- The Washington Times - Tuesday, April 23, 2002

About six years ago, Judith Leitner, 62, of Chevy Chase had urgent quadruple bypass surgery. She had had several warning signs of heart disease before the procedure, but doctors had dismissed them all as stress- or anxiety-related.
"'Take a Pepcid, honey,' is what the doctors told me," Mrs. Leitner says, "and I was a good girl. I believed them."
Mrs. Leitner is one of 8 million women in the United States who has cardiovascular disease. She has arteriosclerosis a condition in which the arterial walls harden and impair the blood circulation but like many other women, she never thought she was at risk.
"I always thought it was a man's disease," Mrs. Leitner says. "My father died of a heart attack when he was 64, but no one saw that as an indication that I might be at risk."
A family history of heart disease is an important risk factor for both women and men, says Nancy Loving, founder of WomenHeart, a Washington-based advocacy group for female heart patients.
She speaks from experience. Six years ago, Ms. Loving, 48, had a heart attack "out of the blue," it seemed.
Had she known that her uncle's and father's heart disease had put her at an increased risk, she might have kept an eye on her own condition, but she, too, thought heart disease was a man's disease.
Her doctors didn't contradict her.
"It's as if, if you don't look like [Vice President] Dick Cheney, you're not at risk," Ms. Loving says.
Ms. Loving founded WomenHeart a few years ago to increase awareness among women about heart disease, but the road toward awareness is a long one.
Only about 10 percent of women think of heart disease as their greatest health threat. In reality, more women die of cardiovascular disease than of all cancers combined.
According to the American Heart Association, more than 500,000 women died of cardiovascular disease in 1998 compared to close to 260,000, who died of cancer.
"Heart disease is the number one killer of women," Mrs. Leitner says, "but we're just now starting to realize that."

Cardiologists and heart-patient advocates say that to improve women's chances of surviving heart disease, patients and doctors alike have to become more knowledgeable and aware of risks, prevention, early detection and treatment.
"I think the big message is that this is a preventable disease," says Dr. Susan Bennett, a cardiologist with a practice in Northwest.
Some improvements can be made by lifestyle changes, such as exercising more, not smoking and eating fewer cholesterol- and fat-laden foods. Sometimes, medications to lower cholesterol and blood pressure are needed.
Mrs. Leitner, who is on at least a half-dozen medications related to her cardiovascular condition and arthritis, says that exercising has improved her health markedly.
"I can't tell you how important exercise is," Mrs. Leitner says. "I have so much more energy now, and I feel so much better."
She works out at least three times a week at Tenley Sport and Health Club, twice with personal trainer Tom McCarthy and once alone. Mr. McCarthy makes sure she follows her doctor's guidelines, such as not elevating her heart rate above 110 beats per minute.
He also helps her focus on certain muscle groups and on fitness goals; some of them are purely health-oriented, and others belong in the realm of well-being and good looks.
"I have a waistline now, and I am starting to get some definition," Mrs. Leitner says, pointing to her triceps.
Being overweight and out of shape is a risk factor in heart disease, but many women are so ashamed and uncomfortable about their weight problems that facing the fact that they also may be at risk for heart disease can be too much to handle.
"There is a shame and blame associated with heart disease that needs to be dealt with," Ms. Loving says. "Women feel like they brought it on themselves because they eat too much or smoke too much. It's not like with cancer, where angelic, vegetarian Linda McCartney gets it."
America, which is increasingly becoming a fast-food nation, is experiencing what some doctors are calling an epidemic in diabetes, often caused by obesity. Diabetes is one of several conditions that can lead to heart disease.
Dr. Bennett agrees with Ms. Loving and says it's important not to look at heart disease as a punitive disease because that may perpetuate a vicious cycle.
"You have to get away from that type of thinking and realize that you have a brand-new life in front of you," Dr. Bennett says. "Otherwise, you'll think, 'I got it because I am fat, and I smoke because I am fat' and on it goes."

One of the most effective ways to prevent heart disease, including its extremes heart attack or stroke is to detect it early.
Because women often don't know that they are at risk, they don't know to ask their primary care doctor to check their cholesterol, blood pressure and blood glucose, all of which can help detect heart problems if their levels are elevated.
Women know to get their annual Pap smear from a young age. They also are told by their gynecologists or other primary care physicians to do self-exams on their breasts and start having mammograms at 35 or 40 years of age to prevent breast cancer.
"That's part of the challenge with heart disease," Dr. Bennett says. "There is no 'mammogram' approach to it. One test is not enough."
She encourages women to ask for cholesterol screenings at their annual exams, making sure that their level of low-density lipoproteins (LDL, or what's viewed as the "bad" cholesterol) is less than 130 milligrams per deciliter of blood and that their level of high-density lipoproteins (HDL, the "good" cholesterol) is at least 60 milligrams per deciliter of blood. When HDL is below 40 milligrams per deciliter of blood, the patient might be at risk for heart disease.
Another problem connected with treating heart disease in women is that heart medications traditionally are tested more often on men than women. Women represent as large a patient group as men, Dr. Bennett says, but only about 20 percent of these scientific trials are done on women.
• • •
Finally, women need to know that their heart attack symptoms may be different from the traditional chest and arm pain.
"Women may get back pain, shortness of breath, as well as sweating and nausea," Dr. Bennett says.
Mrs. Leitner's urgent quadruple bypass surgery, for example, was preceded by low energy, headaches and neck pain all symptoms that could point to stress or anxiety, which is what her doctors initially thought.
While working on and waiting for pharmaceutical companies and other doctors to start focusing on women, Dr. Bennett says the first line of defense is for women to learn which questions to ask, where to look for information and to identify lifestyle changes they can make to prevent heart disease.
"Women need to be good consumers of health care," Dr. Bennett says. "They need to be aware of their cholesterol figures, and even young women need to be concerned with lifestyle changes.
"Few people realize that more women die of heart disease in their early thirties than of breast cancer," she adds.

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