“Women erode, men explode.” — Dr. Noel Bairey Merz
Noel Bairey Merz: The single biggest health threat women face
More women die of cardiovascular disease (CVD) than anything else. Mortality rates for women have increased for heart disease and declined for breast cancer, likely because that’s where we’ve dedicated our resources and attention (Merz, 2011).
CVD for younger women is on the rise (“HEART for Women Act”), and heart medication prescriptions are increasing (Berkrot, 2007). Women have a greater chance of dying within a year of a heart attack. Possibly because a surprising number of family physicians don’t know these facts, women with CVD often are not diagnosed and treated accordingly (“HEART for Women Act”).
Much of the problem is that women’s heart disease is different from men’s. Our conventional ‘knowledge’ is based on research, diagnostics, and therapies related to men’s hearts (Merz, 2011). The HEART for Women Act introduced in 2011 was intended to change that projectile by funding research and education. It gained no momentum and has remained in the House Subcommittee on Health (H.R.3526). This lack of political interest doesn’t help our lack of public knowledge.
Women’s heart attack symptoms are different from men’s. They tend to have symptoms “unrelated to chest pain, such as neck, shoulder, upper back or abdominal discomfort; shortness of breath: nausea or vomiting; sweating; lightheadedness or dizziness (and) unusual fatigue” (“Heart disease in women”). The EKG readings may be different–male pattern readings from massive chest pain are loud and clear, while female pattern readings without chest pain are smooth (Merz 2011). Here lies a critical distinction. Since these symptoms are not commonly linked with a heart attack, a woman may not be aware she is having one.
For the past 16 years the National Heart, Lung, and Blood Institute has been conducting the Women’s Ischemia Syndrome Evaluation (WISE), looking at why more women are dying of heart disease. Using intravascular ultrasound, they discovered different patterns of atherosclerosis. Parallel to their weight gain, men tend to develop arterial plaque in large deposits easily discernable in an angiogram. Parallel to women’s weight gain, their arterial plaque tends to spread out through the arteries, difficult to see in an angiogram (Merz 2011). This female pattern is termed Coronary Microvascular Disease (MVD) since the plaque develops in smaller arteries (“How does heart disease affect women?”). The range of female symptoms may be due to Coronary MVD where smaller, more distal arteries become blocked or diseased, leading to dizziness, shoulder pain, sweating, and so on.
Another female pattern, Microvascular Coronary Dysfunction (MCD), is a narrowing of small arteries inside the heart (“Small Vessel Disease”). Difficult to detect, MCD requires cardiac magnetic resonance imaging to see inside the heart (Merz 2011). Women are also more likely to get stress-induced cardiomyopathy, commonly known as broken heart syndrome. Doctors and researchers are now recognizing that severe emotional stress can result in temporary heart failure. The symptoms are the same as a heart attack, but there are no blocked arteries and people generally recover (“How does heart disease affect women?”).
Bottom line–two of the the primary tests we have, the EKG and angiogram, do not adequately indicate or measure heart disease for women. The tests that do, intravascular ultrasound and cardiac magnetic resonance, are not commonly available. We don’t have a collective awareness of symptomology or that women have CVD in increasing numbers. We are equally misinformed about risk factors.
The general consensus on risk factors for CVD has been shifting in the last few years. Literature and physicians still warn about high blood pressure, poor diet, diabetes, high LDL cholesterol, high triglycerides, lack of movement, smoking, and stress. There are additional risk factors more specific to women: Metabolic Syndrome, depression, and low levels of post-menopausal estrogen. Smoking is more of a risk for women (“Heart disease in women”).
The biggest shift may be over fat recommendations. The nutrition department at the Harvard School of Public Health has collected data from several large studies, including the Nurses Health Study, that upgrade our knowledge about dietary fat:
“After adjusting the analysis to account for smoking, physical activity and other recognized risk factors, we found that a participant’s risk of heart disease was strongly influenced by the type of dietary fat consumed. Eating trans fat increased the risk substantially, and eating saturated fat increased it slightly. In contrast, eating monounsaturated and polyunsaturated fats decreased the risk.” (Willet & Stampfer, 2003, p.17)
Healthy unsaturated fats found in olive oil, avocados, nuts, safflower oil, fish, and legumes help regulate HDL and LDL balance, prevent blood clots, and prevent arrhythmia (“A Voice of Reason”). The low-fat diet trend does not support heart health. “No study has demonstrated long-term health benefits that can be directly attributed to a low-fat diet. The 30 percent limit on fat was essentially drawn from thin air” (Willet & Stampfer 2003, p.15).
While it may be disconcerting to hear conventional wisdom turned around, it’s a good example of how ‘knowledge’ changes. Fat tastes good, and we know our bodies need it. One simple way to choose fat wisely is to look at its status at room temperature. A saturated fat from red meat, margarine, butter, and lard is hard. What that becomes in an artery isn’t hard to imagine.
The final bubble to burst is over cholesterol screening. While high levels of LDL that support plaque deposits do pose a risk, people with normal cholesterol numbers still get heart attacks. Half of all heart attacks, in fact (Gorman and Park). So high LDL is not a precise predictor. Additionally, as demonstrated with female plaque pattern, the deposits can be small and still pose a risk.
A better predictor is the C-reactive protein test. The C-reactive protein is released by the liver in response to inflammation. High levels increase risk of CVD by three times, especially in women (Gorman and Park). Dr. Paul Ridker, who pioneered the research on inflammation and the C-reactive protein test, clarifies the relationship: “This is not about replacing cholesterol as a risk factor. Cholesterol deposits, high blood pressure, smoking—all contribute to the development of underlying plaques. What inflammation seems to contribute is the propensity of those plaques to rupture and cause a heart attack” (as cited in in Gorman and Park, p.13). Cholesterol remains a risk, just not an accurate predictor. And with this understanding, we can add inflammation as a risk factor for CVD.
This reflects the current trend among researchers, that “heart disease is more of a systemic disease rather than just a plumbing problem,” says Dr. Mary S. Beattie. (as cited in Brody, p.19). It makes sense from a whole health perspective especially to support every system, rather than focusing on cholesterol results. The C-reactive protein test is relatively inexpensive and can be added to regular blood testing. It is a good tool to measure general inflammation and treat all systems accordingly, not just CVD propensity specifically.
Whole Health Recommendations
Since we are treating all systems, not just the “plumbing,” we apply anti-inflammatory recommendations in addition to those specific to the cardiac system.
Consume the following, all in moderation (Nutrition Research at Harvard):
1. Monounsaturated and polyunsaturated fats–olive oil, avocados, nuts, safflower oil, fish, and legumes.
2. Whole grains
3. Fiber
4. Protein from fish, poultry, legumes, and nuts
5. A majority of plants
6. Nuts
7. A green food before a saturated fat (Plotnick, Corretti, Vogel, Hesslink, Wise, 2003)
Recommended supplements:
1. Multivitamin
2. Folic acid
3. Comprehensive Bs
4. Essential Fatty Acid
5. Vitamin D according to latitude and time of year
6. Both a water soluble and fat soluble antioxidant such as vitamin C and vitamin E (Plotnick, et al., 2003)
In general
1. Stay hydrated
2. Consume moderate amounts of alcohol
4. Follow glycemic load guidelines
5. Stop smoking
6. Lose weight if appropriate
7. Avoid carbohydrate-loading and refined carbohydrates
Exercise
Regular exercise may be the best prevention for heart disease, decreasing risk by 50%. Exercise supports the neurological response to stress, improves the oxygen/carbon-dioxide exchange, supports HDL production, helps lower blood sugar, reduces inflammation, and helps prevent blood clots. Exercise lowers resting and exercising blood pressure and heart rates. This gives the heart the ability to better handle exertion. However, over-exercising will not reverse existing plaques and may induce a heart attack in a normally sedentary person (Franklin & Sweetgall 2013). Exercise is essential, but not a cure-all.
A Final Word–Cardio-Energetics
The field of neurocardiology studies the relationship between the neurological, cardiovascular, endocrine, and immune systems. Researchers have identified common neurotransmitters between the brain and heart. Atrial Naturetic Factor (ATF) is a peptide released by the heart that communicates with both the brain and the immune system (Pearsall 1998). Why is it that when we have an emotional experience, our bodies may have autonomic visceral responses–sweat, heat, tears, loose bowels, shaking? Why is it that after a stressful incident we may get sick? We intuitively understand how the life of our hearts affects the health of our bodies, and researchers are working hard to find empirical evidence like ATF. A whole health approach to heart health has to include the emotional, energetic anatomy, whether we can explain it with science or not.
Dr. Pearsall lists seven contemplative habits for the heart (pp.158):
1. Be still–listen to the heart
2. Lighten up–life is transient
3. Shut up–let the brain relax
4. Resonate–connect with spirit
5. Feel–tune into senses
6. Learn–”by heart”
7. Connect–be aware of the surrounding world
Feeding our emotional center with stillness and awareness is also health. It helps us heal from a place of energetic strength. Yes, we can eat our vegetables, walk every day, and monitor blood pressure, and that isn’t how we measure our lives. We resonate and remember by who we love, the times we hurt, the joys of celebration, the grief of loss. Supporting heart health is also respecting the power and importance of this emotional and energetic center.
References
A voice of reason on diet. Nutritionist and physician Walter Willett. NIWH Nutrition Research at Harvard course.
Berkot, B. (2007) Rapid growth in heart medications seen in younger patients. NIWH Inflammation and Disease course, pp 37.
Brody, J. 2004. Hunt for heart disease tracks a new suspect. New York Times, January 6, 2004. NIWH Inflammation and Disease course.
Franklin, B., & Sweetgall, R. (2013) One heart, two feet. Clayton, MO: Creative Walking, Inc.
Gorman, C and Park, A. Inflammation is a secret killer: the surprising link between inflammation and asthma, heart attacks, cancer, Alzheimer’s and other diseases. NIWH Inflammation and Disease course.
Heart disease in women: Understand symptoms and risk factors. Mayo Clinic. Retrieved April 3, 2013, from http://www.mayoclinic.com/health/heart-disease/HB00040
HEART for Women Act. (Heart disease Education, Analysis, Research, and Treatment for Women Act). Bill Summary: S. 438/H.R. 3526. American Heart Association. Retrieved April 3, 2013, from
http://www.heart.org/idc/groups/heart-public/@wcm/@adv/documents/downloadable/ucm_435251.pdf
“How does heart disease affect women?” National Heart, Lung, and Blood Institute. Retrieved April 3, 2013, from http://www.nhlbi.nih.gov/health/health-topics/topics/hdw/
H.R.3526 – HEART for Women Act. Retrieved April 4, 2013 at http://beta.congress.gov/bill/112th-congress/house-bill/3526
Merz, N. (2011, December). The single biggest health threat women face. [Video file]. Retrieved from
http://www.ted.com/talks/noel_bairey_merz_the_single_biggest_health_threat_women_face.html
Pearsall, Paul (1998). The heart’s code. New York: Broadway Books.
Plotnick, G., Corretti, M., Vogel, R., Hesslink, R., Wise, J. (2003). Effect of supplemental phytonutrients on impairment of the flow-mediated brachial artery vasoactivity after a single high-fat meal. Journal of the American College of Cardiology. 41(10). NIWH Cardiac Whole Health course.
Small Vessel Disease. Mayo Clinic. Retrieved April 4, 2013 at http://www.mayoclinic.com/health/small-vessel-disease/DS01080
Willet, W. & Stampfer, M. (2003, Janurary). Rebuilding the food pyramid. Scientific American. NIWH Nutrition Research at Harvard course.
Women and heart disease. (2000). Harvard Heart Letter. 10(5). NIWH Cardiac Whole Health course, pp.45.