MEDICAL SURFARI; HEART DISEASE CAN STRIKE WOMEN TOO

EDITORS NOTE: This is the third in a series of four articles on menopause and post-menopausal health care issues.

If you are like many woman you probably have thought that coronary heart disease is something to worry about for your father, your husband, your brother and your son. Although women have been conditioned to think of heart disease as a male problem, nothing could be further from the truth. Heart attacks occur almost equally among men and women over age 65. In fact, heart attack is the single largest killer of American women.

With menopause and the falling estrogen hormone levels, the protective cardiovascular effect of estrogen is lost and this may change a woman's heart in terms of increasing her risk for heart disease. Last week I outlined the advantages and disadvantages of hormone replacement therapy (HRT). It is generally accepted that estrogen alone or with progestin helps to cuts the risk of coronary heart disease in post-menopausal women. However, a recent study in the Journal of the American Medical Association found that post-menopausal women who already have serious heart disease are not necessarily helped by taking HRT. In other words, adding HRT may not have enough beneficial effect in woman who are already severely affected by coronary heart disease. In relatively healthy post-menopausal woman, HRT may still help to lower cholesterol and reduce the risk of developing heart disease. If you are considering HRT, discuss this carefully with your physician so that your individual risk factors may be taken into account.

The American Heart Association has developed "the healthy heart action plan" to attack the major modifiable risk factors for coronary heart disease. This plan includes losing weight if your are overweight, getting more exercise, checking your blood pressure and blood cholesterol levels, and cutting back on high fat foods, especially those with saturated fat and cholesterol. And, the best gift that you can give your heart and your body is to stop smoking. In the last 100 years cigarette smoking has gone from being considered risqu82 to fashionable in the 1950s, to the greatest single preventable cause of death in the United States in the 1990s.

Survival and recovery depend upon recognition of the signs of a heart attack and immediately seeking medical help. Of course, good long-term recovery depends upon making changes in the way we live and developing a personal action plan with the help of your physician. Coronary heart disease is all about risk factors and some woman have more risk factors than others. Risk factors are genetic traits or social habits that predispose some people to develop a particular disease.

Women's heart attack symptoms are sometimes different than those of men. Men often have sudden pressure, fullness, or squeezing pain in the center of their chest, and this pain may radiate to the jaw, shoulders or arm and be accompanied with a sense of nausea, light-headedness, and shortness of breath. Women may have the same symptoms although sometimes their symptoms are more subtle. They may have chronic breathlessness or shortness of breath at night, as well as overwhelming unusual chronic fatigue. This may be associated with swelling of the ankles and legs, as well as fluttering or rapid heartbeats.

The final responsibility for a healthy heart lies with each woman. Remember Maya Angelou's advice from one woman to another, "We have to look after our own health... those of us who have so long looked after the health of others".

Worldwide Web Resources

The Healthy Heart Handbook for Women

www.nih.gov/health/chip/nhlbi/heart

This is a very comprehensive guide to all aspects of heart disease and women, including post-menopausal health issues.

Health Information Network

www.hertinfo.com/hinf-hp.html

This educational Web site provides a wide range of information and services to heart patients including women and others interested in learning about lowering risk factors.

American Heart Association

www.amhrt.org/Heart-and-Stroke-A-Z-Guide/womens.html

This site provides you with an A to Z guide filled with facts and statistics on heart disease.

Dr. Scott Gibbs is a Cape Girardeau neurosurgeon and editor-in-chief of Mosby's Medical Surfari. You may e-mail questions to him at drgibbs@semissourian.com or write in care of the Southeast Missourian, P.O. Box 699, Cape Girardeau, Mo., 63701.