Heart disease

Cardiovascular disease — what every woman should know

by Marcelle Pick, OB/GYN NP,
and Dixie Mills, MD

Conventional medicine has been battling heart disease for decades. But its major therapies, surgery and prescription drugs have been reactionary, not preventative, and arguably ineffective. For over 25 years at Women to Women, we have practiced a holistic approach to heart health that focuses on preventing heart disease and the wide range of related conditions. And conventional medicine is starting to catch on. Let’s take a look at the historical development of heart disease in America, the conventional response, what the research says, and why we advocate a holistic approach.

What is cardiovascular disease?

Heart disease, hypertension and stroke are cardiovascular conditions, meaning they involve your heart and arteries; click here for a list of the most common cardiovascular diseases and conditions.

Heart damage is caused when the heart muscle weakens or dies because of infection or reduced blood flow. Stroke occurs when the blood vessels leading to the brain are similarly blocked or constricted. On both accounts, this is most commonly the result of a build-up of arterial plaque (called atherosclerosis). High blood pressure, or hypertension, also results from the narrowing and hardening of the arteries caused by atherosclerosis.

Cardiovascular disease is most common in industrialized countries where modern lifestyles include the worst risk factors: smoking, obesity, lack of physical activity, high cholesterol, and inflammation.

Heart disease sounds so simple, it should be preventable. Then why is heart disease so pervasive, affecting over 500,000 women a year?

Heart disease is not the same for women

If you already know that heart disease is the leading cause of death for American women, you may be more aware than your healthcare practitioner. In a recent study, fewer than one in five physicians recognized that more women than men die of heart disease each year. This cultural gender bias perpetuates the myth that heart disease is a man’s problem. That myth poses a significant threat to women. The reality is that, while mortality rates for men over the past 20 years have been steadily declining, the rates for women have remained relatively stable.

Why is this misperception so prevalent? After all, women have hearts! In part it’s because the symptoms of heart disease show up differently in women. Many doctors don’t recognize them until a major cardiac event is taking place. (See our list for warning signs of heart attack and stroke). Therefore, women receive less aggressive treatment, and occasionally no treatment at all.

And this is partly because many physicians use the same risk assessment tools for both men and women (e.g., the Framingham Risk Estimation [FRE]), a practice that fails to identify a significant number of their female patients as already having coronary disease.

Moreover, most women aren’t informed about prevention without a prior diagnosis or family history, despite the universal risk posed by menopause when levels of “good” cholesterol drop. This translates into women being misinformed, misdiagnosed, and compromised in terms of their heart health.

In addition, the majority of studies on heart disease have been conducted on a white male population. How did women get left out of the picture? The answers will tell us much about the shortcomings of a conventional approach to heart disease.

A brief history of heart disease

There is one sense in which heart disease is a man’s disease: medicine has approached it as an evil threat created by one villain after another — at first it was fat, then smoking, then stress, then cholesterol and, most recently, inflammation. This line of thinking begs for a “heroic” solution like surgery or medication to save the day.

Doctors began diagnosing men with symptoms of cardiovascular disease as early as the 1930’s. After World War II, our cultural evolution from a farm-based society to an urban/industrial society was complete, with a distinct shift to a life of relative wealth, abundant food, and physical ease.

And guess what? We became victims of our own prosperity and good fortune. We began eating too much, driving everywhere, working at desks, and smoking and drinking to excess. The new stressors of modern life multiplied, as did the pollution in our environment. Some people’s arteries reacted by creating sticky plaque that, among other things, constricted blood flow to the heart and other organs and weakened them.

By the late 1940’s, heart disease was officially proclaimed the number–one killer — even though statistics on women from that time don’t exist. Doctors blamed the condition on an overly rich diet — much the same as gout — because a majority of the men who had it were overweight. Doctors learned in the 1950’s that smoking was a huge risk factor, but cigarette makers kept this knowledge from gaining public recognition.

Twenty years later deaths from heart disease were still rising and little headway had been made. The government got involved. Huge amounts of funding went towards finding causes and a cure. In 1971, the US Public Health Service underwrote the landmark Framingham Heart Study. This ongoing study, the first to include women, is the basis for much of what we know about heart disease today. And — for the first time ever — it verified beyond a doubt the link between cardiovascular disease and our habits, or what we soon came to know as “heart disease risk factors.”

From that point, the hunt was on to find the villain. New information in the 1970’s fingered stress and the “type–A personality.” By the 1980’s, we discovered the link with saturated fat and cholesterol and ushered in the low-fat craze (much to our detriment — more on that in our article on cholesterol and fat).

In the 1990’s we discovered “good” and “bad” cholesterol. Current research is pointing to inflammation as the chief assailant. My guess is that individual DNA variations will move to the forefront in the near future as genetic profiling improves.

But the truth is, if the cause of heart disease were a multiple-choice question, the answer would be “all of the above.” And more.

The mess we’re in now

The great danger of the “villain” approach to heart disease is that it oversimplifies the problem to the detriment of prevention. Western medicine already has an unfortunate bias toward disease screening: wait until the patient reaches a disease state, then diagnose and treat aggressively. This wait-then-intervene approach may save your life once you’re sick, but isn’t very effective at preventing the problem in the first place, when it’s so much easier to solve.

Think for a moment about the solutions offered by conventional medicine for heart disease.

Surgical solutions like heart by-pass surgery (which “fixes” the heart by “by-passing” it — a fundamentally Western approach) and arterial stents may be crucial for people with advanced heart disease. But they tend to “buy time” for the patient without getting at the underlying cause of the disease.

Similarly, statins (Lipitor, Zocor, Pravachol, Lescol, Mevacor) may lower cholesterol, but lead the patient to rely on a drug rather than getting at what drove their cholesterol up in the first place. Importantly, these are not magic potions but powerful drugs — with powerful side effects. Look at the COX-II inhibitors Vioxx and Celebrex: both were hailed as medical breakthroughs in anti-inflammation but later proved to radically damage the cardiovascular system. We know that sometimes high cholesterol is correlated with cardiovascular disease risk, but that doesn’t mean it causes it. A majority of heart attack sufferers have normal cholesterol readings. The truth is, we don’t know all the long-term implications of statin use. And the supposed cause-and-effect link between high cholesterol and heart disease has never been proven in the first place.

The low-fat diet first advocated in the 1970’s has led to thousands of low-fat food products and created a generation of pasta eaters. Unfortunately these diets starve the body of the nutrients it needs while overlooking completely their negative side effects, creating an epidemic of insulin resistance, which new studies show is clearly a risk factor for heart disease.

We haven’t done much about stress, either, except to multiply exponentially our use of antidepressants. (See our article on antidepressants and alternative treatments for depression.)

Don’t get me wrong. When you need a cardiologist and a heart surgeon, thank heavens they’re there for you. And if I were having a heart attack, I would be so grateful for the drugs and stents that would save my life. But why wait ‘til I’m sick to care for my heart?

Heart disease prevention — a new approach and a better understanding

The good news is that as conventional medicine learns more about the heart, more cardiologists are realizing that there’s no simple answer: heart disease is multifactorial and is best treated by identifying and reversing the underlying problems.

There have been so many important studies of heart disease in recent years: We’ve established that inflammation is a critical risk factor — perhaps more important than cholesterol — which means that heart health is related to all the other systems of the body, from nutrition to dental health to digestion to hormonal balance to heavy metal toxicity. High blood sugar, whether you are diabetic or not, also appears to raise the risk of heart disease. The connections to depression and stress are clearer and stronger, which means that the role of emotional experience is getting greater recognition. We have proven beyond any doubt that synthetic hormones raise the risk of cardiovascular disease; we don’t know yet but hope that bioidentical hormones may actually reduce it. We are learning that the risk factors for heart disease reach far back into our personal history. Finally, we are realizing that genetic factors play a smaller role than we may at first have feared. For guidance on how to care for your heart holistically, read our seven-step approach to natural heart disease prevention.

At Women to Women we are so encouraged by these developments. We see conventional medicine backing into an understanding of heart health that is profoundly holistic: that everything in our lives is connected; that our mind, body and spirit each play a role in determining our health; that nature is the real healer, not man; and that prevention is more effective than treatment.

Related to this article:

References & further reading on cardiovascular disease

 

Last Modified Date: 04/20/2011
Principal Authors: Dixie Mills, MD & Marcelle Pick, OB/GYN NP