The Female Frontier: Women's heart disease - challenges and opportunities

The Female Frontier: Women's heart disease -- challenges and opportunities

Heart attacks kill about 250,000 women every year, accounting for one-third of all deaths among American women, more than breast or lung cancer. Can we change this trend? What options do we have? Because prevailing opinion was that heart disease affects only men, the female aspects of this disease have been ignored. But by 1950, deaths of women from heart disease increased even as they declined in men.

After the Framingham Heart Study was published in 1983, the largest and most respected study of heart disease to date, it became clear that heart disease is not just a male phenomenon. The data pointed out that this disease strikes women later in life, after menopause. Despite that, in 1987, the Coronary Artery Surgical Study sponsored by National Institutes of Health included no women over the age of 60, leading to the faulty conclusion that female heart disease is not prevalent. It is no surprise that disinterest in women's aspects of heart disease continued. Prior to the Nurse's Health Study (prospective study on 90,000 women) and the pending Women's Health Initiative, women were not merely ignored, they were regularly excluded from various clinical trials.

Gender bias in heart disease still persists, and it is not uncommon that women's heart problems are misdiagnosed, overlooked or simply ignored.

This year the Archives of Internal Medicine published a study that confirms many previous findings on this issue. An evaluation of 227 female and 450 male heart patients concluded that women receive worse medical treatment despite having more cardiac symptoms or poorer health than men. It is not uncommon that women are denied diagnostic tests routinely used to evaluate heart disease in men. Even such basic procedures as ECG and exercise stress tests are used inconsistently on female patients, and in heart rehabilitation only 20 percent of those enrolled are women.

Now, at the end of the 20th century, women face the situation that either our health problems do not get sufficient attention or we receive medical treatment of unknown specificity. The prevalent attitude remains that what works for men should also be good for women.

Detecting heart disease

The most frequent form of heart disease, atherosclerosis, develops silently over decades and culminates in heart attacks and strokes. We are usually unaware of the disease until substantial blockage in blood vessels and narrowing of blood passages providing oxygen and nutrients to the heart muscle induce symptoms. Chest pain or shortness of breath signal the cry of a starving heart.

The classic male symptoms of heart disease are frequently absent in women. Instead women may experience a variety of symptoms: shortness of breath, fatigue, even back pain. To make matters worse, for many women a first attack can be followed swiftly by a second one. This may be fatal because women's arteries seem less able to compensate for the partial death of heart muscle, the result of a previous heart attack. To add further complexity, the cardiac symptoms women frequently suffer can mimic other medical problems, such as mitral valve prolapse syndrome. In general, women should be concerned about symptoms of jaw pain (if not a dental problem), back pain, fatigue, shortness of breath, abdominal bloating, or heartburn. The best advice is to always contact your physician, especially if you are post-menopausal, smoke, or have a family history of heart disease.

These examples illustrate that a female body has specific ways of signaling the presence of a disease. It also responds differently to various stimuli, including diet or the impact of smoking. There is still much more to discover.

Heart disease is preventable

Fortunately, heart disease is neither inevitable nor irreversible. We learned that much like many other chronic diseases we suffer today, heart disease can result from specific nutrient deficiencies. As such it can be prevented, even treated naturally.

In the first-ever clinical study with a dietary supplement program in patients with coronary heart disease, it was demonstrated that vitamins, minerals, and other essential nutrients can stop progression of this disease at early stages. In individual patients this nutritional program helped to reverse calcified atherosclerotic deposits in coronary arteries. Even in advanced stages of the disease, a slowdown of its progression was observed after only one year of supplementation. The study was published in 1996 in the Journal of Applied Nutrition and many readers of Healthy & Natural had already learned about it in the July issue of the magazine.

Knowing whether you have heart disease before feeling symptoms is important. This early diagnosis is possible with a noninvasive technique, Ultrafast Computed Tomography (UCT), also called "mammography of the heart." It helps you find out within a few minutes whether you have calcified plaques in coronary arteries and determines their size and vessel location. This allows you to intervene before symptoms develop. It is worth mentioning that much more expensive, invasive diagnostic procedures such as coronary angiography can detect a problem only when there is already substantial occlusion of blood passages (50 percent or more). It is not surprising that when the result indicates coronary narrowing, drugs and surgical procedures follow.

An estrogen dilemma

Heart disease in women cannot be discussed without a reference to estrogen. Clinical observations and, particularly, the dramatic increase in heart disease after menopause have suggested that hormonal changes may play a role. Since menopause involves a decrease in estrogen production, this hormone has been targeted as a contributing factor. There have been evident incentives from the pharmaceutical companies, such as Wyeth-Ayers, producer of Premarin, in pursuing clinical research exploring various options for marketing this hormone. Estrogen replacement has already grown to a near billion dollar industry since it was launched in the 1940s. Marketing of estrogen in the form of oral contraceptives since the 1960s has been surrounded by a continuous debate about its involvement in breast and ovarian cancer.

Although the use of estrogen is promoted, its ability to prevent heart disease remains a controversial issue. By now we have learned that women using an estrogen-containing contraceptive pill, and thereby exposed to high doses of this hormone, actually increase their risk of heart attack, stroke, and developing serious blood clotting problems. This can be related to the loss of nutrients, such as vitamin C, folic acid, and B-vitamins, triggered by extra estrogen. The risk multiplies with cigarette smoking. We still have more to learn about other health consequences of this hormonal exposure since women taking early marketed forms of "the pill," containing high estrogen doses, are only now entering menopausal age.

On the other hand, advertisements in women's magazines and even your doctor tell you that extra estrogen during menopause may lower your risk of heart disease. This is by no means certain. A review of women's estrogen studies in heart disease presented last October at the International Meeting on Atherosclerosis in Paris concluded that many benefits attributed to estrogen may result from population selection bias or changes toward healthier lifestyles during studies. Actually there is more compelling evidence of the benefits of soy in preventing heart disease than those of estrogen.

Estrogen replacement therapy studies are not always conclusive or unbiased. Many are financed by pharmaceutical companies with vested commercial interests or are conducted by consultants paid by these companies. An old saying is: who pays the band, orders the music. Articles in major medical journals confirm that many doctors and scientists have become concerned with increased intimidation of research by special interest groups and see it as an alarming issue.

Starting estrogen therapy at menopausal age to prevent heart disease means that a woman is exposed to estrogen for many years without knowing if it really helps but faces risks for other devastating diseases. Estrogen's actions in the body are complex, and involve different forms of estrogens with varying physiological effects on different cell types and organs. Its doses need to be adjusted to individual basal hormone production levels and balanced with other hormones. This is a complex issue of critical importance to women's health and will receive special attention in a future The Female Frontier column.

Heart healthy nutrients

You can protect your cardiovascular health naturally without drugs or surgery with certain beneficial nutrients.

The benefits of soy in cardiovascular health, without the risk of cancer associated with current estrogen drugs, have been confirmed in many clinical studies. A high content of plant estrogenic compounds in soy is responsible for this effect.

The evidence of benefits of vitamins and other nutrients in prevention of heart disease is now so overwhelming that even skeptics take notice. So far the most interest has been directed toward vitamin C and vitamin E, also studied in women. A large, multi-year epidemiological survey published a few years ago by Dr. James Enstrom showed that women supplementing their diets with at least 300 mg. of vitamin C daily experienced about 33 percent fewer heart attacks and lived longer than women taking this vitamin only from food.

We also learned that maintaining a healthy blood vessel system is more important for cardiovascular health than lowering cholesterol. According to Dr. Matthias Rath, an author of this new concept of heart disease, a critical key is vitamin C. This vitamin is essential for preserving integrity of the blood vessel walls, thereby making them resistant to cholesterol deposits. The majority of known risk factors for heart disease, including loss of estrogen production, relate to low vitamin C status in our body. For instance, smoking or stress rapidly uses up vitamin C reserves. High cholesterol or diabetes are the body's response to chronic insufficiency of vitamin C. Supplementing this vitamin helps to correct abnormal cholesterol and glucose levels. Also, the homocysteine blood level, another risk factor for heart disease, is regulated by coordinated action of vitamin C, vitamin B-6, and folic acid.

Although vitamin C is critical for cardiovascular health, there are more nutrients that work together in protecting blood vessels. A study of 87,000 female nurses showed that 100 I.U. of vitamin E daily lowered the heart attack rate by 46 percent. Many other studies have followed, confirming health benefits of this vitamin. Clinical evidence of cardiovascular benefits of amino acids, lysine, praline, arginine, vitamin B6, copper, magnesium, calcium and other minerals is steadily increasing.

Consensus is that modifying one's diet or taking nutritional supplements to prevent heart disease are simple, risk-free and economical measures. However, incorporating this philosophy into a modem medical practice faces powerful opponents: pharmaceutical companies, medical manufacturers and others whose financial gain comes from managing diseases, not protecting our health. These companies spend millions of dollars every year to influence doctors, researchers, and policy makers to insure that their interests are represented.

A substantial source of revenue for these companies is the women's market. Advertisement of pharmaceutical products targeting women has intensified. These are not only breast implants, estrogen drugs, or the infamous fen-phen, but also drugs "recommended by doctor Mom" for our home medicine cabinets. Pharmaceutical companies have recognized that women use more health services and are involved in a majority of health related family decisions.

Women need to be considered much more than a target market. We suffer more illnesses, especially chronic diseases, than men. Numbers speak for themselves: women comprise 80 percent of osteoporosis cases, 60 percent of newly diagnosed diabetes cases and two-thirds of Alzheimer disease patients. Auto-immune diseases are practically women's diseases: 90 percent of patients with rheumatoid arthritis are women, and the same is true for lupus.

Because powerful commercial sources dominate and shape public opinion today, it is becoming more and more difficult to gain access to unbiased information to make the right decisions about your health. This is why being informed and learning about health choices is important in protecting your health.

Measurements & Data Corporation.

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By Aleksandra Niedzwiecki

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