HERE’s TO YOUR HEART ; Local Hospitals Are Joining a Nationwide Effort to Bring Awareness to the Issue of Cardiovascular Disease in Women

By Tamara N. Shope TSHOPE@ABQTRIB.COM / 823-3637

One in 30 women die of breast cancer, and still it is not the biggest threat to the gender.

Heart disease kills one of every 2.5 women, the American Heart Association says.

President Bush has declared February American Heart Month, and at University of New Mexico Hospital a campaign for heart disease awareness has been gaining strength in the past year.

The hospital is finishing the first year of its Women’s Cardiovascular Health Program, a permanent clinic focusing on preventing heart disease in women.

Cardiologist Charlotte Jutila, one of the founders of the program, says educating women and physicians is one of the program’s priorities.

“The No. 1 thing is awareness — awareness that there’s a problem and that there is something we can do about it,” she said.

The program began in January 2005, with three cardiologists setting aside entire Tuesdays to focus on women’s heart health.

Jutila says patients can also be seen any weekday. All insurances are accepted, and people in Bernalillo County without a health plan can work out payments with the financial aid department at the hospital.

She says her dream for the program is to expand clinic hours to fit around women’s schedules.

“I’d love to see it held on Saturdays and evenings, because a lot of women can’t come in during the weekday,” she said.

She says the program has not cost the university any extra money, but she said she is beginning to see a need for more medical assistants and other clinical staff.

“Everything we need is already here. It just took us utilizing what we have,” she said.

A patient at Jutila’s clinic talks with a cardiologist, who asks questions about family health history, exercise and diet habits. She will then be tested for cholesterol, blood pressure and heart stress levels. The clinical staff creates an individualized program for the patient, including diet and exercise, to maintain a healthy heart. Every three months, she will meet with her doctor again to monitor her progress.

That part is one of the keys to success, Jutila says, because patients usually don’t feel different when their cholesterol is lowered, so they might not feel an incentive to stick with their program.

“Only 60 percent of people at the end of six months remain on (medication) therapy when it’s being used for prevention because they don’t notice the benefit; they don’t feel any different,” she said. “What we do is, we have little flow charts. Where is their cholesterol, and we plot it as we go along, showing them the materials that say (by taking the medicine) you reduce your chance of having a stroke by 25 to 35 percent.”

Creating awareness

During her New Mexico visit Feb. 3 with the president, Laura Bush used her few minutes at the microphone to remind women of American Heart Month.

“I want to encourage Americans to remember that heart disease is the No. 1 killer, to talk to people about all the ways we can prevent heart disease through exercise, healthy eating, not smoking, seeing your doctor on a regular basis so you can find out if you have any early signs of heart disease,” she said at Intel in Rio Rancho, where her husband was giving a speech.

In an effort to boost awareness, the first lady’s Web site has a link for heart health, where visitors will find questions to ask their doctors and other cardiovascular health tips.

Jutila says she wants to model breast cancer advocates in creating awareness about women’s heart disease risk.

“They’ve done a tremendous job at educating the public,” she said. “So much so that now women don’t even think about their heart – - they think about breast cancer. That’s what they’re terrified of.”

Cindy Foster, a public affairs representative for the hospital, says it’s not just the women who need to be made aware of the problem.

“Studies show something like 20 percent of all physicians still don’t know heart disease is the No. 1 killer for women,” she said. “There’s a (misconception) that women don’t have heart attacks and heart disease.”

That misconception could be costing lives, Jutila says. She says women often do not have the same heart disease symptoms as men, and are consequently misdiagnosed.

“The deal with women and heart disease is, 60 percent of them when they present with heart disease, it’s sudden cardiac death,” she said. “That’s their first warning. Their first sign is, they’re dead.

“We need to educate women, but we also need to educate health care professionals. We need to be out there and keep hammering the whole story home.”

The difference in symptoms can also lead women to not take the problem seriously, she says.

“Only half the women who truly have cardiovascular disease present with chest pain. Women present with symptoms of fatigue or shortness of breath, just not feeling quite right, a sense of impending doom,” she said. “There’s this whole deal out in medicine now about how women perceive pain. And so it may be women are having symptoms, but they are not paying attention to it. ‘I just don’t feel quite right, but I’ll just sit here for a second, and then I’ll go on doing what I was doing.’ And that’s just the woman’s style.”

Jutila says women, and even some of their physicians, do not consider they could be having heart failure.

“In their own minds they’re saying, ‘It’s got to be my stomach. I’ve been under a lot of stress, so I’m probably developing an ulcer,’ ” Jutila said.

Cardiologist Monica Escarzaga, who works at Presbyterian Hospital, agrees that the biggest obstacle is a lack of awareness about the danger of heart disease.

“There was a big campaign for breast cancer in order to educate women and get them to do their exams,” she said. “And I think the same wasn’t true for women and heart disease, but I think that’s changing now.”

And Escarzaga may be right. The American Heart Association issued a report at the end of January showing that in 2003, 55 percent of women surveyed knew cardiovascular disease was the No. 1 cause of death for women. In 1997, that figure was 30 percent.

Still, that same report also showed that a study of 142 women and 348 men with heart disease found that women perceived their conditions to be less serious and debilitating, even when their cases were more severe, required more medication and caused more physical limitations for them.

Which may explain Jutila’s worry that women might not be taking care of themselves as well as they care for others.

“It’s still a challenge to get the word out there that yes, the No. 1 killer of women is heart disease, and yes, it can happen to them,” she said. “To personalize that message, it’s been very, very difficult.”

She says a fellow in her practice is studying women and why they might delay seeking care.

“Preliminary stuff (shows there) is this belief that still only about 13 percent of women don’t personalize it. They don’t think it’s going to happen to them,” she said. “If you ask them the No. 1 killer, they say heart disease. But if you ask what is the greatest threat to them, it’s cancer.”

She says she often hears from women that they do not have time to care for themselves because they are busy caring for their families. “Paradoxically, that’s exactly what a woman needs to do (see her physician) to remain independent, to remain a caretaker,” Jutila said. “She needs to take of herself first, and that’s such a difficult message to get across.”

At Lovelace’s Women’s Hospital, CEO Sheri Milone says cardiologists are working on developing a program of their own.

Meanwhile, the company is sponsoring a free event Feb. 25 at the Sheraton Uptown to educate women about cardiovascular health using dance and booths. They also offer Lovelace patients a program called “Women Take Heart,” including nonmedical counseling and help interpreting lab results relating to heart health.

The key to heart disease prevention, Milone says, is going to be keeping the issue on women’s minds.

“(We need to have) people see this over and over again until people almost get tired of it,” she said. “We’ve got to all face the issue, and we’ve got to address it.”

Assessing the damages

More than $250 billion. That’s what the American Heart Association expects heart diseases to cost the nation this year, according to its January report in Circulation magazine.

That doesn’t include what it considers “indirect costs,” such as lost productivity and lost future earnings of people who die from cardiac events. If those figures are included, the number jumps to $400 billion.

The costs include money charged by hospitals and other physicians for treatment, as well as dollars spent on medication and home health care.

And reducing those figures, along with mortality rates, means getting women educated about the importance of heart health, says Lovelace cardiologist Anita Kedia.

“The biggest thing is cholesterol screening, blood pressure screening, more literature,” she said, adding there is also a lack of awareness about the danger to the heart of smoking. “Everybody hears about smoking with lung cancer and they don’t hear about smoking with heart disease.

“Even one cigarette a day probably won’t cause lung cancer, but it really increases your chance for stroke or heart attack.”

Loving her heart

This is the third year of the American Heart Association’s “Go Red for Women” campaign, selling tiny red-dress pins as a fund- raiser, like the one Laura Bush wore during her New Mexico visit. This year, the slogan is “Love Your Heart.”

The program includes Web features such as heart-healthy recipes and tips for wellness. It encourages women to attend cholesterol screenings and to talk to their primary care physicians about getting a physical — the kind of things offered at Jutila’s weekly clinic.

Foster, who works for UNM Hospital, says she became interested in being seen at the clinic a year ago, when it was a fledgling program at the institution.

“I really liked the idea of doing baseline testing, and seeing where I was,” she said. “Once you hit 50, you see it in friends: high blood pressure, high cholesterol. If there are problems, I can deal with those now. It was one of those things, can I take responsibility for this?”

She says she was surprised by her results. All her life, she had low blood pressure, and did not expect to be considered at-risk.

“(Jutila) was like, you’re exactly what we’re looking for in an intervention,” Foster said quietly. Her blood pressure and cholesterol were both high.

But there was positive news, too.

“At the same time, she said, ‘You’ve got a heart of a 30- yearold.’ The stress test came back really well,” Foster said. “It made it more possible and more important to do something now because I hadn’t done anything to damage my heart.”

Foster says she had struggled with her weight and that she was a smoker but quit 15 years ago. But it was her family history of high cholesterol and blood pressure that convinced her to go to the clinic.

After she talked to the cardiologist, she had a plan to diet and exercise more. But she knew it would not be easy to change years of habits.

“After I went through the clinic, I went back and talked to my primary care guy, and he said, even if you don’t go crazy and just cut back a little of what you eat and exercise a little, you’ll still be surprised at how hard you have to work at change,” she said. “It’s really hard to incorporate those changes in your life.”

Foster says she was resolved to do right by her heart nonetheless. She says she tries to watch what she eats — not major changes, but “little habits” like portions and variety — and takes a yoga class at lunchtime.

Jutila says every little bit of effort toward weight loss helps.

“For every 3-pound weight loss, for example, you have this tremendous benefit of not only altering risk factors, but lowering your cholesterol, lowering your blood pressure by making your cells more able to metabolize sugar, but it also significantly decreases your morbidity rate from cardiovascular disease,” she says. “It’s never too late.”

Foster says she is proud of herself for making healthier choices now.

“You can do it,” she said. “I’m in it for the long haul. I may not get it all done today, but I’m not going to quit.”

KNOW THE RISKS

Here are the major risk factors for heart disease:

Increasing age: Four out of five people who die of coronary heart disease are 65 or older. Heredity: If your parents have a history of heart disease, your chances greatly increase. Stress. Cigarette smoking or tobacco use. “We’re not making headway with young women as we hoped,” says University of New Mexico cardiologist Charlotte Jutila. High blood pressure. High cholesterol. Physical inactivity. Obesity, or if your waistline measures more than 35 inches. Diabetes.

Source: www.americanheart.org, cardiologist Charlotte Jutila

KNOW THE SYMPTOMS

Heart disease in women can sometimes look and feel like other ailments, cardiologist Charlotte Jutila says. See your doctor if you experience a combination of:

Shortness of breath, especially during regular daily activities, such as walking to your car Chest discomfort Fatigue Nausea or vomiting A feeling of impending doom

KNOW MORE

For information on the University of New Mexico Hospital’s Women’s Cardiovascular Health Program, call 272-6588. For information on the American Heart Association’s Go Red For Women program, visit www.americanheart.org. For information on Lovelace’s “Day of Dance,” call 262-7353.