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Men Versus Women (Mortality)
Men & Women Risk Factors for Heart Attack


Men VERSUS Women (Mortality)

A prospective study of elderly patients who survived a hospitalization for congestive heart failure (CHF) has found that, while men have higher mortality than women within the first year after discharge, rates of impairment are similar among all patients. The results of the study appear in a recent issue of the Journal of the American Geriatrics Society.

Researchers for the Post-Acute Care study conducted by the University of Minnesota School of Public Health , Minneapolis, examined 519 Medicare patients, aged 65 years and older, who were consecutively discharged in 1988 and 1989 after being hospitalized for CHF. Data were collected from hospitals in three cities: Minneapolis, Houston, Tex, and Pittsburgh, Pa. Participants were first interviewed by a trained research nurse 2 days before discharge to establish demographic information, type of care received before admission, ability to perform activities of daily living (ADL), and perceived health status.

Additional outcomes (ie, shortness of breath upon walking, living situation, rehospitalization, and mortality) were measured and compared 6 weeks, 6 months, and 1 year postdischarge. The investigators sought to determine whether these outcomes differed by gender.

The researchers found similar adjusted outcome measures between men and women, with the exception of mortality percentage. At each interval following discharge, more men had died than women; the 1-year adjusted cumulative mortality rate was 48% for men and 35% for women.

At 1 year, the authors discovered substantial impairment on all outcome measures: 46% returned to the hospital; 35% developed shortness of breath upon walking less than one block; 62% considered their health "fair" or "poor"; and 32% received some formal care. Moreover, the researchers concluded that the average patient needed some degree of assistance with multiple ADL or complete assistance with one activity (eg, feeding or continence).

The researchers noted several limitations to their study, including the inability to adjust for some relevant factors-most notably ejection fraction, which previous studies indicate "has a profound effect on survival. " The study's generalizability may also be limited, since it was conducted in only three cities and not all hospitals in two of the cities participated. "Our results may have differed if all hospitals in the three cities participated or if additional cities were included," comment the researchers. However, they called the study's sample comparable with the general Medicare population in terms of age, gender, race, and length of stay.

Source: Journal of the American Geriatrics Society.



Heart Attacks: An Equal Opportunity Health Problem
Sandra Carden, Medical Writer


... Describe a person having a heart attack. Most people will picture a middle-aged man gripping his chest, grimacing and gasping for breath. But women have heart attacks, too. Each year, 234,000 women in the United States die from heart attacks. In fact, heart disease is the number one killer of American women, claiming the lives of 500,000 each year, more than twice as many as all forms of cancer.

"It is certainly appropriate that women focus on conditions that are particular to them, like cancer of the breast, ovaries and cervix, and osteoporosis. But in reality, women have a higher risk of heart disease and stroke. This concept is something that cannot be overemphasized," says Dr. Roy Ziegelstein, deputy chairman of the department of medicine at the Johns Hopkins Bayview Medical Center in Baltimore.

"Symptoms of a heart attack could be different for women than for men," says Dr. Nieca Goldberg, chief of the Women's Heart Program at Lenox Hill Hospital in New York City, and spokesperson for the American Heart Association. "Men having a heart attack usually experience chest pain, difficulty breathing, and sweating."

"Women may have the severe chest pressure as men do but may describe shortness of breath, fatigue or lower chest discomfort misinterpreted as stomach or gall bladder problems, resulting in a delay in seeking emergency medical attention," adds Goldberg. And a delay in getting treatment can be deadly.

Risk Factors:
Most Can be Improved Most heart disease risk factors for men affect women, too, although there are some subtle differences. For example, high blood pressure is an important risk factor for women and men, and may be present without any symptoms or warning signs.

Most heart disease risk factors for men affect women, too, although there are some subtle differences. "If you have several risk factors, your risk of heart disease multiplies. For instance, if you smoke, have high blood pressure, diabetes, and high cholesterol, your risk is 30 times more than if you had none of these risk factors," says Dr. Susan Graham, cardiologist and clinical associate professor of medicine at State University of New York at Buffalo School of Medicine. Lifestyle changes that help one risk factor can help others. Often, lifestyle habits plus medication produce the best results.

Smoking is the single most preventable cause of heart disease. "We don't fully understand the mechanism of smoking and heart attacks," says Dr. Charlie Shaeffer, cardiologist with Desert Cardiology Consultants in Palm Springs, California, and chair of the American Heart Association's Public Policy Subcommittee. "We know that when a plaque rupture in the artery occurs, a substance is released from that plaque that closes off the artery, causing a heart attack. And smoking causes that substance to be released from the plaque." Smoking increases the risk of developing disease in the arteries of your heart, but within months of quitting, your risk for heart attack drops. After you quit smoking, your heart attack risk is the same as a nonsmoker within two to three years. If you smoke, quit. Prescription drugs can help. Talk to your doctor to learn if one is right for you, and about other resources to help you become a former smoker.

Extra body fat increases your risk of heart disease, especially if your extra fat is around your waist. You can calculate your waist-to-hip ratio. Divide your waist measurement by your hip measurement. If your answer is greater than 0.8, your waist-to-hip ratio is high enough to be an added risk, even if your overall weight is in the healthy range. Regular physical activity plus a healthy diet are the two most important components of achieving and maintaining a healthy weight. Cut down on the fat in your diet. Eat enough vegetables and fruits each day.

Physical Inactivity "A sedentary lifestyle may double your risk of heart disease. Exercise helps to improve body weight, diabetes, and high blood pressure. And it's a natural way to improve your blood lipids," says Graham. "Brisk walking is the exercise that most people can incorporate into their lifestyle--at least 20 minutes three times a week, but more is better," she adds. Experiment until you find activities you enjoy and can fit into your lifestyle. Teach by example the young people in your life, especially girls, that it's worthwhile to exercise.

High Blood Pressure "All adults should aim for a blood pressure of 135/85 or lower," advises Graham. Have your blood pressure checked regularly, especially if you are on blood pressure medication or have other risk factors for heart disease. Tell your doctor if you have any problems with your blood pressure medication.

"A sedentary lifestyle may double your risk of heart disease."

High Cholesterol (over 200 mg/dl) is a risk factor for both sexes. However, when the lipid profile is evaluated, some differences emerge. In women, low levels of high-density lipoprotein cholesterol (HDL-C, the "good" cholesterol) is a greater risk factor than high levels of low-density lipoprotein cholesterol (LDL-C, the "bad" cholesterol), though having an elevated LDL level also puts you at a higher risk of having a heart attack. And high levels of triglycerides are a greater risk factor for women than for men. Your doctor can help you interpret your lipid profile, and can recommend strategies to improve it. Quit smoking and increase your exercise to raise your HDL-C. To lower your LDL-C, keep your diet low in fat, especially saturated fat, and limit your dietary cholesterol. Eat at least five servings of vegetables and fruits each day. Lose weight if you are overweight or have a high waist-to-hip ratio.

Menopause The estrogen circulating in a woman's body before menopause helps to protect against heart disease. "Estrogen raises the HDL-C (good) and lowers the LDL-C (bad). After menopause, estrogen decreases, and a woman loses its benefit. In addition to relieving symptoms of menopause, hormone replacement therapy (HRT) may lower a woman's risk of heart disease as well," says Goldberg. However, recent research has shown that women who have recently had a heart attack should not start estrogen therapy immediately, so the benefit of estrogen on heart disease is not as clear as was previously thought. Since HRT is not appropriate for all postmenopausal women, its use to lower risk of heart disease should be discussed by a woman and her doctor.

Diabetes "Because elevated blood sugar, or diabetes, affects the cardiovascular system, people with diabetes are at markedly higher risk for heart disease than those without it," warns Graham. People with diabetes are also at a higher risk of developing "silent angina," or a heart attack without chest pain, because of damage to nerves that can occur after many years of diabetes. And women with diabetes are at greater risk than men with diabetes, according to Graham. She advises women with diabetes to pay careful attention to their cholesterol, blood pressure and weight, in addition to their blood sugar, and to follow up with their doctor. The nutrition recommendations for diabetes can also improve other risk factors for heart disease.

Heart Attack Symptoms in Women: Shortness of breath Difficulty breathing Pain or weakness in the shoulder, arms, or all over the body Nausea not relieved by burping or antacids Vomiting Overwhelming fatigue Chest pain

This article is from JohnsHopkins

Our thanks to Jon from for the use of his graphic the Heartman.


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Last Modified on August 7, 2001