It wasn’t until 1990 that the Office of Research on Women’s Health at the National Institute of Health was founded. Senator Barbara Mikulski (D-Maryland) teamed with Senator Edward Kennedy to make it happen. They knew that women were being excluded from clinical research at the NIH, as exemplified by the well-known aspirin and heart disease study that had been undertaken. There were 22,000 men who were used as research subjects, and zero women. The findings results were applied to both men and women.
In 1991, Dr. Bernadine Healy wrote in The New England Journal of Medicine, about a situation she named The Yentl Syndrome. Her premise was that women were treated less favorably than men for the management of coronary heart disease. She used the name of the title character of an Isaac Bashevis Singer short story about a woman who had to disguise herself as a man in order to attend school in 19th century Poland.
Today, heart disease is the number one killer of women in the United States. Sudden cardiac death is the most frequent presentation of the disease in women. The statistics from the American Heart Association are eye opening:
· 1 in 5 females in the U.S. have some form of heart disease.
· 1 in every 3 women dies of heart disease.
· A woman dies from heart disease every 34 seconds.
· The prevalence of high blood pressure in minority women in the U.S. is among the highest in the world.
· Coronary heart disease rates in women after menopause are two to three times those of women the same age before menopause.
· Heart disease claims more women’s lives than the next eight causes of deaths combined – including breast cancer.
· Nearly two-thirds of American women who die suddenly of a heart attack had no prior symptoms.
It sounds very overwhelming, until you learn that cardiovascular heart disease can be prevented. Every doctor that I spoke with underscored “prevention” as the key to changing the picture. In fact, they have built their practices on that premise.
Dr. Suzanne Steinbaum was unequivocal in her view that individuals have control over heart disease. “80 percent of the time, heart disease is reversible,” she told me. Her mission is to “change people’s mindsets” and show them how to make lifestyle changes. As the Director of Women and Heart Disease of the Heart and Vascular Institute of Lenox Hill Hospital in New York, her credo is, “You never need to get sick from heart disease.” She explained, “It’s different then getting cancer. The more you know, the more information you get, the more changes you can make.” Her “Blood Sugar Self-Quiz for Professional Women” pinpoints what you need to understand about managing your blood sugar.
An advocate of eating complex carbohydrates (whole grains and multigrain items) and limited sugar, Dr. Steinbaum said, “Often times, increasing triglycerides in the diet, increases calories and increases belly fat.” Simple sugars (a form of triglycerides) such as pasta, white rice or sweets, often lead to increasing abdominal fat. “With increasing abdominal fat, the mechanisms to metabolize sugars become dysfunctional, and eventually diabetes may ensue.” For women, diabetes leads to a seven-fold increase in heart disease. Dr. Steinbaum gave me the news that it was better to have a pear shaped figure than an apple shaped figure. Or, in her words, “It’s better to have a big butt than a big belly.” If your waistline measures more than 35 inches, it’s time to get proactive. As Dr. Steinbaum emphasized, “It’s a progressive disease. It takes awhile to manifest, so the goal is to start early.”
Combining the traditions of Eastern and Western medicine informs the philosophy of Dr. Rashmi Gulati, who is a board certified internist and MD of pathology. Dr. Gulati told me that she has seen both the over treating and under treating of patients, with neither approach unearthing the root cause of the problem. She applauds the diagnostic expertise of Western medicine and its ability to treat acute illness. However, she made a choice to look at the larger picture by taking a year off to study integrative medicine at the American Holistic Medical Association and the Institute of Functional Medicine. At a time when the national debate on health care is at a fevered pitch, Dr. Gulati asserted, “The insurance model has to change. We should move to wellness and prevention.” With her approach to patient care, the “seven to nine minute visit” does not work.
Looking at risk factors and lifestyle, Dr. Gulati cites the mind-body connection. Stress can come from various areas of our lives including finances, relationships, and work. In terms of heart health, I asked her what stress does to the body. Dr. Gulati responded, “Chronic stress exposes your body to unhealthy, persistently elevated levels of stress hormones like adrenaline and cortisol, elevates your blood pressure and heart rates, and creates oxidized molecules.” She noted that some studies link stress to changes or increases in blood viscosity – which can lead to blood clots and increases the risk of heart disease.
Her suggestions for getting on the right track includes modalities such as exercise (qualified by a doctor’s guidelines), yoga, meditation, and acupuncture. A diet that avoids foods that raise the blood sugar and then drop it (cookies, candy, soda, potato chips, bagels, and white flour products) is essential. Adding supplements that help boost heart health, including co-enzyme Q 10 and an Omega 3-6-9 combo, is also helpful.
Women do not present with the typical symptoms of the “elephant on your chest” sensation or a tightening and numbness of the left side. Dr. Gulati recommended between ages 40 to 50, when women’s hormones begin to change, that they get screened with baseline tests. She believes that a stress test, and non-invasive EBT scans or CT scans of the heart should be promoted the same way colonoscopies are.
The question is why are women, who have been thoroughly educated about the importance of breast self-exams and Pap smear, so far behind the curve on heart care issues? Patti Armus, a registered nurse who is a “Cardiac Health Coach,” is working to change the status quo. She related circumstances she witnessed as a nurse saying, “Women are not treated the same as men when it comes to heart disease. They are less likely to have an ECG done on arrival to the Emergency Room, and are less likely than men to receive discharge medication and referral to cardiac rehab programs.” For Armus, it’s also personal. She related, “My mother had a family history of drop-dead heart disease.” Armus provides her clients with “a road map and guidance” on how to prevent heart disease, and encourages them to be more assertive. “Women need to demand the proper care from their physicians, and they need to look at their risk factors.”
Heading off these dangers has added another dimension to the conversation for several physicians. Dr. John M. Kennedy, an invasive cardiologist, has just written The Fifteen Minute Heart Cure, which outlines how to cope with stress through breathing techniques.
Dr. Richard Collins, Medical Director of Cardiac Rehabilitation and the Lifestyle programs at South Denver Heart Center in Colorado, has become known as “The Cooking Cardiologist.” He wrote me by e-mail, “I actually was an interventional cardiologist a number of years ago, but I hung up all my catheters and balloons and became a preventive cardiologist. So I am sort of a forest ranger, rather than a fire fighter. I teach people that helping your heart starts right in the kitchen.”
Explaining the importance of diet in preventing and controlling heart disease, Dr. Collins uses the guidelines of “fruit, fiber, fluids (good quality), and fewer fats.” He believes that healthy cooking can be as simple as choosing the right preparation methods. Serving fruits and vegetables raw, or cutting just before cooking minimizes the loss of vitamin C. Heating vegetables in a microwave will actually preserve more vitamins than boiling or steaming. When using frozen vegetables he recommends, “Avoid thawing before cooking, preheat the water first, and remember that microwaving is best.”
Reading nutritional labels and food content is high on Dr. Collin’s list. He suggests looking for foods that are rich in vitamin C. (Vitamin C can support heart health by helping to neutralize free radicals that can cause cell and tissue damage). He points out that not all fats are bad. While you should avoid saturated fats and trans fats, Omega-3 fats (found in foods such as walnuts, flaxseed and fatty fish – like salmon or tuna) may help reduce the risk of heart disease and stroke. Finally, beware of hidden salt by checking labels for sodium content. Limiting your sodium intake can help to reduce blood pressure. According to the CDC, current dietary guidelines for Americans recommend that adults in general should consume no more than 2,300 mg of sodium per day. (See one of Dr. Collin’s recipes below.)
It took a Hollywood star and activist, Barbra Streisand, to make a dramatic statement on behalf of the 42 million American women who are currently living with cardiovascular disease. In 2008, Streisand endowed 5 million dollars to Cedars-Sinai for the creation of the Barbra Streisand Women’s Cardiovascular Research and Education Program. Streisand commented, “The medical system has failed to recognize female-pattern heart attack symptoms…current testing and treatments are geared to male physiology.” Funds have been earmarked to support sex-specific cardiovascular research and education, and for raising awareness of the disease within the medical community.
There is a wave of doctors who are making prevention and lifestyle change the preeminent tool in the fight against cardiovascular disease. It’s now up to women to take the next step.
Orange-Apricot Chicken Tagine
Makes 4 servings
1 tablespoon canola oil
4 small skinless chicken breasts, approximately 4 ounces each
1 yellow onion, sliced
1 tablespoon minced fresh garlic
1 tablespoon minced fresh ginger
1 cup 100% orange juice
1 tablespoon turmeric
1 teaspoon ground nutmeg
1 teaspoon ground cinnamon
1 saffron thread, optional
1 (15-ounce) can garbanzo beans, drained
1 cup dried apricots
1 cup diced fresh tomatoes
½ cup cashews, chopped and toasted
2 tablespoons fresh cilantro, chopped
Heat oil in tagine and brown chicken breasts for 3 to 5 minutes; remove chicken breasts and reserve. Add onion, garlic and ginger to tagine; sauté for 3 minutes. Add orange juice, turmeric, nutmeg, cinnamon and saffron, if desired. Simmer for 3 minutes; do not boil. Add garbanzo beans, apricots and tomatoes. Bring to simmer; add reserved chicken breasts. Cover tagine and cook for 20 to 30 minutes over low heat until chicken is thoroughly cooked. Garnish with cashews and cilantro; serve immediately.