The female heart

Quick – what’s the number-one killer of women in the U.S.?

Did you say cancer?

The fact is that coronary disease kills more American women every year than any other illness. According to the American Heart Association, 7.2 million women have heart disease. The risk starts to soar after menopause. One in four women over the age of 65 has heart disease. The rate is one in eight among women from 45 to 54. And it’s rising.

But women’s heart disease isn’t the same as men’s. Dr. Amparo Villablanca, a California cardiologist, said the blame can’t be put solely on hormones. We’re facing what she said doctors are calling the “diabesity” epidemic. We’re all getting fatter – and that leads to diabetes. Half the people who are diagnosed with diabetes are also discovered to have heart disease.

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“The key is knowing your risks,” Villablanca said. “Know your genetic risks, know your numbers for blood pressure and cholesterol, know your body-mass index. And get them under control. Deaths from heart attacks are going down thanks to efforts to make more people aware of the risk factors. But the rates aren’t going down as fast for young women because they may not know they’re at risk for heart disease.”

That’s information that Dr. Ramin Manshadi, a cardiologist in Stockton, California, hopes to spread in his new book “The Wisdom of Heart Health.” He said the medical establishment was now beginning to understand that women’s heart attacks are very different from men’s. They are often “silent” heart attacks, and they are more likely to be fatal.

“Women do not have the classic chest pain that we equate with heart attack,” wrote Manshadi. “A heart attack, for a woman, may produce profuse sweating, or sudden fatigue that lasts for hours, or palpitations, or light-headedness. The pain might radiate to the center of the chest or even between the shoulder blades. They may not recognize these as symptoms of a heart attack, and it’s possible that a primary doctor might not recognize them, either.”

Those symptoms sound like they could easily be mistaken for symptoms of menopause. That’s why knowing your numbers, as Villablanca calls it, is so important. “If you know you’re at risk for heart disease, you will know that you can’t just ignore these symptoms or tell yourself they’re probably nothing. You know you have to consult with your doctor.”

Dr. Manshadi said women’s hormones were responsible for differences in the way coronary disease manifests. Before menopause, plaque buildup for women tends to erode arteries rather than rupture them as is more common for men and older women. And blockages tend to be more diffuse, making the surgical use of a stent to open blockages useless for many women.

“I’m hoping this book helps make women aware of their risks and makes them more educated about heart disease in general,” said Manashadi, “as they are often the ones who are responsible for health care decisions for their families.” He said he planned to donate the proceeds from the book to purchase defibrilliators for public schools throughout California.

Diet has a lot to do with reducing risk of heart disease. Dr. Dean Ornish proved back in the Eighties that a strict vegan diet combined with exercise and meditation to relieve stress could dramatically reverse existing heart disease. Since his groundbreaking 1982 diet book, “Stress, Diet and Your Heart,” the American diet has become less, rather than more, healthy. Dinner from a box was once advertised as a once-a-week break for a busy homemaker. It’s now the usual fare.

Sandra Lee, better known in New York for her relationship with governor Andrew Cuomo and nationally known for a show called “Semi-Homemade,” is the queen of the I-don’t-have-time-to-cook philosophy. A recipe for Creamy Chicken Noodle Soup on her website calls for a store-roasted chicken and two cans of cream of mushroom soup. Lee’s cooking technique, which favors speed and convenience, utilizes prepackaged foods loaded with sugar, sodium and preservatives.

TV food guru Paula Deen’s deep-fried, butter-soaked style of cooking has left her diabetic. Not exactly the healthy role model we’re looking for.

“Dr. Ornish paved the way,” said Vicki Koenig, a licensed nutritionist in New Paltz. “But there are a lot of ways to address our eating habits, lose weight, and reduce the risk of heart disease.” Koenig argued. She has had dramatic success with overweight clients by combining coaching with low-glycemic meal replacements. “I’ve been doing this a long time,” Koenig said, “and since starting to work with my clients using pre-packaged, pre-portioned meals, I’ve seen an 80% success rate. It’s a teachable moment.”

Dr. Ellis Lader, a cardiologist at MidValley Cardiology in Kingston, said that meal replacements, those pre-packaged you-can’t-get-this-wrong entrees, are successful for patients who have to lose weight and have to lose it now. But they present a challenge once the weight is off. They don’t come with a system to transition off the product and back to the dizzying choices in the local grocery store. That means you need a nutritionist.

Or you can drive to Albany. “Dr. Paul Lemanski [an Albany cardiologist who used to have a practice in Kingston] has a great program,” Lader said. “It gets the weight off, then teaches you how to keep it off.”

CardioFit, Lemanski’s program, utilizes Medifast meals to get the weight off, and also educates patients about the importance of exercise. It teaches them to reduce stress and stop smoking, and even offers cooking classes.

You can also learn to make healthier meals a little closer to home.

Roni Shapiro recently opened Healthy Gourmet To Go in Saugerties after years of offering vegan meals to area clients.

“I’ve worked with many clients with heart disease and hypertension,” said Shapiro. “I am convinced that the most important thing you can do for your heart is switch to a plant-based diet. Dairy and animal protein are full of saturated fat that clogs arteries. I’ve seen a plant-based diet work and I’ve seen people’s health improve. It’s easier to switch than it’s ever been. You can go to any regular grocery store and find meat substitutes.” You can also contact Shapiro at carrottalk@aol.com to find out about heart healthy cooking classes.

Lader said current science points to a Mediterranean diet as the best for heart health, but he said more research is needed.

Exercise matters, too. “Thirty minutes of aerobic exercise a day. Walking’s plenty,” Lader said. “Jog if you’re up to it, but you don’t have to. Some resistance training. That lowers your blood pressure, lowers your blood sugar, lowers your bad cholesterol, and raises your good cholesterol. Just use common sense. If you have chest discomfort – stop!”

Particularly for women, chest discomfort could indicate another issue – one that your doctor may not consider. “It’s called Syndrome X or Small-Vessel Disease,” said Lader. “It is a narrowing of the little vessels, ones too small to see in most tests. But we can measure the reduction in the blood flow during exertion. It causes chest discomfort. We see it most often in women, particularly diabetic women.”

Lader said routine tests for heart disease won’t find Syndrome X, and some doctors will dismiss a woman’s symptoms if they don’t know about it. “It responds well to angina medication and calls for the same changes in lifestyle that other heart disease patients need to make,” said the local cardiologist. “Lose weight, get cholesterol and blood pressure under control, exercise.”

 

The local American Heart Association heart walks are scheduled for this month. On Saturday, March 10 the Dutchess County walk will take place at Vassar College in Poughkeepsie. On Saturday, March 24 the Ulster County walk will take place at Dietz Stadium in Kingston. Registration for both events will be at 8:30 a.m., and both walks will begin at ten o’clock.

 

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