The Women's Healthy Heart Program Lifesaving Strategies for Preventing and Healing Heart Disease

by GOLDBERG, NIECA

• ISBN13: 9780345492289
• ISBN10: 0345492285
• Edition: 1st
• Format: Paperback
• Copyright: 2006-01-31
• Publisher: Ballantine Books

Summary

WINNER OF THE BOOKS FOR A BETTER LIFE AWARD One out of every two women will die of heart disease. It is the single greatest health risk for women todaymore than stroke and all cancers combined. In the course of her practice, and as chief of Women's Cardiac Care at New York's Lenox Hill Hospital, Dr. NiecaGoldberg has come to a startling realization: Women experience heart disease in a fundamentally different way than men do. The physiology of a woman's heart attack is not the same as a man's, the symptoms of heart disease and signs of impending heart attack differ for women, and once heart disease has been recognized, women often do not get the treatment and medications they require. Now here are detailed, age-specific programs that give women the facts and the guidance they need to recognize, treat, and prevent heart disease, including how you can rate your risk of heart disease the effects of menopause on your heart risk factors you can changestarting today a heart-healthy exercise plan that works for you a complete guide to heart-healthy supplements the truth about hormone replacement therapy and the heart recovering from a heart attack or surgery Authoritative, caring, and up-to-the-minute, this is the women's health book for the new millennium.

Author Biography

Nieca Goldberg, M.D., is the chief of cardiac rehabilitation and chief of the Women’s Heart Program, a unique cardiac rehabilitation and prevention program for women that she created at Lenox Hill Hospital in New York City. She is also medical director of the cardio-rehab program and the May Center for Health, Fitness, and Sport at the 92nd Street Y. In New York magazine’s “Best Doctors” of 1999 and 2000 lists Dr. Goldberg was among the top ten Hall of Fame of physicians.


From the Hardcover edition.

Table of Contents

Acknowledgments	xix
Part I: Understanding Your Heart	1	(124)
Chapter 1: Women's Hearts Are Different	3	(19)
Women Have Different Symptoms from Men	7	(6)
Total Heart Care for Women	13	(3)
Your Personal Heart Consultation	16	(1)
Assess Your Risk for Heart Attack	16	(6)
Chapter 2: Women's Symptoms of Heart Attack	22	(26)
Are Women at Higher Risk for Heart Attack Today?	25	(1)
The Anatomy of a Heart Attack	26	(7)
Atherosclerosis Can Cause Heart Attacks	27	(1)
Arterial Spasms Can Cause Heart Attacks	28	(2)
Your Heart's Plumbing	30	(1)
Heart Damage Leads to Abnormal Rhythm	31	(2)
Sudden Cardiac Death	33	(1)
Understanding Your Symptoms	34	(3)
Coronary Artery Disease and Women	37	(5)
Stable Angina	38	(2)
Unstable Angina	40	(1)
Variant Angina	41	(1)
Other Serious Causes of Chest Pain	42	(2)
Syndrome X	42	(1)
Pericarditis	43	(1)
Pulmonary Embolism	44	(2)
Be Smart! See Your Doctor	46	(2)
Timing Is Crucial	46	(1)
Do Not Treat Cardiovascular Symptoms Yourself	46	(1)
Stop a Heart Attack Before Damage Occurs	46	(2)
Chapter 3: Are You at Risk?	48	(29)
Understanding Your Risk Factors	49	(3)
Early Recognition May Save Your Life	49	(1)
Some Risk Factors Are Age-Specific	50	(2)
Common Risk Factors for Women Under Forty	52	(10)
Family History	53	(1)
Smoking	54	(1)
Oral Contraceptives	55	(1)
Polycystic Ovary Syndrome (PCOS)	56	(1)
Abnormal Lipids	57	(3)
Diabetes	60	(2)
Common Risk Factors for Women Forty to Fifty	62	(5)
Perimenopause	63	(1)
Weight Gain and Obesity	63	(1)
Hypertension	64	(2)
Sedentary Lifestyle	66	(1)
Common Risk Factors for Women Over Fifty	67	(2)
Age and Menopause	68	(1)
Special Considerations for Women of Color	69	(1)
Race	69	(1)
Emerging Risk Factors	70	(6)
Homocysteine	71	(1)
Insulin Resistance/Metabolic Syndrome	72	(1)
Lp(a)	73	(1)
C-reactive Protein	74	(1)
Fibrinogen	75	(1)
White Blood Cell Count	75	(1)
Control Your Risk Factors	76	(1)
Chapter 4: The Hormone Connection	77	(25)
Understanding the Hormone-Heart Connection	79	(3)
Concerns of Childbearing Years	79	(1)
Perimenopausal Changes	80	(1)
Menopause	80	(2)
Hormone Therapy	82	(3)
Estrogen Therapy	83	(1)
The Role of Progesterone	84	(1)
Should You Take HT?	85	(6)
Four Major Studies	86	(2)
The Women's Health Initiative	88	(1)
Estrogen Is a Bone Booster	89	(1)
Making Your Decision	90	(1)
Alternatives to HT	91	(6)
Selective Estrogen Receptor Modulators (SERMs)	91	(1)
Natural or Herbal Preparations	92	(2)
Phytoestrogens	94	(3)
Other Medications for Menopausal Symptoms	97	(1)
Your Personal HT Evaluation	97	(4)
Your Best Bet at Menopause: Change Your Lifestyle	101	(1)
Chapter 5: The Truth About Stress, Emotions, and Your Heart	102	(23)
Are You All Stressed Up with No Place to Go?	103	(3)
Lack of Control Adds to Stress	106	(1)
How Stress Affects Your Heart	107	(5)
Perception	109	(1)
Control	110	(1)
Coping Style	110	(1)
Personality Type	111	(1)
Managing Anger and Stress	112	(2)
Panic Attacks May Mimic Heart Disease Symptoms	114	(1)
Depression May Be a Risk Factor	114	(2)
The Importance of Social Support	116	(6)
Social Isolation Increases Stress Symptoms	116	(1)
Seek Support for Optimal Health	117	(3)
Taking Action: Your Plan to Expand Your Social Network	120	(2)
Behavioral Interventions	122	(3)
Part II: Examining Your Heart	125	(76)
Chapter 6: Your Guide to the Symptoms and Diagnoses of Cardiovascular Disease	127	(40)
A Powerful Pump	128	(4)
Arteries Carry Blood Throughout the Body	132	(1)
The Electrical System Charges Your Heart	132	(1)
Heart Rhythm Problems	132	(8)
Arrhythmias	133	(7)
Blood Vessel Diseases	140	(9)
High Blood Pressure, or Hypertension	140	(4)
Stroke	144	(5)
Valvular Heart Disease	149	(13)
Mitral Valve Prolapse	150	(3)
Mitral Stenosis	153	(2)
Aortic Stenosis	155	(3)
Aortic Regurgitation	158	(1)
Heart Disease from Diet Drugs	159	(3)
Heart Muscle Diseases	162	(5)
Heart Failure	162	(3)
Peripartum Cardiomyopathy	165	(2)
Chapter 7: The Women's Healthy Heart Checkup	167	(34)
Guidelines for Choosing the Best Doctor	168	(4)
Get Recommendations from Friends	168	(1)
Understand Your Personal Preferences	168	(1)
Narrow the Search	169	(1)
Choosing a Cardiologist	169	(3)
Be Your Own Health Advocate	172	(3)
Ask Questions	173	(1)
Write Down Your Concerns and Get Answers	173	(1)
Get a Second Opinion	174	(1)
Your Checkup Appointment	175	(6)
The Visual Check	175	(2)
Understanding the Healthy Heart Tests	177	(1)
Age-Appropriate Tests	177	(1)
Testing Your Cholesterol	178	(1)
Testing Your Blood Pressure	179	(2)
Checking Your Heart Rhythm	181	(5)
Electrocardiogram	183	(1)
Holter Monitor	184	(1)
Event Recorder	185	(1)
Checking Heart Muscle Function Noninvasively	186	(3)
Echocardiogram (Resting Echocardiogram)	187	(1)
Transesophageal Echocardiogram	188	(1)
Checking for Coronary Artery Disease Noninvasively	189	(8)
Exercise Electrocardiogram (Stress Electrocardiogram)	189	(3)
Nuclear Exercise Electrocardiogram (Sestamibi or Thallium Stress Test)	192	(1)
Exercise Echocardiogram (Stress Echocardiogram)	193	(2)
Pharmacological Stress Tests	195	(1)
Ultrafast CT (Electron Beam CT)	195	(1)
CT Coronary Angiography	196	(1)
Checking for Blood Vessel Problems	197	(1)
Carotid Doppler	197	(1)
Magnetic Resonance Imaging	198	(1)
Magnetic Resonance Angiography	198	(1)
Where Do You Go from Here?	198	(3)
Part III: The Women's Healthy Heart Program	201	(144)
Chapter 8: Your Commitment	203	(18)
A Mountain of Excuses	205	(1)
Facing Reality	206	(5)
The Health Belief Model	206	(1)
Women in Denial	207	(4)
Making the Commitment to Change	211	(2)
Are You Ready to Change?	212	(1)
The Five Stages of Change	213	(2)
Stage 1: Pre-contemplation (Denial)	213	(1)
Stage 2: Contemplation (Considering Making Change)	213	(1)
Stage 3: Preparation (Making the Commitment to Change)	214	(1)
Stage 4: Action (Taking Steps for Change)	214	(1)
Stage 5: Maintenance (Change Becomes Part of Your Routine)	215	(1)
Maintaining the Commitment	215	(6)
Relapses Do Happen	215	(1)
Set Realistic Goals	216	(2)
Be Prepared for Motivational Lapses	218	(1)
Focus on the Benefits	218	(1)
Focus on the Reality	219	(1)
Focus on Yourself	219	(2)
Chapter 9: Your Exercise Prescription	221	(38)
Aerobic Exercise Is the Foundation	222	(1)
Resistance Training Strengthens Your Body	222	(2)
Benefits of Exercise	224	(1)
Exercise Boosts Positive Feelings and Improves Mood	224	(1)
Exercise Boosts Bone Strength	224	(1)
Exercise Decreases Risk of Cancer	225	(1)
No Matter What Your Age, Move Around More to Protect Your Heart	225	(3)
Get Physical	227	(1)
Overcoming Common Barriers to Exercise	228	(3)
How to Exercise	231	(6)
Frequency	231	(1)
Intensity	232	(3)
Type of Exercise	235	(2)
Duration	237	(1)
Your Exercise Prescription	237	(16)
Your Rx: Add Up Your Daily Activities	238	(1)
Your Rx: Set a Dedicated Workout Time	239	(1)
Your Rx: Find Activities You Enjoy	239	(2)
Your Rx: Add Resistance Training	241	(4)
Your Rx: Calculate Your Total Workout Time	245	(1)
Your Rx: Add Toning Exercises	245	(2)
Your Rx: Add Stretches for Flexibility	247	(5)
Your Rx: Enjoy the Results!	252	(1)
Putting It All Together	252	(1)
Measurable Healthy Heart Results from Exercise	253	(2)
Lower Systolic Blood Pressure	253	(1)
Higher HDL ("Good") Cholesterol Levels	253	(1)
Weight Loss and Lower LDL ("Bad") Cholesterol Levels	254	(1)
Lower Triglyceride Levels	254	(1)
Four Tips to Exercise Safely	255	(2)
Tip 1: Always Warm Up Before Exercising	255	(1)
Tip 2: Stop If It Hurts!	255	(1)
Tip 3: Stay Hydrated	256	(1)
Tip 4: Finish with a Cool-down	257	(1)
Give It Time	257	(1)
Watch for Burnout	257	(2)
Chapter 10: Your Healthy Heart Eating Plan	259	(45)
The Mediterranean-Style Diet	261	(3)
Lose Weight and Stay at Your Desired Weight	264	(9)
How Much Should You Weigh?	264	(1)
Calories Do Count	265	(2)
Eat Small to Moderate Portions	267	(3)
Yo-yo Dieting May Increase Your Risk	270	(1)
Avoid Low-Fat, High-Carbohydrate Diets	270	(3)
Heart-Boosting Weight-Loss Tips for Women	273	(4)
Choose Foods High in Antioxidants	277	(4)
Beta-carotene	277	(1)
Vitamin C	278	(1)
Vitamin E	279	(2)
Choose Foods with Heart Smart B Vitamins	281	(5)
Folic Acid	282	(1)
Niacin (B3)	283	(1)
Vitamin B6	284	(1)
Vitamin B12	284	(2)
Choose Foods with Flavonoids	286	(2)
Choose Foods with Phytochemicals	288	(3)
Should You Use Soy?	288	(3)
Choose Whole Grains	291	(1)
Choose Healthy Fats	291	(7)
Eat Fish High in Omega-3 Fatty Acids	293	(5)
Watch Your Intake of Sodium	298	(4)
A Healthy Diet Can Reduce Blood Pressure	300	(2)
Limit Your Alcohol intake	302	(1)
Heart Healthy Eating Plan Recap	302	(2)
Chapter 11: Nonvitamin Supplements and Heart Disease	304	(15)
Separating Fact from Fiction	306	(2)
Become an Expert	308	(1)
Commonly Used Supplements for Heart Disease	308	(3)
Coenzyme Q10	309	(1)
Aspirin	309	(1)
Garlic	310	(1)
Cholesterol-Lowering Margarines	311	(1)
Herbs to Avoid	311	(5)
Ephedra	312	(1)
Phenylpropanolamine	312	(1)
Ginkgo Biloba	312	(1)
Ginseng	313	(1)
Cholestin	313	(1)
Grapefruit Juice	313	(3)
The Bottom Line on Supplements	316	(3)
Chapter 12: Your Stress Reduction Program	319	(12)
Relaxation Response	320	(1)
Deep Abdominal Breathing	321	(1)
Progressive Muscle Relaxation	322	(1)
Visualization	323	(1)
Meditation	324	(1)
Yoga	325	(1)
Aromatherapy	325	(1)
Music Therapy	326	(1)
Prayer	326	(1)
Finding the Right Stress Reduction Therapy	327	(2)
When Counseling May Help	329	(2)
Chapter 13: Your Stop Smoking Program	331	(14)
But It Feels So Good!	332	(1)
Common Misconceptions About Stopping Cigarettes	333	(3)
Your Stop Smoking Program	336	(7)
Step 1: Identify Your Reasons for Smoking	337	(1)
Step 2: Identify Your Past Successes and Failures	337	(1)
Step 3: Plan to Quit	338	(2)
Step 4: Plan to Face the Triggers	340	(2)
Step 5: Plan to Reward Yourself!	342	(1)
Step 6: Set a Date	342	(1)
What If You Relapse?	343	(2)
Part IV: Medical Treatments for Cardiovascular Disease	345	(72)
Chapter 14: Medications That Can Save Your Life	347	(27)
Combine Medications with Lifestyle Changes	349	(1)
My Philosophy of Prescribing Medication	350	(2)
Common Medications for Treating High Blood Pressure	352	(4)
Diuretics	352	(1)
Calcium Channel Blockers	353	(1)
ACE Inhibitors	354	(1)
Angiotensin II Blockers	355	(1)
Clonidine	356	(1)
Common Medications for Treating Coronary Artery Disease	356	(6)
Aspirin	356	(1)
Clopidogrel	357	(1)
Warfarin	358	(1)
Heparin	359	(1)
Ticlopidine	359	(1)
Dipyridamole and Pentoxifylline	360	(1)
Beta-blockers	360	(1)
Nitroglycerin	361	(1)
Common Medications for Lowering Cholesterol	362	(3)
Statins	362	(2)
Fibric Acid Derivatives	364	(1)
Bile Acid Sequestrants	364	(1)
Ezetimibe	365	(1)
Niacin	365	(1)
Drug Combinations	366	(4)
Arrhythmias	367	(1)
Anti-Arrhythmic Medication	367	(1)
Atrial Fibrillation	368	(1)
Ventricular Tachycardia	369	(1)
Supraventricular Tachycardia	370	(1)
Congestive Heart Failure (CHF)	370	(1)
Digoxin	371	(1)
Other Medications	371	(3)
Antidepressants	371	(3)
Chapter 15: The Heart Attack Survival Guide	374	(20)
Heart Attack: How to Respond	376	(4)
Quick Action Saves Lives	376	(1)
Emergency Treatment Starts in the Ambulance	377	(1)
Priority Care at the Emergency Room	377	(3)
Other Serious Causes of Chest Discomfort	380	(1)
Unstable Angina: A Serious Warning Sign	380	(1)
Heart Attack Without Abnormal Electrocardiograms	380	(1)
After the Heart Attack	381	(1)
Commonly Used Medications	381	(1)
From CCU to Step-Down Unit	382	(1)
Cardiac Rehabilitation: A Lifelong Process	382	(12)
Discharge and Continued Recovery	383	(1)
How Soon Is Sex Safe?	383	(2)
See Your Doctor	385	(1)
Know Your Limits Ahead of Time	385	(1)
Referral to Cardiac Rehabilitation	386	(2)
Now That You're Home, Go Slow	388	(2)
Depression Is a Common Feeling	390	(2)
Call the American Heart Association for Support and Information	392	(2)
Chapter 16: Heart Surgery and Procedures	394	(19)
Coronary Angiography	395	(3)
Coronary Angioplasty and Stents	398	(4)
Coronary Angioplasty Is Beneficial But Not Perfect	401	(1)
Recurrence of Symptoms After Angioplasty and Stents	401	(1)
Making the Surgery Decision	402	(2)
Choosing a Surgeon	404	(1)
Coronary Artery Bypass Surgery	404	(3)
Open-Heart Surgery	406	(1)
Minimally Invasive Direct Coronary Artery Bypass Surgery	406	(1)
Off-Pump Coronary Artery Bypass Surgery	407	(1)
Valve Surgery	407	(2)
Mitral Valve Repair	407	(1)
Percutaneous Balloon Valvuloplasty	408	(1)
Valve Replacement	408	(1)
Surgery to Treat Arrhythmia	409	(2)
Electrophysiological Study	409	(1)
Radiofrequency Ablation	410	(1)
Pacemaker	410	(1)
Automatic Implantable Cardio Defibrillator	411	(1)
Other Issues Important to Women Facing Heart Surgery	411	(2)
Chapter 17: The Future of Women and Heart Disease	413	(4)
Resources	417	(2)
Notes	419	(14)
Glossary	433	(8)
Index	441

Excerpts

Women’s Hearts Are Different

As a woman and a cardiologist, I’ve written this book to help you improve the health of the most important muscle in your body—your heart. Knowing that heart disease has taken over the lives of 8 million women in the United States, I want to show you how taking care of yourself today will help you to have a stronger heart and a healthier life for years to come. You can prevent a heart attack from happening to you—even if it runs in your family—by following the Women’s Healthy Heart Program that I present in this book. If you’ve had a heart attack already, this program will show how to keep it from happening again. I have designed this unique cardiac prevention and treatment program specifically for women.

Until very recently, no book like this could have been written, because all the knowledge, research, and treatments concerning heart disease were based on findings in men. For too many years, the medical establishment was ignorant of women’s unique needs and physiology and looked upon women as simply “small men.”

But women are not small men. It is now understood that our physiology is very different from that of men, especially when it comes to heart disease. Our hearts are proportionately smaller, and when we develop the first signs and symptoms of heart disease, we are usually ten years older than men. Consequently, to be effective, heart disease prevention and treatment programs for women must be different from those for men.

If you’re like most women, you probably have a Pap smear every year and, especially if you’re over forty, a mammogram every year or two. I’m sure you’ve heard all the scare stories about breast and cervical cancer, and you know that these two simple tests can reduce your risk for them. But you may not realize that heart ailments disable and kill more women than all cancers combined.

Five years ago I established the Women’s Heart Program at Lenox Hill Hospital in New York City to deal with that reality. Now that baby boomer women are entering menopause—the heart disease years—by the millions, I want to spread the word that heart disease is a woman’s greatest health threat.

I’m not interested only in the condition of your heart; I want to help you become healthier as a whole person: healthier in your mind and entire body as well. That means you need to learn better ways to deal with stress, which takes a toll on your overall health and can set you up for heart disease as well as high blood pressure. As a woman working almost exclusively with female patients for over a decade, I know that we often tend to put off seeing to our own health needs in favor of seeing to the needs of those close to us. In this book, I’ll help you figure out some ways you can make time to take care of yourself, which will help you have a stronger heart and a healthier life in general. You’ll also learn to recognize unhealthy behaviors and replace them with healthy ones.

Perhaps you’ve already been diagnosed with heart disease, and you’re feeling overwhelmed and frightened. This book is for you too. I’ll tell you about the latest research on how to keep your disease under control and even—in some cases of high cholesterol—reverse its course. And if you’ve already had a heart attack, this book is for you too because following my program step by step can make your heart healthier and reduce your risk of further heart damage.

Sometimes it’s hard for women to relate to heart disease unless they’re already suffering from it. It’s a silent and initially a painless killer, doing its dirty work in secret and over time. Heart disease can start early in life, even before the age of twenty. In its earliest stages, you can’t see it or feel it—it has no symptoms.

Sometimes physicians have difficulty conceptualizing coronary artery disease in women too, even though they have been to medical school and seen the life-threatening waxy buildup of cholesterol on the insides of the coronary arteries—the atherosclerosis that lies at the root of heart disease. When I was training during the 1980s, doctors didn’t even believe women got heart disease. In fact, when I was a resident, anytime we saw a woman with chest pain, a familiar symptom of heart attack, everyone said, “Oh, this is so unusual!” In my first month of internship, I examined a thirty-eight-year-old woman who worked at the hospital and was suddenly having chest pain. At first no one believed me when I said that she was having a heart attack. Yet she smoked two packs of cigarettes a day, and everyone knew that smoking put men at risk for heart disease. Even though heart disease was right there in front of them, the doctors couldn’t see it in a woman!

Doctors now know that heart disease is so deadly for women that their chances of dying from it are one in two. That means basically that either you or your best girlfriend is likely to die of a heart attack, stroke, or related heart problem. By contrast, the odds of getting breast cancer during the course of your life are approximately one in eight, and your chances of dying from it are one in twenty-five.

The younger a woman is, the less likely she is to have symptoms of heart disease. Until the age of fifty-five, men are much more likely than women to develop symptoms. But after menopause a woman’s risk goes up sharply. In fact, if you don’t take steps to reduce the risk, your chances of having a heart attack after you reach sixty are as great as a man’s.

In over a decade’s practice helping women patients, I have learned a lot, and now through this book I want to help as many women as I can to recognize the prevalence of heart disease and to teach them how to be proactive in preventing it. I want you to see how improving the health of your heart will improve the health of your entire body. I want you to be able to recognize the signs and symptoms of heart disease and to know what to do if you should become affected. I want to show you how to demand the proper treatments if and when you need them. Above all, I want to keep you from ending up like a patient I will call Teresa.

At forty-seven, Teresa was a successful hospital administrator. She was a single mom and active in her church. Although she smoked, was overweight, and was often short of breath, she believed these habits and discomforts were due to her stressful job. One evening after a delicious restaurant meal, Teresa experienced a burning sensation in the lower part of her chest. The pain became so worrisome that she called her doctor, who assured her that it was just indigestion. “Take some Maalox,” he advised. “And Teresa, next time don’t eat so much.”

The following day Teresa went to work, but the burning never stopped. When she finished work at the end of the day, she paged one of my colleagues, a cardiologist. He recognized from her symptoms that she needed to get to the coronary care unit. There she was given medications. I spoke with Teresa the next morning; her blood tests showed that she had not had a heart attack. But it was clear to me that she was at high risk and that anxiety alone was not the cause of her symptoms. In the past few months, she said, four doctors had told her to take a vacation or sign up for a yoga class to relieve her symptoms. I ordered a stress test to evaluate her heart, which, given Teresa’s health history, should have been done days or even months earlier. (In a stress test, as the patient walks on a treadmill at a slightly increasing speed and elevation, her heart is monitored and its rhythm is recorded.)

Later that day, while Teresa was on the treadmill for her stress test, she got the burning feeling again, and the test had to be stopped. This is usually an indication that the patient has an obstruction in her coronary arteries, the blood vessels that supply the heart. Yet when I reported my findings to Teresa’s doctor, he couldn’t believe she had heart disease. “After all, she’s a woman,” he said to me. But Teresa did have heart disease; her stress test as well as other cardiac tests showed that one of the major arteries supplying her heart muscle had a near-total blockage. That was what had made her short of breath, a common symptom of heart disease in women. Teresa’s specific heart disease was coronary artery disease, one of the first steps on the road to a heart attack.

Had her doctors been negligent? Maybe not—like many doctors, they simply didn’t recognize Teresa’s specifically female signs of heart attack. Except for her weight and smoking habit, Teresa had always been relatively healthy. She had never experienced the “classic warning signs” of heart disease; nor had her heart attack appeared to be a classic (that is, male) heart attack.

Women Have Different Symptoms from Men

Teresa didn’t experience the “classic” signs and symptoms of heart disease, precisely because she is a woman. The guidelines upon which her doctor relied had been developed from clinical experience only with men. In short, Teresa’s doctors treated her as a “small man.” And because her heart disease did not conform to the male norm, it wasn’t recognized for what it was.

Heart disease has too often been characterized by the stereotypical image of the middle-aged businessman turning red or pale, sweating, and clutching his chest. But for women, the picture is often very different. For women, the symptoms of heart disease or an incipient heart attack may resemble indigestion (as in Teresa’s case), or backache, or a vague feeling of malaise. Twelve years ago, during my cardiology fellowship, different women who had had heart attacks told me this same story over and over: “I noticed that I felt breathless even during my usual activities.” “Occasionally I’d feel a pressure in my upper abdomen, and there would be numbness in my jaw.” “I’d get a strange numbness in my arm.”

For other women, heart disease first shows up as unusual fatigue, dizziness, or palpitations. One patient, a relatively young woman in her mid-forties, experienced back pain whenever she walked up the hills in her Bronx neighborhood. Not until she went to a hospital in the middle of having a heart attack did she learn that her back pain had actually been the sign of that impending heart attack.

Because fatigue, shortness of breath, back pain, and the like were not known to be “classic” signs of heart attack, no doctors thought to test or treat these women for heart disease. Even today many women go from doctor to doctor knowing that something is wrong but being told that the problem is “just” their “nerves,” fatigue, indigestion, or stress. But these problems are female symptoms of heart disease. Attention must be paid!

How did this life-threatening situation come about, and what can women do about it? Above all, we have to educate ourselves about the risks and learn how to protect ourselves and get the best care, if and when we need to see a doctor. This book is my attempt to help you with that education.

Prevention, diagnosis, and treatment of heart disease in women have all lagged behind that in men for a very long time. Until recently, as I mentioned, all clinical research on heart disease was based on studies conducted only on men: the commonly accepted symptoms, the risk factor evaluations, the types and dosages of medications, the surgical treatments, and the rehabilitation recommendations were all based on what was found to be true for men. As a medical student, I was taught that all medical care is based on what was normal for a 165-pound man. This particularly annoyed me, since I am a five-foot-one-and-a-half-inch, hundred-pound woman. How could a drug dosage for someone who weighed sixty-five pounds more than I did be correct for me? How could that drug act the same in my smaller female body? For too long, most researchers have assumed that women’s reactions were exactly like those of men, except on a smaller scale.

My firsthand clinical and research experience underscores the important fact that women’s heart disease is in fact very different from men’s. I first became interested in this issue in 1990, when I began my own career as a full-time academic cardiologist at SUNY’s Health Science Center in Brooklyn, where I ran the Heart Exercise and Imaging Laboratory. There I could not help but notice that fewer women than men were even referred for stress testing. Perhaps the reason was that stress tests tend to produce a higher rate of false positives for women than for men—that is, they more often indicate the presence of heart disease when none is actually present. As a result, many doctors avoided referring women for stress tests at all, even when it was the best option for helping them diagnose what was wrong. Later, improved techniques for stress-testing women, such as stress echocardiography (the use of ultrasound to visualize the heart during exercise), became available, yet even then women were still greatly underreferred. Today more women are referred for stress-testing than ever before, but they are less likely to be referred for follow-up tests if the results confirm a problem.1 This is particularly true for minority women, who often have to insist on further testing to uncover the particular form of heart disease they have.


From the Hardcover edition.

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Excerpted from The Women's Healthy Heart Program: Lifesaving Strategies for Preventing and Healing Heart Disease by Nieca Goldberg
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