By Marissa Bergman and Annabelle Santos Volgman, MD
Heart disease long was thought to be solely a men’s health concern, but it’s the No. 1 killer of women as well. In fact, 2013 was the first year since 1984 that fewer women died of heart disease than men. This decline was the result of the tireless work of a small group of women who have dedicated their lives to eradicating the misunderstanding and unequal treatment of women’s heart disease. Since March is Women’s History Month, it’s an apt time to look back on their lifesaving work.
Heart disease first came to medical prominence in 1948 with the start of the long-term, ongoing Framingham Heart Study — which now is in its third generation of subjects residing in the Massachusetts town for which the study is named. It was reported in 1955 that age and sex were clearly risk factors for heart attacks; men suffered from heart attacks as early as their 30s and 40s, while women seemingly were spared, because they had much less incidence and experienced heart attacks about ten years later than men.
By 1979, 30,000 more men were succumbing to heart disease than women, cementing the perception of heart disease as a men’s disease. As a result, medical attention was focused almost exclusively on men and their hearts — the Multiple Risk Factor Intervention Trial started in 1974 only examined one sex.
As a primary care physician and internist, I have spent more than nine years building relationships with patients.
I explain to my patients that I am their coach and their medical detective helping them sort through their medical problems and referring them to specialists as needed. Teaching patients is one of the aspects of my practice that I most value, as it draws on my background in nursing and as a teacher to medical students as an attending physician.
A foundation of trust
Along with teaching, another key foundation of my practice is building trust with my patients. I believe it is extremely important to build trustful physician-patient relationships in order to work together on the challenges of an illness or chronic condition. In order to have a relationship in which my patients feel comfortable with my recommendations, they must first trust me: trust that I am both listening to them and that I’m providing them with the most up-to-date medical advice. In this way, trust is the foundation of compliance and good health, which includes taking medications as directed, following up for cancer screenings, and keeping follow-up visits.
In 2009, I was diagnosed with breast cancer in my left breast and in some of the lymph nodes on the left side. I had a successful surgery and treatment with chemotherapy followed by reconstructive surgery. They removed 12 lymph nodes, and I had radiation. Everything was going well.
As I approached the five-year mark that would have given me a clean bill of health, I started not feeling well. I had a lot of pain in my upper back, and I felt a lump under my right arm. But my dad was dying at the time, and I was at the hospital a lot. I thought it was just fatigue.
When I went to the doctor, I was diagnosed with metastatic breast cancer in my bones. It was very, very aggressive. I went to the same hospital near my home where I’d received my first round of treatment. The doctor there told me that there was nothing they could do. That it was hopeless, and I only had a short time left to live.
I knew I wanted to breastfeed long before I became pregnant. However, I would be the first woman in my family to breastfeed for many generations, so I knew I had a lot to learn.
I had the opportunity to watch my best friend successfully breastfeed her daughter to a year old and beyond. I researched breastfeeding on the Internet, and I read The Womanly Art of Breastfeeding. I even attended Rush’s breastfeeding class while I was pregnant.
My daughter was born happy and healthy, but early. Delivered at just 36 weeks, she was considered preterm, a word I’d never heard before. It was not unusual in my family for babies to come early. All four of my sister’s kids were born two to five weeks early.
My preterm baby had a healthy appetite, but a shallow latch due to her size and early gestation. She gained weight slowly at first, which was very frightening to me as a new mom who was new to breastfeeding as well.
In 1984, there were more women who died of cardiovascular disease than men. Cardiovascular disease has been the number one killer of American women, more than all cancers put together. Women were being treated differently than men, including hormone replacement therapy for high cholesterol instead of the more effective cholesterol-lowering medications called statins. This resulted in thousands more women dying from cardiovascular disease.
In 2001, the American Heart Association started a campaign to increase awareness about heart disease in women. This campaign was named the Go Red for Women campaign in 2003. Lynne Braun PhD, ANP, and I were involved with the inception of the awareness campaign, and we both continue to be involved with Go Red for Women.
In 2003, the Rush Heart Center for Women opened its doors to prevent and treat heart disease in women. In addition to our services, we also offered complimentary nutrition counseling, which we were able to offer through funding from grateful donors. We wanted to give comprehensive evaluation and compassionate care to prevent devastating cardiac events.
As an expectant mother with an active lifestyle, I had many questions about exercising during pregnancy. After some research and discussion with my doctor, I learned the following:
Gone are the days when women are discouraged from being active during pregnancy. Unless you have a medical or pregnancy complication, the American College of Obstetrics and Gynecology recommends 30 minutes of moderate exercise on most if not all days of the week.
There are many benefits to exercising throughout pregnancy, including:
Preventing excess weight gain and fat accumulation
Decreased health problems such as gestational diabetes, pregnancy induced high blood pressure and postpartum depression
Fewer pregnancy discomforts such as backaches, constipation, bloating and swelling
Improved your mood and energy level
Increased stamina and endurance, which will help prepare you for labor
Women tend to not only take on their own stress, but also that of their families. This compounds the potential health hazards that include both psychological and physical issues.
Women tend to use food to suppress the impact of stress, resulting in increased weight and decreased exercise. When our weight increases and we have decreased exercise tolerance, the health-related heart risk factors can develop or worsen: Our blood pressure increases, cholesterol increases and the risk of developing diabetes increases.
Obesity, high blood pressure, high cholesterol and diabetes are the leading risk factors for developing heart and cerebral vascular disease, such as a heart attack and stroke. Women of all ages are at risk, even those who still have not undergone menopause. If a woman is postmenopausal, then her risk is greater.