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Heart HEALTH An Issue Women Can’t Ignore


This is care for generations. Our goal is keeping the people of our communities healthy so they can live the way they want. This is why we’re continuing to innovate, and to expand and invest in the areas we serve, the conditions we treat, and the people we care for.

This is Penn State Health.

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Dear friends and colleagues, Do you know your cholesterol and blood pressure numbers? Many women do not. Are you aware of your risks for heart disease? Many women are not. But not knowing these things can put you at greater risk for heart disease … and death. I think most women have an inherent fear of developing breast cancer; it’s understandable. But women are at greater risk for heart disease, and unfortunately, heart attacks are generally more severe in women than in men. Statistically, women are more than 50% more likely to die than men in the first year after a heart attack. Women’s most common heart attack symptom is chest pain and discomfort; however, we also suffer different symptoms than men, particularly shortness of breath, nausea/vomiting and back or jaw pain. We are grateful to Penn State Health Milton S. Hershey Medical Center for sponsoring this special insert that highlights heart health, an issue women can’t ignore. But even more importantly, we appreciate the knowledge and expertise that members of their staff have shared so that we can take steps to reduce our risks or to know our options if one of us or someone we love learns they have heart disease. We also thank two local women who have shared their stories about their conditions, treatments, and roads to recovery. Please take some time to read through this special insert. It should awaken you to the fact that we women should be paying more attention to our risks for heart disease and what is already going on within our bodies and to take action.

Inside:

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Heart-Healthy Habits

7 heart-healthy habits you can follow.

5, 13 Personal Life Stories 6 Women and Heart Disease

Different heart disease factors can impact women.

8 Transcatheter Aortic Valve Replacement A minimally invasive procedure for high-risk patients.

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Heart-Healthy Habits

By Lisa A. Beach Show your heart some love! Celebrated annually in February, American Heart Health month provides the perfect opportunity to take a look at how you can protect your heart through a healthy lifestyle. As a major cause of disability, heart disease can also restrict activity and diminish quality of life for people living with this condition. But a recent study published in the Journal of the American College of Cardiology found that, no matter what your age, it’s never too late to improve your health. That’s great news because there are plenty of things you can do to prevent heart disease. But before jumping into some solid, heart-healthy habits, get a quick refresher on what a heart attack or stroke looks like. Be Symptom Savvy First, it helps to know how to spot the signs of heart disease. In the early stages, heart disease symptoms are either nonexistent or barely noticeable. This makes annual exams a must, allowing your doctor to ask questions and run tests, as needed. But when heart disease progresses to the point of a heart attack or stroke, knowing the signs could help save your life. According to the American Heart Association, call 911 if any of these signs are present: Heart Attack: • Chest discomfort or pain (usually in the center, lasting more than a few minutes) • Upper body discomfort (arms, back, neck, jaw, or stomach) • Shortness of breath (with or without chest discomfort) • Other signs (such as a cold sweat, nausea, or lightheadedness)

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How to find time to exercise at the office.

Exercise at Work

Stroke (remember F.A.S.T.): • Face drooping or numb on one side

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Menopause and Heart Disease

• Arm weakness or numbness

linked to higher risk for heart disease.

• Time to call 911 if person shows any of these symptoms

Increased testosterone levels during menopause

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Heart Matters

A dynamic new online DIY heart-health checkup.

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Recipes

Greek cucumber walnut bites and banana bread

• Speech difficulty

Heart-Healthy Habits Now that you’re savvy about symptoms, you can take preventive steps to reduce the chance of a heart attack

overnight oats.

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or stroke occurring. Follow these healthy lifestyle guidelines from the American Heart Association. 1. Get active. Aim for a minimum of 150 minutes per week of moderate aerobic exercise or 75 minutes per week of strenuous aerobic exercise. One of the simplest ways to do this? Walk more. Other aerobic activities include gardening, swimming, and tennis. If you can work in activity to increase flexibility, improve balance, and strengthen muscles twice a week, even better. Stuck for ideas? Try yardwork (think raking leaves or pushing a lawnmower), bike riding, or yoga. Tip: Schedule exercise on your calendar, making it easier to stick to a routine. Strive for 30 minutes of exercise five days a week, or 20-25 minutes of activity every day. 2. Eat better. Focus on eating mostly a plant-based diet, with whole fruits and veggies making up the bulk of the food you eat every day. When eating grains, choose a variety of whole grains, such as barley, brown rice, bulgur, millet, oatmeal, and whole wheat. For dairy (e.g., cheese, milk, yogurt), opt for low-fat and fat-free. Consume heart-healthy proteins, such as fish, skinless poultry, lean meat, eggs, nuts, seeds, beans, and legumes. When adding fats, choose polyunsaturated oils (such as sunflower and safflower oils) and monounsaturated oils (such as olive, peanut, and canola oils). Avoid saturated and trans fats, such as those found in whole milk, butter, tropical oils, and processed foods, such as cookies, cakes, and crackers. Tip: Limit salty foods, sugary drinks, sweets, and highly processed foods; drink plenty of water; and watch portion sizes. 3. Lose weight. Extra pounds can lead to a variety of health issues. Learning to move more and eat healthier helps you shed pounds and maintain a healthy weight. Keeping a food journal can help you see what you’re eating and how much. Tracking your exercise gives you a glimpse into the frequency and level of activity. Tip: Use tools to help you track your activity, such as a Fitbit, a fitness app on your cellphone (many are free!), or simply marking exercise on a calendar. 4. Control cholesterol. A fat-like substance, cholesterol comes from two sources: food from animal sources and your body. The “good” cholesterol is HDL (high-density lipoprotein) and the “bad” cholesterol is LDL (low-density lipoprotein). The HDL is good because it helps reduce plaque buildup in arteries, partially caused by LDL sticking to artery walls. Plaque buildup blocks blood flow, which can lead to heart disease. Ask your doctor about getting a blood test to measure your 4

Heart Health 2020

cholesterol level. Tip: Healthy lifestyle choices to control cholesterol include eating healthier, exercising, choosing healthy fats, and quitting smoking. 5. Manage blood pressure. Know your numbers and what they mean. Blood pressure records two values: systolic (the pressure in the arteries when the heart beats) and diastolic (the pressure in the arteries when the heart is resting between heartbeats). It’s written similarly to a fraction, with the systolic number on top and the diastolic on the bottom. Normal blood pressure is 120 (or less) over 80 (or less), and elevated blood pressure is 120-129 over 80 (or less). High blood pressure (also known as hypertension) starts at 130 over 80 (or higher). Tip: Healthy lifestyle choices to manage blood pressure include eating healthier, exercising, maintaining a healthy weight, quitting smoking, and reducing the amount of sodium you eat. 6. Reduce blood sugar. Your body turns much of the food you eat into glucose (or blood sugar) to use for energy, so it’s important to make smart food choices. If your blood sugar level is too high, it can damage your heart (and other parts of your body) and cause diabetes. Tip: Healthy lifestyle choices to reduce blood sugar include eating healthier, exercising, maintaining a healthy weight, and quitting smoking. 7. Stop smoking. If you smoke, you increase your chances of developing heart disease (and lung cancer). Quitting smoking should top your list of heart-healthy choices. The longer you smoke, the more damage you do to your body. The good news? Your body begins to heal itself as soon as you stop smoking. In just one year of quitting, you’ve cut your risk of heart disease by 50%! Tip: Make a plan to quit, whether that means going cold turkey, cutting back gradually, using a nicotine replacement, or seeking help from a health provider. Visit https://smokefree.gov/ for free resources to help you quit smoking. Use American Heart Health Month as the perfect opportunity to start showing your heart more love. Take steps today toward a healthier lifestyle with these seven heart-healthy habits. Lisa Beach is a freelance journalist and copywriter. Her work has been published in The New York Times, Good Housekeeping, Eating Well, USA Today, Go Escape Florida & Caribbean, Parents, and dozens more. Check out her website at www.LisaBeachWrites.com. Originally published on www.AmeriDisability.com. Reprinted with their permission.

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From Coronary Care Nurse to Patient By Lynda Hudzick As a retired coronary care nurse, Sandy Norcross knows a little bit about heart health. One of her biggest heart-related pieces of advice to women is to keep in mind that “sometimes women have different heart symptoms from men,” she said. “My advice is to have regular checkups by your family physician, and if you think something is not right, say something.” Norcross knew she had a heart murmur (aortic stenosis) and controlled high blood pressure for at least 12 years but didn’t necessarily realize that someday she would need surgery to correct the heart problem. “I had my first echocardiogram in 2009, and about three years ago, I was referred to a cardiologist,” Norcross said. After more frequent visits, it was recommended that she see a cardiac surgeon as the tests indicated the stenosis was getting to be more severe. “I wasn’t having any symptoms,” she said. “I asked to be referred to Penn State Health Milton S. Hershey Medical Center and was seen by Dr. Conte.” She was told about a new technique called a transcatheter aortic valve replacement (TAVR), and she decided to have the procedure done before any significant damage to her heart occurred. Norcross said she wasn’t nervous, but instead, after successfully completing all of her pre-op testing and instructions about the procedure, she was ready. “The whole procedure was mind-boggling and awesome,” Norcross said. “It took about 1 ½ hours. You are not ‘put to sleep’ for this; just an IV for light sedation.” Following the procedure, she was on bedrest for four hours but experienced no pain or nausea. Norcross considers it a great success. “I have resumed walking at our local park and realize now that I was having slight chest heaviness when I was walking up the hills,” Norcross said. She suggests that losing weight and making sure you have some type of physical activity at least three days a week can go a long way toward maintaining good heart health.

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Different Heart Disease Factors Can Impact Women

By Barry Sparks Ask women what’s the leading threat to women’s health and the most likely answer will be “breast cancer.” That misconception has existed for at least a decade. In fact, it’s heart disease — by a large margin. According to the Centers for Disease Control and Prevention, about 41,000 women die of breast cancer each year. Heart disease in women accounts for about seven times more deaths. Ten times as many women have a history of heart disease than breast cancer. According to Annick Haouzi, M.D., a cardiologist at Penn State Health Milton S. Hershey Medical Center, some factors put women at greater risk for heart failure than men. Those factors include diabetes, high levels of uric acid, and cancer. “While neuropathy, disease of the nerves, is the most common complication of diabetes, most diabetic patients will die from a cardiovascular complication,” says Haouzi. “We already knew that diabetes was a factor of atherosclerosis, the building up of fatty plaques in the arteries. And now, we just found that women with diabetes are at a greater risk of heart failure than men.” A recent study revealed that women with Type 1 diabetes had a 47% higher risk of heart failure than men. Women with Type 2 diabetes, the most common type, had a 9% higher risk of heart failure than men. 6

Heart Health 2020

Men generally have heart disease in their 50s, about a decade earlier than women. For diabetic women, however, the cardiovascular risk occurs earlier. John Osborne, M.D., an American Heart Association spokesman, said women may have had a prolonged exposure to high glucose levels, which can affect the heart’s ability to function. He said it can take up to two years longer for women to be diagnosed with diabetes than men. As a result, they spend longer in the prediabetes stage than men. “Diabetes is bad for everyone, but in women, it’s really bad,” says Osborne. Haouzi adds that it’s important for women to better manage their diabetes, cholesterol, and high blood pressure. She says there are a number of new medications for treating diabetes, and several more medications are in development. Unfortunately, one-third of women who have diabetes don’t know they have it. A number of healthcare organizations recommend women have their blood glucose tested, particularly if they have a history of diabetes. Haouzi believes it’s important for women to lower their blood pressure. She recommends following the DASH (Dietary Approaches to Stop Hypertension) diet. Losing weight and regular exercise tend to reduce your blood pressure. In 2017, the American Heart Association and the American www.BusinessWomanPA.com


College of Cardiology lowered the threshold for what’s considered to be high blood pressure. Instead of 140/90 mm/Hg, it is now 130/80 mm/Hg. Although gout is a much less common disease than diabetes, it’s another factor that can put women at a greater risk for heart disease. It was once thought that women didn’t get gout, but that’s no longer the case. In the past 20 years, cases of gout have more than doubled among women. Two million women have gout in the United States, according to the Arthritis Foundation. “Gout is an inflammatory form of arthritis that causes joint swelling and pain, often in the big toe. It occurs when high levels of uric acid build up in the blood,” says Haouzi. Physicians think high levels of uric acid increase inflammation and make blood platelets “stickier,” which can lead to blood clots. A Canadian study showed that women with gout were 39% more likely to have a heart attack than women who didn’t have gout. The risks were significantly higher among the women than the men. Men with gout were only 11% more likely than those without the disease to have a heart attack. Annick Haouzi, M.D., cardiologist at “Although it’s unclear why gout Penn State Health Milton S. Hershey Medical Center. may increase the risk of cardiovascular disease, it can be effectively treated with medication,” says Haouzi. between the two diseases.” Because gout can affect the heart, as well as other organs, it One clinical trial is testing whether statin drugs, which are should never be ignored. taken to lower cholesterol and reduce heart disease risk, may Women are much more familiar with breast cancer help preserve heart function during cancer chemotherapy. than gout. A five-year survival rate for women diagnosed Haouzi stresses the importance of a healthy lifestyle in with invasive breast cancer is 9%. In fact, women who are regards to lowering the risks for both breast cancer and heart diagnosed with breast cancer today are more likely to die from disease. cardiovascular disease than breast cancer. “Eating right, exercising regularly, not smoking, lowering Some treatment options for breast cancer put women at a your blood pressure, and maintaining a healthy weight all have greater risk for other health problems. Heart disease appears positive effects on your health. Take your health seriously,” she more commonly in women treated for breast cancer because advises. of toxicities of chemotherapy, radiation therapy, and use Women should be evaluated for heart disease risk while they of aromatase inhibitors that lower estrogen, according to are being treated for breast cancer. They also should be followed BreastCancer.org. for increased risk after cancer treatment. “Cancer’s relationship to heart disease has not been well “Heart disease can be devastating, and women, with studied,” points out Haouzi. “It is a major concern. One advancing age, certainly have more risk factors than men,” says can beat cancer and unfortunately die from cardiovascular Haouzi. “Research and studies are being conducted to learn complications related to the cancer itself or its treatment. More more. In the meantime, women need to focus on preventative studies are being conducted to learn more about the connection care.” www.BusinessWomanPA.com

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TAVR Offers an Option to a Broader Array of Heart Patients By Barry Sparks

significant,” says Denise Rhodes, structural heart coordinator, Interventional Cardiology, Penn State Health Milton S. Hershey Medical Center. “The fact that TAVR is now available Open heart surgery has been the standard treatment for to all patients is good news.” people who suffer from severe aortic stenosis, a condition where Rhodes says severe aortic stenosis may be caused by a the aortic valve becomes diseased. congenital heart defect, a calcium buildup on the valve, or a The valve leaflets, or cusps, are tightly fitting, triangularshaped flaps of tissue. They are pushed open to allow blood flow history of rheumatic fever. Symptoms of severe aortic stenosis include chest pain, and then close together to seal and prevent backflow. When dizziness, fatigue, shortness of breath, and an irregular diseased, the valve leaflets become stiff and thickened. As a heartbeat. result, they have a difficult time opening and closing. The heart “The symptoms typically start to limit a person’s daily has to work harder to pump blood to the body. activities,” says Rhodes. “They often get to the point where For some people, however, open heart surgery was too risky they can’t take care of themselves. It can become an issue for of an option. Either they were in poor health, or they were too the entire family. TAVR alleviates old. many of the symptoms, allowing In 2012, the Food and patients to assume their daily Drug Administration approved activities and possibly continue to live Transcatheter Aortic Valve independently. It’s a win-win for the Replacement (TAVR), a minimally patient and family members.” invasive procedure, for high-risk Rhodes adds that TAVR allows patients with severe aortic stenosis. low-risk patients to return to work According to the American Heart sooner. Association, nearly 500,000 people in It’s extremely important that the United States suffer from severe patients diagnosed with severe aortic aortic stenosis. It usually occurs in stenosis take action. Rhodes says those 75 or older. In April 2019, Mick research has shown that if patients Jagger, the 75-year-old lead singer with severe aortic stenosis do nothing for the Rolling Stones, underwent a after being diagnosed, half of that TAVR procedure. population will be dead in two years. After several years of highly Patients may be referred to a heart successful clinical trial results, the specialist by their family physician procedure was approved for those at or another specialist. Referred moderate risk for surgery. In August patients need to undergo a heart 2019, TAVR was approved for those catheterization and CT scan and with a low risk for surgery. Now, meet with a cardiothoracic surgeon patients, who in the past may have and an interventional cardiologist. had open heart surgery to replace If a TAVR is scheduled, the an aortic valve can be considered a patient is required to limit his or her Denise Rhodes, structural heart coordinator, candidate for the TAVR procedure. physical activity for approximately Interventional Cardiology, Penn State Health “The success rate and effectiveness a week prior to the procedure. The Milton S. Hershey Medical Center. of TAVR have been clinically

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Heart Health 2020

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A transcatheter aortic valve replacement (TAVR) is used in patients whose own aortic heart valve is diseased due to calcium build up, which causes the valve to narrow (aortic stenosis) and restricts blood flow through the valve.

patient is not permitted to drive, lift heavy objects, or perform housework or yardwork during that time. The TAVR procedure is performed by a multidisciplinary team, which includes a cardiothoracic surgeon, an interventional cardiologist, echocardiographers, and others. During the procedure, the team delivers a fully collapsible replacement valve to the valve site through a catheter that is inserted into a large artery in the groin or chest. Once the new valve is in place, it is expanded, pushing the old valve leaflets out of the way. The tissue in the replacement valve takes over the job of regulating blood flow. This is considered a minimally invasive procedure, which is similar to a stent placed in an artery within the heart. Typically, a large percentage of TAVR patients are discharged one day post-op, according to Rhodes. Patients have clinical follow-ups at one month and one year with their cardiac specialists. They continue to be seen by their family physician on a regular basis. “We are using the third generation of FDA-approved valves,” points out Rhodes. “We have experienced improvements in the procedural aspects of TAVR and the equipment. As a result, we can perform the procedure quicker, and patients spend less time in the hospital and recovering.” Penn State Health Milton S. Hershey Medical Center has performed approximately 600 TAVR procedures since 2014. Most patients who undergo TAVR begin cardiac rehabilitation within a few days or weeks. Recovery is much different from open-heart surgery since patients don’t have a chest incision. Patients are encouraged to talk to their doctor or therapist about realistic goals and a timetable. It is common to experience some pain at the catheter incision site for several days. Wound healing at the site takes about two weeks. www.BusinessWomanPA.com

It’s important to return gradually to your daily activities. In most cases, doctors encourage walking for short periods after TAVR. Doing too much too fast can cause problems. It may take several weeks to months before a patient returns to all of their regular activities. It will depend on their overall health and heart health. Looking ahead, Rhodes says the TAVR procedure will be performed more often, particularly since more people are eligible. TAVR, however, will not totally replace open heart surgery. “There are times when open heart surgery is appropriate,” she says. “TAVR simply offers an option to a broader array of patients. It’s a good feeling knowing we can offer patients an alternative to open heart surgery.”

The positioning of the new TAVR on the delivery system inside of the native aortic valve. The compressed valve is expanded using a balloon, which is deflated and removed.

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How to Find Time to Exercise at Work By Barry Sparks An age-old question is: “Where do you find the time to exercise, particularly if you have a desk job?” Roxanne Hollen, an exercise physiologist at Penn State Health Milton S. Hershey Medical Center, Cardiac Rehab and Wellness Program, says it may not be as difficult as you think. “Being intentional and conscious about being more active, a desire to build healthy habits, and a little creativity are keys to finding the time to exercise,” she says. Exercise has a multitude of benefits. It improves heart health, relieves stress, helps with weight management, decreases the need for medication, and improves sleep. Exercise doesn’t just affect your health; it also affects your productivity at work. According to studies in the American College of Sports Medicine:

won’t interrupt your work.” Women can use 1- to 5-pound dumbbells at their desks. Arm exercises are easy to do while you are on an individual phone call or a conference call. Blogger Sabrina Son suggests some other possible desk exercises: Hovering leg raise: Sit upright in your chair and raise both legs so they are parallel to the floor. Slowly lower your legs until they are hovering an inch or two above the ground. Hold the position for as long as you can, and then release. Football fast feet: Sit in your desk chair with your feet flat on the ground. Rapidly tap your feet in place, just as you would

• 6 0% of employees said their time-management skills, mental performance, and ability to meet deadlines improved on days they exercised. • 2 7% of employees reported higher levels of “dealing calmly with stress” on days they exercised. • 4 1% of employees reported higher rates of “feeling motivated to work” on exercise days. The American Heart Association guidelines recommends adults should get 150 minutes a week of moderate aerobic activity, such as ballroom dancing or walking, or 75 minutes of vigorous activity, such as biking or jogging. Most adults, however, don’t get enough physical activity or muscle-strengthening activity, such as resistance training. Less than 25% of Americans are meeting all national physical activity guidelines, according to a report from the Centers for Disease Control and Prevention’s National Center for Health Statistics. Kelli Calabrese, an exercise physiologist and spokesperson for the American Council on Exercise, says improving your health rate variability — your heart’s ability to jump from resting to “pumped” — has been shown to increase longevity and decrease heart disease risk. Since most Americans spend seven hours a day sedentary, Hollen stresses it’s important to take advantage of that time. She recommends asking your supervisor if you can get a standing desk or a stability ball instead of a chair. Both will increase your activity and strengthen your muscles. Hollen suggests office workers do core training and leg lifts at their desk. “March in place and be active with your legs,” she says. “It

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Heart Health 2020

Roxanne Hollen, an exercise physiologist at Penn State Health Milton S. Hershey Medical Center, works with patients to get them back to their best health.

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Alexis Vogel, a nurse in Cardiac Rehab at Penn State Health Milton S. Hershey Medical Center, sitting at the desktop getting in a few ab swivels.

do if you were running in place. Do this for 30 seconds, and then pause. Repeat for another 30 seconds. Chair dips: For this exercise you need an office chair that won’t roll away from you. Scoot up to the very front edge of your chair, place your legs out in front of you, and place your hands on either side of your hips, fingers pointing toward your desk. Grasp the edges of the chair with both hands, and use your core and arms to raise your body up off the chair and then down so that your rear goes down to the floor. Push yourself back up, and repeat 15 times. Swiveling abs: Sit upright in your swivel chair and lift your feet off the ground. Lightly hold on to the desk with your fingers. Make sure your hands and arms aren’t doing all the work. The goal is to use your core oblique abdominals. Use those abs and the rest of your core to swivel the chair from left to right and back again. Leaning plank: Step back so you are at least 1 foot away from a wall and then lean forward against it, using only your forearms for support. Hold this position for as long as you can. Setting your smartphone or Fitbit alarm to go off every 45 www.BusinessWomanPA.com

Jackie Brow, an exercise physiologist at Penn State Health Milton S. Hershey Medical Center, shows how easy it is to lift dumbbells while working.

minutes to remind you to get up and walk or stretch helps to develop a healthy habit. Walk up a couple flights of stairs, down the hallways, or to a colleague’s office or cubicle to tell them what you would have sent them in an email. Vow to take the stairs instead of the elevator. Here are some additional workplace exercise tips from the Michigan State University Extension: • Park in the back of the parking lot. • Put your office filing cabinet across the room, making you get up when you need an item. • Use the restroom the farthest from your office. Lunchtime is a big opportunity to squeeze in some physical activity, says Hollen. Is there a possible paved walking route close to your office? Are there walking trails? Can you find a friend or co-worker to walk with? Perhaps you can only walk 10 minutes, but that’s OK. All physical activity mounts up. “Some exercise is better than none,” stresses Hollen. “Set small and realistic goals at first. Eventually, your small goals will get larger. Forming a habit is key.” Heart Health 2020

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A Brief Pause for Menopause and Heart Disease An increase in testosterone levels during menopause is linked to a higher risk for heart disease By Dawn Klingensmith Hormonal changes preceding menopause are known to cause hot flashes, night sweats, irritability, and loss of libido. Now, new research suggests shifting hormone levels puts certain women at risk for cardiovascular disease, and the so-called “male” hormone, testosterone, is to blame. Estrogen levels nosedive as a woman transitions into menopause, so the naturally occurring testosterone in her body eventually predominates. Testosterone exists in either a bound or “free” state. Bound testosterone is partnered with a protein that renders it inactive, while free, or bioavailable, testosterone is at liberty to “cause some action” in the body. Free testosterone might also cause some trouble. It had already been established that women tend to develop cardiovascular disease 10 years later than men, with a marked increase throughout the menopausal years. In fact, women older than 55 are more likely than men to have the disease. A nine-year study of 949 women shows a link between elevated bioavailable testosterone levels and the development of metabolic syndrome, a constellation of health risks that increases the chance of getting heart disease, stroke, and diabetes. Over the course of the study, 24% of the women developed the syndrome; of those, 55% had rising levels of active testosterone. By comparison, only 39% of women who did not develop the syndrome had rising amounts. After adjusting for age, weight, and a host of other factors, the researchers estimated 12

Heart Health 2020

that women with an increase in testosterone are almost twice as likely to develop metabolic syndrome. Getting diagnosed with metabolic syndrome is an early warning sign of diseases that might develop over time. Overall testosterone levels decrease throughout adulthood, and by the time a woman is approaching menopause, the deficiency can diminish or kill her sex drive, among other unfortunate outcomes. A woman suffering from menopausal symptoms associated with low testosterone should not be afraid to incorporate it into her hormone replacement therapy, if her physician recommends that course of action. Generally speaking, though, hormone therapy is not as widely prescribed as it once was, and women who glide through “the change” with relative ease probably should forgo it. ©CTW Features

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Be a Little Selfish A Personal Story By Lynda Hudzick As a recently retired nurse who spent many years working in the ICU open heart care unit and the cardiac catheterization lab, Deb knew the signs of heart trouble. In the early spring, she started experiencing pain and a great shortness of breath, something that gradually got worse over a three-week period until “it really hit when I was at the grocery store,” she recalls. “I couldn’t unload the groceries; I had to sit down, and I just couldn’t breathe,” Deb said. “It wasn’t chest pain. It was back pain and shortness of breath, and I had no doubt at all what was going on, so I called a neighbor and she took me to the hospital.” It was determined that Deb was experiencing a type of heart attack known as a non-ST-elevation myocardial infarction (NSTEMI). A cardiac catheterization was performed and a stent put in a proximal left anterior descending artery. “It wasn’t a long procedure, and I felt immediately better,” Deb recalled. Recovery was a positive and eye-opening experience. “I worked for years in ICU, but you never know what happens to people when they leave,” she said. “I never understood how helpful cardiac rehab is … I went for 12 weeks and felt so much better.” Deb continues to follow what she learned in rehab with changes in her lifestyle that are serving her well. “I’m not eating processed sugars, I walk a few miles a week, and I sleep a lot better. People notice how much better I look,” she said. But the most important factor on the road to recovery was realizing that there is nothing wrong with “being a little selfish and putting myself first,” she said. “I recently retired and it’s wonderful,” Deb said. “Stress and hereditary factors played a big role in my situation, and I needed to make some changes.” In a way, Deb admits that she’s sometimes glad she experienced the heart attack because it forced her to pay attention to her own health. “I would advise that every woman find even just 30 minutes a day for herself,” she says. “And allow people to help you when you need it. Maybe you think you can do it quicker or better, but allowing others to help allows them to show you that they love you.”

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Heart Matters A dynamic new online DIY heart-health checkup adds up to better long-term health for women

By Mark L. Fuerst Using a new online tool, women across the country can now track their “heart-a-scope” or heart disease risk over the next 10 years. Developed by the American Heart Association (AHA), the easy-to-navigate tool helps women put their heart disease risk into context and identifies lifestyle issues that could potentially put them at risk for heart disease. The new tool also can help provide a backdrop for a conversation with your doctor about heart disease and encourage you to know your own personal risks. These include family history, lifestyle risks such as being overweight or smoking cigarettes, or other signs of heart disease, such as high blood pressure and high cholesterol levels. Although awareness for heart disease risk is on the rise, 1 out of 5 doctors do not diagnose heart disease among women. At the same time, consumer surveys have found that women are less concerned about their individual heart health but are more concerned about their friends’ and family’s heart health. In fact, a recent study showed that one-third of women underestimate their personal risk of heart disease, and a majority don’t know what cholesterol, blood pressure, and blood sugar levels are healthy for them. Nearly 30,000 people logged onto the “Go Red Heart Checkup” tool within the first month that it was launched on the internet (www.goredforwomen.org/en/healthy-living/ healthy-lifestyle/my-life-check--lifes-simple-7). By entering key health numbers (including weight, blood pressure, and cholesterol levels) and information about your lifestyle (such as how frequently you exercise and whether you smoke), you can receive a report that reveals your risk of having a heart attack or suffering from heart disease in the next 10 years. The Go Red Heart Checkup report also identifies the risk factors you can change and provides a personalized action plan you can print out and discuss with your doctor. That action plan may include suggestions such as losing weight, reducing stress, stopping smoking, or managing your blood pressure. After answering a series of questions, you are able to print 14

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out your own personal heart-o-scope profile and take this to your next doctor’s appointment to address any concerns you may have. The online tool also is available in hard copy (call the AHA at 1-88-MY-HEART) if you prefer that format. If you do not already know your pertinent numbers, such as blood pressure, cholesterol count, and fasting glucose, you can simply download the blood test approval form found on the website and take or fax it to your doctor to order a blood test. Once the blood test determines your numbers, you can enter them into the tool and get your personalized heart-health check. The AHA has long urged women to know their health numbers: “good” (high-density lipoprotein, or HDL) and “bad” (low-density lipoprotein, or LDL) cholesterol counts, blood pressure, fasting glucose, body mass index, waist circumference and minutes of physical activity performed each day. Now, you can determine for yourself whether your numbers add up to a high risk of heart disease or stroke, and then decide what to do about it. The Go Red Heart Checkup gives you a firsthand, personalized way to learn your risks and get useful recommendations for taking the first steps toward a hearthealthy lifestyle. Both user-friendly and comprehensive, the Go Red Heart Checkup takes all major risk factors for heart disease into consideration, including diabetes and metabolic syndrome. For example, diabetes makes a woman two to four times likelier to die from heart disease than a woman without this condition. Metabolic syndrome is defined as someone having any three of the following five diagnostic measures, each of them an indication of increased heart disease risk: elevated waist circumference, triglycerides, blood pressure, and fasting glucose and reduced HDL cholesterol. The risk of heart disease increases substantially over your lifetime if you do not control or manage your risk factors. The more risk factors you have, the greater your chances of developing heart disease and having a heart attack or stroke. The new tool can help you identify, then work on, risk factors, even if you have only one or two. © CTW Features

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Show Your Heart Some Love While heart disease is a leading cause of death for both men and women in the United States, many of the risk factors associated with the condition can be controlled with dietary and lifestyle changes. By centering your meals around betterfor-you ingredients and recipes, you can show your heart some extra love. Consider walnuts, which are a heart-healthy food certified by the American Heart Association. More than 25 years of research shows walnuts may play a key role in heart health. In fact, the U.S. Food and Drug Administration approved one of the first qualified health claims for a whole food, finding that eating 1 1/2 ounces of walnuts per day as part of a low-

saturated-fat and low-cholesterol diet, while not increasing caloric intake, may reduce the risk of coronary heart disease. Additionally, walnuts are the only nut significantly high in omega-3s, with 2 1/2 grams of alpha-linolenic acid per ounce. Walnuts can add this essential nutrient to dishes like these certified American Heart Association Heart-Check Mark recipes for Greek Cucumber Walnut Bites and Banana Bread Overnight Oats. Find more information and heart-healthy recipes at walnuts. org/heart-health. (Family Features)

Greek Cucumber Walnut Bites

Banana Bread Overnight Oats

Recipe courtesy of Beth Stark, RDN, LDN, on behalf of the California Walnut Board Prep time: 25 minutes Servings: 6

Recipe courtesy of Crowded Kitchen on behalf of the California Walnut Board Prep time: 15 minutes Servings: 4

• 1/2 cup walnuts, chopped • 1 English cucumber, ends trimmed (about 14 ounces) • 1/2 cup roasted red pepper hummus • 1/2 cup reduced-fat crumbled feta cheese • 5 cherry tomatoes, quartered Heat oven to 350 F. On small baking sheet, arrange walnuts evenly. Bake 8 minutes, checking frequently, until toasted. Slice cucumber crosswise into 3/4-inch thick slices. Using a small spoon, gently scoop out and discard center of each cucumber slice, leaving bottom and sides intact. In small bowl, stir 6 tablespoons chopped walnuts and hummus. Spoon walnut-hummus mixture into each cucumber slice and top with reserved chopped walnuts, feta cheese, and quartered tomatoes.

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• 3 ripe bananas, sliced • 2 cups old-fashioned oats • 1 tablespoon ground cinnamon • 1/2 teaspoon salt • 1 teaspoon vanilla • 3/4 cup chopped California walnuts, divided • 1 tablespoon maple syrup • 3 cups skim milk In large container with lid, add sliced bananas. Use potato masher or fork to mash bananas until smooth. Add oats, cinnamon, salt, vanilla, half the chopped walnuts, maple syrup, and milk. Combine thoroughly and refrigerate overnight. To serve, divide among four canning jars or glass containers with lids. Top each with remaining walnuts before serving.

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pennstatehealth.org/ChildrensHeart

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Heart Health – An Issue Women Can't Ignore  

Heart disease deaths in women have decreased more than 30 percent over the last 10 years. But we need to keep the momentum moving forward by...

Heart Health – An Issue Women Can't Ignore  

Heart disease deaths in women have decreased more than 30 percent over the last 10 years. But we need to keep the momentum moving forward by...

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