Younger Women Often Miss Signs of Heart Attack

Many younger women ignore or simply don't recognize the warning signs of a heart attack, often because it doesn't resemble the typical "Hollywood heart attack."

So say the authors of a study being presented Friday at the American Heart Association's annual Scientific Forum on Quality of Care and Outcomes Research in Cardiovascular Disease and Stroke, in Baltimore.

"So many women said, 'We wish we had a better stereotype, you never see anything in the media,'" said study author Judith Lichtman, an associate professor of epidemiology and public health at Yale School of Medicine. "I personally would love to see some cutting-edge TV series of, for example, a young person having a heart attack with atypical symptoms."

"The classic image of someone having a heart attack is someone like John Belushi. It's a heavy man clutching his chest. We never think of young women as having heart disease, so the image is not part of their consciousness," added Dr. Suzanne Steinbaum, director of Women & Heart Disease at Lenox Hill Hospital in New York City. "It's so important that we not only tell women that heart disease doesn't necessary have to look like [a Hollywood script], but they have to understand what makes them at risk."

Heart disease is the leading killer of American women, claiming almost half a million lives a year, or about one death per minute. According to background information from the authors, 16,000 young women with heart disease die every year and 40,000 are hospitalized.

Last year, a study from the same group of researchers found that women under the age of 55 often fail to recognize the symptoms of a heart attack until it's too late.

Eighty-eight percent of women in that trial reported traditional symptoms of severe chest pain. Yet only 42 percent suspected something was wrong with their heart.

Only half of the women experiencing heart attack symptoms sought care within the first hour, apparently because they thought their symptoms weren't real or weren't serious.

For this study, researchers conducted in-depth interviews with 30 women aged 55 and older a week after they had been discharged from the hospital following a heart attack.

Many didn't realize the symptoms were due to a heart attack. For example, one woman said she was told she was experiencing symptoms of acid reflux. Others attributed symptoms to fatigue, overexertion or stress.

Often, the symptoms just didn't line up with how heart attacks are presented in the popular media.

"I had probably seen a show or something with somebody having a heart attack," said one woman. "And they fall. They grab their chest. And then they grab their arm... I mean, you don't see anybody saying I have pain in my jaw or especially a heart attack, you don't see them vomiting... I did not know that and it's probably because of television, I would say is why I thought it would just be in the chest."

Similarly, another woman told investigators, "It's like... I didn't have any of the typical heart attack symptoms that you always hear about on TV and the ER hospital shows."

Some delayed treatment because symptoms went away for a while, or because they were too busy or had experienced prior, negative encounters with the health-care system ("...they throw you out, you know," said one woman. "If you don't have the money right there, then in two days you're gone").

One woman said she called her doctor about chest pains but was scheduled for a regular appointment in five days. Another woman who went to the emergency room spent an hour trying to find a supervisor to help her after a "rude" nurse just kept telling her to have a seat.

"A lot of women were triaged for a regular visit or, even in the ER, were being looked up for a lot of things other than a heart attack," Lichtman said.

Ironically, for some women, it was actually a relief to know that they were having a heart attack, that finally the mystery was over, Lichtman said.

Lichtman and her colleagues will be looking at this issue in more depth in a U.S. National Institutes of Health-funded study enrolling 2,000 women under 55 and 1,000 men in the same age range.

"A little bit of empowerment goes a long way," Steinbaum said. "Knowing your risk and knowing the potential for heart disease, seeking early care for symptoms that are really unclear and then saying, 'I am at risk for heart disease, please help me' becomes important in the paradigm of how this needs to develop."

Source: www.washingtonpost.com

Chocolate May Cut Diabetes Risk

Scientists are to investigate whether eating chocolate can reduce the risk of heart disease in women with diabetes.

Volunteers - postmenopausal women with type 2 diabetes - will be asked to eat a bar of chocolate a day for a year.

Cocoa is rich in compounds called flavonoids, which are thought to benefit the heart.

The University of East Anglia is using a specially formulated form of chocolate which contains more flavonoids than usual.

This compensates for the fact that many flavonoids are destroyed in the process of turning cocoa into chocolate.

Soy - another source of flavonoids - has also been added to the special bars.

The scientists are testing the theory that adding flavonoids to the diet may give added protection against heart disease on top of that provided by prescription drugs.

Deaths due to heart disease among women increase rapidly after the menopause and having type 2 diabetes increases this risk by a further three-and-a-half times.

If the trial confirms the hypothesis then it could have a far-reaching impact on the advice given to at-risk women.

Additional protection

Lead researcher Professor Aedin Cassidy said: "Despite postmenopausal women being at a similar risk to men for developing cardiovascular disease, to date they are under-represented in clinical trials.

"We hope to show that adding flavonoids to their diets will provide additional protection from heart disease and give women the opportunity to take more control over reducing their risk of heart disease in the future."

The researchers aim to recruit 150 women under the age of 70 with type 2 diabetes who have not had a period for at least a year, and who have been taking cholesterol-lowering statin drugs for at least 12 months.

Dr Iain Frame, director of research at the charity Diabetes UK, said: "We certainly don't advise people to start eating a lot of chocolate as it is very high in sugar and fat.

"We would always recommend that people with diabetes eat a diet low in fat, salt and sugar with plenty of fruit and vegetables."

"However, there are compounds found in chocolate, called flavonoids, that are thought to provide some protection from heart disease.

"A successful outcome of this research would hopefully mean being able to offer people at high risk better protection over and above that provided by conventional drugs."

Source: news.bbc.co.uk

Use of Hypertension Drugs Leads to Hip Bone Loss in Older Men

Powerful diuretics, commonly prescribed drugs for heart failure and hypertension, can also steal calcium from the bones and cause significant bone loss in men taking them, study finds.

Between 2000 and 2002, Dr. Lionel S. Lim of Griffin Hospital, in Derby, Connecticut and colleagues tested the bone mineral density levels of 3,269 men older than age 65. Patients received follow-up examinations about 4.6 years later. The researchers collected data on medication use and found that 84 men were continuous users of loop diuretics, 181 were intermittent users and 3,004 were non-users.

At the end of the study, the researchers found that the average annual rate of decline in total hip bone mineral density was -0.78 among continuous users, -0.58 among intermittent users and -0.33 among nonusers.

“Compared with rates of hip bone loss among non-users of diuretics, adjusted rates of loss were about twofold greater among intermittent loop diuretic users and about 2.5-fold greater among continuous loop diuretic users,” wrote Dr. Lim and colleagues in the study.

These findings come to reinforce previous studies, which have found an association between the use of powerful diuretics and increased risk of fractures.

“We conclude that loop diuretic use in older men is associated with increased rates of hip bone loss. Our findings suggest that health care providers should take into account loop diuretic use when evaluating older men for risk factors for bone loss and fracture risk,” the study wrote.

The findings were similar for change at the femoral neck and trochanter, the researchers said.

The study, supported by the national Institute of Health, was published in the April 14 issue of the Archives of Internal Medicine.

Source: eFluxMedia.com

Early Dementia Often Caused by Autoimmune Disorders

Dementia in patients who are younger than 45 years of age is often caused by degenerative, metabolic or autoimmune diseases, Dr. Brendan Kelley, of the Mayo Clinic in Rochester, Minnesota, told attendees at the 60th annual meeting of the American Academy of Neurology, being held this week in Chicago.

Kelley and colleagues searched the Mayo Clinic database for patients who began to develop dementia between 17 and 45 years that was not related to trauma, brain infections or mental retardation. They identified 235 such patients receiving care between 1996 and 2006. The average age at dementia onset was 34.7 years.

Neurodegenerative causes accounted for dementia in 29.8 percent of the group, frontotemporal dementia occurred in 13.2 percent and Alzheimer's disease was seen in less than 1 percent," data presented by Kelley showed.

Autoimmune-inflammatory causes, including multiple sclerosis, accounted for 21.2 percent. Inborn errors of metabolism were identified in 10.6 percent.

At the last evaluation, the cause of dementia was still unknown in 44 patients (18.7 percent) despite exhaustive evaluations, Kelley reported.

Inborn errors of metabolism were more common in individuals with symptoms appearing before age 30. Neurodegenerative causes were more common in dementias occurring after age 35.

"Some of the important causes, such as lupus, metabolic disorders, Huntington chorea, among others, can occur in very young children," Kelley told Reuters Health. "Only 4 of the 235 cases in our series resembled Alzheimer's type dementia."

"It is important to increase awareness that dementia can and does occur in young patients," Kelley continued. "This is important for social services and other aid-giving organizations to know."

"Symptoms in younger patients have more of a neuropsychiatric focus, with a lot of psychiatric features," he said. These patients can be misdiagnosed with psychiatric disorders, such as schizophrenia.

The causes of young-onset dementia are more often hereditary or genetic than they are in older patients with dementia.

"We are now looking to determine which clinical features are more classic...which clinical features to focus on," Kelley said. "This is a single disorder with multiple underlying causes. Treating the causes may correct to some extent the disorder."

www.reuters.com