If several Baby Boomer women gathered together and were asked to name the one disease which is their greatest health fear, most would probably say breast cancer. But the statistics show that we should be just as, if not more, frightened of heart disease (coronary heart disease, or CHD). While 44,000 women will die from breast cancer this year, 500,000 will die of CHD, which is also the number one killer of both women and men. CHD ranks first among all disease categories in hospital discharges for women. And cardiovascular disease, which includes coronary heart disease, stroke, and other diseases of the blood vessels, causes nearly 39% of all female deaths in America.

Perhaps you did say that heart disease is your biggest health fear, but if you didn\’t, you are definitely not alone for many reasons. These include : 1) the misconception that CHD occurs only in men or in “much older” women, 2) the fact that until recent years, there were not any medical studies specifically on heart disease in women, so there was little knowledge about it, 3) the fact that women with heart disease have some symptoms which are different from those in men, and thus are misdiagnosed, and 4) since often a woman\’s heart disease has been either unnoticed or misdiagnosed, many of us don\’t know any women with this diagnosis, and thus have no personal experience with it.

Recently, knowledge about this killer has dramatically increased, and with that, so has the publicity. For instance, the American Heart Association (AHA) sponsors the nationwide movement, “Go Red for Women”, to raise awareness. This campaign includes a “Go Red for Women day” on February 2, during which participating work places make an AHA donation for each woman wearing red to work.

In order to understand what happens when the heart becomes diseased, we have to talk about what the heart does for the body. The heart is actually one big muscle which pumps the blood around the body through a series of tubes, or blood vessels, known as the vascular system. The blood vessels can be compromised through thickening of their walls (secondary to atherosclerosis or a clot), or from spasm of the muscles in the walls. Either way, blood cannot pass through the narrowed vessel to deliver the oxygen, and thus, that part of the organ dies from lack of oxygen. Coronary heart disease involves a compromise of the specific blood vessels which feed the heart itself, known as the coronary arteries, which can lead to a heart attack. A stroke, also known as a cerebrovascular accident (CVA) or a “brain attack”, occurs when the vessels supplying blood to the brain are diseased. Therefore it follows that the same risk factors which may lead to a heart attack, can also lead to a stroke.

What are the risk factors for CHD? Those factors which put you at risk for CHD or a stroke may be divided into those which cannot be modified and those which can be modified. The first category includes heredity (a family history of heart disease in a first-degree relative at a young age), gender (men have a greater risk of heart attacks, and have them at an earlier age than do women; women have more strokes than do men), increasing age, and a history of having had a prior heart attack or stroke.

Those risk factors which can be modified high blood pressure, diabetes, abnormal blood cholesterol levels (high “bad” cholesterol – LDL, low “good” cholesterol – HDL), a history of cigarette smoking, weight gain and obesity, and a sedentary lifestyle. Contributing factors to the development of CHD or stroke include excessive alcohol intake, high triglyceride levels, and how you respond to stress. There are several other risk factors which have only recently been discovered or are still being studied, including elevated blood levels of homocysteine, lipoprotein A, C reactive protein, and fibrinogen, and the insulin resistance/metabolic syndrome. In addition, the presence of clinical depression has recently been associated with the occurrence of a heart attack in susceptible individuals.

What about those hormones about which we BBW\’s always seem to be asking? For many years, it was thought that menopause was inevitably linked with CHD due to the lack of estrogen. One of the reasons estrogen therapy was prescribed was to prevent CHD. In recent years, however, a large study found that this was not necessarily the case. Though the association between estrogen and CHD is still debated by some in the medical community, it is now accepted that the estrogen loss by itself does not cause CHD. Put another way, menopause does not make the development of CHD inevitable; other factors – those known and unknown – combine with the estrogen lack to play a role. Very interestingly, there have been studies which show that the incidence of heart disease increases after the ovaries are surgically removed (ie, while having a hysterectomy), suggesting that perhaps the ovaries themselves are producing a substance, other than estrogen, which is protective against heart disease.

How can you keep your heart healthy? Here\’s a brief overview. To minimize your risk for CHD or a stroke, you should first become aware of all of your risk factors, which means knowing your family history, having a complete physical examination including the appropriate bloodwork, and an electrocardiogram (EKG) followed by further cardiac studies as deemed appropriate by your healthcare provider. Once you know your complete risk profile, you can get to work making and keeping yourself as healthy and risk-free as possible.

This will include treating any abnormal physical signs, such as high blood pressure, and abnormal blood levels of cholesterol and glucose, as well as stopping smoking, participating in an aerobic exercise program, eating an appropriate “heart healthy” diet, and maintaining an appropriate weight. Since the risk factors for stroke are the same as those for a heart attack, the preventive methods are also the same. For more specifics regarding how to keep your heart healthy, see the tips for a healthy brain outlined by Robin in her September NABBW newsletter column “Preventing Brain Drain”. Here\’s the link: http://www.nabbw.com/display_associate.php?associate_id=23&column_id=150

In next month\’s newsletter, we\’ll continue talking about the heart, including a discussion of the other, less common types of heart disease, the specific symptoms caused by all types of heart disease in women, and what other diseases can mimic these same symptoms. Then we\’ll go into greater detail about the recommendations for keeping your heart healthy.

Facts about heart disease could easily fill an entire book, and in fact does. For more detailed information, I would suggest your reading the book The Women\’s Healthy Heart Program by Nieca Goldberg, M.D. (Ballantine, 2006). As an interesting aside, this book was first published with the title Women Are Not Small Men! I would also recommend your visiting the website of the American Heart Association

http://www.americanheart.org/presenter.jhtml?identifier=4786.

Now for some exercise for your brain: recognize the title of this column? Being a true Baby Boomer, of course you do. It is the title of the hit song first made popular by the Isley Brothers in 1966, then sung by Tammi Terrell in 1969, and finally made into a huge hit by Rod Stewart in 1976. And since we can never forget the writers -the words and music were written by Brian Holland, Lamont Dozier, Eddie Holland, and Sylvia Moy in 1966. Happy Valentine\’s Day!

Janet Horn, M.D. Physician