What are the Symptoms of a Heart Attack? What are the Symptoms of Heart Disease?

One would think that something as dramatic as a heart attack would be easy to diagnose. However, women are often misdiagnosed when they are having one. This happens in part because they fail to recognize that their symptoms are indicative of a heart attack and because the doctors that they go to may fail to recognize the symptoms of a heart attack as well.

Why is this? For years heart disease was felt to be a man’s disease. It was only relatively recently that physicians and medical researchers realized that it is also very much a woman’s disease. Heart disease is the number one killer of men and women in the United States.

Now we know that women often do not have the same type of heart attack symptoms as men. Men generally present at a younger age than women do with crushing chest pain radiating to the neck or down the arm with sweating, nausea and shortness of breath. They will often describe the pain as “squeezing” or “heaviness,” and may say they feel like an elephant is sitting on their chest. This pain does not stop immediately, but persists for minutes to hours with exercise, and often at rest.

Women’s symptoms

Women are relatively protected from heart disease until menopause (unless they are diabetic). After menopause we catch up with men. So in general women present at an older age with heart disease than men, which is in part why the symptoms may be different. Those who are older in general are less likely to present with chest pain as a heart attack symptom.

Women having a heart attack will most often present with shortness of breath, weakness, overwhelming fatigue, dizziness, nausea, and anxiety. They may experience chest discomfort but they may also have arm pain, jaw pain or indigestion. They also can have pain in the upper back or abdominal pain.

Real women, real stories

Dr. R had one woman patient who presented with severe jaw pain and shortness of breath and another who presented with nausea, vomiting, diarrhea, fatigue, shortness of breath and dizziness. The first patient thought she had a tooth infection and the second patient thought she had the stomach flu. Both waited to seek help and both had severe heart attacks that left them with diminished heart function.

Is it possible to have symptoms of early CHD, before it has reached the stage of a heart attack?

Absolutely. The majority of women who have had a heart attack had symptoms the month leading up to the heart attack that they ignored. And many women had recurring symptoms over a longer period of time that they ignored because the symptoms seemed to go away on their own; but they came back. These symptoms include the ones mentioned above under “women’s symptoms” of a heart attack; they also include becoming short of breath, or getting chest symptoms, with any type of exercise that you were able to do before with no shortness of breath; getting more fatigued after doing an activity that previously did not fatigue you; and always feeling fatigued, or run down, even after you have rested.

What Should I Do if I have any of these Symptoms?

Easy: don’t wait to seek help. The take home lesson here is that we all need to listen to our bodies and not motor on if we think that something is seriously wrong. In addition, if we do think that something is wrong and our medical provider is not addressing our concerns, find another provider who will evaluate them. So, does this mean if you are dog tired for a prolonged period of time, or don’t ever to feel rested no matter how much you rest, you should see a doctor? Yes, especially if you have any of the risk factors. Don’t chalk your symptoms up to doing too much or working out too hard. Pay attention to what your body is trying to tell you.

If you are having a heart attack the goal is to protect your heart. Remember time is heart muscle. Do not wait- call 911 and if you are not allergic, chew an aspirin while you wait for the ambulance to arrive. Be smart, save your heart and save your life.

We discuss heart disease (and stroke) in much greater detail in our book. Also, for further information go to the following website: www.americanheart.org.

What Exactly Do I Need to Know about Heart Disease?

The most important thing to know about heart disease is that it is preventable. But, in order to prevent it, you must know the facts. Since it’s such a huge subject, what exactly do you need to know? 3 main things: 1) what puts you at risk for having it; 2) what symptoms to look for that may tell you that you have it; and 3) what you can you do to prevent it AND what you must do if you have the symptoms.

What Exactly Is “Heart Disease” Anyway?

Let’s talk about what we really mean when we say “heart disease.” There are several types of heart disease that one may get. These include: disease of the arteries that feed, or supply, the heart with the life-giving blood that has oxygen in it, known as coronary artery disease (CAD) or coronary heart disease (CHD); disease of the conduction system of the heart that keeps the heart beating at a regular rate and rhythm; diseases of the muscle of the heart, known as cardiomyopathy and myocarditis ; and disease of the valves and the inner lining of the heart, one of which is known as endocarditis.

By convention, whenever the term “heart disease” is used, it is referring to disease of the arteries of the heart, or CHD, which is far more common than the other types of heart disease.  Therefore, here we are only going to be talking about CHD. Stroke is mentioned because its cause is identical to that of CHD. What happens in a stroke is that the arteries feeding the brain with oxygenated blood are diseased, just like the arteries feeding the heart in CHD. Therefore, it makes sense that the risk factors that can lead to heart disease can also lead to stroke.

What Exactly are “Risk Factors?” What are the risk factors for CHD and stroke

A risk factor is exactly as it sounds: it is something that makes it more likely that you will get a disease or, that puts you at risk for getting it. Put another way, you are less likely to get a certain disease if you do not have the risk factors for it.

Unfortunately, we all become more at risk for heart disease as each year passes because one of the risk factors is increasing age. This is obviously a risk factor that you cannot change. The other risk factors that cannot be changed include: race, heredity, or having a family history of heart disease, and having already had a heart attack or stroke.

Having one or more of these risk factors that you cannot change does not automatically mean that you are definitely going to get heart disease, or have a heart attack or stroke. The risk goes up with the more risk factors you have. So, even though you cannot change this group of risk factors, you can still do something to help prevent CHD or stroke. And, what is that? You can make sure that you do not have any of the risk factors that can be changed as described below, or if you do have them, you are keeping them under control.

The risk factors for CHD and stroke that can be changed include: having high blood pressure; having high cholesterol levels; having diabetes; smoking cigarettes; being overweight and/or having your waistline be too large; being sedentary, or not being physically active; being depressed or stressed for long periods of time; being on hormone replacement therapy for too long.

How you can change these is obvious: keep your blood pressure, cholesterol, and diabetes under control; stop smoking; maintain a normal weight for your height, and a normal waistline measurement; do regular physical exercise; seek help for your depression and try to cut down on your stress levels; and discuss with your doctor whether you should or should not be on hormone therapy.

All of the above are also risk factors for having a stroke as well. However, there is an additional risk factor for stroke alone: an arrhythmia of the heart known as atrial fibrillation. With this problem, the heart beats way too fast and irregularly.

How Do I Even Know if I have Risk Factors?

The answer to that question is obvious with some of the risk factors: you obviously know if you smoke or used to smoke, if you are physically active, if you have gained weight or are very overweight, or are feeling stressed or depressed. You need to find out as much about your family history as possible.

Equally as important is getting a complete physical examination by your primary care provider, even if you are feeling fine. This will include a full evaluation of all your organ systems. With reference to your cardiac risk factors, it will include: checking your weight, height, and waist measurement, as well as your blood pressure, a heart examination, an EKG, and full panel of bloodwork including a fasting blood sugar and fasting cholesterol (lipid) levels. If an abnormality in your pulse (heartrate) is found on exam, the EKG will also include a longer strip just to look at your heart rhythm, especially to see if you atrial fibrillation.

If you have a family history of heart disease, other of the risk factors, symptoms, or are in midlife, your clinician will want to have you do a test of the heart when you are exercising, called an exercise stress test, and will probably want to do the type of stress test that involves taking pictures of the heart as well – called either a stress echo or a thallium stress test.

Paying attention to ourselves- our family histories and your risk factors – is a must now that we’ve reached midlife. Next, we’ll talk about the symptoms of heart disease.

Heart disease is the NUMBER ONE cause of death in this country, and that includes for us women! And one of the most important things to know about heart disease is that in most cases it is preventable. Because we know the factors that put us at risk for heart disease, many of which are related to choices we make in our own lifestyles, we can learn how to prevent this deadly disease.

This Friday, February 6, 2009, like the other first Fridays in February in prior years, is Wear Red Day.  The reason for this is to raise awareness about heart disease, especially in women.  That is not to say that men shouldn’t be aware of it as well, it’s just that for so many years, women didn’t think heart disease was a woman’s problem. IT IS. 

In the coming weeks of February, we are going to go over each of the risk factors for heart disease and how many of them can be changed. As you know, if you’ve read our book and/or have kept up with our blog here, we believe that knowledge is the ultimate power. If you learn about those things that can lead to various diseases, and then change those factors, your life can not only be a long one, but a healthy and vibrant one!

For starters this week, do two things. 

Read the part of our chapter on heart disease that is on this website by going back to the Home page, and clicking on the “Excerpt” page. Then click on “Chapter 3”.

The second thing you should definitely do this week? WEAR RED ON FRIDAY!  And when you  see friends, neighbors, family and coworkers, tell them why you are wearing red and why they need to learn about heart disease too.

This month is Cervical Health Awareness Month. I’m referring here to the opening of your uterus (womb), not to be confused with the part of your spine that is located in your neck.

You may wonder exactly what you need to be “aware” of regarding your cervix, especially at this age if you’re either approaching, are in the midst of, or have completed menopause. It turns out that there’s a lot you still need to know, particularly about the disease, cancer of the cervix. In fact, the US Congress thought this was such an important topic that they’re the ones who actually designated this January as cervical awareness month.

One of the most important things about cervical cancer , and perhaps surprising to many of you, is that it is, in most cases, a preventable disease. Yes – that’s right – it can be prevented. Now, you might say that that is no big deal because we can prevent lung cancer by not smoking cigarettes, and breast cancer by not taking estrogen, but you’d be wrong on both counts. Yes – smoking can cause some lung cancers, but may not be the only thing to do that since not everyone who smokes gets it; neither does smoking cause all lung cancers as there are certain types of lung cancer which occur in people who have never smoked. And yes – taking estrogen may be related to breast cancer, but there are other factors that also may cause it.

We can prevent cervical cancer because we absolutely know what the main cause is – certain types (the “high-risk” types) of the viral infection, Human papillomavirus (HPV). That’s why the vaccine against cervical cancer that you’ve been hearing so much about, Gardasil, works – because it actually prevents infection with several of the high-risk types of HPV that can lead to cervical cancer. So, does every woman who has an HPV infection of her cervix get the cancer? No, because not all types of HPV cause the cells of the cervix to become abnormal and develop into cancer. Even women who are diagnosed with one of the high-risk types of HPV do not necessarily go on to develop cervical cancer.

There’s another way cervical cancer can be prevented: screening. This means that by finding the early, pre-cancerous condition of the cervix, sometimes called cervical dysplasia, and treating it, those abnormal cells should no longer progress on to cancer. How is this done? Simple. By that test that you’ve known about and had done since you were young – the Pap smear. This test, taken at the time that you have your yearly visit with your gynecologist and your pelvic exam, has been a true medical success story; there has been a great decrease in the number of cervical cancer cases, and in the number of deaths from cervical cancer, since the Pap smear began to be routinely used in 1950. Today, death from cervical cancer is rare in women who get regular Pap smears.

And there’s more good news. There is another test that can help to prevent cervical cancer, which is as easily taken at the same time as the Pap smear, called the HPV test. This test takes cells from the cervix, as the Pap smear does, but looks for HPV infection itself within the cells. If the types of HPV that lead to cancer are found, further studies may be done to look for very early cancer of the cervix not seen on the Pap smear. Most gynecologists these days will obtain both a Pap smear and the HPV test in appropriate patients.

Now, here’s what is special about women our age and cervical cancer and the Pap smear. First of all, would it surprise you to know that many postmenopausal women no longer have annual pelvic exams because they think they don’t need them any longer? Studies have shown that the women least likely to get Pap smears and pelvic exams are over 50. And, within that group (our age group), women in their 70’s and 80’s are much less likely to have these exams than are women in their 50’s and 60’s.

If you happen to be one of the women who doesn’t think you need annual or routine pelvic exams, think again. The risk of getting cancers of the reproductive tract organs, like ovarian and uterine cancer, goes up with age; the risk of death from cervical cancer is highest for white women between the ages of 45 and 70 years of age, and for black women in their 70’s. Sometimes, particularly when the cancer has not progressed, these diseases don’t cause any symptoms, and are only found by your clinician. And we all know that the earlier any cancer is found, the better the chance is for a cure. So, if you’re not getting regular exams that screen for these cancers, you are missing the chance to save your own life.

The second thing that some women our age are surprised about is that we still can get sexually transmitted infection (STI). Yes – even after menopause and even if you’ve had a hysterectomy. If you’ve had a new sexual partner recently, you could’ve become infected with an STI, and not even know it. Further, several of the STI’s – HPV, HIV, and herpes virus included can remain silent in the body for years, only showing up and causing disease years later. This means that you might’ve been infected by a prior sexual partner – say, 10 years ago (even earlier for HPV and herpes) – and did not realize it at the time, only to have that infection become active in your body now, after all these years.

Bottom line, you still need to be aware of your cervix and its health. And you still need to get annual pelvic exams from your gynecologist or from your primary care provider. Even though cervical cancer most often shows up in younger women than our age group, it can show up at any age. As you’ve read above, not only can cervical cancer be prevented, but the chances of your dying from cervical cancer are much less if it is caught early. Make that appointment for a pelvic exam and the testing that goes with it today! And make sure all your girlfriends, as well as the younger women in your life, go too!

For more information, go to: http://www.nci.nih.gov/cancertopics/pdq/screening/cervical/Patient/page2 and to: http://www.nccc-online.org/index.html

Also, there is an entire chapter in our book devoted to cancers in women our age, including cervical cancer, and which goes into more detail than the above. There is another entire chapter devoted to the health, and the most common diseases, of the aging organs of the female reproductive tract, other than cancer. The latter chapter talks about the most common symptoms occurring in women of our age group, discusses the Pap smear and the need for us to continue to get annual pelvic exams, and the issue of sexually transmitted infections (remember – we can still get these at this age, but that’s topic for another blog…)

RM: Happy New Year!

JH: Same to you and to all our readers! Do I dare bring up the obvious…

RM: No – New Year Resolutions are a set up. We all tend to set lofty goals for ourselves, and eventually we break them (usually within the first month).

JH: Then we beat ourselves up, and to compensate for feeling weak, we do the exact opposite of our resolutions, like get a quart of Ben&Jerry’s Chunky Monkey to eat all at once to keep us company in our misery.

RM: Exactly my point. We set ourselves up for failure right from the start.

JH: Yes, and I’ll bet you’ve had some really high-falutin’ resolutions in the past, like doing bungee jumping twice a week, or going on, and winning, “Survivor” on TV, or…

RM: How’d you know?!! And I’ll bet you’ve had some doozies yourself, like becoming a gourmet cook, or opening a dog breeding kennel and actually giving away/selling all the puppies (and not keeping them for yourself), or …

JH: You got it – no need to go further. So what’s your solution?

RM: Well, keeping the fact in mind that most resolutions are doomed to fail, I have decided to take a new direction. I suggest you and our readers do the same. How about making resolutions that we can keep? They should be simple and fun, while still being good for you.

JH: Great idea! Let’s hear yours.

RM: These are what I propose. I will:

Take at least one spontaneous trip this year
Eat at least one hot fudge sundae without feeling guilty (this is a good one!)
Make a new friend
Try to learn to speak a new language
Go to the movies once a month
Laugh at least 10 times a day

JH: Love them!! Especially that last one; it’s much easier than drinking a glass of water 10 times a day. And because they are fun and manageable, you’ll stick to them, and be a better, healthier person because of it.

RM: That’s the idea. Now, let’s hear yours.

JH: OK. Hope you don’t think I’m copying you on some of them. I will:

Brush up my speaking Spanish
Do something positive for a different person at least once a week
Think about how good it feels to be healthy at least once daily
Read at least one totally junky novel each month
Rub all of my dogs’ bellies at least once a day
Take more naps

RM: Good job. Finding things that are fun and do-able allows us all to be successful in keeping our resolutions, which then makes us feel positively about ourselves.

JH: And that then lets us get on with whatever work we have to do, including doing the things that keep us healthy, without that huge bugaboo of self-doubt, negativity, and failure.

RM: You got it. So, now we’ll wish our readers …

Both: A Happy, Safe, and Healthy 2009!

RM: So, I can’t imagine what we’re talking about in this blog – what’s with that title?!

JH: You know – “Tis the season to be jolly…” So, I wanted us to talk about abdominal fat.

RM: Ok, important topic – but what’s the relation to those other things?

JH: I’ll tell you that when we finish talking about belly fat. In our book, we discuss how body weight and body fat are dangerous for our health, especially as we get older and are more at risk for certain diseases anyway (because of advancing age), like heart disease.

RM: Right. And we discuss how medical people don’t talk about “pounds” of weight, but use the term “body mass index” or BMI to talk about body weight. BMI takes into consideration one’s weight and height. A normal BMI is less than 25. But being overweight is not the only problem, is it?

JH: No. The distribution of the body fat is just as important. Having much of the body fat concentrated in the abdominal area is more of a risk for heart disease and diabetes than having that body fat concentrated in the area of the hips and thighs.

RM: So, being an “apple” in shape (fat mostly in the middle, or the belly, area) is more dangerous than being a “pear” shape?

JH: Absolutely. We can tell for sure which of these body shapes a person has by measuring the waist and then the hips, and figuring out what the waist measurement divided by the hip measurement, or the “waist to hip ratio”, is.

RM: So, we’ve known for awhile that being apple-shaped is dangerous to our health; is there more recent information?

JH: Yes. An important study was published in the November 13, 2008 issue of the New England Journal of Medicine in which 359,000 men and women (ages 25-70) in nine different European countries were followed for a little over nine and a half years; the researchers were able to assess the association of each person’s BMI, waist circumference, and waist-to-hip ratio with their risk for death, while controlling for other factors, such as smoking, alcohol consumption, and physical inactivity, that might increase that person’s risk of dying.

RM: That sounds like a very thorough study. What did they find?

JH: Several things. The first one was expected: that those with the lowest risk of death had a BMI around or just below 25. The risk of death increased as the BMI increased. For those people with the same BMI, the risk of death increased as their waist circumference and their waist-to-hip ratios increased. The people with the largest waists had double the risk of death as those whose waists were normal.

RM: That’s impressive. And this was the same for men and women?

JH: Yes.

RM: And wasn’t being underweight dangerous as well?

JH:Absolutely. But since there’s a lot to talk about with that issue alone, we’ll save that for another blog. Back to the study and the risks of being overweight, more impressive was that even people who were not considered to be much overweight, but had increased abdominal fat, were at an increased risk for death.

RM: So, we’re not even safe if we’re at a good weight but have a paunch – how unfair. Two questions: isn’t the reason that increased fat in the belly area is dangerous is that it’s thought to be a special type of fat different than elsewhere in the body? And, can’t we just go get liposuction of the belly so we’ll live longer?

JH: Yes to the first question. No to the second one – go look at chapter 11 in the book again to remember why!

RM: Ok, so we know again that too much fat in the belly is bad for us. What should we do?

JH: Women should know their waist-to-hip ratios, as well as their weight and BMI. And all of this should be considered when coming up with a comprehensive plan for staying healthy. For instance, if a woman has too much belly fat, she may be advised to lose more weight through increased aerobic exercise in order to specifically get rid of the belly fat.

RM: Right. Those crunches and sit-ups just won’t do that. Actually, we should talk more about the different types of exercise and what each type specifically does for our bodies when the New Year rolls around… in 2 weeks! Now, you promised to tell what this whole topic has to do with the holidays and Santa.

JH: Easy. This time of year, there are always office and neighborhood and kids’ parties to go to, and all forms of peppermint and other candies and sweets to eat, and wonderful sequined and sparkly clothes that we pull out of the closet to wear… which often don’t fit, especially in the belly area, which makes us buy Spanx or a real girdle…

RM: I get it. You’re saying that we shouldn’t wait until the Holidays, and those glittery but too-tight clothes, to figure out that our belly is too big; and we shouldn’t make it worse by sampling all the delicious sweets sitting out this time of year! It’s best to work on it all year by keeping the body weight normal, and trying to go without the Spanx once in awhile to see how bad that paunch really is. And what about Santa?

JH: Remember the poem “Twas the night before Christmas”? What did it say about Santa?

RM: I’m supposed to recite a poem in this blog?!!! Are you nuts?

JH: Ok then, I will. About Santa, it said: “He had a broad face and a little round belly, that shook, when he laughed like a bowlful of jelly.”

RM: So the moral of the story is that Santa needs Spanx!

JH: Not quite! But on the risk of getting silly…or more silly… let’s just wish our readers…

BOTH: Happy and Safe and Healthy Holidays!

The Centers for Disease Control and Prevention has designated this week as National Influenza Vaccination Week not only to highlight the importance of the appropriate people (that includes us – anyone over the age of 50) getting the vaccine, but also to let people know that the months of November. December and even January are not too late to get the vaccine. Why is this? Because many people believe that if they haven’t gotten their flu shot by October, it’s too late to get it. This is not true. The activity of the influenza virus does not reach its peak until February, or later depending on your location; therefore there is still a lot of time to get it.

Who specifically should get a yearly flu shot? A new recommendation of the 2008 Advisory Committee on Immunization Practices (ACIP) is that all children and adolescents between the ages of 5 years and 18 years should now be getting it. Previous to this, only children ages 6 months to 4 years, and children of other ages who have a chronic medical condition were advised to have a flu shot. What has not changed is that children below the age of 6 months are not advised to have it. In sum, children ages 6 months to 18 years should be getting a yearly flu shot.

The recommendation for which adults should get a yearly flu shot has not changed, and basically includes any adult who wants to reduce the risk of getting the flu, or of transmitting it to others. Adults who are especially advised to have the vaccination are those who are at high risk for getting the medical complications of the flu, like pneumonia and other infections with the bacteria Staph aureus, or those adults who are close contacts of others who are at high risk.

These recommendations specifically name the following groups of adults who should definitely get the flu shot every year:

• • People over the age of 50
• • People who have chronic lung, heart, liver, kidney, blood, or diabetes
• • People whose immune system is suppressed – by having cancer or HIV/AIDS, or by taking medications that suppress the immune system (steroids or chemotherapy or drugs to prevent rejection of transplanted organs)
• • People who live in nursing homes or other chronic care facilities
• • Health-care workers
• • People who live with, or are caregivers of, adults over the age of 50 or children under the age of 5 and especially under the age of 6 months
• • People who live with, or are caregivers of, others with chronic medical conditions who would be at high risk for complications if exposed to the flu

Why is getting vaccinated so important? Many people think that getting the flu is no big deal, and just amounts to a few muscle aches and pains, fever, and respiratory symptoms that go away quickly. This is definitely not always the case. For instance, during flu season last year (the 2007-2008 season), influenza was associated with a higher death rate, and with higher rates of hospitalizations in children ages 0-4 years, than in each of the three prior years. Also notable is the fact that flu season peaked in mid-February, and continued to be seen into the month of May last year.

Is there anyone who should not get the flu vaccine? Yes. If you have an allergy to egg yolks, you should not get the flu shot; this is because the vaccine itself is made up in egg yolk. Also, if you’ve had a severe reaction to the flu shot in the past, you should tell your health care provider about that. Many of these so-called “reactions” will not prevent you from receiving it again.

Today, December 9^th, is Children’s Vaccination Day, and this Thursday, December 11^th, is Seniors’ Vaccination Day (remember that Medicare pays for the flu vaccine). So, if you haven’t gotten your flu shot yet, get it! And if you know someone that hasn’t gotten it, especially if they fall into one of the groups mentioned above, remind them that it is definitely not too late in the season to get it.

We wanted to make you aware that November is National Diabetes Awareness Month, but especially to call your attention to a disease that all too frequently is, at best, minimized, and, at worst, ignored.

Why is this the case? Probably for many reasons: 1) Diabetes has been around for a long time, and for many years was not discussed much, so that many people think it is just a “nuisance” disease; 2) Many people remember their parents and grandparents having it, and referring to it as “just a little sugar problem”; 3) Many people do not know of the serious complications that are a direct result of diabetes – such as heart attacks , kidney failure, and stroke; 4) Since diabetics usually die of these complications rather than from the diabetes itself, many people unknowingly think that the diabetes itself isn’t serious or cannot lead to death; and 5) Many people think that the available “treatments” for diabetes – pills or insulin injections – are in fact “curing,” or at least “treating,” the disease itself; in reality the medications simply keep the blood sugar in a normal range, but do nothing to treat the underlying disease.

Think that information about diabetes doesn’t apply to you? Think again. Currently, over 23 million people in the United States (8% of the population) have diabetes – 5.7 million of these are undiagnosed; approximately 57 million people in the US have prediabetes, a condition in which the blood sugar is high and may go on to frank diabetes. Research has shown that some people with prediabetes already have the long term damage to the body – especially to the heart and circulatory system – that most diabetics get. If you have been carrying around some extra pounds, you are risk for diabetes (Type II) and prediabetes. You are even more at risk if there is someone in your family with diabetes, or if you had gestational diabetes when you were pregnant. Remember, early on this is a silent disease; your blood sugar can be elevated without any symptoms.

Since the facts about diabetes are readily available in many places, both in hard copy (like in our book!) and online (see websites below), we will not discuss those here, other than to say that although it is indeed a serious disease with serious consequences if left untreated, it is also a controllable disease, and in many cases, a preventable one. The one thing diabetes is NOT: that “little sugar problem” that your grandmother had.

It is because of the misconceptions mentioned above that the American Diabetes Association (www.diabetes.org/home.jsp) and the National Diabetes Awareness Program, sponsored by the National Institutes of Health (www.ndep.nih.gov), work all year to educate everyone about this disease with excellent programs across the country. Please go these websites, learn the facts, and help yourself and others to avoid or control this disease and its devastating complications.

And once again, please read our blog of November 5, “The Danger Season” as it relates directly to weight gain, obesity and diabetes. And, remember to ask your clinician to check your blood glucose level at your next office visit.

RM: Last week you said we would talk about some new information on breast cancer prevention and exercise. Let’s start there this week.

JH:Ok.You know how we talk so much in our book about exercise and its beneficial effects on virtually every organ system in the body as shown by rigorous scientific research in recent years?

RM: Absolutely. During our research for our book we were both surprised by how much research has shown that. Exercise is no longer about “going out for a little walk” to relieve stress or get outside; it’s not a “nice to do” any longer, but a “must do”. In particular, we mentioned that studies have shown that the proper amount of regular exercise may prevent a recurrence of breast cancer in a woman who has been successfully treated.

JH: That’s exactly where I’m going, and there’s even more now.A recent issue of the NCI Cancer Bulletin, which comes out weekly from the National Cancer Institute, put the spotlight on the entire issue of the role of exercise in breast cancer prevention (October 21, 2008; Volume 5, Number 21). More and more research studies indicate that the levels of hormones in the body can be modified by physical activity. Since one of the major theories of breast cancer is that its development is closely related to, and may be caused by, the total amount of estrogen and progesterone a woman is exposed to over her lifetime, knowing that a woman can reduce these hormone levels through exercise is very important information.

RM: In other words, you’re saying that doing regular exercise – by reducing the hormone levels in the body – may be able to actually prevent breast cancer?

JH: That’s the working theory. And there are some good studies to back this up. In one study, known as the “California Teacher’s Study” in which over 133,000 current and retired California teachers and administrators have been enrolled since 1995, the researchers found that the risk of invasive breast cancer (specifically estrogen receptor-negative breast cancer) was inversely related to the amount of strenuous exercise the women had done throughout their lives.

RM: Meaning that the women who did more exercise had a lower risk of invasive breast cancer than those women who didn’t? And how much “strenuous” exercise are we talking about here?

JH: Specifically, the researchers found that those women who had done 5 hours per week of strenuous exercise from the time they were in high school until their current age (around 54 yo), had a significantly lower risk than women who had done ½ hour or less of strenuous exercise over the same time period.

RM: That’s impressive. Are there more studies to back that up?

JH: Yes. The National Institutes of Health (NIH) and the American Association of Retired Persons (AARP) are doing a similar study known as “The Diet and Health Study” that began in 1995. These researchers looked at the amount of physical exercise done by participating women (between the ages of 50 and 71) at the study’s beginning, and found the same thing: that higher levels of physical activity seemed to decrease the risk of estrogen receptor-negative (ER-negative) breast cancer.

RM: I have two questions about these findings. First, a simple explanation. Breast tumors are categorized based on whether or not they have estrogen receptors; those that do have them are known as ER-positive tumors, and those that don’t are called ER-negative.

My first question is: does the fact that exercise reduced the risk of ER-negative breast cancer, rather than other types, make a difference?

JH: Good question. Yes. Here’s why. There are drugs currently in use that can help prevent the formation of ER-positive breast tumors; these drugs are tamoxifen (Novaldex) and raloxifene (Evista). However, there are no drugs available that prevent ER-negative breast tumors. Knowing that physical activity may do that is crucially important.

RM: Very impressive that we may soon be able to help prevent both types of breast cancer.

My second question: You say that the theory is that it is the amount of physical exercise done over a woman’s entire lifetime that may be important in breast cancer prevention. That sounds to me like you’re implying that the earlier she starts doing regular exercise in her life, the less likely she may be to get it. Is that right?

JH: Bingo. (You’re SO smart; glad you are my coauthor! LOL) Remember the Nurse’s Health Study II (NHSII) that you talk a lot about in the book in regard to the use of hormone therapy at menopause?

RM: How could I forget?!

JH: Well, researchers in that study looked at the amount of lifetime regular activity done, from the age of 12 yo and up, in nearly 65,000 premenopausal women, and found a 23 % reduced risk for premenopausal breast cancer in those women who had regularly exercised. Specifically, the higher the levels of physical activity between the ages of 12 and 22, the lower the risk. The researchers think that may have something to do with adolescence being the period of breast development, a time when the breast tissue is most susceptible to hormones and other influences.

RM: So, to all our readers: Get your daughter, granddaughters, nieces and girlfriends’ daughters out there regularly exercising!!

JH: Absolutely. But also a caution to our readers: just because you may not have been physically active when you were younger doesn’t mean it’s too late for you to reap the benefits of exercise now. Researchers from the NCI, and we, strongly believe that becoming regularly physically active at any age is beneficial, especially since we are all living longer.

RM: So don’t forget to take that long walk after dinner on Turkey Day!

JH: And everyday, for that matter. Or at least 5 days a week.

RM: I thought we were going to talk about the importance of abdominal fat this week, but I guess we’re giving our readers/friends a break before Thanksgiving, right?

JH: Yes. We’ll get to that topic right after the Holiday. In the meantime, please read (or reread) our blog from November 5, “The Danger Season.” You’ll see why we’re recommending it again when you read it.

Both: Have a safe and healthy Thanksgiving!!

JH: Lots to talk about this week. The study that made the biggest splash in the news showed that one of the cholesterol-lowering drugs in the group known as statins (such as Lipitor, Zocor, Crestor) prevented heart attacks and strokes even in people who did NOT have high cholesterol levels. Does that mean that everyone, regardless of their cholesterol levels should now take one of these meds?

RM: Well, it’s a bit more complicated than that. In a study in the New England Journal of Medicine of November 9 (published online ahead of its regular publication date), nearly 18,000 people – including men and women of diverse ethnic backgrounds – who had normal “bad” cholesterol levels (LDL) but high CRP levels, were given either a placebo or a statin drug and followed for almost 2 years. They were being watched for their first occurrence of an event involving the cardiovascular system, including a nonfatal heart attack, a nonfatal stroke, hospitalization for unstable angina, the need for a procedure to open blocked arteries, or death from one of these causes. The study had to be stopped because there was a significant difference found in the occurrence of these events between the group taking a statin drug and the group taking a placebo.

JH: So the group taking the statin drug had significantly fewer heart attacks and strokes and other cardiovascular events?

RM: Yes.

JH: Doesn’t that mean, then, that everyone should take one of these drugs regardless of their cholesterol level?

RM: No, but what it does mean is that you might want to find out what your CRP level is, especially if you have risk factors for stroke or heart attack.

JH: Ok. CRP stands for C-reactive protein, and has been used for years as an indication that some type of inflammation is going on in the body. It is measured by a simple blood test. That inflammation, however, can be due to many causes such as an ongoing infection, certain types of arthritis, like rheumatoid arthritis, and active heart disease. The high level of the CRP only says that inflammation is going on, but does not specify where the inflammation is coming from.

RM: Exactly. We say that the CRP test is nonspecific. Therefore, we’re not sure who in this study really had active heart disease, and who didn’t, even though they all had a high CRP.

JH: So, if someone has a normal cholesterol, but other risk factors for heart disease, they should ask for their CRP level to be checked, and then let their doctor decide if they need a statin, right?

RM: Yes. Although the statins are relatively safe, there can be side effects to them and they are expensive; therefore, one should only take them if they really need them. And that should be decided individually for each person. More studies need to be done to follow up this one.

JH: Another study receiving a lot of press attention recently showed that postmenopausal women who had a migraine diagnosis had a lower risk for breast cancer. The authors of this study, which appeared in Cancer Epidemiology, Biomarkers and Prevention, speculate that this difference is due to lower levels of estrogen occurring in migraine patients.

RM: I’ll bet you were especially interested in this study, right?

JH: Yes – it’s the first good thing about migraines I’ve seen! And since I have migraines, I’ll be very interested to see if further studies on this show the same thing. Another study, reported in the August 19 issue of Neurology, showed that chronic migraines were underdiagnosed and undertreated in this country.

RM: Interesting. That finding leads directly to one of the mantras in our book: that women need to advocate for themselves. If you have recurrent and severe headaches, even if your clinician does not make much of them, you should ask if it’s possible you are having migraines, or ask for a referral to see a neurologist.

JH: Absolutely. There are good treatments for migraines these days, including medications to prevent them from occurring. So, there’s a good possibility that if you have migraines, you don’t have to suffer as much, or at all, with them by taking treatment.

RM: Right. Next time we’ll talk about placebos and another new study on the relationship of exercise and breast cancer.