(continued from previous page)

He sent her to a cardiologist, who performed an arteriogram to visualize her coronary arteries. It indicated some blockage, but he wasn’t overly concerned. He sent her to Vanderbilt.

“I thought I needed a stent (a non-invasive procedure). In the holding area, the interventional cardiologist said I needed open heart surgery and I could not go home until I had it.”

Busby had an 88 percent blockage of the left main coronary artery, known, ironically, as the widow maker because complete obstruction of the artery can result in a fatal heart attack and it’s most often associated with men.

“I knew enough about that to get frightened,” Busby said.

Despite the “widow maker” moniker, some studies indicate that middle-aged women fare worse than their male peers after a heart attack. An Emory study reported that women younger than age 50 were nearly three times more likely to die than men of the same age regardless of their medical history, the severity of their condition, when they were admitted to hospital, and the hospital treatment they were given.

Fortunately, Busby’s blockage was detected before she had a heart attack, and she underwent double bypass surgery at Vanderbilt. A year and a half later, Busby, a lecturer at Vanderbilt’s School of Nursing, is on a mission to educate women about heart disease and to let them know that when it strikes, it may not feel the way they think it would.

Both men and women think of the “Hollywood heart attack” – when a person is knocked to his knees in excruciating pain. But heart attacks in both genders are very often subtle – pain or discomfort you could put up with, or even no real “pain” at all. Since that’s more often the case in older individuals, and since women usually have heart attacks on average at an older age than men, these more subtle symptoms are more often seen in women.

“There are a couple of reasons I want women to know my story,” Busby said. “Open heart surgery was a traumatic experience. I didn’t feel like myself until seven months after my surgery. I went through a period of depression, which doctors don’t always talk about. I still live with fear of having a heart attack. I want to see heart disease get the attention it deserves.”

The No. 1 Killer
According to the American Heart Association, cardiovascular disease claims the lives of more women than the next four causes of death combined – almost twice as many as all forms of cancer. Yet, a survey commissioned by the Society for Women’s Health Research found that, while women’s fear of heart disease has almost doubled since 2002, breast cancer continues to be the most feared disease.

“While 49 percent of women now know the No. 1 killer in women is heart disease, if you ask them if the risk factors apply to them, only 13 percent say yes. We’re doing a good job of getting the word out, but we’re still not getting through to them that this applies to you, not the lady sitting next to you,” said Lisa Mendes, M.D., assistant professor of Medicine at the Vanderbilt Heart and Vascular Institute.

Cardiovascular disease typically presents in women 10 years later than it does in men, at about age 70, although women can certainly have heart attacks much younger. Mendes said that conventional wisdom suggests that female hormones may protect the heart, and when they are depleted, a woman’s risk becomes the same as a man’s. Heart disease actually starts developing during the teenage years and early 20s, although it may not show up until much later. For this reason, early prevention is the key.

Jim Atkinson, M.D., Ph.D., professor of Pathology at VUMC, conducted a study called the “Pathologic Diagnosis of Atherosclerosis in Youth,” which revealed a great deal about the progress of atherosclerosis and its natural history. Researchers examined blood vessels of young people who died from non-cardiovascular causes. What was clear was that both groups already had the early stages of atherosclerosis in their blood vessels, boys in their teens and young women in their 20s.

“The bottom line is this is a disease that starts in youth,” Mendes said. “By the time you are in your 40s the disease is already there. The thing to remember is, start prevention in your 20s, not in your 60s when you’re having your first heart attack.”

Middle-aged women often care for others more than themselves. They don’t take the time to assess their health risks because they are busy working, raising children, and taking care of aging parents.

“There are a lot of factors in women’s lives that make it harder for them to focus on their own health. They do need to be aware of that and do the things the American Heart Association has outlined in terms of preventing and reducing their risk of developing coronary disease,” Mendes said.

The first step in preventing heart disease is to know your risk. The Framingham Heart Study has played an important role in establishing risk factors, which include age, cholesterol (total cholesterol and HDL), systolic blood pressure, whether or not the patient uses medical treatment for hypertension, and cigarette smoking. It estimates the risk of developing coronary heart disease within 10 years.

<<back     continued>>