Women's hearts are also an issue

Until very recently, almost all research involving heart disease has been confined to studies involving us guys - the human male.

The reasons for this unisex approach escapes logical analysis, but for our purposes here, it is prudent that we avoid in-depth or sexist evaluation of such a disastrous oversight. We'll just get on with a review of what is known about the health of those beloved hearts that have sustained and succored us unworthy guy recipients forever.

So, how big a health problem is the understudied female heart? Let's just see - hopefully without driving our lady bearers to drink - but only one drink and of average size each day! More on that later. Here are some important women's heart figures:

4 More women succumb to heart disease alone than the seven next illnesses together! For example, a woman's chance of dying from breast cancer is one in 27, but from heart disease, one in two.

4 Heart disease takes more senior women than men. It is responsible for 40 percent of all women's deaths.

4 Women's heart attacks are generally more severe than men's and women are, in the first post-attack year, more likely to die than men.

4 Since women are most likely to be diagnosed with heart disease later in the disorder, their outlook is worse.

This is a very sad and neglected litany which, fortunately, is crumbling under a new unfolding of aggressive women's heart disease detection and management. Thank God!

Our ladies risk factors for heart and cardiovascular disease are similar to ours - with some important variables. Smoking, for instance, is one of these. Although the smoking habit is regularly decreasing in most settings, it is still significantly increasing in teenage girls. Sadly, this habit is much more dangerous for women's future cardiac health than for us men. Other contributing variables include, obesity, hypertension, elevated cholesterol and other abnormal lipid levels, diabetes, inheritance, sedentary lifestyles, oral contraceptives and hormone replacement therapy, alcohol in excess and stress. Added to these usual predators are the two recently identified co-conspirators that we have written about in the past few months - namely chronic inflammation and inadequate sleep.

Complicating this causation parade is the controversial role that hormone replacement plays in female heart disease progression - one way or the other. Initially, studies seemed to show that estrogen and progesterone, the loss of which at the menopause produced a multitude of disorders - some, like osteoporosis, being very destructive - could be allayed by continuing these hormones. Over time, it became clear, however, that hormone replacement carried too many dangerous barnacles with it - both for the heart and the breasts, and so its use became very limited and it is not now regularly recommended.

The most overlooked aspect of women's heart disease has been our failure to determine early on in our general heart disease studies the distinguishing and separate symptoms that this massive problem produces in women. It had been incorrectly assumed - based upon the original research done exclusively on middle-aged males, that such symptoms should be the same for both sexes.

As a result of such faulty speculation, women have in the recent past sustained undiagnosed heart disease progression and damage, because that disorder's diagnosis and treatment has many times been delayed. Now it is clear that the stabbing left chest pain so characteristic of male coronary artery disease is not equally so for women.

According to the renowned Texas Heart Institute's findings, in the month prior to a heart attack, women may experience unusual fatigue, sleep disturbances, shortness of breath, indigestion and anxiety. Their warning signs of an actual impending attack include pressure and fullness or pain in the chest lasting over five minutes - pain which may move to shoulders, arms, neck, jaw or back; constant indigestion-like discomfort; dizziness, fainting, sweating or a sick stomach; unexplained shortness of breath, anxiety, weakness or tiredness; cold sweat or palpitations. Let it be clearly known, though, that almost half of the burdened women had no chest pain at all! The clinical and laboratory confirmation of heart disease in women should be no more difficult or complicated than it is for men. There is sometimes some difficulty in visualizing arterial plaque formation in women because of their tendency to involve smaller heart vessels in such plaques but skilled examiners well realize this. Early diagnosis and treatment is of paramount importance for our ladies because their primary occlusive episode is more treacherous than ours and their early mortal subsequent risk is greater. Treatment includes a great variety of medications accompanied by strenuously and repeatedly urged opposition to the multitude of contributing factors we noted earlier.

There is a great feast of new research working its way into the better prevention and care of all heart problems in both sexes - even us guys. In a future column, we may be able to look at these advances together - if our broken but salvaged hearts allow that future.

Clark Gillespie is a retired OB/GYN who now lives in Aiken.