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HOUSE CALL WITH DR. SANJAY GUPTA

A Look Inside the Heart of a Woman

Aired February 5, 2005 - 08:30   ET

THIS IS A RUSH TRANSCRIPT. THIS COPY MAY NOT BE IN ITS FINAL FORM AND MAY BE UPDATED.


UNIDENTIFIED FEMALE: Going red for women, how a little red dress is become a symbol for women and heart disease. A reminder that what you don't know could kill you.
And don't think it couldn't happen to you. Know the risks. Know yourself. And take heart. HOUSECALL is here.

SANJAY GUPTA, HOST: Good morning, welcome to HOUSECALL. I'm Dr. Sanjay Gupta.

Today, we look inside the heart of a woman. Not love or romance, but a very real problem that oftentimes goes unnoticed. Nearly one in every three women will die of heart disease or stroke. And that's compared to one in 30 from breast cancer. But many women don't pay attention to the warning signs or they wait too long to seek treatment.

CNN's Christy Feig take as look at one woman's story.

(BEGIN VIDEOTAPE)

CHRISTY FEIG, CNN CORRESPONDENT (voice-over): Last year when she was 51-years old, Cheryl Miller woke up in the middle of the night suffering from a pain in her arm.

CHERYL MILLER, HEART ATTACK SURVIVOR: It was just kind of a dull ache. And I had thought maybe I'd done something, you know, pulled a muscle or something. So I did get up and sat there and read for a while.

FEIG: When the pain got worse, Miller went to the emergency room. But because she didn't have the typical symptom of a heart attack, severe chest pain, doctors diagnosed her with a stomach problem.

MILLER: They were going to send me home because I was having esophageal spasms. And I thought, you know, I've had indigestion and it doesn't feel like this.

FEIG: But Miller insisted her results be sent to a cardiologist. And she was rediagnosed with a heart attack. According to Dr. Elizabeth Ross, Miller's cardiologist, misdiagnosis of women's heart disease is very common.

ELIZABETH ROSS. DR., WASHINGTON HOSPITAL CENTER: Men, when they have heart disease, frequently have severe chest pain. They may describe it as a crushing or pressure like pain. Women, on the other hand, may not have chest pain at all. They may just be excessively fatigued, or nauseated, or more short of breath.

FEIG: Experts say more women need to know what their symptoms might be and be pro-active like Miller.

ALEXANDER LANSKY, DR., NY PRESBYTERIAN HOSPITAL: The difference between 30 minutes and 60 minutes could be the difference between life and death.

FEIG: After all, cardiovascular disease is the number one killer of both men and women in the U.S.

Christy Feig, CNN, Washington.

(END VIDEOTAPE)

GUPTA: Christy, thanks. As Christy reported, heart disease in women is often not taken seriously by doctors. According to a new study by the American Heart Association, there is a gender gap for treatment. Women are much less likely than men to receive preventive therapy such as cholesterol lowering drugs or even aspirin therapy even though their risk for heart disease is the same.

Joining us to talk with us is the importance of women's heart health and answer your question is Dr. Nanette Wenger. She's chief of cardiology at Grady Hospital here in Atlanta and a professor as well at the Emory School of Medicine.

Thanks for being here in your red dress.

NANETTE WENGER, DR., CARDIOLOGIST: Delighted to be here, Sanjay.

GUPTA: This has been a big issue for you for a long time.

WENGER: Well, it's very important because we have tried to emphasize both to women and to the healthcare providers that heart disease is the leading cause of death for women. But most important that it can be prevented.

GUPTA: Right. You know, a lot of patients obviously don't know that and are right now sitting at home saying, huh, I thought it was breast cancer. But what's remarkable to me is a lot of doctors don't even know that.

WENGER: Well, this has been an educational effort. And the American Heart Association has taken leadership in this. We have tried to teach physicians and other healthcare providers that they must consider that the woman's heart is vulnerable to heart disease.

GUPTA: And lots of questions coming in on this. Throughout the show, we're going to be answering your e-mail questions at home. But we also took to the streets of New York City to see what was on the minds of women in the Big Apple. Let's start with this question from Jennifer. (BEGIN VIDEO CLIP)

JENNIFER: I'd be interested to know about the statistics compared to men and women because the perception I have is that women are having more heart problems now. And they don't know whether that's to do with our deteriorating diet or whether it's actually stress, you know, multitasking, women having hard jobs. So I'd be quite interested to see what's happening statistically and why that might be.

(END VIDEO CLIP)

GUPTA: And Jennifer's right, according to the American Heart Association, more women than men die of heart disease every year, but they receive only 33 percent of stent procedures, bypass operations, and angioplasties. Women are twice as likely as men to die after bypass surgery. And women comprise only a fourth of all participants in heart related studies. Those are some of the statistics. Let's ask Dr. Wenger about why the gender gap?

WENGER: I expect the gender gap is several fold. First is, often the women are not seeking care. Remember, you have to perceive yourself as vulnerable. I have seen men come into the office just clutching their chest, saying I'm having angina, I'm having a heart attack. The woman will come in with the same symptoms and say I'm having indigestion.

And it's very important for a woman to realize that chest pain must be evaluated. The interesting thing is, you know, men tend to be noun-verb people. Women are adjective, adverb people. And often, the woman, in addition to the chest pain, will describe neck, back, shoulder pain, fatigue, restlessness.

GUPTA: Because it's more vague.

WENGER: And because of this multiplicity, often the chest pain core message is lost. So we must address it, having women note, look for the chest pain. And it's often not pain. It's pressure, heaviness, discomfort.

GUPTA: Right. I really hope a lot of women are listening to you today because it's really important. In fact, let's move on to another question that came up several times in e-mails and on the streets. Bianca and Joy asked about age and your heart.

(BEGIN VIDEO CLIP)

BIANCA: I guess I'm too young for it now to really talk -- to think about it. And maybe when I get older, maybe when I'm like 30 or 40, it would affect me more.

JOY: From what age should have you a cardiologist look at the health of your heart?

(END VIDEO CLIP)

GUPTA: Is it ever too young?

WENGER: Well, it's never too young. But remember, the cardiologists aren't the only healthcare providers interested in heart health. Young and healthy women often see their obstetrician gynecologist. These are individuals who are trained to do prevention. They do mammography. They do pap smears. They really have to learn how to do screening for heart disease.

Blood pressure, cholesterol, diet, exercise, smoking cessation, you know, the OB community has been so successful in having women stop smoking during pregnancy. But often, these women will resume their smoking and not only that, expose their babies to second-hand smoke.

GUPTA: It's a really interesting point because men typically have their primary care doctors. But for women, it's typically going to be a gynecologist/obstetrician. And not all of them -- more of them hopefully, but not all of them screen for heart disease.

WENGER: Well, I expect this is going to be an increasing trend because healthy women often get much of their care.

But remember, the primary care physician, the family physician, the internal medicine physician, all of these individuals should have as part of their routine examination an evaluation for heart disease risk factors.

GUPTA: We're talking with Dr. Nanette Wenger. She is talking to us about women and heart disease, a really important topic. More of your questions coming up. Plus...

UNIDENTIFIED FEMALE: Your baby and your heart, what you may want to know before you get pregnant. And later, from aspirin to Vioxx, how some medications may be affecting your heart.

But first, take today's daily dose quiz. How much blood pumps through the average adult heart every day? A, 10 gallons, B, 25 gallons, C, 1000 gallons, or D, 2000 gallons? The answer straight ahead.

(COMMERCIAL BREAK)

UNIDENTIFIED FEMALE: Checking the daily doze quiz, before the break we asked how much blood pumps through the average adult heart every day? A, 10 gallons, B, 25 gallons, C, 1000 gallons, or D, 2000 gallons?

The answer is D. An adult heart pumps about 2,000 gallons of blood every day. Not bad for an organ that weighs just about 12 ounces.

GUPTA: And really important to keep that organ healthy as well for men and women both.

Welcome back to HOUSECALL. We're talking about women and health disease. We're joined again by Dr. Nanette Wenger. She's chief of cardiology at Grady Hospital here in Atlanta and a professor at Emory University.

Dr. Wenger, there is some heart issues that are specific to women. We're going to try and work through as many of those as we can today.

First of all, talking about hormone replacement therapy. We got some questions about that. The hormone replacement therapy trial was stopped because they were concerned about heart disease. What is the latest on that? Should women take hormone replacement therapy?

WENGER: Well, remember, we're saying hormone replacement therapy for what? The research studies were looking for hormone therapy only as regards heart disease prevention. And it doesn't do that. Certainly hormones for menopausal symptoms are fine. Hormones for osteoporosis may be appropriate. But what we learned is that both for healthy women and for women who have underlying heart disease that hormone therapy is not protective against heart attack and stroke and indeed may even be associated with an excess of heart attack and stroke.

But the other concern that was raised by particularly the women's health initiative study is that the myth was that that there was prevention of dementia, of Alzheimers with hormone therapy. And in these studies there was actually a slight increase in dementia and perhaps more cognitive dysfunction.

GUPTA: Certainly from a heart perspective and maybe dementia as well, hormone replacement therapy not a good option.

Let's keep on topic...

WENGER: But you see, this is really important because that -- now put aside, what we are doing is we're refocusing on those factors that have been proven to show benefit. And so many of these as we'll be talking about are lifestyle factors.

GUPTA: Yes, and we are going to get to these because these are important for women certainly as well as men. But let's start off with some particular e-mails that are unique to women. Debbie in Princeton, New Jersey asks. "What precaution should be taken by a woman with a history of heart arrhythmia before planning a pregnancy?"

So a relatively young person, probably, has this heart arrhythmia. Any specific precautions?

WENGER: But you see, the important thing is that arrhythmia is not one thing. First is what is the abnormality of rhythm? So the physician has to say what is it? It may just be a skipped beat occasionally, which is perfectly normal and has no relevance to pregnancy.

But you have to say what is the rhythm disturbance? Is it serious enough? And most importantly, is there any underlying heart disease? If there's any suspicion of heart disease that should be evaluated before pregnancy to ensure an optimal outcome for the mother and the baby. GUPTA: And this goes back to what you were saying earlier about obstetricians and gynecologists screening for heart disease in women. They are good doctors to talk to about this.

WENGER: Well, remember that often, this has to be done before the pregnancy is planned. So this may be done before the woman sees her obstetrician/gynecologist.

GUPTA: Right, good point. Let's get to another question from New York City. Jessica is concerned about heart murmurs.

(BEGIN VIDEO CLIP)

JESSICA: I know a lot of people have heart murmurs when they're young. Does that turn into anything when they get older? Is that something you have to continue to have checked up on?

(END VIDEO CLIP)

GUPTA: A lot of people have heart murmurs. What do you tell her?

WENGER: Well, there's a whole spectrum of heart murmurs. Some of them may mean nothing. Remember, blood flows through the heart. And it may cause a murmur. So the important thing is to have the physician say does this heart murmur mean heart disease?

And today, we have wonderful non-invasive tests called echocardiograms, essentially ultrasound tests, that can outline the structure of the heart and say does this murmur represent disease or is it quite trivial?

GUPTA: You know, for the women out there watching, never had a problem with their hearts, are there basic tests they should be getting checked like men to make sure they don't develop problems?

WENGER: Well, again, the woman should be checked for risk factors for disease. But a routine physical examination can detect if there is a heart murmur and then an appropriate evaluation. A woman who has symptoms, who has palpitations, who has shortness of breath, who has chest pain should have the specific symptoms evaluated.

But what is new and new in our emphasis is that a routine evaluation of a woman, as of a man, should explore the risk factors for heart disease. And those would be high blood pressure, high blood cholesterol, sedentary lifestyle, overweight, cigarette smoking. And essentially intervene to alter these risk factors.

GUPTA: And we typically hear about those things in association with men. But now we got to think about them with women as well.

More of your e-mails are coming up on this topic. Stay with us. Plus...

UNIDENTIFIED FEMALE: Some popular pain medications have been in the news lately, not for what they can do for your heart, but what they may be doing to it. We'll take a closer look.

But first, a look at some of this week's medical headlines in the pulse.

(BEGIN VIDEO CLIP)

CHRISTY FEIG, CNN CORRESPONDENT (voice-over): If you're one of the millions of women who've had the history of migraines, listen up. Female migraine sufferers who experience vision loss as a symptom have a 70 percent increased risk for stroke, compared to women who don't get migraines. That's according to a report from the American Stroke Association's Conference. Other stroke risk factors include smoking and birth control pills.

And a study in the Journal of Clinical Oncology shows evidence that women's weight plays a key role in breast cancer survival. Researchers found that women who maintain a healthy weight prior to the diagnosis, or who are lean and don't put on weight after diagnosis may have improved survival. They say it's particularly true for women who have never smoked. The lead author stresses that women with breast cancer or those at high risk for the disease maintain a healthy weight.

Christy Feig, CNN.

(END VIDEO CLIP)

(COMMERCIAL BREAK)

(BEGIN VIDEO CLIP)

LAURA BUSH, FIRST LADY: One of the reasons that women -- that more women than men die of heart disease is that women don't really know what the symptoms of a heart attack are. And because they think of heart disease as a man's disease, they don't go straight to the emergency room if they are suffering any symptoms.

(END VIDEO CLIP)

GUPTA: Of course, that's First Lady Laura Bush. She's one of the spokespeople for the Go Red for Women Campaign to raise awareness of heart risk for women. And that's, of course, our topic today on HOUSECALL.

In addition to the gender specific issues we've covered this morning, we've also received many questions about how some prescription pain medications may affect your heart.

You've heard about this. Among them Celebrex, Vioxx and Bextra. There was a well publicized recall of Vioxx in September after thousands of heart attacks were blamed on the drug. Vioxx, of course, is just one of the medications prescription and over the counter drugs canned NSAIDS, which stands for Non Steroidal Anti-Inflammatory Drugs, which are typically used to treat arthritis, muscle pain and fever.

We're joined, of course, today again by Dr. Nanette Wenger. She's chief of cardiology at Grady, professor at Emory as well. She's here to answer your questions.

A lot of questions coming in on this particular topic, the NSAIDS. Let's get to one e-mail right away, this one from Lisa in Washington.

"Where can we go to get more information about NSAIDS and heart disease? You hear stories about the risk, without specifics, I take Aleve for two or three days every month for menstrual cramps. Does this put me at risk for heart disease?"

A lot of people really panicked after that recall, Dr. Wenger.

WENGER: Well, remember that the recall really related to a very specific subset of drugs called Cox-2 inhibitors. And the only ones currently on the market or that were on the market in the U.S. were Celebrex, Vioxx, and Bextra. There are a number of other non- steroidal drugs that thus far have not been shown to have problem.

Again, this is still a work in progress. But most certainly if I had heart disease or were at risk for heart disease, I would not be taking any of these medicines. And physicians are not prescribing these currently until the air gets cleared on the information.

GUPTA: And there was a lot to sort of clear up there, because for a long time, the rumors were coming out that in fact these were linked to heart disease, but the drug stayed on the market for a while. How do you feel about that as a cardiologist?

WENGER: Well, again, I think we have to balance risk and benefits. These drugs have some benefit in preventing pain and symptoms.

The question is, were they being overused? Were they being overmarketed? And I expect this is a work in progress. The important feature is to look at the reason for which they were prescribed. If this is intractable pain, and these were the only drugs that were safe and that could relieve that pain, perhaps the women would be willing to take a specific risk as would the men.

But I think we have to know what is the risk and what is the benefit of these drugs? And this still has to be determined.

GUPTA: Lots of work to do there still. And we're going to keep on that story. But we move now from pain medications to vitamin supplements. And this e-mail question from Genevieve in Memphis Tennessee. She asks, "Will increasing folic acid intake improve high blood pressure?"

And of course, we know a lot about foliate for pregnant women in particular.

WENGER: Well, that's really where the good information is. And supplementary foliate really is extremely beneficial for pregnant women in preventing defects in their babies.

But aside from that, except for the levels of foliate that are in usual vitamin tablets, foliate supplementation is not specifically recommended.

Get the foliate from foods. There is really no good evidence on benefit from any of the vitamins. And that will also include the anti-oxidant Vitamin C, E and beta carotene. For a period of time, a lot of people took this as theoretically a heart disease preventive. And the studies actually both for women and for men have not shown benefit. And indeed, sometime have been associated with risk. So we're back to the basics of heart disease prevention. No mega doses of vitamins.

GUPTA: And a lot of commonsense, it sounds like, because everything you're saying today, it makes a lot of sense to people I'm sure who are watching.

We're going to -- stay with us. Dr. Wenger's talking to us about women and heart disease. There's a lot more to come still on HOUSECALL.

UNIDENTIFIED FEMALE: We're taking the plunge to you're your blood pumping and keep your body and your heart healthy.

And grab some paper and a pen. We'll have some good resources for you to find out more about women and heart disease.

(COMMERCIAL BREAK)

(BEGIN VIDEOTAPE)

HOLLY FIRFIR, CNN CORRESPONDENT (voice-over): Exercising in water adds variety to any workout routine, but it can be especially beneficial for people recovering from an injury or who suffer from pain.

UNIDENTIFIED FEMALE: Good cardiovascular. And it's good for muscular strength, endurance, flexibility. And it's also good for the blood pressure.

FIRFIR: Many rehab programs incorporate aquatic exercise because it's less jarring on the joints. That's because the buoyancy of water helps support your body, so your joints only bear 10 percent of your weight.

Being submerged in water can also increase your circulation. The pressure of water on your body could reduce swelling if you have painful injury. Water offers resistance, which strengthens your muscles as you push against it. Since the effects of gravity diminish in water, you can do stretching exercises that you might not be able to do on land.

As with many forms of exercise, water aerobic participants say coming to class just makes them feel better.

UNIDENTIFIED FEMALE: I enjoy it. I really do. I'm not sore when I leave, so that's a plus.

FIRFIR: Holly Firfir, CNN. (END VIDEOTAPE)

GUPTA: Holly, thanks.

Catch a wave on the worldwide web for more information about women and heart disease. Check out the American Heart Association's Web site at www.americanheart.org or go to the National Heart-Lung Blood Institute Web site at www.hearttruth.gov.

And finally, one more for the feminine heart, www.womenheart.org. Really interesting show. Let's try and get one more e-mail question. This comes from Brinda in Clifton, Virginia. She asks, "If you had to choose one thing women can do to lower their risk of getting heart disease, what would it be?"

GUPTA: This is sort of the ultimate question here.

WENGER: It would be lifestyle. It would be a heart healthy diet. It would be physical activity. It would be not smoking. But it would also be know your numbers. And the...

GUPTA: Give us the specifics.

WENGER: ...ideal blood pressure for all women is below 120/80. And three numbers that you have to know ideal blood fat. The bad cholesterol, the LDL, under 100. The good cholesterol, the HDL, over 50. And another blood fact, the triglycerides under 150. So it's 100, 50, 150. And get your numbers from your healthcare provider.

GUPTA: Dr. Nanette Wenger's been joining us today. Really important topic. That's all the time we have for today. Thanks for watching and thank you for educating us about heart disease.

WENGER: Thank you. Good being here.

GUPTA: I'm Dr. Sanjay Gupta. Stay tuned now for more news on CNN.

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