By Mary Ann Carson
For The Independent

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Independent/Barrett Stinson Dr. Erich Fruehling looks at a 64-slice CT scan of a heart at St. Francis Medical Center in Grand Island. The main focus of the scan is the ability to examine the coronary arteries. Independent/Barrett Stinson Assisted by Debra Rakosky, LPN, (left), Dr. Erich Fruehling performs a heart catheterization procedure at St. Francis Medical Center in Grand Island. All personnel working in the room must wear protective lead garments and glasses during the procedure. Independent/Barrett Stinson Michael Kingsley, RN, keeps watch on various readouts during a heart catheterization procedure in the operating room behind him. Click Thumbnails to View

With that attention comes this message: Women are just as susceptible to cardiovascular disease as men.

"Today, cardiovascular disease is the No. 1 killer of women, as well as men," said Dr. Erich Fruehling, a cardiologist with the Nebraska Heart Institute in Grand Island. "Pre-menopausal women have some protection against CVD. Then, as women generally live longer than men, their rate of developing CVD catches up to men's after menopause."

Those are discouraging words, but the message doesn't have to be all bad.

"The primary thrust in women's heart health today is prevention," said Dr. Steve Husen with Family Practice of Grand Island. "To encourage prevention, we try to help our patients identify and modify their risk factors. Remember the old adage, 'An ounce of prevention is worth a pound of cure.'"

Registered dietitian Doreen Foland and Bonnie Jensen, a registered nurse with Wellness Works/Por Su Salud in the Conestoga Mall, said research and studies on heart disease in women are on the increase. Locally, the University of Nebraska Medical Center College of Nursing is conducting a two-year study to identify pre-hypertension and to prevent high blood pressure through lifestyles changes in women.

"Women in Grand Island and surrounding areas in Central Nebraska, between the ages of 40 and 69, are invited to participate in the UNMC study," Foland said. "The key is to find hypertension in women early and help them make changes."

Husen and Fruehling agreed that the push in women's heart health is to modify their risk factors. If you smoke, stop. If you don't smoke, don't start. Even secondhand smoke can be damaging to heart health.

"There is no magic pill," Fruehling said. "The goal is taking control and reducing your risks. Americans consume too many calories from too much food. It's all about portion control eat less and exercise more."

Husen said he encourages women to know their numbers.

"Recent studies show blood pressure readings should be lower than previous recommendations," he said. "Blood pressures of 135/85 are the maximum, and 120/70 or a little lower are even better. Lower cholesterol levels than in the past are also encouraged."

In addition, Husen said the new theory of treating high blood pressure, high cholesterol levels and diabetes aggressively is working. Treatments include combinations of healthy diets, exercise and new medications.

"Statin drugs prescribed to lower cholesterol levels have sometimes had bad press from the news media for their potential side effects," Husen said, "but they are having phenomenal effects in the fight against heart disease."

Besides lowering a patient's cholesterol, statins also help to stabilize plaque in the arteries. Most women and men have little or no side effects when taking statins.

Exercise is central to a heart-healthy lifestyle.

"Everyone, especially women, needs to be selfish about setting aside time to exercise daily," Husen said. "It's easy to neglect it when you're busy, but it's essential for your heart health."

Exercise helps to lower blood pressure and cholesterol and helps weight loss. It also reduces stress and depression.

"The new recommendations from the American Heart Association are to get 30 minutes of moderate-intensity exercise seven days a week to decrease the risk of CVD and 60 minutes a day to lose weight," Foland said.

Upper-body obesity is also a risk factor. The AHA says a healthy waist circumference is less than 35 inches for women and less than 40 inches for men.

AHA guidelines say a healthy diet low in fats and cholesterol and high in fiber from fresh fruits and vegetables and whole grains reduces the risk of cardiovascular disease. They also suggest limiting salt intake to 2,400 milligram a day and limiting alcohol to one drink per day.

If cardiovascular disease has not been avoided and the disease has progressed to the point that symptoms are present, Fruehling said, "the symptoms of CVD in women may be different from those experienced by men. Many patients with advanced CVD describe their sensations as discomfort and not severe pain."

Jensen agreed.

"Recent studies have shown that early symptoms of CVD in women may include fatigue, shortness of breath and neck and back pain," she said. "In the case of an acute attack, the discomfort or pain may be in the shoulder, arm, jaw or throat."

Nausea, vomiting and dizziness may also be experienced.

Over the last few decades, giant strides have been made in the emergency care of heart-related problems.

"In the 1970s, an apparent heart attack admitted to a hospital emergency room would have been stabilized, a clot buster drug administered, and then bypass surgery was done if needed," Husen said.

If someone comes to the emergency room today complaining of chest pain, Husen said, the person is usually admitted to the hospital for 24-hour observation if he or she is older than mid-20s. If acute coronary symptoms are observed, the patient is taken directly to the catheterization lab.

"Most (blood) vessels can be stented," Husen said, "but there is still the exception where the blockage is so severe or in a location that requires the more invasive bypass surgery."

But stents aren't a license to resume unhealthy habits.

"Cardiovascular disease is a chronic problem, and patients with stents are not done," Fruehling said. "Plaque can still build up on arterial walls. To live successfully with CVD, one has to make a daily commitment to maintain a healthy lifestyle."

That commitment includes eating right, exercising, taking the medications prescribed to help your condition, maintaining medical checkups, not smoking and reducing stress whenever possible.

A new diagnostic tool to detect CVD in its early stages is available at St. Francis Medical Center, Fruehling said.

The 64-slice CT scanner takes high-speed thin-slice pictures of the heart, then reassembles the slices to create a 3-D picture. The new scanner is a good tool, but actual heart catheterization still provides the most data and the best visual pictures of the arteries.

The future for women's heart health is advancing on all fronts, all the experts said. Foland and Jensen are working through the programs at Wellness Works to inform women of the latest findings concerning heart health.

"We want to give women the facts on CVD, so they will become empowered and take a proactive role in their own heart health," Jensen said.

"Women are better informed on how to prevent and manage CVD than ever before," Husen added. "Also, emergency treatments for acute coronary events have advanced tremendously with the help of angioplasty and the use of stents. It's now rare to see heart bypass patients in our general medical practice."

And finally

"Remember cardiovascular disease is the No. 1 killer of women in this country," Fruehling said, "and through continued education and the combinations of doctors and patients working together, we can decrease the risks of CVD and save the lives of many women across the nation."

For more information

UNMC Women's Blood Pressure Study

Denise Waibel-Rycek

UNMC College of Nursing Kearney Division

(308) 865-1606

dwaibelrycek@unmc.edu

Wellness Works/Por Su Salud

398-5050