. For too many years, the medical establishment was ignorant of women’s unique needs and physiology and looked upon women as simply “small men.”
But women are not small men. It is now understood that our physiology is very different from that of men, especially when it comes to heart disease. Our hearts are proportionately smaller, and when we develop the first signs and symptoms of heart disease, we are usually ten years older than men. Consequently, to be effective, heart disease prevention and treatment programs for women must be different from those for men.
If you’re like most women, you probably have a Pap smear every year and, especially if you’re over forty, a mammogram every year or two. I’m sure you’ve heard all the scare stories about breast and cervical cancer, and you know that these two simple tests can reduce your risk for them. But you may not realize that heart ailments disable and kill more women than all cancers combined.
Three years ago I established Total Heart Care, a cardiovascular practice for women in New York City, to deal with that reality. Now that baby boomer women are entering menopause—the heart disease years—by the millions, I want to spread the word that heart disease is a woman’s greatest health threat.
I’m not interested only in the condition of your heart; I want to help you become healthier as a whole person: healthier in your mind and entire body as well. That means you need to learn better ways to deal with stress, which takes a toll on your overall health and can set you up for heart disease as well as high blood pressure. As a woman working almost exclusively with female patients for over a decade, I know that we often tend to put off seeing to our own health needs in favor of seeing to the needs of those close to us. In this book, I’ll help you figure out some ways you can make time to take care of yourself, which will help you have a stronger heart and a healthier life in general. You’ll also learn to recognize unhealthy behaviors and replace them with healthy ones.
Perhaps you’ve already been diagnosed with heart disease, and you’re feeling overwhelmed and frightened. This book is for you too. I’ll tell you about the latest research on how to keep your disease under control and even—in some cases of high cholesterol—reverse its course. And if you’ve already had a heart attack, this book is for you too because following my program step by step can make your heart healthier and reduce your risk of further heart damage.
Sometimes it’s hard for women to relate to heart disease unless they’re already suffering from it. It’s a silent and initially a painless killer, doing its dirty work in secret and over time. Heart disease can start early in life, even before the age of twenty. In its earliest stages, you can’t see it or feel it—it has no symptoms.
Sometimes physicians have difficulty conceptualizing coronary artery disease in women too, even though they have been to medical school and seen the life-threatening waxy buildup of cholesterol on the insides of the coronary arteries—the atherosclerosis that lies at the root of heart disease. When I was training during the 1980s, doctors didn’t even believe women got heart disease. In fact, when I was a resident, anytime we saw a woman with chest pain, a familiar symptom of heart attack, everyone said, “Oh, this is so unusual!” In my first month of internship, I examined a thirty-eight-year-old woman who worked at the hospital and was suddenly having chest pain. At first no one believed me when I said that she was having a heart attack. Yet she smoked two packs of cigarettes a day, and everyone knew that smoking put men at risk for heart disease. Even though heart disease was right there in front of them, the doctors couldn’t see it in a woman!
Doctors now know that heart disease is so deadly for women that their chances of dying from it are one in two. That means basically that either you or your best girlfriend is likely to die of a heart attack, stroke, or related heart problem. By contrast, the odds of getting breast cancer during the course of your life are approximately one in eight, and your chances of dying from it are one in twenty-five.
The younger a woman is, the less likely she is to have symptoms of heart disease. Until the age of fifty-five, men are much more likely than women to develop symptoms. But after menopause a woman’s risk goes up sharply. In fact, if you don’t take steps to reduce the risk, your chances of having a heart attack after you reach sixty are as great as a man’s.
In over a decade’s practice helping women patients, I have learned a lot, and now through this book I want to help as many women as I can to recognize the prevalence of heart disease and to teach them how to be proactive in preventing it. I want you to see how improving the health of your heart will improve the health of your entire body. I want you to be able to recognize the signs and symptoms of heart disease and to know what to do if you should become affected. I want to show you how to demand the proper treatments if and when you need them. Above all, I want to keep you from ending up like a patient I will call Teresa.
At forty-seven, Teresa was a successful hospital administrator. She was a single mom and active in her church. Although she smoked, was overweight, and was often short of breath, she believed these habits and discomforts were due to her stressful job. One evening after a delicious restaurant meal, Teresa experienced a burning sensation in the lower part of her chest. The pain became so worrisome that she called her doctor, who assured her that it was just indigestion. “Take some Maalox,” he advised. “And Teresa, next time don’t eat so much.”
The following day Teresa went to work, but the burning never stopped. When she finished work at the end of the day, she paged one of my colleagues, a cardiologist. He recognized from her symptoms that she needed to get to the coronary care unit. There she was given medications. I spoke with Teresa the next morning; her blood tests showed that she had not had a heart attack. But it was clear to me that she was at high risk and that anxiety alone was not the cause of her symptoms. In the past few months, she said, four doctors had told her to take a vacation or sign up for a yoga class to relieve her symptoms. I ordered a stress test to evaluate her heart, which, given Teresa’s health history, should have been done days or even months earlier. (In a stress test, as the patient walks on a treadmill at a slightly increasing speed and elevation, her heart is monitored and its rhythm is recorded.)
Later that day, while Teresa was on the treadmill for her stress test, she got the burning feeling again, and the test had to be stopped. This is usually an indication that the patient has an obstruction in her coronary arteries, the blood vessels that supply the heart. Yet when I reported my findings to Teresa’s doctor, he couldn’t believe she had heart disease. “After all, she’s a woman,” he said to me. But Teresa did have heart disease; her stress test as well as other cardiac tests showed that one of the major arteries supplying her heart muscle had a near-total blockage. That was what had made her short of breath, a common symptom of heart disease in women. Teresa’s specific heart disease was coronary artery disease, one of the first steps on the road to a heart attack.
Had her doctors been negligent? Maybe not—like many doctors, they simply didn’t recognize Teresa’s specifically female signs of heart attack. Except for her weight and smoking habit, Teresa had always been relatively healthy. She had never experienced the “classic warning signs” of heart disease; nor had her heart attack appeared to be a classic (that is, male) heart attack.
