A Woman’s Heart

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Special ReportHEART DISEASE & WOMEN

Press your ear against the breast of a woman and hear her heartbeat: Rhythmic, strong, warm. That heart never rests, except between pulses. It pumps more than thirty times its own weight in blood each day, more than 1,800 gallons, and over 1.3 million gallons a year. —From A Woman’s Guide to a Healthy Heart, Carol Simontacchi, CCN, MS, and Frances Fitzgerald

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Table of ContentsIntroduction

Heart disease is the number one killer of American women. Every year since 1984,

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Vive Le Difference!Surprise! Surprise! Women are not small men with inconvenient plumbing and reproductive

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A Woman’s Place Is In The Know

The symptoms of a woman’s heart attack are much more subtle than a man’s

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Risky BusinessA woman’s risk for heart disease changes through time. In general, however, risk factors are classified

....Page 7Supplements For A Healthy Heart

The following list is based on recommendations made by Matthias Rath, MD ....Page 9

To E Or Not To EEstrogen’s functions go far beyond its influence over the female reproductive system

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• Which Is The Greater Threat To A Woman’s Health: Breast Cancer Or Heart Disease?

• Is A Man Or A Woman More Likely To Die From Heart Disease?

• How Do A Woman’s Heart Attack Symptoms Differ?

• What Are A Woman’s Risk Factors?

• How Can She Protect Herself?

Read on and give yourself the best health insurance.... Knowledge.

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A Woman’s HeartHeart disease is the number one killer of American women. Every year since 1984, more women than men have died of cardiovascular disease. (CVD includes heart disease and stroke.) In fact, more women die from CVD each year than die from all other causes combined.

Paradoxically, a Gallup Survey showed that 86 percent of women believe it is unlikely that they will ever have a heart attack! Most continue to identify breast cancer as the leading cause of death in women. However, the reality is that six times as many women will die of heart disease as will die of breast cancer.

Heart studies are gender biased towards men. Despite their high mortality rates, women comprise only 25 percent of participants in all heart-related research studies. Thus, it isn’t surprising to learn that women and their doctors fail both to accurately assess the risk and to identify the symptoms of this deadly disease. An online random survey of 500 doctors revealed that women at risk of developing heart disease were more likely than men to be put in a lower risk category. As a result, women were less likely to receive recommendations to change their living habits or to receive medications to help prevent heart attacks. Further, a number of studies have shown that when women with heart disease symptoms go to doctors, these symptoms are not taken seriously.

Introduction3

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Vive la Difference!

Unfortunately, even many women who survive heart attacks still don’t take the disease seriously. A Mayo Clinic study showed that women survivors are less likely to participate in rehab programs. Among 1,821 men and women, only about 40 percent of the women chose to attend postcoronary exercise and health improvement programs, compared with nearly 70 percent of men. Of those who participated in the Mayo Clinic programs, the three year survival rate was 95 percent while the survival rate for those choosing not to participate was only 64 percent.

Women of all ages must learn to think in terms of heart disease prevention. Although heart attacks are more likely to occur after menopause, the roots of the disease start in childhood or adolescence and develop over a lifetime. Long term abuses include an unhealthy diet, cigarette smoking, alcohol consumption, and insufficient exercise. These plus other lifestyle and psychological stressors slowly accumulate, leading to deterioration of the cardiovascular system.

Surprise! Surprise! Women are not small men with inconvenient plumbing and reproductive differences! There are distinct differences between women’s and men’s bones, brains, skin, saliva, and hearts. For years, it was believed that when it came to heart disease, men and women were physiologically the same. The breakthrough came in in 1991 when The Female Heart by Dr. Marianne J. Lagato was published.1

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The heart is the one organ about which there is the most gender-specific knowledge. Women’s hearts are built differently from men’s.

1) In general, a woman’s heart is only two-thirds the size of a man’s, plus women have smaller coronary arteries.

2) Women’s heart rates are higher than men’s, even during sleep.

3) Structural differences in the mitral valve of the heart (which separates the left atrium from the left ventricle) may explain why mitral valve prolapse (MVP) is more common in women.

4) Importantly, women are also at three times greater risk than men of potentially fatal side effects from drugs prescribed to control arrhythmia.

5) Heart disease usually appears 10-15 years later in women than in men. (Once thought to possibly be due to protective effects of estrogen, the reason for this is no longer clear. See page 12, “To E Or Not To E”)

6) Diabetes appears to predispose women to CVD more than men.

7) In addition, reports that moderate alcohol consumption can protect against heart disease are more relevant to men because alcohol in women may increase the risk of breast cancer.

8) Studies show that heart attacks are much more likely to be fatal for women than for men.

9) A major reason for this is that, unknown to most women, a woman’s heart attack symptoms can be very different from a man’s.

10) Thus, heart attacks can go unrecognized in women.

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The symptoms of a woman’s heart attack are much more subtle than a man’s. Seen over and over in movies and on TV, the well-known portrayal of heart attack as excruciating chest pain is only typical for men. Women often have chest pains on and off for years before they have a heart attack. Even if a woman is concerned enough to consult her physician, she may not be taken seriously, particularly if she is not menopausal. Approximately 35 percent of heart attacks in women go unnoticed or unreported. Even when they do seek help, women typically wait four to eight hours. (Men wait an average of only one hour.) It follows that heart attacks in women are more often fatal. Forty-four percent of women who have heart attacks die within a year, compared with 27 percent of men. Some 63 percent of women who die suddenly of heart disease had never reported any symptoms. It is very important that we women become educated to recognize our unique symptoms. Please read the sidebar, “Heart Attack Symptoms in Women”.

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A Woman’s Place Is In The ...Know

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A woman’s risk for heart disease changes through time. In general, however, risk factors are classified as those a woman cannot change, those she can, and a few that fall in between. Oral contraceptive use, pregnancy, having had both ovaries removed, and premature menopause are considered “tweenies”. Totally beyond control are age, height, and family history. However, by understanding these, adaptations can be made in the individual woman’s heart health program. Risk increases with age. Between the ages of 45-64, one in nine women has some form of CVD. After 65, that jumps to one in three. After age 75, even women who don’t have CVD are prone to congestive heart failure caused by the heart’s impaired ability to relax. According to the National Coalition for Women with Heart Disease, the age-adjusted rate of heart disease among African American women is 72 percent higher than for European American women. African American women ages 55-64 are twice as likely as Euro-Americans to have a heart attack and 35 percent more likely to have CVD in the first place. No doubt, not only race but economics enter into this. Regarding family history, women are at a genetic disadvantage if their father or brother had CVD before 55 or their mother or sister before 65. (When parents who died young also smoked, genetics may not be implicated.) As for height, women taller than 5 feet 6 inches are 27 percent less likely to develop CVD than those shorter than 5 feet 2 inches.

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Risky Business

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Risk factors which can be controlled include smoking, alcohol intake, obesity, high blood pressure (HBP), diabetes, blood lipid profile,2 lack of exercise, depression,3 and stress. Also included are a BMI (Body Mass Index) of 29 or greater (body composition is 29 or more percent fat) and waist to hip ratio is greater than 0.8 for middle-aged women. (For the latter, divide your hip measurement into that of your waist.) Of all controllable risks, smoking is the greatest predictor of CVD. In fact, heart disease due to smoking kills nearly as many women as lung cancer. Furthermore, the results of a study involving some 32,000 nurses found that steady exposure to smoke nearly doubles the risk of heart attack and death. This becomes even more important when the use of birth control pills is put into the equation. High dose pills can make high blood pressure and internal clot formation more likely. Women who smoke and use The Pill are up to 39 times more likely to have a heart attack than women who neither smoke nor use oral contraceptives.

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Heart Attack SymptomsIn Women• Pain in the upper abdominal or “epigastrica” region, rather than midchest

• Uncomfortable pressure in chest, neck, shoulder, or left arm

• Pain spreading to neck, jaw, shoulders, or arms

• Vague discomfort or heaviness

• Lightheadedness or fainting

• Nausea which doesn’t seem related to diet

• Shortness of breath with/ without exertion

• Abdominal discomfort

• Fatigue not relieved by rest

• Sweating

• Persistant – Belching, bloating – Toothache – Joint pain – Back pain – Heartburn

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The following list is based on recommendations made by Matthias Rath, MD (from Eradicating Heart Disease), Tori Hudson, ND (author of the sensational Women’s Encyclopedia of Natural Medicine), Stephen T. Sinatra, MD (well-known cardiologist), and Carol Simontacchi, MS, CN (with Frances Fitzgerald), of A Women’s Guide to a Healthy Heart. Incidentally, entire issues of Nutrition News Special Reports have been dedicated to many of these individual nutrients.

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Supplements For A Healthy Heart

VitaminsVitamin C 500-3000 mg dailyVitamin D 1000-2000 IU Vitamin E 400-1200 IUTocotrienols 10-60 mg (Included in some vitamin E products.) Vitamin K2 90 mcgVitamin B3 (niacin) 1500-3000 mg (See footnote 4.)Pantethine 900 mg (active form of pantothenic acid)Folic acid 400 mcg-2.5 mgVitamin B6 10-50 mgVitamin B12 100-1000 mcg

MineralsMagnesium 200-1200 mgCalcium 150-1500 mgPotassium is needed only when HBP is involved.

Other NutrientsCoQ10 25-150 mg (See footnote 5.)Carnitine 150 mgProline 500 mgLysine 500 mg

* These supplements are to be taken in divided doses during the day.

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Dr. Rath’s position is that heart disease is caused by a deficiency of vitamin C (subclinical scurvy). The amino acids listed under “Other Nutrients” are part of his patented program for eradicating heart disease. Vitamin E and its metabolites tocotrienols have long been associated with supporting a healthy heart. Unfortunately, less than 10 percent of Americans are getting even the recommended amount of this important vitamin. Carnitine, a derivative of lysine, brings support directly to the heart muscle. The listed vitamins B3 through B12 are all part of the vitamin B complex. An FDA-allowed claim for B-vitamins appears on supplement labels. It reads, “As part of a well-balanced diet that is low in saturated fat and cholesterol, Folic Acid, Vitamin B6, and Vitamin B12 may reduce the risk of vascular disease.” This specific claim can appear on all products containing a combination of vitamins B6, B12, and folic acid. This combination is a deterrent to high homocysteine levels, a marker for CVD risk. Coenzyme Q10, commonly called CoQ or CoQ10 has become famous for its beneficial effects on the heart. Over the last 20 years, it has also been shown to protect against a number of age-related disorders. In addition, delivery systems have improved. Recently, a large CoQ10 producer discovered a way to deliver the highest concentrations of the most biologically active form of the supplement into the bloodstream. This novel compound, known as ubiquinol, absorbs up to eight times better and remains in the body longer than the commonly used form (ubiquinone). It has demonstrated unprecedented anti-aging effects compared to the older form. Life Extension Foundation director William Faloon has written that CoQ as ubiquinol “could revolutionize how a number of age-related disorders are both prevented and treated”.

Keep It Simple, Sister!If you smoke, STOP!!!

Eat a healthy diet — rich in fresh fruits, veggies, and fiber — low in fat and sugar.

Support your heart with supplements.

Exercise regularly.

Make time to relax.

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In addition to the supplements we have listed, there are several other effective substances plus a number of botanicals that support heart health. First among these are red yeast rice, and gugulipids. Red yeast rice contains naturally-occurring cholesterol-lowering compounds related to statins. Researchers at UCLA found that after 12 weeks, 79 participants taking 2.4 grams of red yeast rice showed cholesterol levels decreased by 15 percent — for about one-fifth the price of pharmaceuticals. Gugulipids contain active plant steroids and are a plant-based derivative from Gugulu. Studies show that 500 mg standardized to 25 mg gugulsterones taken 3 times daily are effective for lowering both cholesterol and triglyceride levels.6 Pure botanicals include ginger, for lowering cholesterol and keeping blood from being too sticky (1 gram). A variety of bioflavonoids such as quercetin, pine bark, and grape seed extract all act to inhibit the oxidation of fat in the blood thought to be the process which makes LDL dangerous. And finally, hawthorn, a traditional herb for the heart and also a bioflavonoid, improves the blood supply to the heart by dilating the coronary arteries, increasing the force of the heartbeat, and regulating cardiac rhythm.

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Estrogen’s functions go far beyond its influence over the female reproductive system. Estrogen receptors are found in the heart itself. They are also in the brain, blood vessels, bones, skin, intestines, respiratory tract, and the genitourinary tract. Estrogen affects everything from how a woman’s brain functions and the way her skin looks to the very beat of her heart. Before menopause, estrogen helps to protect women from heart disease. Research shows that estrogen may modulate enzymes that control cholesterol. This effect raises HDL (“good”) levels and lowers LDL (“bad”), improving the ratio between the two (a good thing). It has also been shown to reduce the levels of clot forming substances in the blood, to benefit the arteries by helping to prevent the formation of atherosclerotic plaque, to help heal injured blood vessels, and reduce arterial spasms. Further, estrogen has antioxidant properties which help protect the arteries from free radical damage. Not surprisingly, estrogen also helps to maintain healthy blood pressure levels. All of these functions and more reduce the risk of heart disease. When a woman reaches menopause, her risk for heart disease increases four-fold. In each decade between 30 and 60, women who have had either surgical or natural menopause have twice the rate of CVD as women of the same age with functioning ovaries. The changes which occur as a result of decreased estrogen levels include alterations in lipid profiles and, frequently, weight gain. In general, total cholesterol increases to the extent that more post-menopausal women have higher levels than men of the same age.

To E Or Not To E...That Is The Question12

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Paradoxically, hormone replacement therapy using patended estrogens and progestins has been shown to degrade heart health rather than support it in postmenopausal women. Several years ago, two large studies using a then popular non-human estrogen and progestin combination and of the estrogen alone were shut down. Both studies used conjugated estrogens derived from mares’ urine and progestin. Progestin (medroxyprogesterone acetate, MPA) is a drug used to mimic the action of progesterone. Since 1997, we have been reporting study results revealing the dangers to the heart of MPA use. The real disappointment here is that no study has been launched to measure the effects of bioidentical hormone therapy. Meanwhile, what happens to the woman who believes hormone replacement may support her own optimal health? In this case, we continue to believe that a prescription for natural, bioidentical estrogen and progesterone is a sensible solution.7

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With each Special Report, Nutrition News features two additional titles to support our main topic. With A Woman’s Heart, we recommend perusing “Skin” and “Osteoporosis”. Skin

Related Resources YourBestFace!

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NATURAL SKIN CARE

Why do men’s faces age more slowly than women’s? First, men’s testosterone stimulates the sebaceous glands to secrete more oil than women secrete, keeping the skin more supple and helping to retain moisture. Then, daily shaving doubles as a massage. This stimulates blood circulation to the face and neck, bringing oxygen and nutrients as it tones the tissues and muscles. Last, men’s skin is usually thicker and sometimes darker so is less vulnerable to sun. Together, these three factors result in men’s skin aging about ten years more slowly than women’s.

Special Report

Osteoporosis

Healthy Bonesfor Life

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Special ReportOSTEOPOROSIS

Often overlooked, osteoporosis in men is a rapidly growing health problem. Although researchers are pointing out the problem, it remains unrecognized by health care providers, insurers, and the general public. Currently, about one-third of all osteoporosis-related fractures occur in men, and it is predicted that the number of fractures in men will double by 2025.

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Footnotes:1 Dr. Legato is an internationally recognized specialist in women’s health. She put into motion a paradigm shift towards the development of a true study of women’s medicine. Not only is she the founder and directorofthePartnershipforGender-SpecificMedicine,sheistheeditorofThe Journal of Gender- SpecificMedicine,andaleadingadvocatefortheinclusionofwomeninclinicaltrials.2Requestafastingcholesterolmeasure.ThisincludesTC(totalcholesterol),HDL,LDL,theratioofTC toHDL,andtriglycerides.Askthatitincludelipoproteina.Gettinghomocysteine,C-reactiveprotein,and fibrinogenstatusisalsoagoodidea.3Accordingtoonestudyinvolvingnearly1000menandwomenwhosufferedheartattacks,thosewhowere depressed were 3-4 times more likely to die of heart problems.4Onlyasinositolhexaniacinate(IHN).Thissafeformofniacinhasbeenshowntoexceedthedruglovastatin initsabilitytoincreaseHDLlevels.5Dr.SinatramakesspecificrecommendationsforCoQasubiquinonewhicharewellworthrepeatinghere. Forwomenover30:60-90mg;forMVP,90-180mgwith400mgofmagnesium;forHBP,180-240mgin divideddoses;andforcongestiveheartfailure,240-440mg.6Triglyceridesareameasureoffatintheblood.Whenweeat,thebodytakesthecaloriesitneedsforquick energy.Anyothercaloriesarestoredastriglycerides.HightriglyceridelevelsareamarkerforMetabolic SyndromeX(consideredaprecursorfordiabetesandCVD)andmaybeastandaloneriskfactorforheart disease.7 Manygynecologistsnowprescribebioidenticalhormones.Ifyoursrefuses,findanewphysician. Inaddition,thereareanumberofreliablecompoundingpharmaciststhatyourprescribingdoctorwill recommend.

For more healthy opportunities, see next page.

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