Source: UCSF School of Medicine
October 31, 2011
Ask anyone to name the leading cause of death among women in the US and you will likely hear the words “breast cancer.” This is why Anne Thorson, MD, a cardiologist and associate director of the UCSF Center for Prevention of Heart and Vascular Disease at Mission Bay, spends much of her time educating patients and the public about the “heart truth”:
But here’s the good news and the take-home message Thorson and her colleagues want women to know: In contrast to most cancers, heart disease is largely preventable, and the sooner it is addressed, the better the chances to prevent serious damage.
Timing is important, because the road towards a potential heart attack or failure starts even at a young age. Autopsies of teenagers reveal the beginning of cholesterol deposits in children and teenagers. “What this tells us is that the earlier you can help someone at risk, the less likely they are to develop the disease”, said Thorson.
The cardiologists at the Center for Prevention of Heart and Vascular Disease use a highly personalized approach, combined with state of the art technology, to screen their patients for coronary disease and to assess their individual risk. Risk factors for heart disease include smoking, high blood pressure, high cholesterol, overweight and obesity, physical inactivity, diabetes, a family history of early heart disease, and age – 55 and older for women.
After taking a detailed family and patient history and ordering any needed tests, Thorson takes time to sit with patients and develop a personal prevention plan. “A lot of women are juggling career, kids and caring for their own parents,” Dr. Thorson said. “I tell them that unless they take care of themselves, they aren’t going to be any help in taking care of anybody else.” To support her patients, Thorson frequently refers them to dieticians and UCSF’s smoking cessation program, two resources which can also help patients make specific and sustainable changes in their lives.
“The foundation of preventing a heart attack and staying healthy in general is lifestyle,” said Thorson’s colleague Rita Redberg, MD, MS (right), Director of Women’s Cardiovascular Services at the UCSF National Center of Excellence in Women’s Health.
Redberg cites diet, exercise and quitting smoking as important ways to prevent heart disease (more info on prevention). “What makes being a cardiologist so rewarding is that we have lots of ways to help people reduce their risk of dying of a heart attack.”
What Women Should Know
Although most risk factors and prevention measures are the same for both men and women, there are some important differences in prevention, testing, how the disease manifests (read: Know Your Symptoms), and sometimes how it is treated.
For instance, the reason why women tend to be at risk later in life than men is that estrogen has a cardio-protective effect on pre-menopausal women: it helps relax blood vessels and modulates the deposition of fats within the blood vessel walls. But smoking, diabetes, oral contraceptive pills, plus the rising incidence of hysterectomies among younger women lowers this protection.
Taking Hormone Replacement Therapy does not protect a woman from heart disease and can even be counter-productive, studies such as the NIH Women’s Health Initiative found.
The side effects and efficacy for various drugs are also not the same for women. Taking a “baby aspirin” daily is a frequent recommendation to prevent heart attacks and strokes, but for women under 65, there is likely no benefit and a higher risk of gastro-intestinal bleeding.
“I don’t think that women are aware that most of the recommendations are made based on studies done in men,” said Rita Redberg. She has been active in promoting the HEART for Women Act, Congressional legislation that would help ensure that heart disease and stroke are more widely recognized and more effectively treated in women.
Nationally, only 6% of cardiologists are women, however, at UCSF, almost 25% of faculty cardiologists are women. Rita Redberg has been a role model and leader in encouraging women to become cardiologists. In 1994, she helped to start a committee for the American Heart Association which encourages women to choose cardiology and promotes women into leadership positions in the profession.
Less Is More
After she was recruited as editor of the influential Archives of Internal Medicine, Redberg instituted an article series on “less is more”, to educate providers and patients on areas of health care with no benefit and definite risks. “Almost all tests, imaging procedures, drugs, surgery, and preventive interventions have some risk of adverse effects. In some cases, these harms have been proven to outweigh benefits”, she wrote in an editorial, and cautions against “technology creep”, the use of too many tests in an attempt to avoid misdiagnoses. As Redberg points out, the US spends more money on health care than any Western nation, with worse outcomes. “For technology to be beneficial, it needs to be the right test in the right person at the right time.”
One way to turn the tide is education for young doctors. At the UCSF Center for Prevention of Heart and Vascular Disease, experienced cardiologists like Anne Thorson teach their residents and medical students to evaluate a patient by starting with a thorough physical examination and a detailed family history. This data will give them a good indication of whether and which tests will actually be useful in each individual case.
This article is based on and updated by Sarah Paris from a previous story published in the UCSF Cardiology Newsletter HeartLine in 2009 by Elizabeth Chur.
Know Your Symptoms
Women are less likely than men to believe they’re having a heart attack and more likely to delay seeking emergency treatment.
Watch a video presentation by Rita Redberg, MD: Women’s Guide to Heart Health: New Strategies for Reducing Risk
Watch a video presentation by Anne Thorson, MD: Women's Heart Health, Fitness and Your Heart
Read information about women and heart disease published by the Center for Prevention of Heart and Vascular Disease
Evaluate your 10-year risk of having a heart attack