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Dr.
Mitra, Director of the Advanced Cardiac Rhythm
Center, is a cardiologist and heart rhythm specialist.
He received his MD and Ph.D. from the University
of Pennsylvania in Philadelphia, where he also
completed his residency and fellowship. He was
then appointed the Director of Elecrophysiology
and Pacemaker Services at Ruth Presbyterian
St. Luke's Medical Center in Chicago. He has
been in Michiana for the past 12 years, and
when not fixing electrical problems of the heart,
plays electric guitar with the doctor band,
Vyagra Falls.
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Cardiovascular
disease (CVD) continues to be the leading cause of death in
both women and men. Nearly a half million women succumb annually
to CVD, which dincludes deaths due to both heart disorders
and stroke. The four leading risk factors for CVD continue
to be the following:
- Tobacco
use
- Diabetes
- Cholesterol
abnormalities
-
High blood pressure
Family
risk factors and obesity are associated with higher risks as
well, often by increasing the severity of one of the four above
mentioned risks. Being overweight alone increases the likelihood
of diabetes, high blood pressure and cholesterol disorders (three
of the four risks); thus, weight loss through diet and exercise
is an extremely effective method to decrease cardiovascular
risk. The incidence of obesity is on the rise. During the late
1990's, a disturbing trend emerged, showing that death to CVD
was increasing in women but decreasing in men. Since women were
traditionally considered to be at less risk for CVD than men,
these findings set off an alarm in the medical community and
public, and ultimately lead to several studies which revealed
the following:
-
In the late 1990's, CVD killed more women than all other
causes of death including cancer although women did not
perceive the risk. Fortunately, by 2003, this misperception
had improved.
- Women
and physicians underestimate and minimize a woman's true
cardiovascular risks
- Women
with significant heart disease often have minimal or no
warning symptoms compared to men.
-
Women with cardiovascular disease are often undertreated
by the medical community compared to men , in part due to
atypical symptoms
- Women
as compared to men respond differently to both medical treatments
as well as invasive procedures, although, they benefit equally
from statin therapy (most common medications to treat high
cholesterol) as well as from angioplasty (a procedure using
a small inflatable balloon to stretch open a blocked artery)
and stenting (crimping a small wire mesh scaffold into the
wall of the balloon-opened artery to keep it from collapsing)
-
Benefits of hormone replacement therapy (HRT) in post menopausal,
long considered to reduce the risks of heart disease due
to favorable effects on cholesterol levels, was called into
serious question in 1998 by the Heart Estrogen/Progestin
Replacement Study (HERS), which showed no decrease in heart
attacks or deaths in women with a previous history of CVD
whether or not they took HRT.
- The
Women's Health Initiative Study (WHI),unlike HERS, examined
post menopausal women without a history of CVD and treated
with estrogen alone (EA) in women with a previous hysterectomy
and estrogen + progesterone (E&P) in women with a uterus
(estrogen alone increases the risk of uterine endometrial
cancer, an effect which is offset by adding progesterone).
This study was also stopped early due to an increased risk
of stroke in women taking HRT (including EA and E&P). In
2002, the E&P arm of the study was stopped early due to
a higher risk of breast cancer and CVD, including stroke.
In 2004 the EA arm was stopped due to a higher risk of stroke
and heart disease, but not breast cancer. In both arms the
risks were higher the longer the duration of treatment and
the longer after menopause for treatment to be initiated.
Due
to the efforts of the National Institutes of Health's HERS and
WHI studies as well as the American Heart Association's Go Red
for Women Campaign, both the public and the medical community
have become more engaged to aggressively reduce the burden of
CVD in women. The most recent data showing a decrease in CVD
in women, while encouraging, still shows that over 450,000 women
a year are dying of CV causes.
Although
cardiologists are usually charming individuals, it is best to
know them socially and not professionally. Here is what you
should do to minimize your risks of CVD and keep your local
friendly cardiologist at an arm's length:
- Quit
smoking!!!!!!!
- Lose
weight by aggressive dieting and exercise! This will reduce
your blood pressure, cholesterol levels and diabetic risks.
- If
you have diabetes: follow a strict diet, keep your glucose
levels as close to normal as possible under the supervision
of your family doctor or an endocrinologist, take a statin-type
cholesterol drug under your doctor's supervision and consider
additional drug treatment for high triglycerides
- Dieting
and exercise may seriously improve your cholesterol levels,
although, genetics play an important role that may not be
overcome by even the most rigorous exercise and dietary
regime. If your cholesterol and or triglyceride levels are
high and you have a strong early family history of CVD (before
the age of 50 or 60), speak to your physician about the
benefits and risks of drug therapy
- If
you have high blood pressure, you must adhere to a diet
that contains 2000mg or less of Sodium Chloride (salt).
This is less than 1/ 4 teaspoon of salt distributed in everything
you eat in a day. For example, a typical slice of bread
has 200 mg which is 10% of your day's allowance. Read labels
of everything you eat!! In addition, keep in mind that high
blood pressure has a strong genetic component, so even if
you keep to a low salt diet, you may need one, two or even
three medications to control your blood pressure. Normal
blood pressure is 100-120/60-80 mmHg.
- HRT
with either estrogen alone or estrogen in combination with
progesterone is not indicated for disease prevention.
If
you are a peri-menopausal or post menopausal woman with severe
estrogen withdrawal symptoms (hot flashes, mood swings, sleep
disorders), that have not subsided within a few months, discuss
the following with your primary physician or gynecologist:
i.
Short- term, low dose HRT with an estrogen/progesterone combination
if you still have your uterus
ii.
Short -term, low dose estrogen alone therapy if you have had
a hysterectomy
iii.
You need to consider significantly higher risks of stroke,
heart disease, or blood clots with either i or ii if you already
have CVD at the time of menopause, or have a personal or family
history of breast cancer, stroke or blood clots. iv. Consider
topical estrogen creams in consultation with your physician
7.
Don't ignore symptoms of shortness of breath, chest discomfort,
unexplained nausea or sweating, severe dizziness or fainting,
or palpitations. These may be indicative of serious cardiovascular
disease. Also keep in mind that not all heart disease is due
to clogged arteries. Palpitations and dizziness due to abnormal
electrical circuits in the heart have been commonly misdiagnosed
as "panic attacks" in women, leading to inappropriate use
of sedatives and antidepressants. These conditions are easily
curable.
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