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Matters of the Heart

Heart disease in women is a silent killer— too often hidden, misunderstood and overlooked

Photograph by William Taufic

March 14, 2001, was a day like any other for Cheri Abruzzini, busy but pleasantly so. She was in the middle of painting her dining room, and had just enough time to put a quick coat on the ceiling and dash out to buy a birthday present before her two daughters got home from elementary school. Suddenly, everything changed.

“I got out of breath,” she remembers. “Because I had my arms over my head my first thought was that I was out of shape, but when I put the stick down I still couldn’t catch my breath. I had this tightness around my chest, like a rope wrapped around me, and I thought I was going to pass out. Then I got numbness in my arms and that’s when I knew something was wrong.” Cheri called her husband’s pager repeatedly but couldn’t reach him. Finally,  not a moment too soon, she dialed 911.

At first the paramedics thought Cheri, then forty-three years old, had been overcome by paint fumes, or was having an anxiety attack. But the EKG machine in the ambulance nailed the diagnosis: Cheri, with no family history of heart disease or problems with blood pressure or cholesterol, was having a heart attack. Since her blockage was in a location that could not be addressed by a stent (a tiny tube inserted in an artery or blood vessel to hold it open), she subsequently underwent bypass surgery.

The Silent Threat

If you asked women to name the greatest threat to their health, most would probably say breast cancer. We wear pink ribbons and buy pink roses in October, and we would no more miss the annual mammogram than we would a family birthday. But how many of us pay attention to our hearts? Do we know if they are ticking along like a little Swiss watch . . . or a time bomb?

“Heart disease and stroke, which is cardiovascular-related, are the No. 1 and No. 3 killers of women in America,” says Carolyn Torella, who oversees the American Heart Association’s Go Red for Women campaign for eight regions, including Fairfield and Westchester counties. “Our mission is to make women aware of this. Too many women think breast cancer is what’s going to get them, but it’s at number two. One in three women dies—and they are dying at the rate of one per minute—from cardiovascular disease.”

There is hope, however, as cardiovascular disease can be prevented in 83 percent of women. “We have the power to make decisions with regard to smoking and diet and exercise,” says Carolyn, “and knowing our cholesterol and blood pressure. These are all within our control, and we can reduce a huge amount of death and disability. That’s what Go Red is about, trying to empower women and give them the tools to live heart-healthy lives.” Go Red for Women is a year-round outreach that culminates with a fundraising luncheon, which this year will be on March 8.

There is also guilt associated with heart disease, Carolyn adds. “Women are very quiet about this—I didn’t exercise thirty minutes every day like I should have; I smoked for ten years, what was I thinking? With breast cancer it’s not anything you did, it just happened. But this is different.

“That’s why women like Cheri, who spoke at our last luncheon, are so important; speaking out does raise awareness. She was lucky that she got help right away. A lot of women wait because they think it’s indigestion or stress.”

Today Cheri no longer drinks coffee or eats red meat, and she exercises more than she ever had before the cardiac event. “I try to eat low-fat, high fiber, more fruits and vegetables, and the whole family eats more healthily. My husband lost so much weight, I told him it was not fair,” she adds, laughing.

It Can Happen to Anyone

Heart disease is insidious, often evidencing itself only at the crisis point, and a healthy lifestyle is no ironclad guarantee.  Last September Kara Kennedy, daughter of Senator Edward Kennedy, died at fifty-one of a heart attack after working out at her gym (she was in remission from brain cancer, and there has been speculation that chemo treatments may have weakened her heart).

Martine Curto, a fifty-year-old triathlete and history teacher at Blind Brook High School in Rye Brook, N.Y., was coming out of the Italian Center gym on July 19 after doing a “boot camp,” when everything changed for her. “I stopped the workout, which I never do, but I was just feeling lousy,” she says. “I went to my car and turned on the air conditioning, thinking that would help, and that’s when I knew it was bad.”

Martine, in the middle of a massive heart attack, literally crawled on her hands and knees back into the building to get help. The blocked artery was corrected with a stent, and by Thanksgiving she was back to working out and running through the neighborhood. (“The neighbors call me Forrest Gump,” she laughs.)

“The bad news was that this happened to me when I was in such great shape; the good news is that because I was in such great shape, I came back much faster than anyone anticipated.”

“Heart disease is the No. 1 killer by far,” confirms Dr. Steven Horowitz, chief of cardiology for Stamford Hospital. “Some estimates put it at ten to fifteen times more likely to kill a woman than breast cancer. It is shocking, and it is interesting that until recently even some women physicians were unaware of that.  There has been a focus on breast cancer to the exclusion of heart disease, which is why the American Heart Association started the Go Red movement.

“If coronary disease is going to occur, it’s going to begin early in life,” he says, a fact first recognized during the Korean War, when autopsies on young servicemen showed advanced coronary disease. “No one had a clue. One of the reasons why we didn’t know a lot about coronary disease in women was that everyone assumed it was a normal part of aging. All the studies were being done on men because it was assumed they were getting it prematurely. Now we understand that it doesn’t really take hold in most women until
the peri- and postmenopausal period, because estrogen protects the heart.”

Understanding Risks and Symptoms

Although symptoms of heart disease are basically the same in men and women, women tend to have a higher degree of atypical symptoms. “Women can present with some sort of burning or discomfort in the chest,” says Dr. Horowitz, “but more often you’ll hear that they just don’t feel well, that they’re fatigued. To me, especially in someone with risk factors, that’s a red flag. And women seem to come to their doctor later because they’re caretakers; they’ll get their husband and kids to the doc before they take care of themselves. It’s so ingrained it’s almost like a syndrome.”

Risk factors include family history, smoking, birth control pills, hypertension, cholesterol and stress. “Stress is an interesting phenomenon because it’s in the eye of the beholder,” he says. “Let’s say some guys who like to ski invite some guys who hate to ski up to a chalet. They wake up the following morning and the snow is up to the second floor. The guys who like to ski say, ‘This is the best day of my life.’ The guys who hate to ski say, ‘We’ll never get out of here alive!’ What is perceived as stressful is not the same for everyone. It’s easier to measure the result of stress: Is the person depressed, do they have anxiety? It’s not the stress; it’s how you handle it.”

Social isolation, says Dr. Horowitz, can as much as double the cause of all mortality. “Studies have been done that are very simple, with questions like ‘If you get sick, do you have someone to drive you to the hospital?’ When you put the whole package together you can profile somebody. You can do a stress test, but the reality is that coronary disease may have been progressing over decades,” he says. “One suggestion is to treat everybody with risk factors although some think that’s extreme. But a lot of people, and I’m one of them, feel that lifestyle is the number one aspect that can be modified.”

Age can also be a factor. At eighty-three, Ann Baker lives a busy, independent life on her own in Queens and has always gone for regular checkups. In October of 2010 she woke up early one morning and wasn’t breathing properly. Not wanting to bother a neighbor, she called a cab and took herself to the emergency room, where doctors found she was in congestive heart failure (which means the heart isn’t pumping enough blood to meet the body’s needs). She called her daughter, who knew Dr. Horowitz from his time at Beth Israel in Manhattan, and they came to Stamford.

“I always had a mitral valve prolapse,” says Ann, “which is nothing—nine million people have it and you live with it. But I just wasn’t feeling well, I was always tired. I was told I should have surgery or I wouldn’t survive.”

“Ann Baker is a little bit different,” says Dr. Horowitz. “She did have some coronary disease, but her problems were related to a narrowing of her aortic valve; aortic stenosis is becoming more common because people are living longer. They came up here to have surgery—if you think of the institutions they passed on the drive!” he exclaims. “The reason had a lot to do with the doctor-patient relationship, and Mike Coady gets it in terms of what patients need.”

Surgery is typically used to treat a severe problem with the heart, says Dr. Michael Coady, chief of cardiac surgery at Stamford Hospital. “Not only is heart surgery more accepted than it once was, we’re also able to perform surgeries routinely, and they have become more complex in terms of what we’re able to do. And when I’m doing a consultation with a patient and the family, I can pretty much tell them what their risks are. For me, it’s a patient-centered approach.”

Ann, who sent Drs. Horowitz and Coady thank-you notes on the anniversary of her aortic valve replacement, says she was never afraid. “I had complete faith in my doctors, and everyone at the hospital was magnificent—I felt like Queen Elizabeth!"

“I’m back to feeling good. A little blood-pressure medication, a little cholesterol medication, vitamins and that’s the extent of it. The only thing is that I need to slow down a little. I tell my daughter I’m tired and she says, ‘Mom, you have to remember you’re eighty-three!’”

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