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A Devastating Lack of AwarenessBy DENISE GRADYNY TIMES, June 24, 2001 STRESS, of course, is not good for you. But when it comes to heart disease and its consequences, cardiologists say they wish women would feel a little more of it. Never in their memory, doctors say, have so many people been so blasé about a disease that kills so many — and, contrary to popular belief, tends to work slowly and painfully, turning millions of women's final years into a prolonged bout with chest pain, weakness, immobility and shortness of breath. Dr. Rose Marie Robertson, the president of the American Heart Association, put it bluntly in an editorial in last month's issue of the journal Circulation. Women show a "devastating lack of awareness," she wrote, and "don't believe heart disease can really affect them." She was lamenting a recent survey showing that less than 10 percent of women thought heart disease was the greatest threat to their health, whereas 62 percent named cancer. They had it backward. Cardiovascular disease, which includes heart attacks and strokes, is the leading cause of death among women, killing more than a half million a year. The total is nearly twice the number of cancer deaths in women, and more than 10 times the deaths from breast cancer. Dr. Robertson said part of the blame lay with doctors, who fail to educate patients. This endemic lack of awareness is all the more troubling, she and other cardiologists say, because heart disease — unlike many forms of cancer — is becoming more preventable. People cannot change their age or their genes. But the other major risk factors are habits that can be changed or conditions that can be treated, including smoking, obesity, lack of exercise, poor diet, high blood pressure, high cholesterol and diabetes. Cardiologists are trying to convince the public that prevention efforts should start early in life, because the underlying problem, fatty deposits that clog the arteries, can begin during adolescence or even earlier. And even though most heart disease in women shows up after age 65, it still kills nearly 50,000 women a year who are younger. It often occurs without warning: more than half the women who die suddenly of coronary disease had no previous symptoms and may not have known they were at risk. Prevention does not require heroic efforts, experts say. People do not have to run marathons or live on brussels sprouts to make a difference. Walking regularly or doing other moderate exercising, losing excess weight and quitting smoking can reduce risks considerably. Exercise alone can reduce the risk of heart attack and stroke by 50 percent. Risk is also lowered by a Mediterranean diet, which is high in fruits, vegetables, grains, beans and fish, and low in sources of saturated and trans fat, like red meat, butter, most margarine, cheese, shortening and pastries. Drugs to lower blood pressure and cholesterol, and to control blood sugar in diabetes, can also substantially lower the odds of having a heart attack or a stroke. So many medications are available that doctors say that nearly everyone who needs them can find ones that work and are tolerable. But experts like Dr. Robertson fault the medical profession again: of 50 million Americans with high blood pressure, only half are being treated, and only half of that half receive proper treatment. Similarly, many people who should take cholesterol- lowering drugs are not advised to do so, and many people have diabetes that goes undiagnosed. The medical profession has had virtually no success in treating weight problems, which affect half of all women, as well as higher proportions of black and Hispanic women. Last month, a government panel asked for radical changes in medical practices, declaring that deaths from heart disease could be lowered substantially if people with high cholesterol changed their diets or began taking cholesterol-lowering drugs. The recommendations tripled the number of Americans who should be advised to take the drugs, to 36 million from 13 million under previous guidelines. The number urged to go on cholesterol-lowering diets rose to 65 million, from 52 million. And everyone with high cholesterol was also urged to exercise and lose excess weight. The guidelines were issued by the National Cholesterol Education Program of the National Heart, Lung and Blood Institute. THE decision over whether a person needs treatment is based on a formula that factors in age, cholesterol, smoking and blood pressure, and calculates the risk of having a heart attack within the next 10 years. If the risk is higher than 20 percent, cholesterol-lowering drugs are recommended, usually statins, which block a liver enzyme that is needed for cholesterol production. Everyone with diabetes is considered to be at high risk and to need statins. Directing its attention specifically to women, the panel noted that although it has been widely believed that hormone replacement after menopause can prevent heart disease, recent studies have cast doubt on that theory. The group said that women with high cholesterol or other risk factors should not rely on estrogen to protect them, but should take statins. Dr. Claude Lenfant, the director of the institute, said that numerous studies had shown that lowering cholesterol could reduce the risk of heart disease by 40 percent or more. If people take the new guidelines seriously, he said, heart disease may lose its place as the leading cause of death in this country. But many people, men and women, assume they are not at risk and ignore messages about prevention. Denial is easy, because two major risk factors, high cholesterol and high blood pressure, have no symptoms; diabetes is also silent in its early stages. People tend to fear cancer more than heart disease, and they figure that because they have to die of something, it may as well be a heart attack. But that attitude reflects a lack of awareness of the suffering involved with cardiovascular disease. Prevention efforts are aimed not at keeping people alive forever but at sparing them years of illness and premature death. "People
have this romanticized image that heart disease is the best way to go
because it happens real fast," said Dr. Nieca Goldberg, the director
of the Women's Heart Program at Lenox Hill Hospital in Manhattan. "It
doesn't happen that way. People with it are disabled. They don't have a
good quality of life." Patients may face years of painful decline,
debility and repeated hospital stays, she said.
Copyright
© 2002 Global Action on Aging
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