{"id":29633,"date":"2018-07-13T03:39:05","date_gmt":"2018-07-13T10:39:05","guid":{"rendered":"http:\/\/www.jewishindependent.ca\/?p=29633"},"modified":"2018-07-11T13:59:46","modified_gmt":"2018-07-11T20:59:46","slug":"new-views-on-heart-disease","status":"publish","type":"post","link":"https:\/\/www.jewishindependent.ca\/index.php\/2018\/07\/13\/new-views-on-heart-disease\/","title":{"rendered":"New views on heart disease"},"content":{"rendered":"

Dr. Ross Feldman is leading various teams as the principal investigator for women\u2019s health at the Institute of Cardiovascular Sciences at the city\u2019s St. Boniface Hospital. (photo from Dr. Ross Feldman)<\/em><\/strong><\/span><\/p>\n

Many of us are under the impression that heart disease mainly affects men. But researchers have been trying for the last few decades to change this skewed view. One such researcher, Dr. Ross Feldman, recently found his way to Winnipeg. Feldman is leading various teams as the principal investigator for women\u2019s health at the Institute of Cardiovascular Sciences at the city\u2019s St. Boniface Hospital.<\/p>\n

According to Feldman, \u201cMost of what we know in terms of risk and benefit and treatment of those factors that contribute to heart disease initially came from studies of younger people with more advanced risk factors \u2013 be it cholesterol, high blood pressure, [etc.] \u2013 and what the benefit was from the treatment of those problems, in terms of reducing risk of heart attacks or strokes. Women tended not<\/em> to be included in those studies, because premenopausal heart disease risk is so much lower. So, in the earlier days, we developed guidelines that were mostly based on findings in younger men. It really wasn\u2019t appreciated that women had accelerating risk after menopause.\u201d<\/p>\n

This new understanding about the connection between post-menopause and heightened risk of heart disease has only come to light in the past 10 to 15 years. The Heart and Stroke Foundation is only now, within the last year, opting to make the topic a priority.<\/p>\n

\u201cI think it\u2019s taken even longer for it to register on the psyche of healthcare professionals … that women are at an increased risk post-menopause,\u201d Feldman told the Independent<\/em>. \u201cThey\u2019re also much less likely to be diagnosed appropriately, less likely to get appropriate treatment, and they are more likely to have complications with trying to fix blood vessel problems. They\u2019re less likely to be sent out following a cardiac event on all the right medications. And then, ultimately, a little more likely to die of heart disease.\u201d<\/p>\n

Feldman believes this lag time \u2013 for women to get the correct diagnostics and treatments \u2013 will not change anytime soon, unfortunately, as the training provided in medical schools is still based on past knowledge about women and heart disease. Medical students are still being taught that women are more likely to present with atypical chest pain, with no further explanation, said Feldman.<\/p>\n

\u201cIf women are most likely to present that way, why are you calling it atypical chest pain?\u201d he asked. \u201cIt gives you an idea of how male-centric our whole approach to heart disease has been. What we get out of it is, you often see a dichotomy, that sometimes you\u2019ll see premenopausal women at risk of being over-treated.<\/p>\n

\u201cA woman, premenopause with hypertension, probably doesn\u2019t need blood pressure-lowering therapy unless their blood pressure is greater than 160 over 100. Whereas, a post-menopausal woman with multiple smaller elevations in individual risk factors \u2013 a little bit higher blood pressure, a little bit higher cholesterol \u2013 will often get overlooked…. Yet, she is at a much greater risk than will be projected, based on consideration of any individual risk factor.<\/p>\n

\u201cThere needs to be a sex-specific approach to management of the risk factors of heart disease and the presentation for heart disease,\u201d he said. \u201cThe guidelines for that approach are still in flux.\u201d<\/p>\n

As medical practitioners are lagging behind the latest findings about women and heart disease, Feldman said that premenopausal women don\u2019t need to be as concerned about risk factors that may be a little out of whack, such as LDL cholesterol or blood pressure. However, he said, post-menopausal women need to be advocates for more aggressive treatment for even seemingly marginal elevations in risk factors.<\/p>\n

\u201cThe problem is that primary care professionals, a lot of them, will tend to underestimate the risks,\u201d said Feldman. \u201cThere are reasonable calculators that will tell people, if you add up several small risks for a post-menopausal woman, that translates into an overall risk level that mandates more aggressive therapy. Generally, blood pressure and cholesterol are the most important factors to look at, but it\u2019s the whole aggregate risk based on the calculation that tells you how aggressively you need to treat, regardless of the extent of the elevation.\u201d<\/p>\n

While researchers like Feldman are working on sex-specific therapies, women can help themselves by reducing their degree of risk via exercise, maintaining a healthy weight and a healthy diet, keeping hydrated and finding ways to keep stress and anxiety levels down.<\/p>\n

\u201cAs women age, as with men, excessive salt intake increases blood pressure and often that excessive salt doesn\u2019t primarily come from the salt shaker, but from processed foods,\u201d said Feldman. \u201cWhen shopping, shop the rim of grocery stores. Stay away from the aisles. Maybe shop in the frozen food sections, but probably not.<\/p>\n

\u201cTo date, there is no real sex-specific preventative approach. That is, exercise, as far as I know, is as effective in blood pressure reduction and weight reduction for men as it is for women … maybe a little more effective in women, but likely marginal differences. I think it\u2019s important for women to know that weight gain and a more sedentary lifestyle are bigger risks for them than for men. Men tolerate being couch potatoes a little better than women do.<\/p>\n

\u201cThe slope of the line for weight gain in men is pretty linear,\u201d he said. \u201cIn women, there\u2019s an increase in slope of weight gain after menopause. Women\u2019s systems are less tolerant of the kinds of changes that occur with age than men\u2019s.<\/p>\n

\u201cWe know there are ethnic differences in risk tolerance,\u201d he added. \u201cWe know that Asians are less tolerant to weight gain than Caucasians. That is a genetic difference. We hadn\u2019t appreciated that sex differences work the same way, although we should have, as, ultimately, a sex difference is<\/em> a genetic difference.\u201d<\/p>\n

Rebeca Kuropatwa<\/strong> is a Winnipeg freelance writer.<\/em><\/p>\n","protected":false},"excerpt":{"rendered":"

Dr. Ross Feldman is leading various teams as the principal investigator for women\u2019s health at the Institute of Cardiovascular Sciences at the city\u2019s St. Boniface Hospital. (photo from Dr. Ross Feldman) Many of us are under the impression that heart disease mainly affects men. But researchers have been trying for the last few decades to […]<\/p>\n","protected":false},"author":2,"featured_media":29634,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[5],"tags":[8269,6530,8270,2225,3021],"class_list":["post-29633","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-national","tag-heart-disease","tag-menopause","tag-ross-feldman","tag-science","tag-women"],"blocksy_meta":{"styles_descriptor":{"styles":{"desktop":"","tablet":"","mobile":""},"google_fonts":[],"version":8}},"_links":{"self":[{"href":"https:\/\/www.jewishindependent.ca\/index.php\/wp-json\/wp\/v2\/posts\/29633","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.jewishindependent.ca\/index.php\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.jewishindependent.ca\/index.php\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.jewishindependent.ca\/index.php\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/www.jewishindependent.ca\/index.php\/wp-json\/wp\/v2\/comments?post=29633"}],"version-history":[{"count":0,"href":"https:\/\/www.jewishindependent.ca\/index.php\/wp-json\/wp\/v2\/posts\/29633\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.jewishindependent.ca\/index.php\/wp-json\/wp\/v2\/media\/29634"}],"wp:attachment":[{"href":"https:\/\/www.jewishindependent.ca\/index.php\/wp-json\/wp\/v2\/media?parent=29633"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.jewishindependent.ca\/index.php\/wp-json\/wp\/v2\/categories?post=29633"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.jewishindependent.ca\/index.php\/wp-json\/wp\/v2\/tags?post=29633"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}