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Weekend House Call

Aired February 7, 2004 - 08:30   ET


FRANK BUCKLEY, CNN CORRESPONDENT: Weekend House Call with Holly Firfer begins right now.
HOLLY FIRFER, CNN CORRESPONDENT: Good morning and welcome to Weekend House Call.

We're getting down to the heart of the matter today, heart disease. It's the number one killer of women in the U.S., claiming the lives of half a million women every year. That's more than all forms of cancer combined. But according to the American Heart Association, only 13 percent of women consider heart disease their greatest health risk. Making sure women are more aware of heart disease is the goal of a national campaign that kicked off this week at the White House. First Lady Laura Bush lent her support as February was declared National Heart Month. And Friday was declared the first ever National Wear Red Day in support of the campaign.

Also this week, the American Heart Association released new heart disease guidelines for women, based for the first time on scientific studies of women instead of men. Now, those new guidelines point to the lifestyle as the first line of attack against heart disease.


FIRFER (voice-over): The American Heart Association says all women should not smoke; they should do 30 minutes of moderate physical activity on most, preferably all, days; eat a healthy diet; and maintain a healthy weight.

DR. NANETTE WENGER, EMORY UNIVERSITY: Physicians talk about prevention to women. They talk about mammography. They talk about pap smears. They don't talk about cardiovascular disease prevention and this is what I trust these guidelines will encourage.

FIRFER: New guidelines for women also suggest some things they should not do. Hormone therapy and anti-oxidant supplements are not recommended to prevent heart disease, nor should those with a low risk of heart disease take aspirin on a regular basis.

For women whose doctors tell them they are at high risk for heart disease, the new guidelines also recommend taking statins or cholesterol lowering drugs; ace inhibitors or beta blockers, which lower blood pressure; and omega-3 fatty acid and folic acid supplements to prevent heart disease.

The Heart Association says women need to be proactive, making a list of questions to start a dialogue with your doctor. DR. SUSAN BENNETT, AMERICAN HEART ASSOCIATION: Start out as what's my risk of having heart disease or stroke? And then the conversation has to follow with respect to is my blood pressure normal, are my bad cholesterols too high, is my good cholesterol too low, do I smoke, am I inactive, do I need to lose weight?


FIRFER: The American Heart Association says any woman with cardiovascular disease should also be evaluated for depression because depression could prevent women from getting the proper treatment that they need.

Now, once again, there are some of the risk factors for heart disease in women. Let's go over it again. If you are a smoker, you have high blood pressure or high cholesterol levels, if you're overweight or obese, if you are physically inactive, if you have diabetes, a family history of heart disease or if you are a woman 55 or older.

Now, even though you are more at risk when you pass the age of 50, younger women in their 20s, their 30s and their 40s can take steps now to prevent heart disease later on.

Now, we want to hear from you with your questions about women and heart disease. You can call us at 1-800-807-2620 or you can e-mail us at

Now, joining us to help answer your questions is Dr. Nanette Wenger, chief of cardiology at Grady Hospital in Atlanta and the coauthor of the new women's heart disease guidelines.

Thanks so much for joining us this morning, Dr. Wenger.

WENGER: Delighted to be here.

FIRFER: Good to have you here.

We have a lot of e-mails and phone calls lined up, so let's get started right away.

We have an e-mail, first off, from Julia in Pennsylvania. She asks, "If a female is not overweight and in her mid-20s, can she still be at risk for heart disease if she's under a lot of stress?"

Now, we know, Dr. Wenger, stress puts a lot of stress on your body. It has a physical reaction.

Does it relate to heart disease?

WENGER: Well, the amazing thing is that there's very little information that suggests that stress in and of itself is a heart disease risk. The problem is that if you're stressed, you may not be doing a lot of the heart healthy issues. Certainly, women have to be checked. It's more likely that there will be high blood pressure and high blood cholesterol as you get older. But a woman who has concerns certainly should see her doctor.

You know, you can tell whether you're at risk. You can tell whether you're eating healthy, whether you're physically active, obviously whether you're not smoking. But there are a number of things that must be checked in a medical setting, that is, blood pressure, blood cholesterol, whether or not you're diabetic. And if you have a family history of heart disease, these should be checked.

FIRFER: And we know women are very good at taking care of their families. They have to remember to take care of themselves.

We have Shirley on the phone from Arkansas with a question.

Go ahead, Shirley.

What's your question for Dr. Wenger?

SHIRLEY: Yes, ma'am, I have very hard, a very fast heartbeat. I'm on 25 milligrams of ratenenol (ph) a day and I had heard that I'm not supposed to take baby aspirin.

Is that true?

WENGER: Well, again, the Heart Association has made recommendations for aspirin depending on risk. And here is the reason. If you have heart disease or you're at high risk, aspirin is unquestionably beneficial. If you're at immediate risk, aspirin likely is beneficial if your blood pressure is controlled and you don't have a risk of having some bleeding from intestinal tract. But for low risk women, and if all you have is a fast heartbeat and not a serious rhythm disturbance -- that's something your doctor has to tell you -- you're probably at low risk for heart disease.

And one of the new Heart Association recommendations is that pending the results of ongoing studies, low risk women probably should not take aspirin. The reason is that younger women, low risk women are probably more likely to have a stroke then they are to have a heart attack.

FIRFER: OK, Dr. Wenger, we'll give you a chance, I know, to catch your breath there.

WENGER: No, no, no.


WENGER: More likely to have a stroke than they are to have a heart attack. And if they happen to have a stroke, it's more likely to bleed. So that the risk-benefit ratio for low risk women is not favorable.

FIRFER: OK, we do have another e-mail from Patricia in Georgia. And she says, "I have mitral valve prolapse. Are there any particular precautions I should be taking?"

First of all, can you explain what that is for us? WENGER: Yes. Patricia, that's a very good question. Mitral valve prolapse is when the valve that separates the upper and lower chambers of the left side of the heart is floppy and it produces a murmur and a little sound called a click.

Most of the time this gives absolutely no problems. But it's important that if that valve tends to be leaky -- and the doctor can tell that by a murmur or it can be told by an echocardiogram -- you need antibiotics when you have invasive procedures, procedures such as dental work, to prevent you from getting an infection on that valve.

Not everyone with mitral prolapse needs the antibiotics. It depends on whether you have a leaky part of that prolapsed valve.

A very good question, Patricia.

FIRFER: OK, Dr. Wenger, we've got a lot more questions and e- mails. But first we have to take a quick break.

Now, you might think you're too sexy for heart disease, but not these celebrities showing off their red dress fashion sense.

Coming up, we take a look at how the fashion industry is trying to raise awareness for women's heart disease.

And we also want to hear from you. You can call us at 1-800-807- 2620, or drop us an e-mail at

Now, quickly, let's take a peek at our daily dose health quiz.

According to a recent survey by the American Heart Association, where do women get most of their information on heart disease? Do they get it from their doctor, from magazines, the Internet or from television? You might be surprised.

We're going to have that answer, when we come back.


FIRFER: In our daily dose quiz, we asked where do women get most of their information on heart disease, from their doctor, magazines, the Internet or television? The answer is magazines. Forty-five percent of women say they get most of their information on heart disease from magazines.

Well, "Glamour" magazine is also contributing to the campaign to raise awareness of women and heart disease. The red dress is the symbol of the Go Red For Women campaign. And in this month's issue, several celebrities are featured wearing a red dress to symbolize that heart disease can strike any woman at any age. Now, each of the dresses were donated by well known designers, including Calvin Klein, Vera Wang, Ralph Lauren and Betsy Johnson.

The red dress collection was also featured yesterday during the kickoff of Fashion Week in New York. Top models took to the catwalk with the message of educating women about heart disease. Well, the classic symptoms of heart disease are different in women than in men. Sixty-three percent of women who died suddenly from a heart attack had no previous symptom or didn't recognize those symptoms. But there are some warning signs of heart attacks that are more prevalent in women.

First of all, unusual fatigue is the most common warning sign, according to the American Heart Association, plus trouble sleeping or sleep disturbances. Other signs are shortness of breath, indigestion or anxiety. And as we said, many women don't even recognize these signs. They think a heart attack is sudden like in the movies, when, in fact, it can come on slowly over weeks or months.

Joining us again is Dr. Nanette Wenger to answer your questions.

And let's go to the phones right away, because Jane is on the phone from Florida with a question.

Good morning, Jane.

JANE: Good morning.

FIRFER: Go ahead with your question.

JANE: OK. Two and a half weeks ago I had the, I think it's called the Holter Monitor, and I wore it for 24 hours. I haven't heard a word from my doctor yet and I'm still having the palpitations and nauseousness. And I'm really concerned about this.

WENGER: Well, a Holter Monitor, or an ambulatory electrocardiogram, is like a tape recorded cardiogram. And you wear it typically for 24 hours and it records every one of your heartbeats. Then it's played back through special equipment and what can happen is that we can see are there any rhythm disturbances when you describe palpitations.

You know, some people have palpitations that's just an unpleasant awareness of their heartbeat, that there really is not a serious rhythm disturbance. Other people can have palpitations and there may be the rhythm disturbance that is not life threatening, not even serious, whereas other individuals can have an important rhythm disturbance. And that is what your doctor wants to check.

Remember that the technician has to check the recording and report it back to your doctor, so certainly call your doctor and see what showed up on that Holter Monitor.

FIRFER: We have an e-mail now from Kathy in Ohio and she's asking, she says, "I've had a stabbing pain that seems to go from my upper left chest to my back, no shortness of breath, just the stabbing pain and my jaw is tender. Could this be a sign of heart disease?"

WENGER: That's a very good question and any time there is an unpleasant pain or discomfort in the chest, in the back, in the arms, in the shoulder, you should have it evaluated. Typically, though, the pain that is associated with coronary disease is brought on by exertion and relieved by rest. So it's going to be important as to whether that is the characteristic of the pain. But, again, since chest pain is the most common presenting symptom of coronary disease, the disease that results in heart attack in women, if you have chest pain, see your physician for an evaluation. There are many ways that that pain can be evaluated.

FIRFER: We have a phone call now from Audrey in Wisconsin.

Good morning, Audrey.

What's your question for Dr. Wenger this morning?

AUDREY: My question is I oftentimes have pressure in my chest like elephants walking on it, real heavy. And at times a nauseous feeling. Could this be -- I've told my doctor and he -- about it and he seems to just not pay much attention.

WENGER: Well, this description could certainly fit heart disease. It can fit many other illnesses, as well. But the important feature that women and their physicians should appreciate is that this is the most life threatening and if you have pain like that, you should have it evaluated by some sort of test, some kind of an exercise test or a stress test to see if there is enough blood getting to your heart or if there is a problem.

I would be concerned and have that evaluated.

FIRFER: Dr. Wenger, just a quick question for you.

Are doctors, do you think, schooled enough on heart disease in women or do they need to sort of hit the books again and look at these new guidelines and sort of reduce themselves on how heart disease affects women?

WENGER: Well, Holly, the most exciting thing about these guidelines is that they were simultaneously released to physicians and to women in the community. And the emphasis here is that women and their health care providers are going to have to be partners in this venture. Certainly in the last decade or so, there has been an enormous emphasis to the medical care community that heart disease is a serious problem for women, it's their most serious health problem and that complaints of chest discomfort in women must be taken as seriously as they are for men.

FIRFER: Good to know.

OK, heart disease can not be cured, as we know, but it can be managed. Get moving for your heart's sake. That and other heart healthy tips when we come back. Plus, more of your phone calls and your e-mails. So stay tuned to Weekend House Call. We're back in two.


(BEGIN VIDEO CLIP) LAURA BUSH, FIRST LADY OF THE UNITED STATES: By leading a healthy lifestyle, women can lower their risk of heart disease by a staggering 82 percent.


FIRFER: Well, leading a healthy lifestyle is easier said than done. But even simple changes could save your life. Now, if you smoke, quit now. Women who smoke are two to six times more likely to suffer a heart attack. Get moving. Try to do some form of moderate exercise 30 minutes a day. Take a walk. Take the stairs. A little is better than nothing. Eat a balanced diet low in saturated fat and cholesterol, with plenty of whole grains, fruits and vegetables. Maintain a healthy weight. Any extra weight you carry may raise your risk. And, finally, know your numbers. Ask your doctor to check blood pressure, cholesterol and blood glucose levels. Now, only about half of women actually know their own cholesterol level.

Now, we're joined again by Dr. Nanette Wenger in Miami to take more of your questions.

Dr. Wenger, we have a phone call from Mary from Virginia.

She's on the phone.

Good morning, Mary.

What's your question?

MARY: Good morning.

If my main cardiovascular workout is just going for a walk, how can I tell if I'm getting enough intensity for it to do any good?

WENGER: Well, really, it's just the idea of exercising. Moderate intensity walking for at least 30 minutes on most days of the week is perfect. It really doesn't make any difference. We're not asking people to run marathons, just reasonable, rapid walking will be fine.

FIRFER: We have an e-mail from Sharon in Arkansas. She asks, "If a woman who has had bypass surgery is unable to take any of the cholesterol lowering drugs because of the side effects, what can she do to lower her cholesterol in addition to diet and exercise?"

Is there anything else to do? Or will diet and exercise do it?

WENGER: Well, diet and exercise can lower cholesterol a certain amount, probably about 15 percent. But if your cholesterol is really high, cholesterol lowering drugs are the way to go.

Probably the first line drugs are the so-called statin drugs. And there are so many of them that if you side effects from one, it may be worthwhile discussing with your doctor trying another or another. And there are several other categories of cholesterol lowering drugs that may be valuable. It's so important to have your cholesterol low.

Remember, because you've had bypass surgery, you have documented heart disease. You're considered one of the high risk women. And that means that your bad cholesterol, the LDL cholesterol, should be less than 100. That's an important number to know. And work with your doctor. There are so many effective cholesterol lowering drugs, you should be able to tolerate one of them.

They're, the statin drugs generally tend to have a very favorable side effect profile and one may be better than the other one for you.

FIRFER: Carlotta is calling us this morning from Kansas.

Good morning, Carlotta.

What is your question?

CARLOTTA: Good morning.

I was diagnosed in '98 with lupus, diabetes, high blood pressure and my mother at the age of 65 died of heart disease. So I know for sure I am a candidate. Should I be checked on a steady basis, like every six months or every year as a physical for my heart?

WENGER: Well, again, all of the things that you've described put you at high risk for heart disease. And therefore what you should do is certainly a heart healthy lifestyle, control your weight, physical activity, unquestionably you should not be smoking. But there are some things that your doctor can work with you to check. To check that your glucose is really well in control, your blood sugar level, and that a test called hemoglobin A1C, which shows how well your diabetes is controlled, is under seven percent. Because you have all these risk factors, the bad cholesterol, the LDL, should be less than 100 and certainly your blood pressure should be stringently controlled, ideally 120, the top number, 80, the bottom number, or less.

So this really requires that you work with your physician to do both the lifestyle and the medication interventions that will keep you from getting heart problems.

FIRFER: All right, straight ahead, some more information we have for you about where you can find your own heart healthy plan for living.

Now, here's a look at another big medical story making news this week.


CHRISTY FEIG, CNN CORRESPONDENT (voice-over): White powder containing ricin was found in a Senate mailroom early this week. Sixteen employees in the Dirkson Senate Office Building had to be decontaminated. But according to Senate Majority Leader Bill Frist, none of the employees have shown signs of ricin poisoning. Ricin poison is derived from the castor bean and typically begins to affect its victims within six to eight hours after exposure. Federal authorities began reopening the congressional office buildings Thursday and say they hope to have all three online by early next week.

For your health, I'm Christy Feig, CNN, Washington.



FIRFER: For more on women's heart health guidelines, the American Heart Month and the red dress program, go online to You can also check out the American Heart Association's Web site at They're also a partner in that red dress program and heart disease awareness.

And you may have noticed I have a little pin on my lapel. It is a little red dress. You can also get that pin at It promotes the Go Red For Women campaign to promote heart disease awareness in women.

Well, I'd like to thank our guest this morning, Dr. Nanette Wenger, for your thoughts and your great information for women and heart disease.

We appreciate your time this morning.

WENGER: Thank you.

FIRFER: Thank you.

And we want to tell you about tomorrow, tomorrow's Weekend House Call, to be sure to tune in. We're going to look at the hidden horrors in your home. The man known as Dr. Germ will be joining us as we find bacteria where you least expect it.

That's all we have for House Call this morning.

We'll see you tomorrow morning, 8:30 a.m. Eastern time.

We appreciate your time this morning.


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