Heart disease is more deadly for women

Here's who should be taking aspirin regularly, according to the American Heart Association: People at high risk of heart attack should take a daily low-dose of aspirin (if told to by their physician) and heart attack survivors should regularly take low-dose aspirin.

But new research published in the Journal of Women's Health found more than half of women who should be taking aspirin to prevent heart attack and stroke do not.

Heart disease is the No. 1 killer of women in the United States. And while slightly more women die from heart disease every year than men (432,709 women compared to 398,563 men in 2006, the most recent year for which data is available), many Americans (women especially) still mistakenly perceive heart problems as a "man's disease." There are too many women who don't know their risk for heart disease — or what to do about it.

In total, 217,987 women took the survey. Of that pool, 29,701 met the national guidelines for daily aspirin use. Only 41 percent of those who met the recommendation for primary prevention (before heart attack or stroke) reported taking aspirin on a daily basis, the researchers found. Additionally, only 48 percent of those who met the criteria for secondary prevention (after heart attack or stroke) responded "yes" to daily aspirin use.

Researchers also noticed some interesting patterns, among them that women with high cholesterol or a family history of heart disease were more likely to take aspirin.

In the Journal of Women's Health article, the researchers also note a need for more heart disease education programs for women: "This study provides direct evidence for the need for education about aspirin among clinicians and women for increased awareness and prevention of cardiovascular disease events," they write.

That doesn't mean you should go out and buy the family-size bottle of low-dose aspirin just yet. Regular aspirin use doesn't come without its own risks, such as bleeding or eye disease — and there's no hard-and-fast rule declaring aspirin a magic bullet for heart disease. Don't start (or stop) taking aspirin regularly without talking to your doctor first. He or she can help you find the right dosage. If you're healthy and have no risk for heart disease, you probably don't need the extra preventive measure.

Are you at risk for congestive heart failure?

Five million Americans are living with congestive heart failure, and 400,000 new diagnoses are made each year.

Heart failure is a chronic, long-term condition with many causes. The most common cause is coronary artery disease, a narrowing of the small blood vessels that supply blood and oxygen to the heart. It can also result from an infection that weakens the heart muscle, a condition known as cardiomyopathy, or by a heart defect at birth. Other heart problems that may cause heart failure include congenital heart disease, heart attack, heart valve disease and some arrhythmias. In addition, diseases like emphysema, severe anemia and thyroid problems may contribute to heart failure.

Heart failure is defined as the inability of the heart to pump a sufficient amount of blood to rest of the body. The failing heart doesn’t stop working; it works less well. At first, congestive heart patients may notice symptoms like shortness of breath, rapid pulse or even fainting only when they exert themselves — while walking, running or dancing, for instance. But over time, breathing problems and other symptoms may occur even during rest.

Because heart failure affects the kidneys’ ability to dispose of sodium and water, common signs of the condition include swollen legs or ankles and weight gain as fluid accumulates.
Heart failure tends to affect older people more often: 1% of people aged 50 have heart failure, compared 5% of those aged 75 or older and 25% of those aged 85 years or older. The condition is more common among African Americans than whites.

To learn more about the symptoms and treatments of heart failure — most people with mild or moderate heart failure can be successfully treated — please see the National Institutes of Health or the AHA websites.

Family history is key factor in fighting heart disease

Doctors often gloss over a key question for assessing a person's risk for coronary heart disease, according to a new study: What is the patient's family history of cardiovascular illness?

Detailed family information could help doctors better predict who is at risk and more accurately target patients for preventive care that may help avert the disease altogether, according to a recent study, published in the Annals of Internal Medicine. Routinely tracking family history sharply boosted the number of people in the study considered at high risk for heart disease.
A widely used scorecard for measuring heart risk, the Framingham Risk Score, fails to take family history directly into account. And while many doctors currently collect some information about the health of their patients' families, the data often lack the detail to be clinically useful for assessing risk and prescribing care.

"Family history remains one of the most important predictors of an event for an individual," says Donna Arnett, a genetic epidemiologist at the University of Alabama at Birmingham and president-elect of the American Heart Association. Still, "most of the family history that we're collecting is just the presence or the absence of heart disease, not the age of onset or the type of disease," says Dr. Arnett, who wasn't involved in the latest research.

Guidelines for heart-risk screening, issued by the heart association in late 2010, encouraged doctors to take family histories into account. Doctors sometimes make judgment calls to treat people as high risk because of family history, even if it isn't part of the patient's risk score.

Family history has been linked to higher risk for a number of illnesses, including cancer and diabetes. Unlike some other diseases, however, clear genetic markers for coronary heart disease, which accounts for 1 in 6 U.S. deaths, remain elusive. Family histories can be used as a proxy for detailed genetic work that may someday be used to help predict heart-disease risk, researchers say.
Another risk-measurement tool, known as the Reynolds Risk Score, developed by Harvard University researchers in the 1990s, does consider if a patient's parent had a heart attack and at what age. However, many medical practices don't yet use the tool, which became available in 2007.
Using the Reynolds system, the researchers tracked 25,000 initially healthy patients over a decade. They found that a 50-year-old male patient who, among other things, smoked, and had high blood pressure and cholesterol, but no family history of heart disease, had a 12%, or moderate, chance of having a heart attack in the 10-year period. But a similar patient with a parent who had a heart attack before age 60 had a 20% risk, putting that patient at high risk for heart disease. Heart risk wasn't significantly affected in patients with a parent who had a heart attack at the age of 60 or older.

Still, many medical practices continue to rely on the older Framingham Risk Score, which became available in the 1990s. Researchers believed that other factors, including blood pressure and cholesterol levels, provided all the information needed to determine a patient's risk for heart disease.

Primary-care doctors say there are obstacles to gathering family histories from patients, including competing priorities for time in the examination room. And patients often don't know many details about their family members. In the Annals of Internal Medicine study, patients were mailed questionnaires and instructed to gather the material before seeing their doctor.
"It's a little bit of detective work," says Charles Cutler, a primary-care doctor in Norristown, Pa. Patients should make a point of knowing the health histories of their parents, siblings and grandparents, he says. To identify clues about specific diseases, however, Dr. Cutler says he sometimes asks patients questions like: "What do you remember about Grandpop's hospitalization? Were his legs swollen?"

Dominic Francis, a 37-year-old high school teacher and wrestling coach in Delaware, says his family history has forced him to be an advocate for his own health. Mr. Francis says he watches his diet and exercises regularly. Although he currently does not suffer with heart disease or heart related problems, he has discussed his paternal family history of heart disease with his doctor.

"I went to the cardiologist and said, 'I may look healthy and my numbers are all good. But my dad and his brother both had a heart attack when they were 40. For my uncle it was a fatal attack. I need to know whether I have any other risk factors that I should be aware of,' Francis says.

Stop the re-hospitalization revolving door

People are hospitalized with acute heart failure when congestion, or fluid build up worsens to the point that it causes severe leg or abdominal swelling and makes it difficult for them to breathe. Treatment is mostly focused to relieve symptons.

Because of inconsistent follow-up care and difficulty getting patients to take prescribed medication properly and to follow a good diet and exercise regimen, many of them relapse and wind up back in the hospital or in some cases die.

The following tips can reduce that risk:

Review medication upon discharge -medical errors often occur during the transition from the hospital to home. Make sure that you review your medications with a health care professional before leaving the hospital. If you are unsure about any aspects of the instructions ASK FOR CLARIFICATION...don not assume anything. If possible try and fill the prescriptions before you return home or within 24 hours.

Schedule a follow-up visit - schedule an appointment with your physician within a week or tow of discharge. Do not be surprised if your primary care doctor does not have all of the facts at your follow up appointment. Make sure to bring all of hospital discharge instructions with you!

Continue to treat symptons - even if your symptons improve enough for your to go home, you still need ongoing care monitoring and medication.

Treat other medical conditions - failure to control contributing conditions such as high blood pressure and kidney disease are just a few reasons why re-admissions are high.

Walk your way to good health

Regular walking, a favorite exercise for senior citizens, is one of the most effective forms of physical activity that delivers substantial health benefits and improves heart health, says the American Heart Association. The latest addition to their tools for persuading people to exercise or Walking Clubs, which are quickly being formed in communities across the U.S.

Walking is also easy to start and continue and it has the lowest dropout rate of any physical activity. By joining or forming an American Heart Association Walking Club you can connect with others who share your goals, lifestyles, schedules and hobbies – and do it all free. Walgreens is the national sponsor.

An American Heart Association study revealed that American adults are 76 percent more likely to take a walk if another person is counting on them.

In contrast, research shows 45 percent of gym members will quit going to the gym in a given year and 30 percent will cancel their membership. Gym fees per member average about $765.40 a year.

“I encourage our patients to engage in regular exercise, including moderate-to-vigorous intensity walking programs, and the American Heart Association’s new Walking Clubs are a great resource,” said Barry A. Franklin, Ph.D., Director of Cardiac Rehabilitation and Exercise Laboratories at William Beaumont Hospital in Royal Oak, Mich.

“The accountability and camaraderie Walking Clubs provide will help those that struggle with a regular exercise commitment. Numerous studies have now identified a sedentary lifestyle and/or a low level of fitness as independent risk factors for cardiovascular disease.

Accordingly, for many people, Walking Clubs may provide a safe and effective lifestyle intervention to prevent heart disease and stroke.”

Things to know about cold weather and heart disease

The fall and winter seasons will bring cooler temperatures, and for some, ice and snow. It’s important to know how cold weather can affect your heart, especially if you have cardiovascular disease. People who are outdoors in cold weather should avoid sudden exertion, like lifting a heavy shovel full of snow. Even walking through heavy, wet snow or snow drifts can strain a person's heart.

Many people aren't conditioned to the physical stress of outdoor activities and don't know the dangers of being outdoors in cold weather. Winter sports enthusiasts who don't take certain precautions can suffer accidental hypothermia.

Hypothermia means the body temperature has fallen below 95 degrees Fahrenheit. It occurs when your body can't produce enough energy to keep the internal body temperature warm enough. It can kill you. Heart failure causes most deaths in hypothermia. Symptoms include lack of coordination, mental confusion, slowed reactions, shivering and sleepiness.

The elderly and those with heart disease are at special risk. As people age, their ability to maintain a normal internal body temperature often decreases. Because elderly people seem to be relatively insensitive to moderately cold conditions, they can suffer hypothermia without knowing they're in danger.

People with coronary heart disease often suffer angina pectoris (chest pain or discomfort) when they're in cold weather. Some studies suggest that harsh winter weather may increase a person's risk of heart attack due to overexertion.

Besides cold temperatures, high winds, snow and rain also can steal body heat. Wind is especially dangerous, because it removes the layer of heated air from around your body. At 30 degrees Fahrenheit in a 30-mile wind, the cooling effect is equal to 15 degrees Fahrenheit. Similarly, dampness causes the body to lose heat faster than it would at the same temperature in drier conditions.

To keep warm, wear layers of clothing. This traps air between layers, forming a protective insulation. Also, wear a hat or head scarf. Heat can be lost through your head. And ears are especially prone to frostbite. Keep your hands and feet warm, too, as they tend to lose heat rapidly.

Don't drink alcoholic beverages before going outdoors or when outside. Alcohol gives an initial feeling of warmth, because blood vessels in the skin expand. Heat is then drawn away from the body's vital organs.