Tag Archives: women

More benefit to physical activity~ Prevents Heart Failure

BW ARA labcoat

Physicians talk about patients with heart failure (HF) when describing someone with shortness of breath, inability to exert physically without having shortness of breath, or also experiencing fluid retention (leg swelling, increased waist size).

 

Non-physicians (my husband for example) hear about ‘heart failure’ and imagine death, or heart stopping like in sudden cardiac death. The terms could be better, but for now are used as above for physicians and for HeartHealth Doctors followers: Heart Failure refers to symptoms of shortness of breath (dyspnea) or fluid retention either due to reduced (r) heart pumping function (also termed Ejection Fraction or EF) (HFrEF) or preserved (p) EF but ineffective heart pumping function (HFpEF).

 

Heart failure is one of the most common reasons for hospitalization and is more common as people get older.   In the US more than 6 million adults have HF.

 

HeartHealth Doctors blog has information regarding the benefits of exercise and heart healthy lifestyle as powerful ways to prevent symptoms from heart issues.

 

For the first time, the Women’s Health Initiative program (WHI) has reported benefit of physical activity specifically walking, for post menopausal women to prevent HF.

Physical Activity and Incidence of Heart Failure in Postmenopausal Women (J Am Coll Cardiol HF 2018;6:983–95) reports findings from WHI that support regular physical activity – reported as recreational physical activity by participants – as a powerful means of reducing Heart Failure risk (both HFrEF and HFpEF).

The findings again support exercise (physical activity) as medicine – without potential side effects, and with a good dose response (more activity time, less chance to develop Heart Failure).

The study looked prospectively at the women, and the following list are possible ways physical activity impacts risks for developing heart failure. As HeartHealth Doctors have outlined, physical activity improves risk factors for heart disease, and as pointed out in the Clinical Research Study, for Heart Failure-

 

Exercise or physical activity helps prevent or manage:

Obesity

Blood pressure

Glucose / blood sugar regulation

Inflammation and Oxidative stress

Left ventricular compliance (heart pumping/relaxing function)

Arterial function

Aerobic capacity

Skeletal muscle function

Coronary Heart Disease

Diabetes

Atrial fibrillation

 

The researchers removed participants who were unable to walk 1 block prior to enrollment.

They included post menopausal women age ~50-79 years at start of the study and followed the group for 15 years with surveys.

The study highlights new benefit to heart healthy habits of exercise and physical activity; still the best way to multi task for your heart health.

How much physical activity is enough?

The study suggests volume of activity is a good focus rather than intensity – just walk for example work toward the authors’ goal of ‘brisk walking (3.3 mph on level ground) with the target of achieving 30 min/day on 5 or more days of the week.’

Benefit was shown with regular walking pretty much in line with current guidelines of 150 minutes per week; which can be 10 minutes twice a day or 30 minutes 5 days per week ~ now a big study shows one more of so many reasons to be physically active.

 

Physical Activity and Incidence of Heart Failure in Postmenopausal Women (JACC: Heart Failure December 2018)

J Am Coll Cardiol HF 2018;6:983–95

#GoRedCbus ~ When should you learn about Heart Failure?

BW ARA labcoatThe American Heart Association’s Go Red for Women event February 23, 2017 gave Columbus information about Heart Health for Women, and provided opportunity to support AHA in advocacy, research, and education.

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Left – right, JS, Dr. Albers, Dr. Basuray

Dr Anup Basuray (photo) presented a breakout session on a complex topic. The name Heart Failure does not in fact mean a heart has stopped working (my engineer/math husband is one of many who question the name Heart Failure – but this has been and remains our wording). The term is broad covering symptoms that occur when the heart is not fully functioning – leading to symptoms including shortness of breath, leg swelling, abdominal swelling, fatigue, and/or weight gain or loss. In his presentation, Prevent. Treat. Recover. : Transforming Heart Failure into a Success Story Dr. Basuray highlighted examples of young women patients he has treated. His case presentations illustrated the different ways people get heart failure; some specific to women, for example in the case of problems associated with pregnancy.

Heart Failure is diverse in cause, outcomes, and treatment. The slide here shows ~ 10 causes of Heart Failure, more recently identified is history of cancer treatment, and also included is ‘unknown‘ or doctor-speak, idiopathic. Heart valve disease, genetics (inherited causes), high blood pressure, drugs and alcohol, infection, coronary artery disease, pregnancy related, and irregular heart rate/rhythm can all be causes of Heart Failure.

Heart Failure results in fluid retention by the kidneys, a problem that is worse with high sodium diet. Western diets have high sodium – top sources are Breads and rolls, cold cuts and cured meats, pizza, poultry, soups, sandwiches, cheese, pasta dishes, meat dishes, SNACKS. Reading labels and being aware of sodium is key to heart health in general and to limiting fluid retention in Heart Failure in particular. Knowledge is power when considering what we eat – see here https://hearthealthdocs.com/heart-healthy-diet/  , and for surprising sources of salt https://hearthealthdocs.com/2016/06/08/surprise-sources-of-salt-in-your-diet/

Dr. Basuray addressed the power of prevention and how to stay healthy by knowing the following KEY modifiable risk factors for heart failure

  • High blood pressure
  • Diabetes
  • Obesity
  • High cholesterol

Know your numbers

  • Blood pressure, cholesterol, diabetes (blood glucose) screen
  • Every 4-6 years, as early as age 20

2013 AHA/ACC Heart Failure Guidelines 

So when should you learn about Heart Failure? Now is good. Same with choosing to live a heart healthier life.

Heart Health Docs recommended resources:

https://www.cardiosmart.org/Heart-Conditions/Heart-Failure

#GoRedWearRed ~ Women’s Heart and Vascular Health

BW ARA labcoatThe OhioHealth Women’s Heart & Vascular Conference January 30, 2016 was a great opportunity for healthcare professionals to focus on current research and practice for Women’s Heart Health.

It takes dedicated research and study to understand how best to identify heart risk and heart disease in women and dedicated clinicians who will put the research findings into practice. The American Heart Association Wear Red Day, Go Red for Women campaigns work to educate women about heart and vascular disease ~ 

For Wear Red Day 2016, here are a few conference takeaways:

Dr Alton

Dr Alton

  1. Ischemic heart disease is not a “Man’s” disease ~ in fact heart disease is the leading killer of mothers, wives, aunts, daughters, sisters. Cardiac tests may include radiation exposure; ask about the tests your doctor is recommending – are there alternatives that don’t involve radiation.

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Dr. Barac discussing CardioOncology

Dr. Barac discussing CardioOncology

2. Cardio Oncology focuses on heart health in the setting of cancer treatment; either history of cancer treatment or current – the goal is to be sure women can receive the most effective cancer treatments while protecting their heart function ~ As with all heart health, making sure you control risk factors for heart disease (hypertension or high blood pressure for example) also helps the heart stay strong during chemotherapy.

 

Dr Amburgey

Dr Amburgey

3. Consider pregnancy a stress test for your heart  It is important to follow up if you have hypertension in pregnancy, pre-eclampsia, or eclampsia or diabetes in pregnancy because these conditions may improve after delivery but are now included as risk factors for heart disease and stroke for women over the next 30 years.

 

 

Dr. Neff-Massullo

Dr. Neff-Massullo

4. Vascular disease is under-diagnosed in women ~ the role of hormone therapy and venous thrombo-embolism (VTE) or blood clots in veins is significant. While it is not recommended to test everyone who starts hormone therapy, it is important to speak up if you have a family history of blood clots or any signs/symptoms of blood clot (leg swelling, pain) – especially in the first 12 months of hormone therapy.

 

Test of venous disease ~ Doppler showing venous reflux

Test of venous disease ~spectral  Doppler ultrasound showing venous reflux

5. Venous disease can cause leg pain and swelling, over time can be disabling due to skin changes such as ulcers; compression socks and vascular procedures can help.

 

 

 

 

Dr. Rock-Willoughby

Dr. Rock-Willoughby

6. Women suffer from delay seeking treatment AND delay of diagnosis of acute MI (heart attack).    For Women: Don’t wait for symptoms to go away; it might not be chest pain; women can experience fatigue, sweats, shortness of breath, dizziness, nausea or abdominal pain – call 911. For Healthcare Providers : Think Nose to Navel ~ a program designed to reduce the time to EKG evaluation for women.

7. What’s a treatment that reduces risk of death, heart attack, and more heart procedures?  Cardiac Rehab. Why are referrals and enrollment not 100%? Why are both even lower for women? Make time for Cardiac Rehab and for Heart Health; it’s worth the effort.

Dr Albers introducing Dr Amin to discuss Atrial Fibrillation

Dr Albers introducing Dr Amin to discuss Atrial Fibrillation

8. Women are underrepresented in Heart Rhythm Disorders research; we know that being a woman increases stroke risk in atrial fibrillation. Be sure to ask your doctor if you have atrial fibrillation, if you need to be checked for atrial fibrillation, and if you should be taking a medicine to reduce your risk of stroke. Get involved and participate in clinical research.

 

McConnell Heart Health Center

McConnell Heart Health Center

Thanks to conference attendees  ~ the room was at capacity ~ more healthcare professionals learning about the diagnosis and treatment of heart and vascular disease in women.

Hello #HeartMonth

BW ARA labcoatThe OhioHealth Women’s Heart & Vascular Program CME event on Saturday 1/30 was a fabulous kick off to February ~ Heart Month ~ which includes #WearRedGoRed for Women Friday February 5 and the Go Red for Women Luncheon here in Columbus on Thursday February 25 to benefit the American Heart Association.

We appreciate the American Heart Association support for the conference (see registration table photo below) with Red Dress pins, wristbands, and great Know & Go cards for participants.

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The morning event at the McConnell Heart Health Center brought together health care professionals interested in learning about Women’s Heart & Vascular Health; from Heart & Vascular physicians with keynote presentation from Dr. Ana Barac discussing CardioOncology.

Dr. Mary Alton gave a great opening lecture on Women & Heart Disease, including Yentl syndrome.  She covered cardiac testing for women ~ or how can we choose the best way to learn about a woman’s heart function.

Dr. Barac presented current research in how to protect women’s hearts during chemotherapy for cancer; as well as the risk of high blood pressure (hypertension) and other risk factors that weaken a woman’s heart function when going through cancer treatments.

IMG_6674The OhioHealth Women’s Heart & Vascular Pregnancy Predicts Risk Program ~ why was this started & what’s a risk from pregnancy? was introduced by Dr. Laurie Amburgey, Maternal Fetal Medicine, and discussed by Dr. Ashley Chambers, Internal Medicine. Both providers discussed the fact that a woman’s heart risk with pregnancy issues like pre-eclampsia doesn’t stop with delivery of the baby. Dr. Chambers told us about the OhioHealth program to be sure women have appropriate risk factor management in the years after having a pregnancy that predicts Heart Risk.

Dr. Joddi Neff with Riverside Radiology and Interventional Associates gave a great “Ask the Expert” session on Vascular Medicine – (a big topic that could have its own conference) and focused on risk of blood clots with hormone therapy, and management of venous diseases for women.

Faculty & Course Director Clockwise from bottom left: Dr. Alton, Dr. Nicholson, Dr. Amin, Dr. Rock-Willoughby, Dr. Chambers, Dr. Amburgey, Dr. Neff-Massullo, Dr. Barac, Dr. Albers

Women’s Heart & Vascular CME Faculty 
Clockwise from bottom left: Dr. Alton, Dr. Nicholson, Dr. Amin, Dr. Rock-Willoughby, Dr. Chambers, Dr. Amburgey, Dr. Neff-Massullo, Dr. Barac, Dr. Albers (Course Director)

Dr. David Nicholson and Dr. Jayme Rock-Willoughby with OhioHealth presented the session “From ER to CR” highlighting the “Nose to Navel” goal for early EKG for women with symptoms occurring in that anatomical range, and the Women’s Cardiac Rehab programming launched at the McConnell Heart Health Center in 2015 ~ an effort to get more women through Cardiac Rehab.

Dr. Anish Amin, a Heart Rhythm Specialist closed with an excellent talk on Women’s risk for stroke with atrial fibrillation (a heart arrhythmia).

More to come with take home points for patients from the morning sessions.

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Lexie Sines, with OhioHealth CME

#Heart Health for Women; Start here this Valentine’s Day #LoveYourHeart

IMG_2641 ara echoWhat better day to talk about the Heart than Valentine’s Day?

More science is showing the benefit of starting early with habits that promote heart health.  Treatments already available & scientifically proven are UNDERUTILIZED: would you think 20% was a good score?! No. But 80% of people eligible for cardiac rehab DON’T take part in this essential treatment / program.

This post covers TWO topics for Women’s Heart Health:

  • A recent study showing the impact of 20 years of healthy choices for young women 
  • A NEW program to promote the established, effective heart treatment Cardiac Rehab.

Heart month is a great time to bring attention to what we know about preventing heart disease as well as what opportunities are available for managing heart risk.

  • A recent study showing the impact of 20 years of healthy choices for young women 

In 2015 we have learned about healthy habits or behaviors that impact RISK for developing heart disease with PRIMARY prevention. A paper published in the Journal of the American College of Cardiology (JACC) in January reports the impact of 6 habits on the risk of heart disease for women. This study,

Healthy Lifestyle in the Primordial Prevention of Cardiovascular Disease Among Young Women

looked at a group of young women ages 27-44 years old and followed them over 20 years. Can you think of what the 6 healthy behaviors might be? We have covered them here on HeartHealthDoctors – like a lot of heart healthy changes they are available to us NOW. So pick one and START living a healthy lifestyle:

A healthy lifestyle was defined as not smoking, a normal body mass index, physical activity ≥ 2.5 h/week, television viewing ≤ 7 h/week, diet in the top 40% of the Alternative Healthy Eating Index–2010, and 0.1 to 14.9 g/day of alcohol.

1) Not smoking

2) Get to GOAL weight which is a normal Body Mass Index (BMI)

3) Move your body through space; physical activity at least 2 1/2 hours per week

4) TV viewing < or equal to 7 hours per week

5) Follow a heart healthy diet 

6) If a woman chooses to drink alcohol, amount of 1 drink per day or 12 oz beer, 4 oz wine, or 1.5 oz liquor correlates to ~14gm

Marlene Busko writes for Medscape about the JACC paper that ” Adoption of six healthy lifestyle behaviors could avert about 73% of coronary heart disease (CHD) cases among women over 20 years, as well as 46% of diabetes, hypertension, and hyperlipidemia, conclude researchers, based on their analysis of about 69 000 participants …”

Key to know with the Nurse’s Health Study findings is that Coronary Heart Disease (CHD) risk was lower for women without AND with heart disease risk factors BOTH groups showed decreased events with more healthy lifestyle habits/behaviors.

  • A NEW program to promote the established, effective heart treatment Cardiac Rehab.

At OhioHealth we have launched a cardiac rehab program for women to help give every opportunity to succeed at SECONDARY prevention and prevent or slow disease progression. To improve the ‘ low test score of 20%’ participation in Cardiac Rehab the OhioHealth Women’s Heart and Vascular Program launched a program for cardiac rehab designed for women. Education and exercise in the company of other women with heart disease offers a new way to help women who have had a heart event (Chest Pain, Heart Attack, Coronary artery Stent, Heart Valve surgery, Coronary artery bypass surgery) and are starting on their SECONDARY prevention journey.

Read more about Cardiac Rehab here; 10TV News did a great story / coverage of the Women’s Cardiac Rehab program (click text to view story and video).

 

 

Cardiac Rehab~Have you heard of it? #hearthealth @CardioSmart #CardiacRehab #exerciseworks

BW ARA labcoatHeart and Vascular Health result from a mix of a lot of different ingredients; we cover many of these ingredients here at the Heart Health Doctors (for example exercise, diet). Think of mixing or using the best ingredients possible (healthy weight, not smoking, healthy diet, staying active) as PRIMARY prevention (for someone who has never had a heart event).

Another important way to work on the ‘ingredients’ is by SECONDARY prevention – how to regain strength, heal after injury, and build back to great Heart & Vascular Health after an EVENT.

Cardiac Rehab is how. The event that will trigger going to Cardiac Rehab may be having a heart stent, a heart attack, open heart surgery for bypass of blocked heart arteries, valve replacement or repair, chest pain or angina, or most recently, a diagnosis of congestive heart failure; even a combination of these.

It would be great to have Cardiac PREhab programs; for now that is what we do at our blog – education for maintaining heart and vascular health.

Cardiac Rehab remains the program that can reduce mortality (death) by 25% if people who have had a heart event complete the program when compared with people who have had a heart event who did not complete a Cardiac Rehab program.

This CardioSmart video gives a great overview of Cardiac Rehab.

The benefits of Cardiac Rehab in our communities cannot be overstated. Often patients will tell me that they plan to “exercise on their own” or that (women here) they are busy making sure their families are organized and cared for, so “no time.” One program offers discount rate for a spouse to attend rehab sessions and exercise with the patient to help increase participation. I encourage and – to use doctor terminology – order my patients to enroll and participate in Cardiac Rehab despite excuses.

At Cardiac Rehab the exercise is monitored – so the patient’s physician learns of any heart arrhythmia, or of any blood pressure issue (under or over treatment). The patient learns about their heart disease, heart healthy habits, how to follow their personal exercise prescription, eat heart healthy, and how to identify and manage stress. It is time well spent. A challenge for patients of late unfortunately can be cost; many programs have financial aid to help patients attend and complete a rehab program, but I had no argument for my patient whose co-pays for cardiac rehab would have approached $2000 for his sessions. He simply could not participate. The hope is that that is an exception; insurers have the data that shows Cardiac Rehab programs result in patients having fewer followup procedures, come out with better quality of life, and are more prepared to succeed with SECONDARY prevention.

Often patients have up to a year to enroll in a Cardiac Rehab program after a qualifying heart EVENT.  Make it a priority to include this therapy and improve Heart & Vascular Health.

 

 

What do Women need to know about Heart Disease?

Women’s Heart & Vascular* Health will be an ongoing topic at HeartHealth Doctors.  Why?  Ladies first applies for women and heart disease; but not in a polite, etiquette way- Since 1984 more women than men have died from heart disease.  *Vascular health is part of circulation, meaning the arteries and veins, the heart is the main active pump in our circulation.

Dr. Albers’ post for Women’s Health talks about the recent Heart of Women’s Health meeting at the American College of Cardiology’s Heart House in Washington DC.  Check out the article, or if you are pressed for time-  Here are 10 great tips for improving your heart health; presented at a breakout session of the Go Red for Women luncheon and seminar February 2013.

These 10 tips apply to anyone wanting to improve their heart health:

Women's Health