Take Health to Heart

NEA Today, Mar 2006 by Crute, Sheree

Did you know that heart disease is the leading cause of death among American women? Your doctor may not know either.

One night six years ago, Evelyn Mallery was strolling out of a play, chatting with her daughter about the evening, when suddenly she was overcome with dizziness. "I thought I was just reacting to someone's strong perfume," Mallery says. "I got into the car, leaned against the door, and waited for it to pass." Luckily for Mallery, her daughter had other ideas. She insisted her mom go to the emergency room. Doctors there told Mallery she'd had a mild heart attack.

"I'd been having mild chest pains for six or seven months at that point, but I thought it was just job-related stress," explains Mallery, who was dealing with a difficult classroom environment at the Vacaville, California, high school where she teaches English. "Heart disease was the last thing on my mind. I didn't have high blood pressure or high cholesterol. I was a few pounds overweight but nothing dramatic, and no one in my family had heart disease."

After several tests, doctors discovered a small blockage in a tiny artery. Mallery, who was 53 at the time, had open heart surgery to remove the blockage, but there was still a question about the role stress might have played, given her lack of other risk factors.

Undiagnosed-and Dangerous

If Mallery's story sounds unusual, it's not. Women like her are the norm, not the exception, when it comes to heart disease. She didn't recognize her symptoms, and she was under severe stress for at least a year before she got sick.

"Physicians often underestimate risk in women, even when their risk factors are the same as men/ says Lori Mosca, M.D., chair of the American Heart Association's (AHA) expert panel on Guidelines for Women. A recent survey of physician awareness found that only one in five knew that heart disease and stroke (which is also a cardiovascular disease) are the first and third leading causes of death among American women-claiming more than 500,000 lives each year.

"There is an even higher risk in Black women, in part because of their higher rates of hypertension and diabetes," explains Elizabeth Ofilli, M.D., chief of cardiology at the Morehouse School of Medicine in Atlanta. "And [there are] higher rates among Hispanic women because of the increasing number of women with diabetes or obesity." Yet a national AHA poll found that only 13 percent of women surveyed identified heart disease as their leading health risk. A whopping 51 percent thought it was breast cancer.

Women are also different than men when it comes to diagnostic tests for cardiovascular disease. "Standard stress testing is less accurate in women," says Sharonne N. Hayes, M.D., director of the Women's Heart Clinic at the Mayo Clinic in Rochester, Minnesota. "Electrocardiograms are also more likely to read false positive or negative in women."

Faced with these issues and attitudes, Mosca and a team of top cardiologists from around the country have been working with AHA, Women Heart (the only national support organization for women who have been diagnosed with heart disease), and other experts to make sure that women like Mallery can recognize and manage their risk in advance, which is the most powerful weapon against heart disease.

How much control do we have? Hereditary factors may increase your personal risk, but "lifestyle is huge," says Mosca. "In some cases, it can account for 80 percent of your risk."

Taking Control

Fortunately for women, scientists, physicians, and health care advocates are working hard to reveal the secrets of heart disease-how it develops, what triggers an attack, how we can protect ourselves-so that we have more hope for prevention than ever before. Everything from attitude to healthy eating and getting enough exercise can make a difference. People working in education have a little extra motivation, says Hayes. "Of course they can help themselves, but they also can have a tremendous positive influence on the next generation." Here's how you can begin to make heart health a priority:

Use the educator's edge. "Teachers are experts at modeling," says Hayes. Use that concept to help the kids and yourself by bringing healthy snacks and exercise into your classroom. And go one step further, she suggests, "Be an advocate for a healthy school environment. Fight for healthier school lunches for you and your students."

Create your personal risk profile. In 2004, AHA teamed up with leading cardiologists and experts to develop specific guidelines to help women recognize their risk. Go to http:// circ.ahajournals.org/cgi/content/full/ 109/5/672 to determine whether you're at a low, moderate, or high level of risk.

Know your numbers. The AHA offers a simple, printable chart for keeping track of cholesterol blood pressure, and weight. Log onto www.americanheart.org and click on "Go Red for Women," then "Know Your Numbers."

Work with your doctor. "Women can teach their physicians to do a better job of treating heart disease by asking the right questions," Hayes advises. "Be proactive; make sure your doctor asks about your cholesterol and blood pressure." If you're at moderate or high risk, ask if you're a candidate for cholesterol-lowering drugs or hypertension medication.