Women unaware of risk for heart disease
Experts warn, start prevention efforts early
Heart disease is the number one killer of women but not their number one concern. Women cite breast cancer as their biggest fear, although there is only a one-in-eight chance of them contracting the disease. The risk of developing heart disease is higher. According to the Dallas-based American Heart Association, of the 500,000 heart attack deaths that occur each year, more than 233,000 are women. By comparison, about 43,000 women die each year from breast cancer.
When a consumer health magazine recently polled its readers, it found that women did not think heart disease was an issue for them, says Marla Mendelson, MD, assistant professor of medicine and pediatrics at Chicago-based Northwestern University Medical School and director of the Heart Disease and Pregnancy program. Education is needed, and women must learn about heart disease and how to identify their individual risk factors, she says.
Many of the risk factors that apply to men apply to women also. These include elevated cholesterol, hypertension, diabetes, and a family history of heart disease, particularly at a young age. The main difference between the sexes is that women generally develop heart disease 10 years later than men. Before menopause, women seem to be partly protected from the risk of heart attack by the hormone estrogen. A woman’s risk of heart disease rises rapidly after menopause.
Teach prevention early
"That doesn’t mean that women should start thinking of heart disease the day after menopause. They should start thinking about it at a young age," says Mendelson. Prevention is key, and patient education managers should develop educational programs that target women of all ages. The best way to teach women how to prevent a heart attack is to develop a questionnaire or screening process that identifies their individual risk factors, says Mendelson. Following assessment, each woman should be advised of what she needs to do to prevent heart disease, whether to revise her diet to lower cholesterol, develop an exercise regimen, or stop smoking. She also should receive help in developing realistic goals.
"The role of education is to help show people how to implement changes," says Mendelson. For example, to reduce their risk of heart attack, women only need to walk briskly three times a week for 20-30 minutes. They can conveniently complete their exercise during their lunch break at work.
At The Ohio State University Medical Center in Columbus, a risk screening program called Heart Partners was implemented as a community outreach tool. Following the screening, a nurse or an exercise physiologist sits down with the individual to explain his or her risk factors and recommend lifestyle changes, explains Katy Hamtak, a certified exercise specialist and manager of the Heart Partners program. People at particularly high risk are referred to their physician. (To learn details of the Heart Partners screening process, see story, above.)
Recently, the medical center implemented a similar program for women called the Women’s Heart Program, which is part of the Center of Excellence in Women’s Health. The University Medical Center was designated as one of six such centers in the nation by the U.S. Department of Health and Human Services. It will act as a model for improving the health of American women.
Women who participate in the program undergo a screening similar to that completed in the Heart Partner program and receive a one-on-one educational consultation with a nurse. "Although our main goal is to uncover risks for heart disease, the assessment is a little more broad-based. We also assess risk factors for other diseases that affect women such as osteoporosis and breast cancer," says Hamtak. If heart disease is suspected, the woman is referred to one of several cardiologists at the medical center who assess her condition and prescribe treatment.
In addition to learning individual risk factors and prevention techniques, women need to understand that their chances of survival after a heart attack are lower than that of men. According to the American Heart Association, 44% of women die within a year of their heart attack compared with 27% of men. During the first four years following a heart attack, the rate of second attacks is 20 % for women compared with 16 % for men.
Part of the reason for the difference in survival rate is the fact that women are older, and they often have more illnesses that impact their prognosis after a heart attack, explains Mendelson. Also, they present to the hospital later so they miss the benefit of immediate treatment, which is the key to saving lives. Prompt care also reduces damage to the heart. Many don’t go to the emergency room right away because they don’t realize they could be having a heart attack or they don’t recognize the symptoms.
Education that focuses on women is vital since many are not aware they are at risk for heart disease, says LaConnie Taylor Jones, division director for the Oakland chapter of the American Heart Association in California. In March, the Oakland chapter held an all-day conference on women and heart disease to draw attention to the problem. The conference included health risk assessments; massages to reduce stress; workshops on stroke, cholesterol, and nutrition; hypertension, heart attacks, and menopause and hormone replacement therapy, as well as a heart-healthy lunch. She advises patient education managers to check with their local chapter of the American Heart Association to uncover educational opportunities for women.
While women can change their lifestyle to improve their health after a heart attack, teaching prevention is the best tactic, says Mendelson. According to the American Heart Association, people who survive the acute stage of a heart attack have a chance of illness and death that is two to nine times higher than the general population. Within six years after a heart attack, 23% of men and 31% of women will have another heart attack. "About 15% of women die after a heart attack, and for those women, it is too late to teach prevention," says Mendelson.
[The American Heart Association produces a pamphlet called "Silent Epidemic: The Truth About Women and Heart Disease." For more information, write: American Heart Association, National Center, 7272 Greenville Avenue, Dallas, TX 75231-4596. Telephone: (800) 242-8721. Krames Communications publishes a booklet titled "Women & Heart Disease." The cost is $1.35 per booklet, but volume discounts are available on orders of 200 or more booklets in any combination of titles. Write: Krames Communication 1100 Grundy Lane, San Bruno, CA 94066-3030. Telephone: (415) 742-0400.]
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