DR. AVITAL Porter and patient.
(photo credit: BINYAMIN ADAM)
Although women seem to fear breast cancer more, heart disease is not just a “man’s disease.”
In fact, every year, more women than men die of cardiovascular disorders. Since hormones tend to protect women from such diseases until menopause, they typically develop cardiovascular symptoms about a decade later than men, and because of this heart conditions in women may be more risky and complicated to treat.
Gender medicine – based on the understanding that the sexes may have different experiences of the same disease, and need different treatment – has begun to alter a variety of specialties, including cardiology.
Apparently, millions of years of adaptation to the genders’ different roles in society have brought about anatomical and biological changes which, added to environmental influences, have significant effects on cardiac health.
One of the leaders in the field is the Rabin Medical Center-Beilinson Campus, where Prof. Marek Glezerman set up and directs the gender-specific medicine center.
Dr. Avital Porter, head of the intermediate cardiac care unit and, since earlier this year, the Women’s Cardiology Center at the Petah Tikva hospital, is a devoted advocate of gender medicine in her field.
She knows of no major medical center in the US lacking an interdisciplinary women’s cardiac health center, but here they are few and far between.
Porter is so fervent about the cause that she hands out her cellphone number to women she encounters and invites them to call her for advice about their hearts.
Now, Porter has organized the country’s first-ever conference on women and heart disease, which will convene on Wednesday at the Glilot Junction Cinema City in Ramat Hasharon. She hopes a few hundred cardiologists, gynecologists and other experts will attend.
PORTER NOTED in an interview with The Jerusalem Post that while about 60 percent of medical students here and abroad are women, there are still relatively few in cardiology. Thus even physicians tended in the past to think more about men and heart disease. A major challenge is that heart attack symptoms may be different in women than in men, but if they are identified in time they are usually treated similarly to those of male patients. Once women become familiar with their often unique symptoms of heart disease, they can take steps to cut their heart disease risks by lifestyle changes and preventive treatment and to identify the first signs that require urgent hospitalization. Once they’re hospitalized, men and women usually undergo the same treatments, such as angioplasties to open up coronary arteries, insertion of stents to hold open vessels, or open-heart surgery, if necessary.
First, to help reduce your risk of heart attacks and strokes, don’t start smoking, and if you do, quit. Exercise – even just walking briskly – 30 minutes to an hour daily on most days of the week or more if you’re overweight. If you don’t have enough time, patience or energy to do this all at once, you can divide your activity into shorter sessions and still benefit.
Small amounts of effort to increase your physical activity, such as going up and down the stairs instead of taking the elevator, should become a routine. You can also get off the bus a stop before your destination and walk, or do some push-ups or sit-ups while watching TV.
Calculate your body-mass index (BMI) from your weight and height to make sure you aren’t overweight; if it’s 25 or higher, you have a higher risk of heart disease.
Once you lose weight, keep it steady rather than going up and down like a yo-yo. A woman’s waist should be no more than 89 centimeters around.
“Just as women know they have to go periodically for a Pap smear or a mammogram at relevant ages, they should know their blood sugar and blood pressure readings,” the cardiologist advised.
Lower the levels of sugar, saturated and trans fat and salt in your diet on the basis of an expert’s advice, and consult your family doctor about whether you need to take drugs for high blood pressure and other chronic conditions. The American Heart Association has guidelines that include some women taking a daily low dose of aspirin to cut their risk of heart disease, especially if they are at high risk of cardiovascular disease, but if followed, one should always ask one’s doctor, as each case is different.
The AHA guidelines recommend that women of any age consider taking between 75 and 325 milligrams of aspirin daily if they have already have diabetes or heart disease. The AHA also recommends that women over 65 years of age can benefit from a daily 81 milligrams of aspirin if their blood pressure is controlled and the risk of digestive bleeding is low. Aspirin might also be considered for at-risk women younger than 65 years old for stroke prevention.
The latest biennial Acute Coronary Syndrome Israeli Survey (ACSIS) from April/ May 2013 provides interesting statistics on heart disease. During those two months, 1,898 people were hospitalized with a coronary infarction (heart attack), 23 percent of them women. The average age of the men at hospitalization was 62, and of women 70. The rate of men sent directly to intensive care or catheterization labs was higher than that of women. Mortality rates of coronary infarction, said Porter, were much higher in women than men during the 30 days after hospitalization for heart attacks and/or strokes.
Women were less likely to undergo angioplasty than men, but fortunately this rate has been evening out more in recent years. Another figure in the survey was that it takes 78 minutes for the average woman to get to the hospital after the first heart attack symptoms, as opposed to 65 minutes for the average man.
PORTER NOTED during the final phase of organizing her conference that the most common heart attack symptom in women is some type of pain, pressure or discomfort in the chest. The classic heart attack symptoms in men are crushing chest pain that radiates down one arm, as well as sweating. While these can occur in women, many feel vague or even silent symptoms that they may not notice. Sometimes, women suffering a heart attack may feel no chest pain at all, but only pressure or tightness. This may be because women tend to have not only clogged major coronary arteries but also obstructions in the smaller arteries that supply blood to the heart – a condition called microvascular disease. Low levels of estrogen after menopause present a significant risk factor for developing cardiovascular disease in these smaller blood vessels.
The pain or discomfort in women may be felt in the neck, jaw, upper back, shoulder or abdomen. Other signs are pain in the right arm, shortness of breath, vomiting or nausea, unusual fatigue, sweating, dizziness or lightheadedness. Symptoms of a heart attack in women may occur more often when they are resting or even when they’re asleep, and are also more often triggered by emotional stress than in men.
Women, said the Beilinson cardiologist, tend to show up in emergency rooms after damage to the heart muscle has already occurred because their symptoms are less clear-cut than men’s and because they ignore their symptoms. But if a woman fears something serious is happening to her, she or those around her should call for an ambulance immediately – never drive yourself to the hospital unless you have absolutely no choice.
Metabolic syndrome, a condition of pre-diabetes involving hypertension, overweight, high blood sugar and a high triglycerides – has a greater impact on women than on men.
“There is a lot of research showing that diabetes can increase the risk of heart disease significantly more in women than men” said Porter. “If blood sugar is unbalanced in diabetics, it can be one of the major causes of heart disease and stroke.
Some doctors may not even know about the connection between gestational diabetes [when blood sugar rises precariously in women during pregnancy and disappears after delivery] and heart disease.
This is because it raises the risk of developing type 2 diabetes later in life; they have to be monitored.” High blood pressure or gestational diabetes during pregnancy raises the risk of development of heart disease in both the mother and her children.
Porter regularly lectures on heart disease and the differences involving women, and she also appears at Knesset committee meetings as an expert in the field. “I try to create more awareness wherever I go both among the general public and physicians.
People hear that cancer is the number-one killer for both men and women, followed by heart disease, stroke and complications of diabetes and kidney disease. But when you think of it, these are all different aspects of the same syndrome, so they are ahead of cancer as a killer,” she stressed.
AMONG THE speakers at Wednesday’s conference will be Prof. Naama Constantini, volunteer chairman of the National Council for Women’s Health and also a leading sports medicine specialist at the Hadassah-University Medical Center’s neurology department and Hadassah Optimal. She told the Post that despite growing awareness of heart disease in women, Israeli medical schools do not offer separate courses in gender medicine.
“Maybe they spend only a day or so on it. There is not enough attention to heart disease in women, who are less likely to exercise than men.”
She always asks her patients – women and men – if they smoke or are regularly exposed to others smoking. Tobacco is a greater risk factor for heart disease in women than in men. Arab women, especially, are exposed to their father’s and husband’s tobacco smoke, tend to be overweight, avoid physical exercise (“just going out alone and walking may be discouraged by society”) and suffer from diabetes, Constantini pointed out. Similarly, ultra-Orthodox women are more likely to suffer from obesity, diabetes and heart risks than secular and national-religious Jewish women.
When women are put through stress tests to determine their heart health, “There are a lot more false positives than in men. The results have to be reassessed.
Only if there are enough risks factors to raise suspicion should women be sent for such tests,” she concluded.