Cardiac concerns

A movement is under way
to educate women about heart
disease, the leading cause
of death in the United States
Sunday, November 28, 2004 | 12:00 a.m. CST; updated 4:49 p.m. CDT, Monday, July 21, 2008

Marilyn Petersen hurries into University Hospital’s Fit for Life center, pulling a T-shirt over her head and lacing her sneakers in preparation for her new routine.

A freshly minted health nut at 62, Petersen boasts that she’s the picture of wellness. With her intense daily regimen of walking, biking and weight lifting, it’s hard to argue.

Then she lowers her voice for a darker tale, recounting the price she paid for her bragging rights.

Only three months ago, Petersen spent Friday afternoons at home, cigarette in hand, taking care of everyone around her and ignoring the warning signs of heart disease. In the evenings, she suffered pains in her arms and chest and shortness of breath, which she chalked up to asthma and treated with an inhaler.

“I thought nothing of it,” Petersen said. The pain intensified until one night in mid-July, when Petersen’s husband, Mark, insisted on taking her to the University Hospital emergency room. Within a half-hour, she was lying in the intensive-care unit.

“I kept saying, ‘There’s nothing wrong with me,’ not to give me aspirin because it upsets my stomach,” Petersen said. Instead, the doctors gave her a stent, a mesh tube used to hold open a blocked artery. Two months later, she had another four stents put into another clogged artery.

Petersen had many risk factors for heart disease. A diabetic with high blood pressure and high cholesterol, she was inactive and a longtime smoker and had a family history of the disease.

Now, she is at the conclusion of a before-and-after transformation.

“I can breathe now,” Petersen said, pausing to convey the gravity of her statement. “I would tell everyone to stop smoking, eat healthy and exercise.”

Angela Winterbower, community information specialist at Boone Hospital Center, is hoping for earlier, less dramatic awakenings.

Winterbower is leading a campaign to penetrate health centers, offices, malls and schools with a message of cardiac awareness.

The nationwide program, Women’s HeartAdvantage, was unveiled in Columbia this month with a day of free health screenings at Hy-Vee. It aimed to educate women about the risk factors and symptoms of heart disease.

The initiative grew out of a buried statistic — that heart disease is the No. 1 killer of women in the United States. Yet even with one-third of all women dying from the disease, Winterbower said, the condition is largely misunderstood and underemphasized.

“The vast majority of people overall think that breast cancer is the number-one killer of women,” she said. But the American Heart Association says heart disease claims more lives than the next seven leading causes combined, including all cancers.

In preparation for the Women’s HeartAdvantage program, Boone Hospital surveyed 500 women in Columbia and surrounding areas between ages 40 and 70.

Results showed that 81 percent of the women who responded to the survey are at risk for a first heart attack — but only 29 percent are aware of the risk.

The program’s kick-off celebration attracted more than 300 women who tested their blood pressure, cholesterol and levels of glucose. Also available were body-mass index measurements, which map the relationship between height and weight and can predict cardiac risk.

A Women’s HeartAdvantage advisory committee is planning outreach efforts for low-income women in the spring. Education and screening events at malls, school fairs and businesses are planned for next summer.

As manager for Boone Hospital’s health and wellness center, Wellaware, Dan Smith was on the scene alternating between needles and stethoscopes.

In his 20 years with Wellaware, Smith said, he has observed important differences between men’s and women’s cardiac health.

While men tend to experience more obvious signs — the sensation of an elephant crushing their chests, jaw pain or tingling and numbness in the left arm — women are more likely to experience weakness, shortness of breath and nausea, he said.

“Women might have a little indigestion and not know they have early signs of heart disease,” Smith said. “Or they’re just tired and they put that off to getting older.”

Wellaware meets many clients after they’ve been through a cardiac event. The center’s cardiac program offers three phases of fitness, nutrition and education programs. Wellaware serves more than 600 clients.

Wellaware also has a three-month outpatient program for cardiac patients who have recently been in the hospital. It monitors clients through an EKG machine during exercise.

The next phase, called the maintenance program, is a mixture of outpatient graduates and other at-risk customers who pay $70 per month to use the same facilities. University Hospital’s Fit for Life center follows a similar model.

With elaborate exercise machines and cheerful music, Wellaware looks like a typical gym — except the average age of clients is 70.

In a row of stationary bikes, Jo Ann Allen, 67, sits with a book in hand, pedaling steadily. A Wellaware regular, Allen first came to Boone Hospital after a heart attack gripped her in the middle of one night in February 2003.

Allen vividly remembers the severe cramp in her left arm that spread across her chest and to her right arm.

She says now that she should have seen it coming. Allen was a smoker since age 17 and was taking steps to quit before her heart attack.

She was overweight, had high blood pressure and had become accustomed to a sedentary lifestyle in the house where she took care of her invalid mother. She ignored warnings about her health and was terrified of being reliant on pills.

“I had all the classic warning signs, but I didn’t know them,” she said.

The lack of awareness is partly because of the lack of cardiac research specific to women, said Armine Alioto, coordinator for Fit for Life, a cardiovascular and pulmonary rehabilitation and prevention service at University Hospital.

“Most symptoms that we know are based on studies on white, middle-aged men,” she said.

It wasn’t until 1999 that the American Heart Association published guidelines for women. The organization’s latest guidelines, released this year, emphasize that heart disease is no longer being approached as a “have or have not” condition but as a continuum of cardiovascular risk.

Echoing warnings from other medical professionals, Alioto believes a shift in financial focus on prevention and diagnosis will save insurance companies money on costly treatments and medications.

But until these changes materialize, she urges women to take control of their cardiac health with regular exercise.

A divide exists between men and women over how they approach their health, Smith said. Women tend to be insecure in discussing and investigating health concerns, and they are less comfortable with the atmosphere of formal exercise and sports and more inclined to deny their illness to appear strong for others, he said.

Allen said she reflected those behaviors before and during her heart attack.

“I was so embarrassed,” Allen said of the time she spent waiting for the paramedics. “I kept thinking, ‘How stupid of me to get myself into this.’ ”

Allen has kept her heart attack a secret from most of her friends. She still feels guilty about ignoring the warning signs but says a new appreciation for health has emerged from the experience.

“I really pay attention now,” she said, winding down on her exercise bike. “I always felt like I was so busy doing things, I didn’t have time to have fun. Now I feel like I’m building memories.”

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