The People's Perspective on Medicine

Show 1026: What Should Women Do to Protect Their Heart Health?

Heart disease is a major cause of death for both women and men, but it may have different symptoms in women. How can they preserve their heart health?
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What Should Women Do to Protect Their Heart Health?

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Heart disease is still the number one killer of women in the US, though the words “heart attack” usually conjure up an image of a gray-haired man. The symptom of chest pain or tightness is the most common signal of a heart attack in either males or females, but the American Heart Association says women need to be aware that they may experience nausea, shortness of breath, or neck and back pain instead or in addition to chest pain.

What Should Women Do to Benefit Their Heart Health?

Two leading women cardiologists discuss what women need to know to keep their hearts healthy. Are statins helpful for healthy women? How should women react if they believe they may be having a heart attack? What else is critical for heart health?

This Week’s Guests:

Rita Redberg, MD, MSc, is Professor of Medicine at the University of California, San Francisco, and Director of the UCSF Women’s Cardiovascular Center. She is editor of the journal JAMA Internal Medicine. The photo is of Dr. Redberg.

Viola Vaccarino, MD, PhD, FAHA, is the Wilton Looney Chair of Cardiovascular Research at Emory University and Professor and Chair of the Department of Epidemiology in the Rollins School of Public Health. She served on the American Heart Association committee that recently issued a scientific statement on Acute Myocardial Infarction in Women (Circulation, online Jan. 25, 2016).  The research she describes during the interview was published in Psychosomatic Medicine, Apr., 2014.

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About the Author
Terry Graedon, PhD, is a medical anthropologist and co-host of The People’s Pharmacy radio show, co-author of The People’s Pharmacy syndicated newspaper columns and numerous books, and co-founder of The People’s Pharmacy website. Terry taught in the Duke University School of Nursing and was an adjunct assistant professor in the Department of Anthropology. She is a Fellow of the Society of Applied Anthropology. Terry is one of the country's leading authorities on the science behind folk remedies. .
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There seems to be no shortage of information about what to do, what not to do, and what to take to prevent heart disease, but never anything about those same concerns for people who already have it. I have had a heart attack, have PAD, and atherosclerosis, and the more I hear about how terrible the drugs I’m on are, the more I want to know if I have any alternatives, and what those might be.

I would like to eat a healthy diet, and do my best, but no one seems to be able to agree on what that is, even for prevention, much less for someone like me. I’m still getting the low fat/ low salt advice from my Dr.s. I also exercise, but all the information on that, too, is for prevention.

I would love it if you would have a show with some advice for people in my situation that also goes beyond the obvious. My weight is fine, I don’t smoke or drink, I exercise. What supplements are good, what medications are best, or not. Thank you.

I was surprised to hear Dr Redberg say that it is not known why heart disease develops later in women than in men, with no further comment. There is at least a promising conjecture: Because women menstruate, they “donate” blood every month, reducing hematocrit and also maintaining a younger average age of red blood cells. (Red blood cells last a few months, gradually losing flexibility as they age, and stiffer ones are harder on the arteries.) When menstruation stops, these advantages disappear. But they can be reinstated by voluntary blood donation, which of course is a good thing to do for charitable reasons. Eating fatty fish, like salmon and sardines, also helps keep the red cells flexible. Of course, these measures are available for men, too.

As my 77th birthday approaches, I never cease to be even more grateful over your decades of contributing so much through your radio and TV broadcasts, in your books and on your website. Many, many thanks for your conscientious efforts on behalf of all of the hundreds of thousands of us that have been further educated and helped regarding our questions about better health.

For women who are obese, it is well worthwhile doing an A1c, mainly to screen for diabetes / prediabetes. If pre-diabetes then should have diabetic educator, holistic diet approach as espoused by Diane Schwarzbein MD (endocrinologist) with book modestly entitled The Schwarzbein Principle, 1999 edition available at reasonable cost from Walmart’s website, aerobic walking exercise – walk one mile in 30 minutes each day, metformin 500 mg twice a day with expectation taking this could have long lasting heart protection effects,

IF elevated triglycerides take enteric coated fish oil (“odor-less”, “burp-less” “cats do not follow you around” softgels) 1200 mg twice a day, IF elevated cholesterol take atorvastatin 20 mg at bedtime every other day, check in with primary care doctor about every 3-4 months.

If significant elevation in blood pressure then take ramipril 5 to 10 mg at BEDTIME as per 2000 HOPE trial to reduce risk of MI by about 20%. IF resistant hypertension take indapamide rather than HCTZ in am as 24 hour acting thiazide diruretic and tested for prevention purposes in patients with diabetes.

Consider taking magnesium + zinc from for magnesium replacement and OTC caplets of potassium (2.5 milliequivalents per 99 mg potassium caplet) as needed after check of K and Mg while on ramipril (or perindopril) at BEDTIME and on indapamide in the am AND careful consideration with primary care physician of ALL of the above recommendations. This is, in this primary care internist’s opinion, the very best and most cost-effective way to prevent heart attacks and strokes in women with pre-diabetes…..etc.

DISCUSS with your primary care doctor possible adverse drug effects and always check in with your PCP if you perceive anything going amiss as in a suspected adverse reaction to a medication, occurrence of chest discomfort on exercise, increasing rather than decreasing weight……etc.

According to the Mayo Clinic 60% or so of heart disease in women is due to small vessel disease – the microvasculature. IMO, there is a need to diagnose small vessel disease as early as possible in women. We should be discussing how to diagnose small vessel disease in women for the purpose of earlier diagnosis and preventive treatment. Hence the following quesions:

1) Does stress cause microvascular vasoconstriction and possibly small vessel disease? Kelly McGonigal PhD at Stanford has a TED talk where she states that stress does cause vasoconstriction and it is possible to modify that effect of stress through the use of metacognition modification – thoughts about thoughts of stress modification. Kelly M. is, I believe, the sister of Jane M. who was recently on the People’s Pharmacy. Perhaps both of their insights about stress modification and control could lend significant protective effects on microvascular dysfunction of women

2) Is the retina and its microvasculature a possible site for small vessel disease risk? Can for instance, the iight flicker stimulus of vasodilitation of the small arteriolar vessels of the eyes be used to identify small vessel disease of the brain and perhaps also small vessel disease of the heart.

3) Could agents that modify vasoconstriction and oxidative stress that creates agents (e.g., the peroxynitrite radical) AND agents that activate anti-oxidative stress enzymes AND agents that activate an anti-vasoconstriction and anti-oxdative stress enzyme, Transketolase – magnesium and thiamine pyrophosphate cofactors – protect women against the following cascade:

Stress, hyperglycemia, chronic inflammation, elevated homocysteine, loneliness (“the lonely mother”), anger, anxiety, PTSD……..etc—–> oxidative stress —–> activation of NF-kB —–> MORE oxidative stress ——> endothelial dysfunction ——> microvascular dysfunction —–> microvascular bed and neurovascular unit dysfunction ——> regional blood flow limitation and small vessel disease —-> regional blood flow abnormalities —–> downstream pathophysiologies including heart attacks, congestive heart failure, arrhythmias, mini-strokes, extension of major strokes…….etc.

I believe more emphasis should be placed on learning and implementing MBSR….Mindfulness- based stress reduction….as defined by Jon Kabat-Zinn, which is applicable to most pyscho social life stressors as well as disease situations.

I am so sick of all these pills, I read about the side effects of them and despair. I am taking a stand , hopefully for the best and have stopped the statins and am now drinking a suppliment called betaheart , this is the first week and I shall look forward to my annual blood test to see if I have done the right thing. Off course I have not told my GP. I am writing this from Australia.

Statins have no bearing on longevity and never did have.

Dear Raelene
It’s possible that a regimen including the oats and barley drink will lower your cholesterol. However keep in mind that studies have shown that beta-glucans only lower cholesterol by 5-10% (
So it depends on how high your cholesterol is. I encourage you to have your blood tested after 3 months to see if it is making a difference. Combining exercise and weight loss will augment the effect. And remember that most people do not get significant side effects from statins, and it varies with different drugs. Good luck! I am a PharmD in Minnesota, USA.

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