The heart truth for women

People think that heart diseases are primarily men's diseases but the data from all over the world indicates that the heart disease is a leading killer of women. They are more likely to die of a heart attack than men, and those who survive the first attack, have higher chances of a recurring heart attack and subsequent death...

 By Dr Sumera Naseem

Many people are under the impression that heart diseases are primarily men's diseases. But here is the blunt truth. Data from all over the world indicates that coronary artery disease or simply 'the heart disease' is a leading killer of women. Almost twice as many women die of cardiovascular disease than from all cancers combined. Women are more likely to die of a heart attack than men, and those who survive the first attack, have higher chances of a recurring heart attack and subsequent death. Women need to understand that the risk of having a heart attack, stroke or other cardiovascular diseases is the same for them as it is for men. While it is important to prevent breast and ovarian cancer, heart disease prevention among females is a subject of prime importance in today's environment.

Women's heart disease differs from men's in terms of the risk factors, symptoms and intensity. However, the public and health care providers are often unaware of these differences. Women develop heart diseases seven or eight years later in life as compared to men. However, after 65 years of age, both men and women are at the same risk. The most important risk factor for women is abnormally high blood pressure (hypertension): the higher the blood pressure, the greater the risk. The optimal blood pressure should be less than 120/80 mmHg. There is a higher prevalence of hypertension in the female population in Pakistan than in men and a significant number of our women have poor control of hypertension, which can be a consequence of multifaceted issues ranging from lack of awareness due to cultural bounds and social taboos restricting access of females to health care.

Cholesterol level is an important predictor of heart disease for both genders but there are some differences for example in women, the level of good cholesterol is a better predictor of heart disease than the high level of bad cholesterol. The presence of Diabetes Mellitus increases the risk of heart disease in women two-fold as compared to men. Smoking is an equally important risk factor for women. More than half of total heart attacks in women of less than 50 years age are related to smoking.

Hormonal medications or pills also increase the risk of heart disease and this risk will be doubled if smoking is already implicated as a risk factor. Obesity is another important risk factor for heart disease in our women population - extra weight puts strain on the heart and arteries. Being overweight means that a woman has a higher propensity for developing major health problems like diabetes, high blood pressure and heart disease. The relative risk of mortality by coronary heart disease is eight times higher in women who accumulate fat and become obese in the central portions of the body such as the tummy, hips, and around the waistline. It therefore becomes extremely important for every woman to know not only their waist circumference, but also the Body Mass Index (BMI). The ideal BMI for our women is 18.5-23 kg/m≤ and waist circumference less than 32 inches.

Remember, our heart is a muscle, which needs regular exercise to stay in shape. Exercise not only helps our heart but also lowers the risk of stroke, osteoporosis, and hot flashes during menopause and helps prevent early wrinkling of skin. We should therefore exercise moderately like a brisk walk for at least 30 minutes per day.

Preparing good and delicious food for family is always a priority for a good wife or mother, but what is important for our heart is good and healthy food, which must contain fruits, vegetables and whole grains. Olive oil or canola oil should be the main source of fat calories and meat should be treated as a condiment, not an entrÈe.

Will medicines lower the risk of heart disease in women? There are certain medicines, which will reduce the risk in men but not in women. For example, cholesterol-lowering medicines reduce the risk of heart attacks in men, but there is not enough evidence to show that these medicines work as well in women who have never had a heart attack. Similarly, taking an aspirin 75 mg every day reduces the risk of having a heart related problem if coronary artery disease is already established or if the woman is older than 65 years of age regardless of the presence of heart disease. However, the specific benefit varies with sex, for instance, with the daily use of aspirin; women younger than 65 years of age experienced a decrease in stroke risk and no decrease in heart attack risk whereas men experienced a decrease in heart attack risk with no decrease in stroke risk.

Unfortunately, symptoms of heart disease in women are not classical. Often they feel no chest discomfort at all. About 50 percent of women experience "atypical" symptoms which may be a hot or burning sensation in the back, shoulders, arms or jaw, breathing difficulty or nausea, vomiting, extreme weakness and a sense of anxiety. It is all too likely to write-off these symptoms to mere musculoskeletal pain or gastrointestinal disturbances or anxiety which results in delayed diagnosis with subsequent increase in mortality after heart attack in the woman population.

Research indicates that behavioural changes on the part of women and reshaping of practice patterns by their health care providers may dramatically reduce the number of women disabled and killed by heart disease each year.

The fact about antidepressants

A new study says some antidepressants are mostly ineffective, but many previous studies show the opposite 

By Debra Fulghum Bruce

A controversial new study suggests that the widely prescribed antidepressants Prozac, Paxil, and Effexor work no better than placebo for most patients who take them, and many depression experts now cry foul. In findings researchers concluded that when taken as a whole, the data show that only a small group of the most severely depressed patients benefit from taking one of the antidepressants.

For less severely depressed patients, the antidepressants were found to work no better than placebos, leading the researchers to conclude that most patients who take antidepressants probably shouldn't be on them.

Does this study contradict numerous positive studies on antidepressants?

Yes, it does. In a statement, American Psychiatric Association President-elect Nada Stotland, MD, maintains that studies like this one, which compare a single drug to placebo, do not accurately reflect the way doctors prescribe antidepressants today.

Stotland says many people who are depressed do not respond to the first antidepressant they try. "It may take up to an average of three or more different antidepressants until we find the one that works for a particular individual. Therefore, testing any single antidepressant on a group of depressed individuals will show that many of them do not improve."

What do other findings show about using antidepressants?

Numerous studies support the benefit of antidepressants in improving mood, increasing ability to function socially, and easing physical complaints of joint pain, insomnia, and low energy. According to Ronald R. Fieve, MD, psychopharmacologist and professor of clinical psychiatry at Columbia Presbyterian Medical Centre in New York City, its not unusual for an antidepressant to take two to six weeks to have an effect on a patient's mood.

"People must realise that we've come a long way in reducing the side effects of antidepressants since first prescribing the tricyclics," Fieve says. "And while drug companies have reduced medication side effects with the newer (antidepressants), there's still not much improvement with onset of action or efficacy."

Fieve notes that in his practice, a good number of patients dramatically come out of their depression within 10 days to two weeks. "About 65 percent see improvement on the first antidepressant, and 85 percent of patients succeed on one to three antidepressant trials."

Why wouldn't an antidepressant work?

According to Fieve, sometimes the doctor chooses the wrong antidepressant, or the right antidepressant in the wrong dosage, or does not administer the antidepressant for at least six weeks at the highest dose tolerable to achieve full therapeutic results.

In addition, if the depressed patient has problems with alcohol or drug abuse and takes an antidepressant, the medication isn't getting at the real problem. There are also patients who are heavily medicated on tranquillisers who wonder why an antidepressant doesn't work to ease their depression. Coming off the tranquillisers may improve mood, Fieve says.

Can alternative treatments help in treating depression?

For minor depression (dysthymia), Fieve says that exercising regularly, reducing stress, and improving sleep can help patients relax and feel better. But what should people do who have major depressive disorder? "Medications are necessary," Fieve says. "Psychotherapy is also a useful adjunct in combination with medications."

What about teens and antidepressants?

The latest findings show that depressed teens who don't respond well to the first prescribed antidepressant medication begin to improve if they are switched to a different antidepressant medication and also offered "talk" therapy.

The combination - switching medications and offering talk therapy - works better than simply changing medications, the researchers found, although switching medications alone also offers improvement.

What are the common signs of depression?

Symptoms of depression vary per person but may include depressed mood most of the day, particularly in the morning, diminished interest or pleasure in activities, weight loss or gain, insomnia or excessive sleep, fatigue or loss of energy, impaired concentration, and feelings of worthlessness or guilt, among others.

Teens and children with depression may experience apathy, social withdrawal, weight loss, insomnia, fatigue, isolation from family and friends, a drop in school performance, and even drug or alcohol abuse.

Fieve said that there are standard guidelines for diagnosing and treating a host of mood disorders, including major depression, dysthymia, seasonal affective disorder (SAD), bipolar depression, and others.

What causes depression?

The causes of depression are many. For some, depression occurs after loss of a loved one, a change in one's life such as getting divorced, or after being diagnosed with a serious medical disease. For others, depression just happens, possibly because of their family history. Medications can cause depression, and nearly 30 percent of people with substance abuse problems also have major depression.

How do most doctors treat depression?

Standard treatment of depression includes antidepressants and/or psychotherapy, as well as a multifaceted programme of diet and lifestyle changes and alternative therapies. Experts believe that different treatment approaches work for different people - and it's not easy to predict what might work.

What if my antidepressant doesn't seem to work?

Talk to your doctor. You may need to try a different type of antidepressant until you find the right fit and may need additional treatment, such as talk therapy. Just like with any chronic medical condition, it takes patience and perseverance to get the best outcome with depression.

Health update
Test to spot early glaucoma signs

Computer software is being developed to spot signs of glaucoma earlier than conventional tests by UK experts. The team at London's Moorfields Eye Hospital say that the test has the potential to prevent many patients going blind. Diagnosing glaucoma can be difficult, as patients are often not aware of symptoms until a great deal of useful sight has been permanently destroyed. It is estimated that glaucoma affects 67m people worldwide - but only half are diagnosed. This has led to glaucoma being dubbed the "silent blinding disease". If diagnosed in time, the condition can be easily treated with eye drops. The condition causes damage to the optic nerve, which carries visual information from the eye to the brain. .

New cancer drug may curb tumours

Scientists report early success in preliminary tests off an experimental cancer drug. Those tests, which were conducted in mice show that the oral drug harnessed the cancer-fighting power of a gene called p53 without harming healthy cells. The drug doesn't have a brand name yet. Its developers call it MI-219. MI-219 frees the healthy p53 from the grasp of a protein called MDM2. The basic idea is that in some cancers, p53 can't curb cancer because it's hindered by MDM2. But when MI-219 is on the scene, MDM2 has trouble latching onto p53. That leaves p53 available to curb cancer. That might not work in all cancers. "In about half of human cancers, the p53 gene is either missing or mutated," noted the researchers, who included Shaomeng Wang, PhD, of the University of Michigan.

Stronger psychiatric warning on Tamiflu

AFlu drug Tamiflu now has a stronger warning about rare reports of delirium and abnormal behaviour leading to self-injury, and, in some cases, death. Tamifu's label continues to stress the importance of watching flu patients for signs of unusual behaviour and seeking immediate care if any such signs are observed. Since November 2006, Tamiflu's warning information has noted post-marketing reports, mainly from Japan, of self-injury and delirium in flu patients - and it's not clear if Tamiflu caused those problems. Now, Tamiflu's warning information also includes more details, including reports of "some cases" of fatal injuries from delirium and abnormal behaviour in patients taking Tamiflu. Tamiflu's updated label also states that those reports appear to be "uncommon", and that the reported cases may happen abruptly.

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