Posts Tagged ‘heart disease’

High-paying Jobs for Women Cause Women to Pay a Price in Cardiovascular Health

Thursday, November 18th, 2010

High-paying jobs typically equate to high-stress jobs for most individuals, that is, fast-paced jobs with a lot of responsibilities and little creativity.  As women have entered the workforce and fought for equality in all types of employment situations, they have slowly and gradually been successful in most venues; we have yet to see a female President of the USA.  Some jobs are much more creative allowing the expression of individual skills while others require strict adherance to company policy (or parent company policy), little decision-making ability, and productivity-driven payscales.  These latter types of jobs, regardless of the gender of the employee, often lead to job strain, a type of psychologic stress that seems to have potent effects on an individual’s health.

This week, the great city of Chicago (a bustling hub-bub of big corporations and highstress jobs) hosted the American Heart Association’s annual meeting.  Abstract 18520 was presented; it was titled, “Women with High Job Strain Have 40 Percent Increased Risk of Heart Disease.”  The study elaborates on details related to job security and the types of cardiovascular ailments.  This was a landmark study, funded by the National Institutes of Health (NIH), called the Women’s Health Study, and it followed 17, 451 women and their development of cardiovascular disease over a 10-year period.  Previous studies related to stress and cardiovascular disease have focused on men.

Women with high job strain were at a 40% increased risk overall of heart attack, ischemic stroke, coronary artery bypass surgery, balloon angioplasty/stent and even death!  The increased risk of heart attack alone in these women was 88%! The study further delineates that even women in high stress jobs who have significant control over decision-making are also at an increased risk long-term of cardiovascular disease.  Women who suffer job insecurity (fear of losing one’s job) are at risk for particular risk factors that contribute to cardiovascular disease (high blood pressure, high cholesterol, obesity), but no direct correlation to the end-effects of cardiovascular disease could be statistically supported.  This truly supports the notion that psychological stress plays a role in the development of cardiovascular disease.

The National Women’s Health Information Center is a government-sponsored organization that collects information on all types of women’s health topics and offers up-to-date information and advice on the topics.  In the Heart Health and Stroke section, the statistics are numbing; coronary artery disease is the number 1 killer amongst women while stroke is the number 3 killer of women.  In other words, women are 4 to 6 times more likely to die of heart disease than of breast cancer according to the American Academy of Family Physicians (AAFP).

Interestingly, breast cancer has much more awareness and publicity as compared to women and heart disease.  This is surprising since the symptoms of heart attack or angina pectoris in women are often atypical, much like the silent growth of microscopic cancer cells in women’s breasts.  Women, for whatever reason, do not necessarily experience the “crushing chest pain” that most people equate with a heart attack; they might develop generalized fatigue or weakness, lightheadedness, back pain, upper abdominal discomfort or simply a feeling of nervousness or anxiety.

Hmm- try being a highly-stressed 48-year-old female executive telling an ER doctor that you are feeling anxious and a little short of breath; you will be given paper bag for breathing and a Valium pill to take instead of an EKG, aspirin, oxygen and nitroglycerine.  A male would most likely get the second treatment!  Litigation involving this aspect of medicine often involves a failure to diagnose the disease.

Now, let’s get back to this landmark Women’s Health Study.  There is finally a long-term study that reports some very frightening statistics for women.  It is time for women to start advocating for themselves and performing primary interventions such as exercise, healthy weight maintenance, smoking cessation, low-fat/high fiber diets, and routine physical exams.  Both the AAFP website (linked above) and the U.S. Food and Drug Administration website offer tips for reducing women’s risk of heart attack and stroke; they will soon have to incorporate job-related stress as potential risk prevention interventions.  Employers, as well, might need to re-examine work policies and provide stress-relief activities for their employees, especially of they do not want to lose them to premature death and disability.

Another abstract presented at these same American Heart Association Scientific Sessions in Chicago addressed a controversial but nonetheless seemingly stroke-protective intervention.  From men’s and women’s  studies, mild to moderate alcohol consumption on a daily basis is associated with a reduction in risk of heart attack, but women were limited to one alcoholic beverage per day.   Abstract 19870 titled, “Alcohol Consumption and Risk of Stroke in Women,” concluded that women who consumed moderate amounts of alcohol on  a daily basis were not at an increased risk of stroke and may be healthier overall in the long-term.

The women in our office got a good laugh when these studies were placed side-by-side since our conclusion was that the boss should sponsor a happy hour on a weekly basis! All kidding aside, these new data offer both  some chilling reality checks and some hope that more research regarding modern women’s health topics will be on the horizon.  One thing is for sure — there needs to be more awareness, advocacy and primary prevention!

What programs do you have at your workplace for stress reduction?

Photo from the-invisible-gym.com

Editorial Comment (Brian Nash): To all employees (especially the women!), there will not be a firm-sponsored, weekly Happy Hour. Nice try, though.

Non-Cardiac Surgery Too Soon After Cardiac Stenting Increases Risk of Complications

Friday, May 14th, 2010

According to a recent study published in Circulation: Cardiovascular Interventions (an American Heart Association journal), patients should attempt to postpone having surgeries for at least six weeks after a coronary angioplasty procedure with stenting.  Researchers found that patients who wait at least six weeks before having another surgery are less likely to develop reduced blood flow to the heart (a.k.a. heart ischemia) and heart attacks.

The study data revealed that 42 % of patients who had other surgeries within the six-week period developed these complications. Only 13 % of patients who had surgeries beyond the six-week period developed the same complications. The study focused 1,953 patients with an average age of 64 who had cardiac angioplasty with stenting between 2003 and 2007.

According to the American Heart Association:

  • Over 70 percent of coronary angioplasty procedures in the United States also include stenting.
  • In 2006, approximately 65 percent of PCI procedures were performed on men, and approximately 50 percent were performed on people age 65 or older.
  • In 2006, an estimated 1,313,000 PCI procedures were performed in the United States.
  • In 2006, approximately 76% of stents implanted during PCI were drug-eluting, compared with 24 percent bare-metal stents.
  • In 2006, there were 652,000 PCI procedures with stents — 425,000 in men, 227,000 in women.

If you recently had cardiac stenting and require another surgery, make sure to ask your doctor about waiting to have the next surgery. This is particularly true if your next surgery is an elective one. If your doctor or surgeon is not a cardiologist, you may want to consider asking your doctor for a referral to a cardiologist.  You may also want to make sure that your physician or surgeon obtains cardiac clearance before proceeding with another surgery.   Don’t assume that your doctor will do these things for you. Be proactive; ask questions.

For related blogs, please see:

Contributing author: Jon Stefanuca

Angina : The Efficacy of Percutaneous Coronary Intervention vs. the Efficacy of Non-Surgical Treatment

Sunday, March 28th, 2010

Angina is characterized by chest pain resulting from insufficient blood flow to the heart. In this context, abnormal blood flow is caused by the build up of plaque in the coronary arteries or as a result of coronary artery stenosis. Consequently, angina symptoms are usually indicative of heart disease. It is estimated that nearly seven million people in the United States have angina and that nearly 400, 000 patients present with new cases of angina each year.

A recent study published by Annals of Internal Medicine compared the efficacy of percutaneous coronary intervention vs. the efficacy of non-surgical medical care in treating angina in patients with stable coronary artery disease. Percutanious coronary intervention refers to coronary angioplasty. The study in question involved cardiac angioplasties with and without cardiac stents. Non-surgical treatment refers to drug treatment of angina symptoms.

Researchers performed a comprehensive review of 14 previous trials, which compared the efficacy of coronary angioplasty (with and without stents) vs. non-surgical medical care. In total, the 14 trials involved 7818 patients. Researchers concluded that older trials suggest that percutaneous coronary intervention was only marginally more effective in the treatment of angina. This, however, did not appear to be true in more recent trials. The study suggests that coronary angioplasty may not be necessary or recommended to treat angina in patients with stable coronary artery disease if proper evidence-based medications are employed.

Contributing author: Jon Stefanuca

Cardiac Catheterizations Overused

Thursday, March 11th, 2010

According to an article published by WebMd, a recent study suggests that almost two-thirds of patients who undergo cardiac catheterizations do not have clogged arteries.

Researchers tracked about two million patients who had the procedure at about 663 hospitals across the nation between 2004 and 2008. Of the two million patients, researchers focused on about 400, 000 patients with stable chest pain and no previous history of heart disease. The study specifically excluded patients with a history of heart disease, angina, or heart attacks.  In this population of patients, about two-thirds did not have significant arterial blockage.

Cardiac catheterization is a commonly used invasive procedure to diagnose blockage in the arteries of the heart. The procedure is performed by inserting a catheter in an artery of the arm or the leg. The catheter is then guided into the coronary arteries of the heart.  At such time, a die is injected through the catheter and its flow is analyzed to determine whether the artery is blocked.

According to Pamela S. Douglas, professor of cardiology at Duke University:

We want to be clear that if someone is having a heart attack and their doctor sends them to a cath lab, they shouldn’t argue. … But a stable patient who has not been diagnosed with heart disease and who does not need catheterization for pain control may want to ask about the risks and benefits.

Contributing author: Jon Stefanuca

New BPA Research – Is Your Plastic Water Bottle Toxic?

Saturday, February 20th, 2010

According to an article published in WebMD Health News, two recent studies suggest that the plastic chemical bisphenol A (BPA) is not toxic to the brain and that it does not inhibit the development of the human reproductive system. One of the studies was funded by the plastics industry. Both studies were originally published in Toxicological Sciences.

BPA is an organic chemical compound, which is used as an additive or building block in several plastics. Its primary purpose is to harden plastic. For this reason, BPA is found in a wide variety of consumer products such as plastic bottles, cups, and even baby milk bottles.

“Some experts are concerned that exposure to BPA and its weak estrogen-like effects, especially during critical periods of development, may be linked to a range of health hazards, including behavioral effects, reproductive problems, cancers, heart disease, and diabetes.”

The two studies in question were designed to specifically study the impact of BPA on the brain and the reproductive system. Both studies used animal models.  The study that focused on neurotoxicity found that female rats and their litters did not develop neurological defects from exposure to BPA.  The study that focused on BPA’s impact on the reproductive system found that rats exposed to low doses of BPA in utero and throughout the breastfeeding period maintaind healthy reproductive systems.

Notwithstanding these new findings, many remain concerned about the toxicity of BPA. Even the FDA reversed its position regarding the safety of BPA in January 2010 and called for additional research on the subject. Previous studies appear to suggest that BPA is toxic. For example, in an article published in Reproductive Toxicology in 2007, 38 experts agreed that average levels of BPA in humans are above those that appear to cause harm in animals.  In 2009, an article publushed in Molecular and Cellular Endocrinology, sumarized past BPA research and concluded that:

“The potential for BPA to influence body weight is suggested by in vitro studies demonstrating effects of BPA on adipocyte differentiation, lipid accumulation, glucose transport and adiponectin secretion. Data from in vivo studies have revealed dose-dependent and sex dependent effects on body weight in rodents exposed perinatally to BPA. The mechanisms through which perinatal BPA exposure acts to exert persistent effects on body weight and adiposity remain to be determined.”

Another study published in the Journal of American Medical Association specifically addressed the impact of BPA on humans.  The study concluded that there was a strong positive correlation between the amount of  BPA in a person’s urine and the incidence of heart disease, diabetes, and enzyme abnormalities.  These are just a few of the many research studies suggesting a link between BPA and varous medical complications.

Contributing Author:  Jon Stefanuca