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Leigh Vinocur, M.D. Headshot

Rosie Is Not Alone!

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When it comes to heart attacks the old doctor's joke -- "Take two aspirin and call me in the morning" -- should never apply!

Fortunately, in August when Rosie O'Donnell suffered her heart attack and did just that, she was one of the lucky ones. More than 200,000 women a year are not that fortunate and die from heart attacks. Some facts women may not realize about heart disease is that it is leading cause of death in women, killing one-third of them. Also, did you know that more women die every year of heart disease than men or that five times as many women die from heart attacks every year than from breast cancer?

Now a new study presented earlier this week at the Acute Cardiac Care Congress, held in Istanbul, Turkey, suggests a heart attack is twice as deadly for women because they delay getting care. In these preliminary findings, researchers discovered delay in being treated for heart attack contributes to the in-hospital mortality of women, which was almost double that of men in the study.

It has now been 10 years since the creation of the "Red Dress Campaign" in 2002, which was started to raise awareness for women's greatest health risk: heart disease. However, still well-informed, intelligent women such as Rosie ignore their symptoms. And she is not alone. According to the American Heart Association's 2012 update on Heart Disease and Stroke Statistics, despite all the public awareness campaigns the average time from onset of symptoms to hospital arrival has not improved and is more than three or four hours! And they go on to say that those victims with prolonged pre-hospital delay are also less likely to get life-saving and effective therapy to restore blood flow to the heart.

Despite women being vigilant when it comes to the heart health of their loved ones, they notoriously put themselves last when it comes to their own health! However, often it isn't that women blatantly ignore their symptoms; many women don't even realize they are having symptoms of a heart attack. Unlike men, who often have easily-identifiable crushing chest pain radiating down their left arm, many women have vague complaints that could easily be attributed to other problems. Atypical symptoms such as indigestion, anxiety, sweating, jaw pain, shoulder pain, and even something as ambiguous as sleep disturbance and fatigue can be a sign of heart attack in women. And who among us hasn't had those symptoms! Add to that symptoms can be completely silent in women who are diabetics.

However, many of the women I have seen in the ER who delayed seeking care, when really pressed have admitted to me they had suspicions that this wasn't their usual heartburn! We women are intuitive, but the real issue is that we don't make ourselves a priority. And by not doing this we are actually contributing to the gender bias in medicine with regard to women and heart disease.

The preliminary findings mentioned above corroborate other older studies that have found women are treated less aggressively than men for heart attack and are less likely to receive recommended therapies. Another study found that even when women finally did call 911 they had delays in transport times to the hospital when compared to men. Ladies, we have to take our heart health seriously and make sure all our doctors and all health care providers do the same!

Red dresses aside, we need to prioritize our health. One of the first things you can do is know your risk. First, there are risk factors we can't change. You can't pick your family, so there is not much you can do about your genetics or a family history. But there are totally preventable risk factors such as smoking, as well as modifying your lifestyle, which can lower your risk with diet and exercise. This will decrease your chances of getting diabetes, having high blood pressure or being obese. All this in turn can then lower your cholesterol, too.

Next, you need to know your numbers. Your total cholesterol should be less than 200, optimally with the bad cholesterol the LDL less 100. Your good cholesterol should be 50 or higher. Your triglycerides should be less than 150, and your fasting blood sugar should be less than 100. Your blood pressure should run around or less than 120/80. Know your BMI (body mass index), which is an approximation of your body fat related to your height and weight. It should be less than 25, and your waist circumference should be less than 35 inches. Being outside these parameters can put you at increase risk for heart disease.

There are medications now and therapies that can help lower your risk, as well treatment and procedures such as cardiac catheterization and stents to break up the clots and open blockage causing a heart attack, but you have to get yourself to a hospital quickly!

The CDC talks about the ABC's of hearth disease prevention. They are:

A -- Aspirin and anti-platelet therapy
B -- Beta blockers and blood pressure control
C -- Cholesterol and cigarette cessation
D -- Diabetes prevention, and diet, weight management and waist circumference
E -- Exercise
F -- Framingham Risk Assessment Calculator (estimates 10-year risk for having a heart attack)
G -- Goals for behavior change

Don't be afraid to talk to your doctor about all this and ask about your risk as well as what you can do to change it.

There is also some interesting research in the form of an investigational device. It called the AngelMed Guardian system. It's like a pacemaker that is implanted in patients and is designed to detect a heart attack very early, sometimes even before the patients has any symptoms. The company is conducting ongoing research now.* If approved, it might be especially useful for people with diabetes who are at risk for silent heart attack as well as women with atypical symptoms of heart attack.

As a physician in the ER I have actually had women patients argue with me that they don't have time to be admitted to the hospital with a heart attack! I practically have to lecture them on the way to the cath lab, "Stop with the excuses and stop running yourself ragged taking care of everyone else. It's time to get selfish about yourself and your health!"

*Disclosure: Among the many positions I hold, I want to disclose that I have consulted for this company.

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