Begging the Questions
Heart disease is the No. 1 killer in the nation, but you'd never know it from eavesdropping on women's annual checkups.
A recent report in the journal Women's Health Issues notes that only about a third of women have discussed heart disease risk with their doctors.
And when the topic does come up, women receive less helpful advice than men who have similar heart attack risk scores. This is especially troubling considering that the majority of heart disease cases are preventable.
On the preventive front, some doctors' knowledge might not be up to snuff. According to a 2012 survey, 76 percent of cardiology fellowship programs fail to offer at least a month of training in prevention—the minimum recommended by the American College of Cardiology Foundation.
What's up, Doc?
"We found that for most physicians specializing in cardiology, the vast majority of training time is spent on the technical aspects of care, like how to handle acute heart attacks and how to read electrocardiograms," says lead study author Quinn Pack, M.D., a cardiology fellow at Henry Ford Hospital in Detroit.
That might be less worrisome if primary care providers were picking up the slack. But a report in the Journal of Women's Health quizzed 1,245 health care professionals on heart disease prevention and found that, on average, the group answered just 65 percent of test questions correctly.
"Primary care doctors are being pulled in many directions and are in a constant time crunch," says Sharonne N. Hayes, M.D., director of the Mayo Clinic Women's Heart Clinic in Rochester, Minnesota. "They've got 10 or 15 minutes in which they have to address a host of urgent issues, including breast cancer, colon cancer screening, and diabetes risk."
We can't let heart health get lost in the shuffle.
Here's a look at five surprising questions that many doctors don't have the time—or the training—to ask, and what your answers might mean for your health.
What Did You Have for Dinner Last Night?
At some point during your checkup, chances are your doctor will ask you to step on the scale. She might even counsel you to lose a few pounds. But while physicians are smart to talk about weight—a key factor in cardiovascular disease risk—it's even smarter to talk about the details of a heart-healthy diet.
Are you choosing healthful fats? (Mono- and polyunsaturated types, found in foods such as salmon and nuts, promote healthy cholesterol levels.) Are you eating enough veggies and fiber? (Most women need about 3 cups and 21 grams a day, respectively.)
Some doctors aren't being schooled in these details: Less than half of medical schools surveyed by The American Journal of Clinical Nutrition provided at least 25 hours of nutrition education, the minimum recommended by the National Academy of Sciences.
Adding to the concern, many popular weight-control strategies are downright harmful to the heart. For example, reduced-calorie snack foods and frozen meals often are pumped with salt to improve taste, which is bad for blood pressure and stroke risk. (Aim to eat no more than 1,500–2,300 mg of sodium per day.)
Meanwhile, research has found that daily diet soda drinkers have a higher-than-average incidence of heart attack, and women who cut calories by skipping breakfast are more likely in the long run to develop certain risk factors for cardiovascular disease, such as high LDL cholesterol.
Fortunately, it is possible to feed your heart while working toward a healthy weight.
Get started by checking our these heart-healthy recipes for nutritious snacks and meals that will leave you feeling as great as you look.
How Have You Been Sleeping Lately?
We spend about a third of our lives in bed, and all the while, our hearts never stop pumping. So doctors who focus solely on our waking habits are skipping important insights.
“Evidence is growing that during sleep, dozens of hormones—including those responsible for repairing blood vessels and regulating blood pressure—are most active,” says JoAnne Foody, M.D., medical director of the Cardiovascular Wellness Service and the Pollin Cardiovascular Wellness Program at Brigham and Women’s Hospital in Boston.
That might explain why people who get fewer than six hours of shut-eye a night tend to have higher blood pressure and sharper increases in blood pressure over time, according to research in the Archives of Internal Medicine. Going one step further, a retrospective study of 3,000 adults presented at the American College of Cardiology found that poor sleepers were twice as likely to suffer a heart attack or stroke as people who sleep six to eight hours at a stretch.
This nightmare scenario need not come to pass. Some of the most common triggers of insomnia are the most fixable, says James Maas, Ph.D., author of Power Sleep (HarperCollins).
Cooling an overheated bedroom, avoiding late-night use of bright computer screens, and cutting out caffeinated drinks after 2 p.m. might be enough to make a difference. More serious culprits, such as depression or chronic pain, could require medical treatment. If you’re regularly up at night or feeling groggy during the day (a sign you’re missing out on the deeper, more restorative phases of slumber), alert your doctor.
How Much Time Do You Spend on Your Tush?
Tell your doctor you’re taking a brisk walk every day or training for a triathlon, and she’ll probably congratulate you and leave it at that. Don’t rest on your laurels, though: The heart needs activity between workouts, too. A 2009 study analyzed the habits of more than 17,000 men and women over 13 years and found that those who stayed seated for most of the day were 54 percent more likely to die of heart attacks, even if they met standard benchmarks for moderate to vigorous exercise.
“The legs contain the largest skeletal muscles in the body, so long periods of inactivity can have a major adverse effect on the metabolism of blood cholesterol and blood sugar,” explains study author Peter T. Katzmarzyk, Ph.D., associate executive director for population science at Pennington Biomedical Research Center in Baton Rouge. He adds, “Formal exercise is great for the heart, but sitting should be viewed as an independent risk factor.”
Researchers are still figuring out exactly how much unseated time we need to stay healthy. Until then, Nieca Goldberg, M.D., medical director of the Joan H. Tisch Center for Women’s Health at NYU Langone Medical Center, suggests standing and stretching at least every 15 minutes. Even if you have a desk job, try to complete noncomputer-related tasks—such as reading reports, taking phone calls, and brainstorming with colleagues—on your feet whenever possible.
How Carefully Do You Avoid the Sun?
If you’re smart, you’re very careful about protecting yourself from the sun’s cancer-causing rays. The downside of this healthy habit, Foody says, is that it can leave you low on vitamin D, a nutrient made in skin when UV light strikes the surface.
In a large University of Kansas study, people with vitamin D deficiency—more than two-thirds of volunteers, it turned out—were 40 percent more likely to have high blood pressure and 30 percent more likely to suffer from cardiomyopathy (a condition that weakens the heart muscle) than people whose D levels were optimal. And researchers at Johns Hopkins University School of Medicine recently looked at data on more than 15,000 adults and found that those who had relatively low levels of vitamin D in their blood had higher levels of C-reactive protein, an inflammatory marker of heart disease.
Make no mistake: Baking in the sun is still a bad idea. You can help maintain a healthy heart by upping your intake of vitamin D-rich foods such as fatty fish and fortified milk. If your diet is low in such sources, tell your doctor. She can order a blood test to check your D status and, if necessary, recommend a vitamin supplement. (Never take a supplement without your doctor’s OK—too much vitamin D can be harmful, too.)
Are You Nurturing Your Social Network?
You might think this question is better left to a psychologist, but primary care physicians have plenty of reason to ask about your friendships.
A study in the journal Social Science & Medicine found that people who were socially isolated—defined as having fewer than three close confidants, not participating in community groups or clubs, and having no religious affiliation—were 2½ times likelier to have elevated C-reactive protein levels than people who routinely sought the company of others.
“Social isolation is a chronically stressful experience that may lead to increases in harmful inflammation throughout the body,” says study author Kathi L. Heffner, Ph.D., an assistant professor of psychiatry at the Rochester Center for Mind-Body Research in New York.
Heffner suggests connecting with others in a social setting at least once a week. If you don’t have a network of pals in place, join a walking group or book club, connect with people through church, or volunteer in an uplifting environment such as a community garden. Heffner notes that even casual acquaintances can have a protective effect.
5 Symptoms to Never Question
Receiving medical treatment within an hour of suffering a heart attack can reduce a person's risk of dying by 50 percent, says heart specialist JoAnne Foody, M.D.
The challenge is recognizing the signs, which often are subtler in women than men. If you develop any of the following symptoms, don't second-guess yourself. Call 911 immediately.
- Severe shortness of breath
that is unrelated to exercise
and doesn't subside with rest.
- Severe pain, pressure, or a sensation of squeezing in the chest or upper abdomen that persists even when you change positions.
- Sudden nausea, vomiting, dizziness, or clammy perspiration.
- Unusual physical exhaustion that goes beyond just feeling tired.
- Unexplained pain, pressure, or discomfort in the neck, back, and/or jaw that you've never experienced before.
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