Heart to Heart

A conversation about heart health with Loyola’s Dr. Binh An P. Phan

Men and women are different. Should the two sexes be looking for different warning signs of heart disease?

One of the biggest things to remember is that heart disease is the number one killer for both men and women. There is a lot of publicity out there about heart disease killing men and not as much about it killing women. Instead, there tends to be a lot of publicity aimed at women and breast cancer, which is important. But heart disease is still their number one killer.

Nevertheless, men are from Mars and women are from Venus, so the symptoms of, say, a heart attack can be different. Men having a heart attack will display typical symptoms like pressure in their chest. Women can present symptoms with no chest pains at all. But other symptoms like tingling in the arm or face, numbness or difficulty breathing…. This is called an atypical presentation.

And that does influence quite a bit how women are treated in an emergency room. If you’re presenting with atypical symptoms of a heart attack, the diagnosis is often overlooked, or the proper testing isn’t done because testing is done based on the symptoms presented. This can all lead to a delayed diagnosis of heart disease. And that can lead to poor healthcare down the road.

This sounds like a systemic problem in treatment.

Part of the problem is a lack of knowledge base and awareness. It is, however, less of a problem than it once was. It’s getting better with more clinical experience, but no matter how knowledgeable a provider is, if you don’t come in with a classic symptom, the provider has to consider a broader diagnosis. This can lead to a delay in proper diagnosis.

Once a woman is diagnosed with heart disease, do you treat her differently than you would a man?

Most of the recommendations for treating a man or a woman are pretty much the same. I do have to say, there are clinical trials that have looked at the benefits of therapies where 80–90 percent of the enrollment were men. Women have been underrepresented. And if you look back on trials that were only women, we find that not all treatments for men would be as beneficial for women. We need to balance out the research. Most trials now are required to have a balance.

But generally, the treatment is all the same such as treatment for elevated cholesterol and blood pressure along with therapies such as aspirin in patients with a diagnosis of heart disease.

Women do manifest heart disease 10 years later than men. And after menopause, the risk does go up. It’s believed that estrogen helps stave off the disease. However, trials show that hormone replacement after menopause does not necessarily reduce a women’s risk of heart disease.

Let’s break basic heart-care factors into age groups. What should someone in their 20s and 30s be doing versus someone in their 60s or 70s?

We know that relevant medical issues arise as you age. Blood pressure and cholesterol levels will go up. Things like diabetes come up as you get older. So, the risk of heart disease is greater. But there are things people should do regardless of age.

It is important to know what your cholesterol levels are. Follow up with regular cholesterol evaluations. Know what your blood pressure is, and treat any elevated hypertension.

For the general population, you should start being screened for cholesterol when you’re 20. I don’t want people to get lulled into a sense of comfort in their 20s because they think that they are unquestionably healthy and that heart disease is a problem only of older people. We know that the underlying cause of the disease is fatty buildup in the arteries. And that begins very early in life. Don’t delay a heart-healthy lifestyle.

Give me a quick crash course in the building blocks for a healthy heart.

Don’t smoke. Exercise five days a week for 30 minutes. It’s not long. Thirty minutes is a TV show. Eat a low saturated-fat diet. Those are things anyone and everyone should do. And do them for the entire length of your life.

So is it ever too late to start taking care of your heart?

No. Absolutely not. Even at 70 or 80, you can get treatment.

Does medication like Lipitor extend lives?

Lipitor and similar medications in the class called “statins” have been shown to be very beneficial to people with high cholesterol, whether they’ve had a heart attack or not. It’s a great preventative treatment to help lower the risk for heart-related events. And yes, it has been shown to extend lives.

If you have abnormal cholesterol levels, you should be treated with a statin medication like Lipitor because it reduces the amount of the fatty buildup in your arteries.

Are drugs like this just for the middle-aged or seniors?

No. For adults at any age, if you have elevated cholesterol levels and are at risk for having heart disease, treatment with medications, such as statins, can be helpful to reduce your risk.