CARDIOVASCULAR RISK AND TREATMENT



CARDIOVASCULAR RISK AND TREATMENT

 

Our expert is Nakela Cook, MD, MPH, Chief of Staff, National Heart, Lung, and Blood Institute.

 

If there’s a story relating to women’s health that you’d like to see explored here, just let me know!

 

Very best,

Mitzi Perdue

perdue@liebertpub.com

 

 

 

HEALTH CARE PRACTITIONERS NEED TO RAISE AWARENESS OF CARDIOVASCULAR DISEASE IN WOMEN

 

Many cardiovascular disease (CVD) deaths could be prevented if women were more aware of the seriousness of CVD and if they knew the signs and symptoms of a heart attack.  The fact is, heart disease is the leading cause of death in women, yet only about half of all women are aware of this,, and in the case of African-American women, only 36% know this.  This may be part of the reason women with a cardiovascular event are likely to show up in the ER later than men.  Health care practitioners need to raise awareness of CVD because awareness can lead to action, and action can save lives.  For more information, visit http://www.nhlbi.nih.gov/health/health-topics/topics/hdw.

 

 

LIFESTYLE IMPROVEMENT STRATEGIES THAT WORK

 

Trying to get patients to change their behavior is not easy.  However, when an individual develops a risk factor for heart disease such as diabetes or high blood sugar, or when a woman finds out that she or someone close to her has heart disease, this can be a critical time to point out why it’s worthwhile to make lifestyle changes.  For the greatest success in making lifestyle improvements, keep in mind that a gradual approach may work best.  Too many changes all at once may not be sustainable.  Ask her to work on choosing foods that have less sugar and lower saturated fats, for example, or to choose foods that are less processed and include fruits, vegetables, whole grains, and lean meats in her diet.

 

EXERCISE:  A PREVENTION STRATEGY THAT WORKS

 

Fortunately, health care practitioners are in a good position to tailor their prevention strategies on a highly individualized basis.  They can not only assess the clinical parameters such as weight, BMI, lipids, and blood pressure, but they can take the individualization still further by understanding the social, economic, and geographical context of the patient’s life.  Having a dialogue with the patient is essential for discovering what makes the most sense in her individual situation.  For example, recommending 20 minutes of outdoor exercise may not make sense to a woman who is concerned about neighborhood safety or does not live where there are sidewalks or parks, but maybe she could take the bus to a local community-based gym.  Another possibility is that the neighborhood where she works may offer an opportunity for her to get the exercise she needs during her lunch break or before or after work.  Unless we have these conversations with patients, we may not know how best to facilitate their success.  Current wearable technologies and step counters may also be helpful for providing positive reinforcement and motivation to continue to move throughout the day.

 

HEALTHIER EATING:  ANOTHER PREVENTION STRATEGY

THAT WORKS

 

The National Heart, Lung, and Blood Institute recommends the DASH diet, which is rich in fruits, vegetables, whole grains, and low-fat dairy foods as well as meat, fish, poultry, nuts, and beans.  It limits red meat, added fats, and added sugar.  She doesn’t need to change to a DASH diet overnight, but this is a diet that has been shown to lower blood pressure, and it’s something to aim for.  Learn more about the DASH diet at https://www.nhlbi.nih.gov/health/health-topics/topics/dash.

 

UNDERSTANDING EQUITY IN CARE

 

All practitioners are motivated to deliver the best quality of care to every patient.  The challenge we face is that women and minorities have not fully shared in the same improvements that men and whites have experienced in the last several decades.  For example, minorities have a greater burden of risk factors.  In fact about 45% of black women have hypertension as compared to 30% of white women.  Further, black Americans are at greater risk than white Americans for cardiovascular disease, heart failure, and stroke.  Treatment for heart failure demonstrates the importance of the intersection of gender and race.  Early reports in the literature documented differences by race and gender in utilization of Implantable Cardioverter Defibrillators (ICDs), with black women having the lowest rates of implantation.  In a study of Medicare recipients examining trends in ICD utilization over time, rates of ICD use were 75% lower for women than for men.  There was a narrowing of the racial gap over time, yet persistence of the gender gap.

 

ENCOURAGE MINORITIES AND WOMEN TO ENROLL IN CVD RESEARCH

 

Although clinical trials are the mainstay for guiding care, women and minorities have been historically under-represented in the trials.  Practitioners can encourage participation in clinical research and identify opportunities for trial enrollment because this drives not only better care but also better delivery of care.  As an example of why we need to know more, in many cases different drugs can have different therapeutic effects for men and women.  When we don’t have adequate representation of women and minorities, the information we get from trials may generate questions about the applicability to all segments of our population.  To find clinical trials that are currently underway, visit www.clinicaltrials.gov




DYSLIPIDIMIA: PROBLEMS AND TREATMENTS



DYSLIPIDIMIA: PROBLEMS AND TREATMENTS

 

Our expert is Richard L. Nemiroff, MD, Clinical Professor of Obstetrics and Gynecology, Perelman School of Medicine, University of Pennsylvania.

 

If there is a medical topic you would like to see explored here, please let me know!

 

Very best,

 

 

Mitzi Perdue

perdue@liebert.com

 

EFFECTIVE LIPID CONTROL CAN INCREASE BOTH THE QUALITY AND LENGTH OF A WOMAN’S LIFE

 

Too many women with dyslipidemia are either never discovered or are undertreated. Often they don’t know they have a problem until after they’ve had an event. However, by finding and treating dyslipidemia, we can help prevent the inflammation that plays a role in numerous diseases including: cardiovascular disease; rheumatoid arthritis; osteoarthritis; fibromyalgia; and various GI diseases such as celiac disease or Crohn’s disease. Although this is unproven, better lipid control might also mean reducing the inflammation that could be implicated in some forms of dementia. By adding just a few minor tests (fasting lipid panel and LDL direct) to the usual testing and evaluations performed during well-women visits, we can find dyslipidemia at its earliest stages. When caught early, it can be treated relatively inexpensively and with very little risk.

 

 

THE MEDITERREAN DIET CAN HELP PREVENT DYSLIPIDEMIA

 

Nutrition is particularly important in controlling dyslipidemia. Omega-3 helps prevent or control dyslipidemia, and both freshwater fish and cold-water fish are good and reliable sources of omega-3. However, these fish are also high in calories so be careful not to overdo them. I also particularly recommend the Mediterranean diet which includes a lot of fish, fresh fruits and vegetables, and also olive oil. It’s interesting that when people who grew up consuming a Mediterranean diet move to the United States, and their diets move to a typical American diet, their cardiovascular risks increase along with their chances of being overweight.

 

For me, diet is so important that in my practice, I’m apt to send two or three patients a day for nutritional counseling.

 

 

EXERCISE CAN HAVE BOTH IMMEDIATE AND LONG TERM BENEFITS.

 

Along with a good diet, exercise is crucial for slowing, preventing, or reversing dyslipidemia. If a patient can get her heart rate up to 90 beats per minute even for 10 or 15 minutes a day several times a week, almost right away she’ll be changing her serum level of triglycerides. She’ll decrease inflammation and she’ll be creating a less pervasive atherosclerotic environment. By the end of six months she’ll be looking at pretty good cardio vascular health.

 

 

AN INDOOR BICYCLE IS OFTEN A GOOD CHOICE FOR EXCERCISING

 

An individual who needs to exercise doesn’t necessarily need to join a gym. Rapid walking outside is good, but since she’s unlikely to want to go outdoors when it’s extremely hot or extremely cold or when it’s raining, having a stationery bicycle available can make consistent exercise more likely. In the case of an obese person, a stationery bicycle as opposed to a treadmill is preferable; the patient is less likely to get light-headed or fall from a stationary bicycle. If she’s not used to exercise, she could start at just 10 minutes a day, and then, over time when she’s able to do that much, have her keep increasing the number of minutes she exercises. A reasonable goal is 20 minutes of exercise four days a week.

 

 

 

OMEGA-3 CAN BE USEFUL FOR LOWERING INFLAMMATORY RESPONSES.

 

While diet and exercise are both crucially important for preventing or improving dyslipidemia, omega-3 supplementation is a highly effective way to lower inflammatory responses throughout the body.  However, I don’t recommend   over-the-counter omega-3 supplements. I’ve tested almost all of them, and I view many of them as being marginal at best. In some cases the ingredients are inert, in other cases quality control is lacking, and in still others, once the seal on the bottle is broken, the contents are unstable and start deteriorating.  For patients who need it, I recommend pure eicosapentaenoic acid (EPA), two 2-gram capsules a day.




BREAST CANCER: CURRENT STRATEGIES



BREAST CANCER: CURRENT STRATEGIES

  

Our Expert is Elisa Port, MD, FACS, Co-Director of the Dubin Breast Center and Chief of Breast Surgery. She spoke at the April Women’s Health 2015: the 23rd Annual Congress.

 

If there is a medical topic you would like to see explored here, please let me know!

 

Very best,

Mitzi Perdue

perdue@liebert.com

 

 

WITH BREAST CANCER THERE IS NEW REASON FOR OPTIMISM

 

More than two million American women will develop breast cancer in their lifetimes and 39,000 of them will die from it every year.  However, even though women who are newly diagnosed may understandably have feelings of doom and gloom, there are good reasons for optimism. The overall survival rate is about 90%, an all-time high. Treatments have improved dramatically, not just in the last ten years, but with each year comes new advances through research, and improvements in outcomes.

 

HELP YOUR PATIENTS TO TUNE OUT THE BACKGROUND NOISE

 

She may not have a realistic view of how she’s doing because there’s a lot of breast cancer misinformation around.  Between the Internet and social media and also the fact that breast cancer is so common that almost everyone knows something about it, your patient may come across a lot of unreliable information or information that doesn’t apply to her. I advise patients to use the internet with caution and to try not to become overwhelmed  by researching the disease online. Each patient’s situation is unique and should be reviewed by a doctor who knows the individual and her unique situation.

 

BREAST CANCER SHOULD BE TREATED BY SPECIALISTS

 

Encourage your patients to seek breast cancer specialists for their care. Experts who devote all their time and energy to the care and treatment of breast cancer will be familiar with the latest medical breakthroughs. In addition, their experience counts for a lot; a general surgeon who is doing gall bladder one day and appendixes the next can’t know as much about, for example, about the nuances of breast cancer surgery as the specialist who is dealing with breast cancer care every day.

 

MORE SURGERY DOESN’T MEAN A BETTER OUTCOME

 

To me, one of the biggest challenges we have is making sure our patients are making the right decisions for the right reasons.  A newly diagnosed breast cancer patient, given that she’s vulnerable and nervous, may feel that it’s intuitively obvious that more surgery is better. For instance, she may choose a bilateral mastectomy in the belief that this improves her chances of survival. Actually, this is far from the truth.   Today we are often able to deliver the same results while doing less and less surgically.  In spite of our successes in this, there’s been a disturbing trend in the last few years of women choosing more aggressive surgery, such as having mastectomies or having all their lymph nodes removed when less aggressive procedures would have served them at least as well.  We need to educate our patients that for many patients, more surgery doesn’t necessarily lead to a better outcome.

 

 

LIFESTYLE FACTORS THAT DO AND DO NOT AFFECT BREAST CANCER

 

Obesity increases the risk of developing breast cancer, and increases risk of recurrence for those who already have been diagnosed. I’m sympathetic with the woman who is overworked, and has trouble making time for physical activity, and who would rather stay indoors when the weather is bad.  But even so, exercise and having a healthy body weight is one of the keys to all of health and in spite of the obstacles, she needs to make exercise and a healthy body weight a priority. Another lifestyle risk she needs to keep in mind is alcohol consumption. Drinking more than one or two alcoholic beverages a day increases her risk, and a habit of having  seven or more drinks a week will also increase her risk .

 

Surprisingly, stress does not seem to impose a higher risk of breast cancer.  There have been many studies involving very significant stressors, such as being a prisoner of war or a holocaust survivor. These women did not have a higher risk of breast cancer.




SEX AND GENDER DIFFERENCES IN STROKE



SEX AND GENDER DIFFERENCES IN STROKE

 

Our expert is Cheryl Bushnell, MD, MHS, Director of the Comprehensive Stroke Center at Wake Forest Baptist Medical Center.  Her clinical interests focus on prevention and treatment of stroke and other cerebrovascular diseases, particularly with respect to women.

 

If there is a medical topic you would like to see explored here, please let me know!

 

Very best,

Mitzi Perdue

perdue@liebert.com

 

 

WOMEN ARE DISPROPORTIONATELY AFFECTED BY STROKE

 

Stroke is the third leading cause of death for women.  For men, it’s the fifth leading cause. Further, women have a higher lifetime risk of stroke, and if they have a stroke, they are more likely to die from it. In addition, they are less likely to be aware of the three-hour window for administering the clot-dissolving drug tPA. Women are often less fully aware of their susceptibility to stroke and are surprised to learn that they are twice as likely to die from a stroke as from breast cancer.

 

 

WOMEN HAVE THEIR OWN GENDER-SPECIFIC RISK FACTORS

 

Although many of the risk factors are the same for men and women, there are a number of female-specific risks. Risk factors for both sexes include:  high blood pressure, coronary artery disease, smoking, obesity, lack of exercise, and metabolic syndrome. Risk factors that occur in both men and women but where there’s a greater impact on women include: migraine with aura, atrial fibrillation, and diabetes.  Female-only risk factors include: pregnancy, pre-eclampsia, gestational diabetes, migraine with aura during pregnancy, oral contraceptives, menopause, and hormone replacement therapy.  One other risk factor: because women live longer, there’s more time to accumulate risk factors.

 

 

PREGNANCY IS A SERIOUS RISK FACTOR FOR STROKE

 

Because a woman’s body has to make adjustments to prevent her from bleeding out during delivery, pregnancy makes women more susceptible to blood clots. This is especially true at the time of delivery and the six weeks postpartum. While blood clots may affect the legs or lungs, they can also end up in the brain, causing a stroke.  Another issue with pregnancy is if a woman has pre-eclampsia, her high blood pressure can put her at risk for stroke. A woman who had pre-eclampsia during pregnancy has a fourfold greater risk of developing hypertension over the next 30 years, and a twofold increase in her risk of stroke.

 

 

RECOMMEND LIFESTYLE CHANGES FOR PATIENTS WHO’VE HAD PRE-ECLAMPSIA

 

If a woman has had pre-eclampsia during pregnancy, this is the time to intervene and encourage lifestyle changes that can lower her risk for stroke later on.   There’s a lot of evidence that physical activity and having a healthy diet can prevent the obesity and diabetes that lead to coronary artery disease and stroke.

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LOW-DOSE ASPRIN MAY BE APPROPRIATE FOR A HEALTHY WOMAN AT AGE 65

 

We know that low-dose aspirin is appropriate for women who have risk factors, but should a healthy 65-year-old woman take aspirin to prevent a first stroke, just because of her age?  A 10-year study in which health care professionals were randomized with half taking aspirin every other day and half receiving a placebo showed that this aspirin regimen did prevent some strokes.  However, there’s a lot to be said for deferring the decision to the individual physician since he or she knows the patient’s situation best. However, as a guideline, if after using a risk assessment tool such as the one available at http://cvdrisk.nhlbi.nih.gov, it shows that the patient has a 20% chance of having a stroke in the next ten years, she would probably benefit from a low-dose aspirin regime.   The existing risk factor tests are a good start, but they could be better, given that they don’t consider the female-specific risk factors such as pregnancy.

 

 

SOURCES FOR ADDITIONAL INFORMATION

 

The 2014 Guidelines for the Prevention of Stroke in Women from the American Heart Association/American Stroke Association summarize the data on stroke risks unique to women and the risks that are more common in women than men.  http://stroke.ahajournals.org/content/early/2014/02/06/01.str.0000442009.06663.48




BREASTFEEDING: IT’S NOT JUST BABIES WHO BENEFIT



BREASTFEEDING: IT’S NOT JUST BABIES WHO BENEFIT

 

Our expert is Eleanor Bimla Schwarz, MD, Professor of Medicine, University of California, Davis. Dr. Schwarz has led multiple studies examining the impact of breastfeeding on the health of women.

 

If there is a medical topic you would like to see explored here, please let me know!

 

Very best,

Mitzi Perdue

mperdue@liebert.com

 

 

BREASTFEEDING BENEFITS FOR MOTHERS MAY EXCEED THE BENEFITS FOR THEIR BABIES

 

Doctors have long understood the benefits of breastfeeding for infants.  Today, more and more people are recognizing the immense benefits of breastfeeding for mothers.  To start with, breastfeeding significantly reduces a mother’s risks for both breast cancer and ovarian cancer.  Lactogenesis suppresses estrogen and ovulation, an important factor in the growth of these cancers. A mother’s risk of breast cancer is reduced by 4% for every year she breastfeeds. Mothers who have ever breastfed reduce their risk of ovarian cancer by 25%. The beauty is that breastfeeding is something women can do to change their future risk of cancer. As opposed to mammograms, which allow early identification of cancer, breastfeeding offers women the option of actual prevention.

 

Mothers who breastfeed for as little as one month also reduce their risks of high blood pressure, diabetes, high cholesterol, and heart disease. These reductions in disease risk hold true regardless of the woman’s race, income, education, and other socioeconomic factors.

 

THINK OF PREGNANCY AS AN 18-MONTH EXPERIENCE

 

Milk requires a woman’s energy resources to produce it. As mammals, our bodies get ready to produce milk as soon as a baby starts to grow. Pregnancy, it turns out, is not just a 9-month experience, it’s more like an 18-month effort.  When the body has prepared to lactate and doesn’t, the ingredients for milk-making, meant to be consumed by the infant, stick on the mother as belly fat.  This visceral fat puts the mother at risk for diabetes, heart disease, and a host of other health problems. Mothers who never lactated typically end up with belly fat close to the size of a stick of butter.  In contrast, mothers who breastfed have, on average, a 6-centimeter smaller waist circumference, and if they do accumulate fat, it’s less likely to end up as visceral fat. Mothers who breastfed are more likely to end up “pear shaped,” where fat accumulates below their waistlines, as opposed to the more dangerous “apple shaped,” with belly fat that is linked to diabetes and heart disease.

 

BREASTFEEDING INCREASES IQs OF CHILDREN

 

We know from MRI comparisons that the brains of children fed with human milk develop differently from children fed with cow’s milk. Children’s brain development requires special fats that are not found in cow’s milk. The long-term consequences of a lack of these fats for babies fed nonhuman milk include an average loss of seven points in IQ.  This difference has been known for years, but many in the U.S. have assumed that this difference came about because mothers who were rich and well-educated were more likely to breastfeed.  However, a recent Brazilian study that followed children to 30 years of age counters these thoughts. In Brazil, rich and educated women were not more likely to breastfeed; even so, breastfed babies had higher IQ, more educational achievement, and higher incomes at 30 years of age.

 

 

THE COSTS TO SOCIETY OF NOT BREASTFEEDING ARE ENORMOUS

 

The health data are staggeringly clear; when breastfeeding is interrupted, both mothers and babies suffer, and our communities are unnecessarily burdened with costly health problems. The tragedy is that despite this, only 8% of our nation’s hospitals are following evidence-based practices in supporting breastfeeding, allowing their recognition as a “baby-friendly” hospital. We need a national conversation about making it easier for mothers to breastfeed, including paid maternity leave, on-site day care, and access to evidence-based maternity care for all.