Your Health: The Heart of the Matter
by Jahaan Martin

OK, you walk a mile or two, several times per week. You eat your fair share of fresh fruits and vegetables, and you quit smoking two years ago. How's your heart health? On the surface, pretty good. So you ask, why all the fuss? Here's why. Heart disease is the leading cause of death for American women. Between 1991 and 1995, over 7,000 women in New Mexico died from heart disease. The rates were highest among African American women, followed by non-Hispanic Whites, Hispanics, and Native American women. Among African American women, high rates of obesity place them at higher risk for heart disease. And recent studies have discovered a high correlation between diabetes and heart disease among Native Americans.

The risk of heart disease can be reduced. It is associated with unhealthy lifestyle behaviors and family history, collectively known as risk factors. You can make changes.

A CLOSER LOOK AT THE RISKS

What are the risks? Some risk factors such as age (45 for men, 55 for women), gender, and family history cannot be changed. But most risk factors relate to a person's behavior (like smoking) or lifestyle (lack of physical activity, obesity, diet) and can be modified to decrease the risk of heart disease.

Dianne Sansonetti, MD New Mexico Heart Institute

Smoking
Smoking is a woman's single biggest risk for heart attack. Cigarette smoking is the biggest risk factor for sudden cardiac death: smokers have two to four times the risk of nonsmokers. Smokers who have a heart attack are more likely to die and die suddenly (within an hour) than are nonsmokers.

Cholesterol and Other Lipids
The risk of coronary heart disease rises as blood cholesterol levels increase. When other risk factors are present (like high blood pressure and smoking) the risk increases.

High Blood Pressure
High blood pressure increases the heart's workload, causing the heart to enlarge and weaken over time. It also increases the risk of stroke, heart attack, kidney failure, and congestive heart disease.

Physical Inactivity
Lack of physical activity is a risk factor for coronary heart disease. Regular, moderate to vigorous exercise plays a significant role in preventing heart and blood vessel disease. Exercise can help control cholesterol, diabetes and obesity as well as help lower blood pressure in some people.

Overweight, Obesity, and Diet
People who have excess body fat are more likely to develop heart disease and stroke even if they have no other risk factors. Obesity is unhealthy because excess weight increases the strain on the heart. It's directly linked with coronary heart disease because it influences blood pressure, blood cholesterol, and triglyceride levels, and makes diabetes more likely to develop. Better food habits can help reduce your risk for heart attack. A healthful eat. The Heart Hospital of New Mexico, founded and staffed by physicians from the New Mexico Heart Institute and Southwest Cardiology Associates, is a medical facility dedicated entirely to fighting heart disease. Located in Albuquerque, it is the newest, most advanced facility in the Southwest and includes a team of doctors and highly trained medical professionals specializing in the diagnosis and treatment of cardiovascular disease. For more information and a virtual tour, visit their Web site at www.hearthospitalnm.com. ing plan means choosing the right foods to eat and preparing foods in a healthy way. Eat heart smart!

Diabetes
Even when glucose levels are under control, diabetes seriously increases the risk of heart disease and stroke. More than 80 percent of people with diabetes die of some form of heart or blood vessel disease.

Elizabeth O. Palmer, MD Southwest Cardiology Associates

WHAT IS HEART DISEASE?

The four most common types of cardiovascular disease (CVD) are high blood pressure, coronary heart disease (which includes heart attack and angina pectoris or chest pain), and stroke and childhood experiences with rheumatic fever/rheumatic heart disease.

There are other forms of heart disease, such as arrhythmias (disorders of heart rhythm); diseases of the arteries, or congenital cardiovascular defects, but in general, most women are concerned with coronary heart disease, which includes heart attack and angina pectoris or chest pain/discomfort.

THE ROLE OF STRESS AND GENDER
All people feel stress, but they react to it in different ways. More and more evidence suggests a relationship between the risk of CVD and environmental and psychosocial factors. These factors include job strain (high work demands, low control, job security), social isolation, cultural practices, lack of access to health care and other services, as well as poverty, racism, sexism, and socioeconomic constraints. A holistic approach that integrates thesepsychosocial factors into diagnosis and treatment will help increase compliance and improve outcomes for patients. According to many researchers, sexism in the allocation of funds, and research on men versus women, has hindered the effective and aggressive treatment of heart disease in women. Because of recent national attention to this bias, research is now beginning to clarify determinants, behavioral risk factors, and the success of treatments in women.

Ruby Bendersky, MD New Mexico Heart Institute

ESTROGEN

New guidelines issued in July 2001 by the American Heart Association contend women should not start estrogen replacement therapy solely to prevent heart disease, or prevent a second heart attack or stroke. According to one local physician, 'estrogen offers absolutely no benefit in the secondary prevention of heart disease and primary prevention is still under considerationÉ we just don't know.'

Several population studies show that the loss of natural estrogen as women age may contribute to a higher risk of heart disease after menopause. If menopause is caused by surgery to remove the uterus and ovaries, the risk rises sharply. If menopause occurs naturally, the risk rises more slowly.

These days, lowdose oral contraceptives (which may contain estrogen) carry a much lower risk of heart disease and stroke than the early Pill did. The exception is in women who smoke or have high blood pressure. Remember, you can make changes.

DIAGNOSIS AND TREATMENT

You can assess your own risk of heart disease based on the risk factors outlined earlier. Do you smoke? Are you overweight? Is your cholesterol level through the roof? If you don't know your cholesterol level, a simple blood test can fill in the blanks. Get the facts. Knowledge is power and can assist you in making informed decisions.

Kathleen Blake, MD New Mexico Heart Institute

Use this information to engage in a dialogue with your doctor about your behavioral lifestyle choices and other possible risk factors for heart disease. Does a family member have high blood pressure or diabetes? Does this mean you'll develop one or both of these conditions? If so, is drug therapy, such as aspirin, right for you, or can your condition be managed with diet and exercise? This information should be discussed with your doctor.

A relationship of mutual trust and respect must exist between doctor and patient for real communication and exchange of ideas to take place. This is a partnership. Patients want their doctor to listen to their concerns, answer questions and then help develop a plan of action that is right for them. Likewise, doctors want patients to listen to their concerns and be actively engaged participants in their own care and recovery.

The power to change is in your hands. You can take control of your health. Yes, you may need some assistance and assistance is available but the first step begins with you. Make a mental change. Think of yourself as a person capable of making healthy lifestyle decisions. Start today and reduce your risk for heart disease.

Put down that cigarette and munch on a carrot stick instead. Get off the couch. Go outside and enjoy the beauty of New Mexico. Prepare one of the new recipes you clipped from the newspaper (you know, the ones with the spicy, steamed entrees).

Heart disease is the leading cause of death among women. You can help make this unfortunate statistic change. It's time to start living your life with a healthy heart.

If you have questions about your risk of heart disease, contact your doctor.

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