Disturbing trends noted in women's heart diseases

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Capital News Service
EDITOR’S NOTE: Capital News Service correspondent Wanda Reese had an intense personal reason for gathering the information for this in-depth story on heart disease in women, as will be noted in the report.
LANSING — When Katherine Hendon found herself being rushed through the doors of Detroit’s Sinai Hospital with chest pain, she didn’t need a diagnosis.
A registered nurse for more than 20 years, Hendon knew the signs all too well — of a heart attack.
To complicate matters, Hendon’s condition, she later learned, was so serious that she was left with few options at that stage. Nor did she even have the luxury of time to make a decision.
Hendon’s younger daughter, Jacquelin, remembers that time as one of her family’s most stressful — and painful.
“She was having chest pains for two consecutive days,” Jacquelin said. “At the hospital, she was later told she’d had a series of heart attacks — two while being treated in the emergency room.
“She was kept at Sinai until her transfer to Hutzel Hospital for surgery. The diagnosis was that her disease was so far advanced that surgery was the only alternative.
“Following the operation, Hendon was told to change her eating habits, stop smoking and exercise by walking.
Hendon’s quadruple bypass procedure was a success. Her quality of life following the surgery was not.
Less than two years after the operation her chest pains resumed, increasing in frequency. Her treatment was further complicated by acute arthritis diagnosed years earlier.
Stricken with both rheumatoid and osteoarthritis, Hendon was crippled, taking steroids and in constant pain. The brief walking program that had been recommended became too painful to endure.
Two years later, returning home from work and in the midst of Detroit evening rush hour traffic, Hendon’s weakened heart simply stopped beating.
Unconscious at the wheel, her car, still traveling at 40 to 50 mph — and out of control — cut neatly across several lanes of traffic before crashing into a building. Miraculously, no one else was hurt.
Despite life-saving efforts by a doctor at the scene, and paramedics arriving moments later, Hendon died before reaching St. Mary’s Hospital in Livonia. She was 60 years old.
She was also this writer’s sister.
Hendon’s death in 1997, along with the deaths of other women heart patients since that time, marks the emergence of several disturbing trends in cardiovascular medicine today, and supported by new research.
Statistics from several recent studies show that not only are more women suffering — and dying — from heart attacks than men, but that they’re also not receiving the same level of care.
Findings from a published study by the Mayo Clinic showed a 36 percent increase in heart attack rates among women, compared with an 8 percent drop in rates among men during the 1980s and early ’90s.
“A quarter of a century ago heart disease was seen as primarily a men’s disease,” said Dr. Veronique Roger, a Mayo Clinic cardiologist and lead author of the study. “Given the trends observed in this study that is clearly not the case now. The burden of heart disease is shifting toward women and older persons.”
In addition, concern also has been raised about other studies that show that both women and minority heart patients receive lower-quality care, are less likely to receive appropriate cardiac medication or undergo bypass surgery. They also often leave hospitals without getting the information necessary to prevent future heart attacks.
Michigan health care professionals share the concern regarding adequate care for women heart patients, despite differing opinions on the issue.
“There are similarities in Michigan,” said Dr. Jwala Prasad, cardiologist at Sparrow Health System’s Heart Center in Lansing.
Prasad said a combination of lifestyle factors, from workplace stress, to diet and inadequate exercise place women at higher risk today than ever before. However, Prasad stopped short of agreeing to differences in quality of treatment.
“Most cardiologists do not differentiate between men and women,” Prasad said. “We diagnose and treat the same. Outcomes for women are good, as heart attacks are treated the same.”
But Prasad acknowledged that differences in symptoms between men and women can and do lead to misdiagnosis.
“Women may present with vague symptoms, such as shortness of breath, pain in the neck and jaw, fatigue, indigestion or dizziness,” said Velma Theisen, a nurse consultant with the cardiovascular unit of the Michigan Department of Community Health.
Theisen said that while many women do experience chest pain, other less suspicious symptoms are more common – and more likely to be overlooked or misdiagnosed. In Katherine Hendon’s case, she repeatedly urged emergency room doctors to perform a critical enzyme test to confirm she was having a heart attack.
Between 1991 and 1995 more than 70,000 women died of heart disease in Michigan, according to research conducted by the U.S. Centers for Disease Control and Prevention and West Virginia University.
The highest death rates were found in counties along the eastern border of the state surrounding Detroit, with the lowest rates occurring in the Upper Peninsula and western regions of the Lower Peninsula. Rates for Grand Rapids and Lansing were intermediate.
The American Heart Association lists cardiovascular disease as the No. 1 killer of both men and women in the United States, claiming the lives of more than 500,000 women in 1998. The organization also said that unlike men, women are not being adequately informed of their risk.
“While using the media is an effective way to get the message out, healthcare workers must reinforce these messages,” said Cindy Hawken, senior director of communications for the American Heart Association’s Midwest affiliate in Southfield.
“Fewer than one in 10 women perceive heart disease as their greatest health problem. We now have solid evidence that the process of heart disease begins in adolescence. The number of physicians talking to their female patients is still low. Our message of prevention is missing a critical audience.”
Hawken said women are getting the message about breast cancer, and the need for regular checkups, mammograms and self-exams.
“That’s a great success story that needs to be translated to cardiovascular disease awareness,” she said.
“Heart disease is a ‘now’ problem – ‘later’ may be too late.”
© 2002, Capital News Service, Michigan State University School of Journalism

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