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Deadly Silence

As Diana Duncan's three children looked on, doctors struggled to revive their 56-year-old mother following a massive heart attack. Duncan survived the ordeal. But then she faced the grim diagnosis: heart failure, one of the many cardiovascular diseases that kill more women than all forms of cancer combined.

"Heart disease is the leading cause of death in women," says Dr. Michael Flynn, interventional cardiologist at Naples Community Hospital. Yet, when Flynn asks his female patients what they see themselves dying from, cardiovascular disease is not on the list.

Duncan was one of these patients. "I never thought of it," she says. Now 64, Duncan has spent the last eight years battling cardiovascular disease. And it can be a silent killer in women, who often experience symptoms such as suffocation, uneasiness in the chest, or a gripping sensation-not necessarily the pain that's the usual hallmark for an attack in men. Many women may not identify their symptoms as a heart attack because they have a higher pain threshold, says Dr. James Talano, director of the Southwest Florida Institute of Cardiovascular Fitness and Treatment.

In Duncan's case, what she thought was heartburn was actually a massive heart attack. When she returned to work after three days at home, she passed out and was taken to the hospital. Even then, she says, "I didn't think I was having a heart attack."

The increased media coverage of cardiovascular disease in women would have you believe it's on the rise among females. It's not. "Women aren't getting any more heart disease than they were previously," Flynn says. "They are just getting more aggressive diagnosis and treatment."

But while the numbers haven't increased, women are being diagnosed at a younger age-typically around 65. The earlier onset is thought to be linked to the increase in smoking among women, which is a major risk factor for cardiovascular disease. "The incidence of smoking has steadily gone down in the last 20 years for men and steadily increased in women," says Flynn. According to the American Heart Association, 21.6 percent of American women over the age of 18 smoke.

Menopause can also act as a catalyst for heart disease, a side effect that makes hot flashes seem trivial. "After menopause, women catch up with the diseases of men," says Talano.

Hormones such as estrogen actually protect women from cardiovascular disease. So those 55 and older should get yearly evaluations, complete with blood and stress tests. And when it comes to heart disease, prevention is key. "Patients end up with a weak heart, which is not curable. But it is treatable," says Sara Billings, a heart failure case manager at Naples Community Hospital.

Though treating heart disease in women is much the same as treating it in men, one of the major differences involves the use of angioplasty, the remodeling of vessels to allow for the passage of blood. "In general, men get more angioplasty because women's vessels and arteries are smaller," says Talano. As a result, angioplasty isn't as successful in women, though new technologies should make it a more viable solution in the future.

The treatment of cardiovascular disease is veering away from medication and toward pacemakers, defibrillators and other devices. Available since the '60s, pacemakers help slow the heartbeat of a patient; defibrillators, which shock the heart to allow a more effective beat or squeeze, came along about 20 years later. The 1990s saw these two devices merge into one. "They revolutionized care for patients, because the biggest killer is sudden death in heart failure," says Dr. Sinan Gursoy, an electrophysiology cardiologist at Naples Community Hospital.

Duncan has one of the most effective devices, the biventricular pacemaker defibrillator. "It's like having four-wheel drive, power locks and windows, XM radio and video in the back," says Gursoy.

The device has the ability to activate the heart from both sides rather than just one. "It increases the heart's output quite a bit," says Gursoy.

And there are even more advanced devices on the horizon. One has a computer chip that records pressure changes and fluid buildup to prevent heart attacks before they occur. Yet despite these technological advances, heart disease is still an everyday reality for Duncan, who survived a 30-day coma and endured 18 months of drug infusion after her attack.

"I am tired a lot and have to be aware of what's happening to my body," she says. "I want to be able to function at a higher level and get back to being a productive person." 

Red Flags for Women

n chest discomfort

n upper body discomfort

n shortness of breath

n cold sweats

n nausea

n lightheadedness

n fluid retention

Source: American Heart Association 

Skimp on the Salt

Too much sodium in your diet can induce fluid retention, which puts added stress on the heart. The 2005 Dietary Recommendations, published by the Department of Health and Human Services and the Department of Agriculture, suggest 2,300 mg-or one teaspoon-of salt a day. Keep these tips in mind when monitoring your salt intake: 

n Check the labels on antacids and other over-the-counter drugs for high sodium content.

n Steer clear of canned vegetables; opt for fresh or frozen.

n Cold cuts and other processed meats can be high in sodium; select fresh or frozen lean meats.

n If you need a snack fix, choose an unsalted variety.

n Instead of reaching for the salt, try lemon juice, pepper, basil or any other variety of spices for an extra flavor boost.

Source: American Heart Association, Department of Health and Human Services, Department of Agriculture. For more information, visit www.healthierus.gov. 

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