Women's Health Outreach: Heart to Heart; Part 1

<v Speaker>You're watching WHRO TV 15, viewer supported television for <v Speaker>Hampton Roads. <v Speaker>[music] The following program is a part of Women's Health on Public Television. <v Cathy Lewis>It's been called the silent killer of women. <v Cathy Lewis>It kills more women each year than any other disease. <v Cathy Lewis>It's long been thought to be a disease of men. <v Cathy Lewis>We're talking about heart disease, and it's a major health concern for women. <v Cathy Lewis>I'm Cathy Lewis. And tonight on TV 15 we're going to spend the evening talking about <v Cathy Lewis>heart disease and women as we begin the Women's Health Initiative on public television. <v Cathy Lewis>During the evening we'll watch Heart to Heart and A Woman's Heart from PBS. <v Cathy Lewis>And we'll speak with some doctors here in Hampton Roads who treat heart disease in women <v Cathy Lewis>with women in our community who have battled it and who will share their experiences with

<v Cathy Lewis>you. And with fitness and nutrition professionals who will help us learn more about what <v Cathy Lewis>we can do to care for ourselves in preventing cardiovascular disease. <v Cathy Lewis>We have volunteers in our studios tonight who are waiting to take your comments and <v Cathy Lewis>questions during the broadcast. <v Cathy Lewis>You can call us at 489- 2700 or 1 800 3 4 4 <v Cathy Lewis>7 7 6 4. If you have a question or comment or if you'd like <v Cathy Lewis>to request a women's health information pack. <v Cathy Lewis>Please stay with us now as we present Heart to Heart. <v Cathy Lewis>[music] <v Speaker>This program is made possible by annual financial support from viewers like you. <v Narrator>It can happen to anyone. It's an equal opportunity killer. <v Narrator>Heart disease. Men as young as their 30s and 40s, women

<v Narrator>who think they're not at risk, and even children who start a lifetime of habits <v Narrator>that will lead straight to a heart attack. <v Narrator>It's an epidemic. The number one cause of death in America. <v Narrator>From Harvard's John F. Kennedy School of Government, Heart to Heart: the truth <v Narrator>about heart disease is Dr. William Castelli, head of the world famous Framingham <v Narrator>Heart Study. <v Dr. William Castelli>Welcome. We're going to be taught a history tells <v Dr. William Castelli>you that someone in your family very close to you in the bloodline died <v Dr. William Castelli>or got a heart attack prior to the age of 40 or even prior to the age of 55 <v Dr. William Castelli>or 60. It will double your risk. <v Dr. William Castelli>For the women of the audience, what about estrogen? <v Dr. William Castelli>Taking estrogen after menopause. <v Dr. William Castelli>We have 50 studies, you know, that have looked at this. <v Dr. William Castelli>And when you take estrogen after menopause in these studies, it cuts the heart attack and <v Dr. William Castelli>stroke rate almost in half.

<v Dr. William Castelli>It cuts the osteoporosis and the hip fracture. <v Dr. William Castelli>Now the bottom line in Framingham is really <v Dr. William Castelli>that the average man and woman who gets a heart attack is not <v Dr. William Castelli>a great mystery. <v Dr. William Castelli>That if you're willing to make a measurement of a few simple things on people's <v Dr. William Castelli>bodies, their total cholesterol, once it's over 150, I want to know <v Dr. William Castelli>the ratio. If it's over 4 you're in trouble. <v Dr. William Castelli>I want to know your blood pressure. Is it over 140, 90? <v Dr. William Castelli>I want to know whether you smoke and inhale, because now you're collecting. <v Dr. William Castelli>We can show you people in Framingham that collected so many risk factors they ran 70 <v Dr. William Castelli>times the rate of heart attack compared to the people who didn't have it. <v Dr. William Castelli>No one should not go through life without finding where they stand. <v Dr. William Castelli>You can find out where you stand on a heart attack, stroke, <v Dr. William Castelli>vascular disease risk. <v Dr. William Castelli>Better than not, you can do something about it.

<v Dr. William Castelli>Now, we're gonna take a little break here and we want you to, in fact, stay <v Dr. William Castelli>tuned to this station, because we're going to tell you in the next two segments <v Dr. William Castelli>of this program what you do about risk and how you can change <v Dr. William Castelli>your destiny. Thank you very much. [applause] [music] <v Cathy Lewis>We're here in the studios of TV 15 talking about women and heart disease. <v Cathy Lewis>I'm Cathy Lewis. And you're watching the first night of our Women's Health Initiative <v Cathy Lewis>here on WHRO. You can call into our studios with questions or comments <v Cathy Lewis>and to request a women's health information pack. <v Cathy Lewis>The numbers to call are 489-2700 or 1 800 3

<v Cathy Lewis>4 4 7 7 6 4. <v Cathy Lewis>With us in the studio this evening is internist, Dr. Sheila Garris of Internal Medicine <v Cathy Lewis>Specialists of Norfolk and cardiologists, Dr. Patricia Nahormek <v Cathy Lewis>of the Tidewater Heart Institute on the Peninsula and Doctor Ahn Campbell from <v Cathy Lewis>the Cardiovascular Center also from the peninsula. <v Cathy Lewis>Welcome and thank you very much for joining us this evening. <v Cathy Lewis>I was shocked when I heard those phones ringing while we were talking. <v Cathy Lewis>That should tell us something shouldn't it. So we have a lot to talk about this evening. <v Cathy Lewis>And again, if you have questions, feel free to give us a call zand we'll certainly direct <v Cathy Lewis>those questions to our panelists. First of all, Dr. Garris, why has this been such a <v Cathy Lewis>silent killer of women? <v Dr. Sheila Garris>Well, I think that the chest pain is a common symptom complex, and <v Dr. Sheila Garris>it's often presented to the physician and interpreted as being anxiety, <v Dr. Sheila Garris>um gastrointestinal complaints. <v Dr. Sheila Garris>It's often overlooked as being cardiovascular in origin. <v Cathy Lewis>Hmm that's interesting. is that for women more so than men? <v Cathy Lewis>I mean, are- are we more likely to think, oh, well, it's just anxiety for women?

<v Dr. Sheila Garris>It's interesting because I find in my practice that most women have often <v Dr. Sheila Garris>gone to other physicians, and it's been overlooked as anxiety or some other cause <v Dr. Sheila Garris>and not really appreciated to be that of cardiovascular origin. <v Cathy Lewis>When it indeed it very well may be and [Dr. Sheila Garris: Absolutely] time is of the <v Cathy Lewis>essence and that sort of thing. It's interesting. <v Cathy Lewis>Dr. Campbell, are there any differences in heart disease for men and women? <v Cathy Lewis>What are those differences? <v Dr. Ahn Campbell>Oh, yes, there are many, many differences when it comes to heart disease and a woman. <v Dr. Ahn Campbell>But before we go to that question, I'd just like to add one thing. <v Dr. Ahn Campbell>In my opinion, one of the reason why heart disease and woman is such as- <v Dr. Ahn Campbell>it's a silent killer is that for many years there's a misperception of <v Dr. Ahn Campbell>the Framingham study we saw and that there's a false belief <v Dr. Ahn Campbell>that coronary heart disease or chest pain is a benign condition <v Dr. Ahn Campbell>in woman. And instead, it was believed that it's mainly a disease <v Dr. Ahn Campbell>in middle age men. So women have been excluded <v Dr. Ahn Campbell>from a lot of studies that study the treatment and prevention

<v Dr. Ahn Campbell>of heart disease. And mainly those studies focus in on middle age men. <v Dr. Ahn Campbell>So we now, even though we recognize that it has been such <v Dr. Ahn Campbell>a major problem for us and that we have unfavorable <v Dr. Ahn Campbell>outcomes of coronary heart disease. <v Dr. Ahn Campbell>We really don't have the data specifically looking at woman. <v Cathy Lewis>And that's something I guess we will begin to have as we start taking a look at this <v Cathy Lewis>subject. <v Dr. Ahn Campbell>As we educate the public more and as we develop more studies and more research <v Dr. Ahn Campbell>into this issue. <v Cathy Lewis>Interesting <v Dr. Ahn Campbell>But there's one thing I like to talk about. The major difference in heart disease and <v Dr. Ahn Campbell>woman is that women lag behind men by at least 10 <v Dr. Ahn Campbell>years when it comes to the the time when they first present with the <v Dr. Ahn Campbell>initial symptoms of coronary heart disease and because of that woman <v Dr. Ahn Campbell>or older and they tend to have more medical problems, more co- co-morbidities <v Dr. Ahn Campbell>like high blood pressure, diabetes, peripheral vascular disease

<v Dr. Ahn Campbell>or kidney problems. <v Dr. Ahn Campbell>So the treatment for woman is even more difficult than <v Dr. Ahn Campbell>for men because we have to deal with so many other issues. <v Cathy Lewis>It's kind of hard to tell. Dr. Nahormek, one of the things that as we were watching <v Cathy Lewis>the segment you mentioned that you felt very strongly about was this whole issue of <v Cathy Lewis>cholesterol and all of the confusion about that and what those numbers really mean and <v Cathy Lewis>what they mean for women as opposed to what they mean for men. <v Dr. Patricia Nahormek>I think Dr. Castelli pointed out that total cholesterol is a predictor of cardiovascular <v Dr. Patricia Nahormek>disease. Risk in women is not nearly as good as it is a predictor of <v Dr. Patricia Nahormek>risk in men. In fact, what's more important as a predictor of risk <v Dr. Patricia Nahormek>in a woman is the good cholesterol or HDL level. <v Dr. Patricia Nahormek>Now, the National Cholesterol Education Program has told <v Dr. Patricia Nahormek>us or suggested to us that an HDL level greater than 35 <v Dr. Patricia Nahormek>would decrease a woman's risk for cardiovascular disease <v Dr. Patricia Nahormek>or indicate a a lesser risk for cardiovascular disease.

<v Dr. Patricia Nahormek>But some more recent research suggests we should up regulate that <v Dr. Patricia Nahormek>number to 50 or possibly even higher. <v Dr. Patricia Nahormek>The most important point is that a woman should know her good cholesterol <v Dr. Patricia Nahormek>level, and that's what she and her physicians should really focus on when <v Dr. Patricia Nahormek>trying to determine what her cardiovascular disease risk is due <v Dr. Patricia Nahormek>to a lipid problem if present. <v Cathy Lewis>So 50 is the new indicator- the benchmark, that we would consider to be <v Cathy Lewis>good? 50 and above. <v Dr. Patricia Nahormek>A number of investigators are strongly proposing that. <v Dr. Patricia Nahormek>Yes. <v Dr. Ahn Campbell>OK. Well, that's good to know because I think a lot of us go to the health fairs and go <v Dr. Ahn Campbell>to the screenings and that sort of thing. We get our- get our tests done and we have this <v Dr. Ahn Campbell>this possibly false, falsely safe feeling that we're all right. <v Dr. Patricia Nahormek>One could get your finger pricked, and learn the total cholesterol level if you're a <v Dr. Patricia Nahormek>woman is 200 and leave the supermarket feeling good that your <v Dr. Patricia Nahormek>cardiovascular disease risk is very low when in fact your HDL or <v Dr. Patricia Nahormek>good cholesterol level, might also be very low.

<v Dr. Patricia Nahormek>And that, in fact, would mean you are at significant risk for developing cardiovascular <v Dr. Patricia Nahormek>disease. On the converse, one could have a total cholesterol level <v Dr. Patricia Nahormek>of as a woman of 250 and leave the health fair thinking <v Dr. Patricia Nahormek>you have a cholesterol problem when in fact you don't because your HDL <v Dr. Patricia Nahormek>level might be 60, 70 or 80, which would be a better <v Dr. Patricia Nahormek>indicator of your cardiovascular disease risk. <v Dr. Patricia Nahormek>And in that case, it would indicate a low risk for cardiovascular disease. <v Cathy Lewis>That's fascinating. So certainly then the whole cholesterol issue is one of the factors <v Cathy Lewis>to consider. Dr. Garris, what are some of the other factors we need to consider when we <v Cathy Lewis>think about heart disease in women? <v Dr. Sheila Garris>Well, you also want to consider the issue of obesity, other medical problems such <v Dr. Sheila Garris>as diabetes. Women often have- often go through <v Dr. Sheila Garris>pre- menopause, either secondary to medications or having <v Dr. Sheila Garris>hysterectomies with their ovaries removed. <v Dr. Sheila Garris>And that will predispose a woman to a lower HDL cholesterol at a earlier <v Dr. Sheila Garris>age so that the damage to the blood vessels begin at a much earlier

<v Dr. Sheila Garris>age. <v Cathy Lewis>Interesting. So those are all things that we might not have previously thought of as <v Cathy Lewis>being [Dr. Sheila Garris: Absolutely] indicators. Before, I wanted to ask a question <v Cathy Lewis>about- to Dr. Campbell, about how women present these issues and <v Cathy Lewis>that type of thing, because I've heard some research that indicates that women tend to <v Cathy Lewis>underreport those symptoms. But because our phones are ringing and we're so delighted <v Cathy Lewis>about that, we do want to be sure to get to our questions from our viewers. <v Cathy Lewis>We have one viewer from Virginia Beach who says she's on steroids, specifically <v Cathy Lewis>prednisone. Does that affect your heart in any way? <v Cathy Lewis>Dr. Campbell, does that affect your heart in any way? <v Dr. Ahn Campbell>It may affect the heart in the sense of if she has a history of family history <v Dr. Ahn Campbell>or coronary artery disease, if she has diabetes, the steroid certainly will increase <v Dr. Ahn Campbell>her sugar. If she has hypercholesterolemia <v Dr. Ahn Campbell>or she has any other risk factor- factor for heart disease, it may affect <v Dr. Ahn Campbell>her. But if she's a normal, young, healthy woman, it <v Dr. Ahn Campbell>may not have any effect at this point in time.

<v Cathy Lewis>How about in terms you- you- you concur with that? <v Cathy Lewis>Both of you concur with that? <v Dr. Sheila Garris>The only other thing is that steroids can also raise your blood pressure and that can <v Dr. Sheila Garris>be a factor. <v Cathy Lewis>Hmm, OK. Good point. <v Dr. Patricia Nahormek>There's somewhat of a dose dependent effect here. <v Dr. Patricia Nahormek>Most people happily are on high dose steroids for very short periods of time, but some <v Dr. Patricia Nahormek>individuals have to be on very high dose sterioids for long periods of times. <v Dr. Patricia Nahormek>And those individuals are the ones who are at most risk for developing premature <v Dr. Patricia Nahormek>coronary disease or even a disease of the heart muscle called cardiomyopathy, where the <v Dr. Patricia Nahormek>muscle becomes weakened and unable to pump. <v Dr. Patricia Nahormek>As I said, happily, most people are on low dose steroids and don't get into- <v Dr. Patricia Nahormek>don't develop any significant cardiovascular disease risk on the steriods. <v Dr. Patricia Nahormek>I would agree totally with the other panelists. <v Cathy Lewis>Great. Thanks to our viewer for that call. <v Cathy Lewis>We have many other calls from viewers that will be- that we'll be responding to <v Cathy Lewis>throughout the evening. So, again, we do encourage you to call us this evening. <v Cathy Lewis>Dr. Campbell, we talked a little bit during during the broadcast about how women <v Cathy Lewis>report symptoms. And the fact is that they may tend to under

<v Cathy Lewis>report. Is that what you find in your practice? <v Dr. Ahn Campbell>Yes, that that is the trend in that woman- we don't want to cause more <v Dr. Ahn Campbell>problems for ourselves. We tend to- to under call <v Dr. Ahn Campbell>the problem. But I find that when women come to my office, seeing me, myself, <v Dr. Ahn Campbell>being a woman, they they feel more open to me and they would tell me <v Dr. Ahn Campbell>more. And I can relate to woman better in that sense. <v Dr. Ahn Campbell>And I can relate to what their level activity is, taking care of their children, cooking <v Dr. Ahn Campbell>household chores and by asking them questions if they have any symptoms, when <v Dr. Ahn Campbell>they do there daily chores then they opened up more. <v Cathy Lewis>And that's when you're able to make a little bit more and formed decision about what <v Cathy Lewis>might be going on. It's an interesting question from one of our viewers who says that she <v Cathy Lewis>is leaving the area. And of course, in this area, we have a lot of people who are coming <v Cathy Lewis>and going all the time. <v Cathy Lewis>She has an irregular heartbeat and a blood pressure of 140 over 70. <v Cathy Lewis>And she has a question about what types of questions she should ask her new physician

<v Cathy Lewis>or to make sure, I guess, that her new physician will be treating her in an appropriate <v Cathy Lewis>way. Any thoughts on that, Dr. Garris? <v Dr. Sheila Garris>Well, I first would encourage the young lady to ask <v Dr. Sheila Garris>her girlfriends. Ask friends about physicians in the new area, go <v Dr. Sheila Garris>in and interview the physician. Sit down. <v Dr. Sheila Garris>And once she has selected a physician interview the physician and see if she can relate <v Dr. Sheila Garris>to the physician. Make sure the physician understands what she's saying and relates to <v Dr. Sheila Garris>her needs and does what she needs to have done. <v Dr. Sheila Garris>Things such as palpitations or irregular heartbeat <v Dr. Sheila Garris>can even- can be benign or can be something that needs to be treated. <v Dr. Sheila Garris>And that depends on the symptom complex and the type of rhythm that she has. <v Dr. Sheila Garris>A 24 hour halter monitor will often delineate exactly what the rhythm is and whether <v Dr. Sheila Garris>or not it needs to be treated. <v Cathy Lewis>You said an interesting thing, which is ask your girlfriends and you were telling me, Dr. <v Cathy Lewis>Nahormek, that you're getting a lot of referrals from women who are talking to other <v Cathy Lewis>women about these issues.

<v Cathy Lewis>How is that? Is that a trend that you've noticed increasing in your practice? <v Dr. Patricia Nahormek>Indeed. And I think it's in part because of the initiatives <v Dr. Patricia Nahormek>by WHRO, among others, to bring the issue of heart disease in women <v Dr. Patricia Nahormek>forward to the public. Also, the American Heart Association has had for the last 3 years <v Dr. Patricia Nahormek>a national initiative on heart disease in women to bring the issue not only to the <v Dr. Patricia Nahormek>layperson, but to the health care professional, to heighten the awareness of <v Dr. Patricia Nahormek>cardiovascular disease and make people aware of some of the new information. <v Dr. Patricia Nahormek>Certainly when a woman has been seen by a cardiologist <v Dr. Patricia Nahormek>and hears her friend saying, you know, I'm having these peculiar discomforts <v Dr. Patricia Nahormek>in my chest, what do you think about that? <v Dr. Patricia Nahormek>And her friend may say, well, you know, I had the same thing. <v Dr. Patricia Nahormek>And I went to my doctor and my doctor she told me <v Dr. Patricia Nahormek>such and such. And that's generally how it happens. <v Dr. Sheila Garris>And it's interesting because most women don't feel as though they'll be <v Dr. Sheila Garris>looked down upon or made to feel in some way bad for for being sick or having

<v Dr. Sheila Garris>a problem in this age, when women are so busy trying to strive and achieve. <v Cathy Lewis>That is fascinating to think that they would- that they would think that way. <v Cathy Lewis>And obviously, because each of you have made this point, the women do feel very <v Cathy Lewis>comfortable telling you in a way they might not otherwise have felt comfortable in the <v Cathy Lewis>past with other physicians. One of our viewers asks an excellent question about the <v Cathy Lewis>kits to check cholesterol that we see from time to time advertised on television. <v Cathy Lewis>Your thoughts on that, Dr. Campbell? Are those accurate? <v Cathy Lewis>Is that something we ought to be getting involved in? <v Dr. Ahn Campbell>I would say that it's very important to make sure you get a complete lipid <v Dr. Ahn Campbell>profile and make sure that's a fasting lipid profile so that we can <v Dr. Ahn Campbell>analyze the data better. So we can look at the the HDL, which is a good <v Dr. Ahn Campbell>cholesterol, and the LDL, which is the bad cholesterol. <v Dr. Ahn Campbell>I don't have much experience with the kit that's available right now, <v Dr. Ahn Campbell>so I can't say for that. But I'd say that the main important thing is this a fasting

<v Dr. Ahn Campbell>lipid profile and they should be done at a doctor's office <v Dr. Ahn Campbell>so that you can receive better counseling. <v Cathy Lewis>Would you agree with that? <v Dr. Sheila Garris>Well, actually, you know, if you're going to go out and spend money on a cholesterol kit, <v Dr. Sheila Garris>it would seem to me that you could go to a health fair or someplace if they do <v Dr. Sheila Garris>cholesterol screening. Absolutely free. <v Dr. Sheila Garris>And then follow up with your physician if there's a problem. <v Dr. Sheila Garris>But most importantly, I would, since we're now looking at HDL and LDL <v Dr. Sheila Garris>cholesterol, what is a general cholesterol going to tell you? <v Cathy Lewis>Yes, exactly. And then- that was the point that that was also being made in the piece. <v Cathy Lewis>What does the average is- is another question from our viewers. <v Cathy Lewis>They come up with wonderful questions. And I'm delighted that you're all calling and I <v Cathy Lewis>hope you will continue to do so throughout the evening. <v Cathy Lewis>What's the average figure for triglycerides? <v Cathy Lewis>A viewer wants to know about that. <v Cathy Lewis>Mm hmm. Dr. Nahormek? <v Dr. Patricia Nahormek>Well, there's mixed information about this. <v Dr. Patricia Nahormek>Clearly, we know if a triglyceride level in a woman. <v Dr. Patricia Nahormek>This soes not apply to men, but in a woman is higher than 300, <v Dr. Patricia Nahormek>that triglyceride level is an independent risk factor for the development of

<v Dr. Patricia Nahormek>cardiovascular disease. <v Dr. Patricia Nahormek>We also have information that suggests that the triglyceride level <v Dr. Patricia Nahormek>under 150 would minimize the triglyceride <v Dr. Patricia Nahormek>effect for cardiovascular disease risk. <v Dr. Patricia Nahormek>We, however, don't know where that magical number below which <v Dr. Patricia Nahormek>or above which we change risk. <v Dr. Patricia Nahormek>We know the extremes. We know under 150 is very good. <v Dr. Patricia Nahormek>We know over 300 is bad. <v Dr. Patricia Nahormek>If you're a cigarette smoker and a woman and you're triglyceride <v Dr. Patricia Nahormek>level is over 300, you're in very high risk. <v Dr. Patricia Nahormek>You're at very high risk for developing cardiovascular disease. <v Cathy Lewis>Good points. One of our other viewers called with a question which I think speaks <v Cathy Lewis>to what we've been talking about and returning to through the evening, which is this <v Cathy Lewis>issue of reporting symptoms and how physicians feel about this. <v Cathy Lewis>This is a 34 year old woman who has had a hysterectomy. <v Cathy Lewis>Her mother died at 55 this year with a heart attack. <v Cathy Lewis>Her doctor says she's too young to have heart disease and she's already having chest

<v Cathy Lewis>pains or she is having. I should say already she is having chest pains. <v Cathy Lewis>Is that is that something she might want to seek a second opinion on or. <v Dr. Ahn Campbell>My next question to her. Does she still have her ovaries? <v Dr. Ahn Campbell>Because, as you know, menstruating woman who still have the ovaries, <v Dr. Ahn Campbell>functional ovaries have the protective effect of estrogen. <v Dr. Ahn Campbell>And that's why you find fewer woman with heart disease, coronary heart disease <v Dr. Ahn Campbell>before menopausal age. <v Dr. Ahn Campbell>So in her I would ask her that question, but I would be very concerned with the fact that <v Dr. Ahn Campbell>she does have a strong family history of coronary artery disease. <v Cathy Lewis>And chest pain. <v Dr. Ahn Campbell>Yes. And chest pain, definitely. And so. <v Cathy Lewis>Let's talk a little bit more about that issue of menopause, because that's a that's a <v Cathy Lewis>very interesting point that they made, which is that the risks are jumped significantly <v Cathy Lewis>with the onset of menopause. <v Cathy Lewis>Why? Why is that? What is it about our bodies that makes that happen? <v Cathy Lewis>They obviously had something do with estrogen. <v Dr. Sheila Garris>Estrogen changes the ratio of HDL to LDL, <v Dr. Sheila Garris>but it actually does is lower the HDL.

<v Dr. Sheila Garris>So that your chances for cardiovascular disease increase. <v Dr. Sheila Garris>That's why when a woman goes through menopause, be it surgical, <v Dr. Sheila Garris>chemical or physiological. <v Dr. Sheila Garris>It's important that she sit down and discuss with her physician the option of estrogen <v Dr. Sheila Garris>replacement therapy. There are some women that is not their treatment <v Dr. Sheila Garris>of choice to provide for. <v Dr. Sheila Garris>But for most women, it's something that should be addressed and should and probably <v Dr. Sheila Garris>instituted. <v Cathy Lewis>That's interesting. What about the issues of race as they relate <v Cathy Lewis>to women and heart disease? Are we know, for instance, that African-American women have a <v Cathy Lewis>higher rate of heart disease than, say, Caucasian women? <v Cathy Lewis>What are the reasons for that? And is that something that African-American women need to <v Cathy Lewis>be on the lookout for at an earlier age? Possibly. <v Dr. Sheila Garris>Well, there is a higher incidence of hyperlipidemia along among African-American women <v Dr. Sheila Garris>as well as diabetes and hypertension. <v Dr. Sheila Garris>Those are all risk factors that compound the cholesterol <v Dr. Sheila Garris>issue with black women.

<v Cathy Lewis>So does this mean that black women need to be aware of this at an earlier age than than, <v Cathy Lewis>say, their Caucasian counterparts or Asian American counterparts? <v Dr. Sheila Garris>That's true. <v Cathy Lewis>We also talked about the fact that diet has a great deal to do with us, too, and the fact <v Cathy Lewis>that depending on what your diet is, that- that is certainly a factor. <v Cathy Lewis>One of our viewers has an interesting point. <v Cathy Lewis>We talked about this during the break. We said, you know, we think this cholesterol <v Cathy Lewis>business problem is confusing thing there is out there. <v Cathy Lewis>And and indeed it is. <v Cathy Lewis>One of our viewers would like us to clarify how the ratio of HDL and LDL <v Cathy Lewis>is calculated and give an example that sounds like a story problem from school. <v Cathy Lewis>And I'm not good at those as anyone else here tonight good at them. <v Dr. Patricia Nahormek>I think that the viewer is probably asking about the ratio of the total <v Dr. Patricia Nahormek>cholesterol to HDL level, although some laboratories will <v Dr. Patricia Nahormek>report out the HDL to LDL ratio and use the LDL as a reflector of total cholesterol. <v Dr. Patricia Nahormek>But generally the ratio we're concerned about is the total cholesterol level to HDL. <v Cathy Lewis>To HDL, ok. <v Dr. Patricia Nahormek>And so, for example, if your cholesterol is 300,

<v Dr. Patricia Nahormek>your total cholesterol is 300, your HDL level is 30. <v Dr. Patricia Nahormek>Your ratio is 10 to 1. <v Dr. Patricia Nahormek>300 divided by 30. <v Dr. Patricia Nahormek>Your ratio would be 10. <v Dr. Patricia Nahormek>That would put you at high risk. <v Dr. Patricia Nahormek>A good ratio would be under 3.5. <v Cathy Lewis>It's very complex. [Dr. Nahormek: Yes it is] It really is very complex. <v Cathy Lewis>I very much sympathize with our viewers out there who are trying to make those decisions. <v Cathy Lewis>You started to say something, Dr. Garrison. I just about that whole issue of comparing. <v Cathy Lewis>Do you find people confused about that in your practice? <v Dr. Sheila Garris>They often will come in and say, you know, I want an lipid profile or I want to have <v Dr. Sheila Garris>my cholesterol checked. One of the things that you need to ask- one of the questions <v Dr. Sheila Garris>you need to ask is, number one, is their family history, because people with family <v Dr. Sheila Garris>histories often no matter how- how much they diet, we can't correct <v Dr. Sheila Garris>their cholesterol. One of the advantages of doing a lipid profile

<v Dr. Sheila Garris>also is to decide which medication a patient might need. <v Dr. Sheila Garris>Certain medicines work on different fractions of the lipid- lipid profile more <v Dr. Sheila Garris>effectively than other medications. <v Dr. Sheila Garris>So history taking is very important. <v Cathy Lewis>Thank you very much. I thank each of you. <v Cathy Lewis>We're going back to Heart to Heart now for a segment with both men and women <v Cathy Lewis>who are heart patients. And you'll hear their stories. <v Cathy Lewis>When we return you'll meet two Hampton Roads women and hear about their particular <v Cathy Lewis>experiences. And we'll talk about treatment and support issues for women. <v Cathy Lewis>We will, of course, continue to take your comments and questions right here in the <v Cathy Lewis>studio. The numbers to call 489-2700 or 1 <v Cathy Lewis>800 3 4 4 7 7, 6, 4. <v Dr. William Castelli>Welcome back to this segment. <v Dr. William Castelli>We're now going to talk with some people who've had experience with bad risk, <v Dr. William Castelli>and they're here with their doctors tonight.

<v Dr. William Castelli>And we hope that by talking to them and and learning something from them, <v Dr. William Castelli>that we can get a better real perspective of what goes on <v Dr. William Castelli>in this disease. <v Dr. William Castelli>Now, we're going to start with you, Dorothy. <v Dr. William Castelli>In a way, it was unusual. You didn't get the typical crushing rush <v Dr. William Castelli>to the hospital type of chest discomfort. <v Dr. William Castelli>What happened? <v Dorothy>Well, I would say in a period of two years, I would get. <v Speaker>It's in a different sub fractions of cholesterol. <v Dr. William Castelli>You know, Howie, you apparently were learning <v Dr. William Castelli>about how to control your cholesterol in the diet. <v Dr. William Castelli>But it wasn't working. <v Howie>Yes. Right correct. <v Dr. William Castelli>And why was that? Why do you think that was? You just didn't get your mindset into this? <v Howie>No. As it turned out, I spent about six months on a very low <v Howie>fat diet, high fiber, and apparently the genetics <v Howie>just didn't work and they weren't working. <v Howie>So I was I was unable to reduce it much beyond 15 points to 65.

<v Howie>And that's pretty much where it stayed. <v Howie>And they were unfortunately forced to put me on medication. <v Howie>And over the last 3 years, I've been able to get it down 25 percent. <v Howie>So my ratio now is around 4. <v Dr. William Castelli>You know, Dorothy, I have some good news for you on the quitting smoking in our <v Dr. William Castelli>study. When women quit smoking, their risk <v Dr. William Castelli>of a heart attack fell all the way back to the risk they would have had had <v Dr. William Castelli>they never smoked in 1 year. <v Dr. William Castelli>Now. If you look at the cancer risk. <v Dr. William Castelli>It takes about 10 years of quitting before your risk gets all the way back. <v Dr. William Castelli>So you still have about 3 more years to go but [laughter] the <v Dr. William Castelli>fact that you still get any yearnings about starting back. <v Dorothy>That day I stopped I haven't. And no- I smoked two packs a day of lucky strikes. <v Dorothy>And I smoked since I was 12 years old and just got rid <v Dorothy>of it like that.

<v Dr. William Castelli>That's great. <v Speaker>Even when you smoke two cigarettes a day, they showed in the nurses health study, <v Speaker>you increase your- your risk of heart attack by more than 2 fold. <v Speaker>So, you know, even if you cut down, it's not good enough. <v Speaker>But- but stopping and for that number of years is wonderful. <v Dr. William Castelli>Well, we want to thank all of you for coming down here. <v Dr. William Castelli>You know, some of the things you said are going to go out and help a lot of people <v Dr. William Castelli>who need to know, you know, that there are real live people that do do these things <v Dr. William Castelli>and are successful at doing them. <v Dr. William Castelli>And it's it's a hard thing to stay and get to the reality when you feel well, it's hard <v Dr. William Castelli>to continue. We'll be right back. <v Dr. William Castelli>And when you come back, we're going to tell you how to go shopping for the low fat foods. <v Dr. William Castelli>We're going to show you how to relax. <v Dr. William Castelli>And we're going to show you how to laugh and relax. <v Dr. William Castelli>Ok. [music] [applause] <v Cathy Lewis>If you've just joined us, welcome to the Women's Health Initiative on WHRO TV 15

<v Cathy Lewis>tonight. We're talking about women and heart disease. <v Cathy Lewis>While we're talking about this important health issue, we are taking your comments, your <v Cathy Lewis>questions and requests for our special information packets. <v Cathy Lewis>People have been calling in all evening, and I hope that you will do the same if you have <v Cathy Lewis>a question. Our number is 489-2700 or 1 800 3 4 <v Cathy Lewis>4 7 7, 6, 4. <v Cathy Lewis>Now, you've just heard from men and women about their experiences with heart disease. <v Cathy Lewis>And now you'll hear from two Hampton Roads women who are contending with it as well. <v Cathy Lewis>We'll also speak with two cardiologists and the coordinator of cardiac outpatient <v Cathy Lewis>services at Riverside Regional Medical Center about the kind of support heart patients <v Cathy Lewis>need. Dr. Patricia Nahormek is from the Tidewater Heart Institute on the Peninsula <v Cathy Lewis>and is the incoming president of the American Heart Association of Virginia. <v Cathy Lewis>Dr. Ahn Campbell is a cardiologist from the Cardiovascular Center on the peninsula. <v Cathy Lewis>Ann Kilgore will be known to many of you. She is a former mayor of the city of Hampton <v Cathy Lewis>and is a patient of Dr. Nahormek. MCC's Margaret Wanca is a heart patient from Virginia

<v Cathy Lewis>Beach. She is active with the Virginia Beach chapter of Mended Hearts, which is a <v Cathy Lewis>support group for heart patients sponsored by the American Heart Association. <v Cathy Lewis>Rita Scott is the coordinator of Riverside Hospital's cardiac services. <v Cathy Lewis>And we're going to talk about the treatment of women with heart disease. <v Cathy Lewis>And then I'll tell you, I'm so amazed to hear the phones ringing the way they have. <v Cathy Lewis>We were talking earlier about how marvelous that is, and we hope that you'll continue to <v Cathy Lewis>call them with your questions through the evening. <v Cathy Lewis>Your questions are the very best ones that we can get here this evening, if you will. <v Cathy Lewis>When you call, though. Please be sure to tell us your age. <v Cathy Lewis>That will be important in- in helping us get a little bit better handle <v Cathy Lewis>on your particular situation and in helping us give specific information about <v Cathy Lewis>age situations and age brackets. <v Cathy Lewis>Mayor Kilgore, if I may call you that? How are you this evening? <v Ann Kilgore>Fine. Thank you. <v Cathy Lewis>How did you first discover that you you had heart disease? <v Cathy Lewis>It came as a bit of a shock, didn't it? <v Ann Kilgore>Yes, I was Christmas shopping in '91. <v Ann Kilgore>And I found myself getting a breath at the mall and sitting down on the benches. <v Ann Kilgore>And more than that, I- when I would get out of breath, I would then have a pain in the

<v Ann Kilgore>back of my neck. I didn't know then that that was associated with women <v Ann Kilgore>and heart disease. But I was told that late by my doctor. <v Ann Kilgore>I had a regular appointment with him and went and he told me that after he did a <v Ann Kilgore>cardiogram that he thought perhaps I had an angina. <v Ann Kilgore>And I asked him if that were worse than angina [laughter] which I had always heard of all <v Ann Kilgore>my life. And he said he assured me that it was. <v Ann Kilgore>And that's when he sent me to a cardiologist. <v Ann Kilgore>So I went to the cardia- I went to him on Tuesday and went to the cardiologist <v Ann Kilgore>on Wednesday. I had the catheterization on Thursday and the surgery on Friday. <v Ann Kilgore>So I didn't have very much time to think about what was happening to me <v Cathy Lewis>I guess you really didn't. That's amazing. But that's the way it often happens is when <v Cathy Lewis>it presents itself, you have to respond to it faitly quickly. <v Ann Kilgore>I think they thought there was a risk that I might have a heart attack. <v Ann Kilgore>And I hadn't had one. <v Cathy Lewis>And had there been history in your family or? <v Ann Kilgore>No, I had expected to have cancer. <v Ann Kilgore>That's what all my family had so I was very surprised. <v Cathy Lewis>Interesting. Interesting. Margaret Wanca you were- you had a heck of a year in 1992, <v Cathy Lewis>didn't you?

<v Margaret Wanca>I certainly did. In April, I had a heart attack. <v Margaret Wanca>In June of the same year I had the angioplast and then August <v Margaret Wanca>14th of '92, I had double bypass. <v Cathy Lewis>That's quite- that's quite a journey. Did you have any clue previously that you were <v Cathy Lewis>having heart problems? <v Margaret Wanca>No, as a matter of fact when I had the heart attack I didn't know that's what was <v Margaret Wanca>happening. <v Cathy Lewis>What did it feel like? <v Margaret Wanca>I was just uncomfortable, chest, arms, nothing severe, just uncomfortable. <v Margaret Wanca>And it was- I was just getting ready to go to bed at night about 11:30 and my husband to <v Margaret Wanca>get having heart attack. <v Margaret Wanca>You've got to be kidding. He said no. Let's go. <v Margaret Wanca>And fortunately, we live one mile from Virginia Beach General Hospital. <v Cathy Lewis>That is fortunate. <v Margaret Wanca>So he took me there and everything worked out beautifully. <v Cathy Lewis>But how interesting that he knew that that's what you were having and you're sitting <v Cathy Lewis>their saying Nah not me- not me. <v Margaret Wanca>Well, he has an experience of being a special police officer, which <v Margaret Wanca>is a part time policeman in New Jersey. <v Margaret Wanca>And so that's where he had his experience in recognizing these problems. <v Cathy Lewis>If it were not for that, though, you might have waited for the sort of the classic heart

<v Cathy Lewis>attack we always see in all the television programs [Margaret Wanca: Exactly] where you <v Cathy Lewis>fall on the floor clutching at your chest. And that wasn't what you had at all. <v Margaret Wanca>That's right. <v Cathy Lewis> Interesting. <v Margaret Wanca> I'm grateful for him for many things. <v Cathy Lewis>Indeed so, indeed so. Now you two both obviously are here to tell the tale is, as <v Cathy Lewis>we were talking in the beginning of the program, about the fact that most people who have <v Cathy Lewis>heart disease at this- at this point in history will be alive to tell the tale. <v Cathy Lewis>And that's- that's a very good thing. You're part of Mended Hearts, which is a support <v Cathy Lewis>group. <v Margaret Wanca>Yes, I belong to Mended Hearts. <v Margaret Wanca>It's a support group. I belong to Chapter 233 in Virginia Beach and <v Margaret Wanca>we meet monthly and it's great because we usually have speakers, a <v Margaret Wanca>cardiologist have spoken to us, even the people from the operating room, the <v Margaret Wanca>profusionist. They work the machine. <v Margaret Wanca>We have different speakers like that and then we have the wonderful support from each <v Margaret Wanca>other. I think we all live with a certain amount of fear, but nobody <v Margaret Wanca>really understands that unless they've been there. <v Margaret Wanca>So having a group of people who have been there to share with is very beneficial. <v Cathy Lewis>And Rita Scott, you're a nurse practitioner in cardiac services.

<v Cathy Lewis>I guess you would agree with that that support is crucial. <v Rita Scott>It's very crucial- that support is very crucial. <v Rita Scott>I think during the hospitalization and afterwards, as you go through your recuperation <v Rita Scott>and learning to overcome those fears of will I have that pain again or what will happen <v Rita Scott>and how can I better take care of myself? So learning the new healthy lifestyle <v Rita Scott>is very important and you can get that support through programs. <v Ann Kilgore>I thought the support that I had when I went to the rehabilitation exercise <v Ann Kilgore>program at the hospital, I thought that was very, very wonderful because you are very <v Ann Kilgore>apprehensive when you first start doing that and they have nurses there who monitor, you <v Ann Kilgore>know, all for- I think it's twelve weeks you go in. <v Cathy Lewis>Are you fearful that it's going to happen again? Is that- is that the fear? <v Ann Kilgore>I guess that's the fear you have. <v Ann Kilgore>But not- not all the time or anything. [Cathy Lewis: Mhm, sure] But when you first start <v Ann Kilgore>back in the exercie program you do think very differently [laughter]. <v Cathy Lewis>Yeah, I can imagine you do especially if it's something you had <v Cathy Lewis>not thought you were going to have to think about. <v Ann Kilgore>That's right. <v Cathy Lewis>Interesting. <v Margaret Wanca>In Virginia Beach, we're very fortunate because they do sponsor an- in addition to the <v Margaret Wanca>rehabilitation at the hospital, we also have a fitness center, which only

<v Margaret Wanca>those people who have a prescription can go to. <v Margaret Wanca>So anything is monitored by people who are trained in sports medicine. <v Cathy Lewis>That's terrific. So a lot of people probably had their first experience of that after <v Cathy Lewis>this kind of experience. They probably wing [Rita Scott: Exactly] up living what more <v Cathy Lewis>healthy lifestyles and they might have previously. <v Rita Scott>Very much so. Very much so. And they feel better than they felt nears- It's typically <v Rita Scott>what our response after they've completed a program and the ongoing program is very <v Rita Scott>important to keep their exercise going because some people need that regimented schedule <v Rita Scott>and others are very much have to continue it on their own. <v Rita Scott>But-. <v Cathy Lewis>I would be a regimented schedule one myself. <v Cathy Lewis>[laughter] We are here this evening on WHRO TV 15, taking your- your calls, your <v Cathy Lewis>questions about heart disease in women. <v Cathy Lewis>We've been absolutely astounded by the volume of calls we're receiving here. <v Cathy Lewis>So we do want to get back to those calls. <v Cathy Lewis>It's very interesting. And I- and I- what we were saying during the break is that is the <v Cathy Lewis>fact that it's astounding that people will call doctors. <v Cathy Lewis>They- they don't know or will call a panel they don't know to ask doctors they don't

<v Cathy Lewis>know questions about their own relationship to heart disease. <v Cathy Lewis>And some of these are very specific, very pointed questions. <v Cathy Lewis>Are you surprised by that or? <v Dr. Patricia Nahormek>A little bit surprised but- in one way, but in another way, not. <v Dr. Patricia Nahormek>I- I think we are here to answer questions <v Dr. Patricia Nahormek>and maybe physicians in a bit busy practice <v Dr. Patricia Nahormek>don't give the impression of being available at that time to answer questions. <v Dr. Patricia Nahormek>Um, certainly I've seen patients who would indicate <v Dr. Patricia Nahormek>that they had a lot of questions, but their doctor just didn't <v Dr. Patricia Nahormek>have the time to answer them. So in part, maybe that's why we're getting so many <v Dr. Patricia Nahormek>questions but I think, too, it's because you've got a couple of lady cardiologists here. <v Dr. Patricia Nahormek>[laughter] <v Cathy Lewis>I think that probably does have a lot to do with it too. I think you're exactly right. <v Cathy Lewis>Let's get back to some of the some of the questions, because they do a beg discussion

<v Cathy Lewis>about some generalized issues. One of the- several questions we had this evening had to <v Cathy Lewis>do with smoking and oral contraception. <v Cathy Lewis>What is it- One person said they've stopped smoking and they're not eating red meat <v Cathy Lewis>anymore and they're still taking their oral contraceptive. <v Cathy Lewis>What happens to the risk of heart disease there? Dr. Nahormek? <v Dr. Patricia Nahormek> Within the first year of a smoker's <v Dr. Patricia Nahormek>last cigarette or at the end of the first year after the last cigarette, <v Dr. Patricia Nahormek>a person's risk for cardiovascular disease is reduced by 50 percent. <v Dr. Patricia Nahormek>So within- at one- at your 1 year anniversary from your last cigarette, your <v Dr. Patricia Nahormek>cardiovascular disease risk drops by 50 percent at your 10 year anniversary. <v Dr. Patricia Nahormek>Your risk for cardiovascular disease from cigarette smoking is equal to that of an <v Dr. Patricia Nahormek>individual who never smoked. <v Dr. Patricia Nahormek>So that's- those are very startling statistics to some people. <v Dr. Patricia Nahormek>But it goes to show you that stopping cigarette smoking is a great benefit to you. <v Dr. Patricia Nahormek>And this can occur regardless of the number of years you've been smoking or

<v Dr. Patricia Nahormek>the age at which you stopped cigarette smoking. <v Dr. Patricia Nahormek>We also know that the single population that's smoking more in the United <v Dr. Patricia Nahormek>States is the woman between the ages of 18 and 25. <v Dr. Patricia Nahormek>A cigarette smoke or a female cigarette smoker will increase your risk of cardiovascular <v Dr. Patricia Nahormek>disease by a factor of 2 to 10, depending upon whether she has any other <v Dr. Patricia Nahormek>risk factors for cardiovascular disease. <v Dr. Patricia Nahormek>None of those risk factors for cardiovascular disease maybe the use of oral <v Dr. Patricia Nahormek>contraceptives. <v Dr. Patricia Nahormek>Oral contraceptives increase- oral contraceptive use increases a woman's <v Dr. Patricia Nahormek>risk slightly for cardiovascular disease, maybe by a factor of 1.2 to 1.3. <v Dr. Patricia Nahormek>If that oral contraceptive using woman also smokes, <v Dr. Patricia Nahormek>her risk for cardiovascular disease goes up by a factor of 6.5. <v Dr. Patricia Nahormek>If she stops smoking, she makes the largest reduction <v Dr. Patricia Nahormek>in her cardiovascular disease risk. <v Dr. Patricia Nahormek>If she stops her oral contraceptives, the impact and cardiovascular

<v Dr. Patricia Nahormek>disease risk is not as great if she continues to smoke. <v Dr. Patricia Nahormek>So if a woman has a choice. <v Cathy Lewis>So you've got the choice, the pill or the cigarette? Which do you do? <v Dr. Patricia Nahormek>Stop smoking. <v Cathy Lewis>That first. <v Cathy Lewis>Did you hear that? If it's the pill or the cigarets, stop that smoking. <v Cathy Lewis>One person- one woman has called in saying that she has heart disease. <v Cathy Lewis>She has a strong pounding in a right ear with pain and whistling. <v Cathy Lewis>Is this a sign of carotid artery blockage indicates that she's on a new medication. <v Cathy Lewis>I'm not even going to attempt to pronounce AMLO dipping. <v Cathy Lewis>Was that close. [mumbling] I could be a doctor. <v Cathy Lewis>I pronounced it right. I'm impressed. <v Cathy Lewis>She wants to know what's the maximum daily dosage and what all of that means. <v Cathy Lewis>Again, that's a very specific question. But the issue of the pounding in the ear and <v Cathy Lewis>the pain and the whistling, those are not symptoms that we would, I guess, ordinarily <v Cathy Lewis>associate with heart problems. <v Cathy Lewis>Is that something she should be concerned about? <v Dr. Ahn Campbell>It certainly could suggest that that she may have problem with her carotid arteries.

<v Dr. Ahn Campbell>But sometime when a woman or man sleeping late at night <v Dr. Ahn Campbell>in the silent room and they can hear or feel the pulsation of their arteries, <v Dr. Ahn Campbell>that may be normal. I don't know. <v Dr. Ahn Campbell>I can't really tell. Certainly it's something if it causes her enough symptoms or enough <v Dr. Ahn Campbell>concern that she should be seen. <v Dr. Ahn Campbell>Without having seen her, I can't really comment. <v Cathy Lewis>And that's the point. The other point we will make about some of these questions that <v Cathy Lewis>they are terribly specific. Obviously, you need to talk to your own physician <v Cathy Lewis>and be brave about asking those questions. <v Cathy Lewis>And that's one lesson that we certainly have learned tonight, is that you can ask <v Cathy Lewis>questions of your physician and indeed you should ask the full range of questions, <v Cathy Lewis>because there are very many indications of heart problems that you might not ordinarily <v Cathy Lewis>think of at the outset. Here is a viewer who's had a mild heart attack last year <v Cathy Lewis>and has had a procedure called a cardioscopy- cardiascopy, <v Cathy Lewis>inserting a needle with a light through the artery in the upper thigh.

<v Cathy Lewis>And the woman is curious about that procedure and what is determined by it. <v Cathy Lewis>That leads us into a discussion, I guess, about treatment issues and treat- or about <v Cathy Lewis>diagnosis options. <v Cathy Lewis>What kinds of options are available for diagnosing heart problems, Dr. Nahormek? <v Dr. Patricia Nahormek>Well, there are a number of noninvasive as well as invasive procedures, the procedure <v Dr. Patricia Nahormek>that was asked about as an invasive experimental procedure. <v Dr. Patricia Nahormek>Stress testing has traditionally been the test used <v Dr. Patricia Nahormek>to determine whether an individual may have significant underlying coronary artery <v Dr. Patricia Nahormek>disease. The problem is a standard treadmill stress test had <v Dr. Patricia Nahormek>a very poor predictive accuracy for <v Dr. Patricia Nahormek>telling whether a woman has coronary artery disease or not. <v Dr. Patricia Nahormek>It's very- it's fairly accurate in men, but very inaccurate in women. <v Dr. Patricia Nahormek>So generally we have to go to other modalities. <v Dr. Patricia Nahormek>For example, we might use radionuclide injections during stress <v Dr. Patricia Nahormek>testing that permit us to see how good the blood flow to the heart muscle is <v Dr. Patricia Nahormek>to get a better feel for whether there's significant underlying coronary artery disease.

<v Dr. Patricia Nahormek>We might use ultrasound echocardiography in the setting of stress testing, <v Dr. Patricia Nahormek>either on a bicycle or with certain medications that trick the heart to thinking <v Dr. Patricia Nahormek>the patient is exercising, again to tell us whether there might be some underlying <v Dr. Patricia Nahormek>coronary artery disease. Aside from those noninvasive diagnostic <v Dr. Patricia Nahormek>procedures, the other diagnostic modalities would include the invasive procedures <v Dr. Patricia Nahormek>such as cardiac catherization, which permit us to see <v Dr. Patricia Nahormek>how severely blocked a coronary artery may be. <v Dr. Patricia Nahormek>The procedure that was alluded to in the question is an experimental procedure in <v Dr. Patricia Nahormek>which the cardiologist can actually see <v Dr. Patricia Nahormek>the inside of the blood vessel and determine how <v Dr. Patricia Nahormek>blocked up the blood vessel is and exactly what the nature of the blockage <v Dr. Patricia Nahormek>is. Is it a blood clot? Is it cholesterol fat? <v Dr. Patricia Nahormek>Is is there calcium that's also involved in the blockage? <v Dr. Patricia Nahormek>This is a very new and very exciting modality.

<v Dr. Patricia Nahormek>Dr. Campbell may have had some experience with this where- where in <v Dr. Patricia Nahormek>Washington, where she recently came from. <v Cathy Lewis> Have you had have you had experience with that particular model? <v Dr. Ahn Campbell>I was exposed to it. I did not perform it. <v Dr. Ahn Campbell>But yes, at the at the Washington Hospital Center, we did a lot of experimental <v Dr. Ahn Campbell>procedures. And that was one of it. <v Dr. Ahn Campbell>And it was very, very, very exciting to see. <v Dr. Ahn Campbell>What is inside a blood vessel without the usage of rate- of <v Dr. Ahn Campbell>extra- of dye- contrast dye? <v Dr. Ahn Campbell>We can see directly the color of the plaque and the blood clot. <v Dr. Ahn Campbell>It was very exciting. <v Cathy Lewis>There are also some exciting discoveries in terms of treatment options as well. <v Cathy Lewis>We get a little bit of discussion about treatment options and I guess in that case, too, <v Cathy Lewis>they're invasive and noninvasive options. <v Cathy Lewis>Doctor Nahormek, you- you do a number of invasive? <v Dr. Patricia Nahormek>I'm a noninvasive and nuclear cardiologist. <v Dr. Patricia Nahormek>[Cathy Lewis: OK] And focus on the noninvasive <v Dr. Patricia Nahormek>diagnostic procedures at this point in my career, although I must say that years

<v Dr. Patricia Nahormek>back, I did cardiac catherization. <v Dr. Patricia Nahormek>But have became- become a little bit more focused in the noninvasive <v Dr. Patricia Nahormek>area. <v Cathy Lewis>I kyou Dr. Campbell, what what what types of treatments do <v Cathy Lewis>you find yourself concentrating on in this, at this time? <v Dr. Ahn Campbell>I basically practice general cardiology. <v Dr. Ahn Campbell>I see patients, examine them, and I do all sorts of tests, noninvasive tests, as well as <v Dr. Ahn Campbell>cardiac catheterization and PTC, which is an angioplasty <v Dr. Ahn Campbell>where we open up the blockage with a balloon procedure. <v Cathy Lewis>Do you find more women coming into your practice at this point? <v Cathy Lewis>And if so, do you? Does that have any impact at all on the type of procedure that you- <v Cathy Lewis>that you use? Does it- does the way it-does gender have an impact? <v Dr. Patricia Nahormek>Oh, yes. As I was indicating, if a woman presents with <v Dr. Patricia Nahormek>chest pain, it's not clear to me whether that's due to underlying coronary disease rather <v Dr. Patricia Nahormek>than do- If I'm going to use a noninvasive procedure, I will not do a standard <v Dr. Patricia Nahormek>treadmill test because that's going to be inaccurate for- for making the diagnosis.

<v Dr. Patricia Nahormek>I will use either the radionuclide or echo unless I decide to go <v Dr. Patricia Nahormek>to the invasive diagnostic procedure, which is the catheterization test. <v Cathy Lewis>One of the things that we're getting a lot of questions about tonight is the issue of <v Cathy Lewis>family history. My father had this. <v Cathy Lewis>My mother had this. My cousin had this. <v Cathy Lewis>What kind of a predictor is family history for- for heart disease? <v Cathy Lewis>[Dr. Campbell: I'll let you answer this] <v Dr. Patricia Nahormek>It's probably the second to gender <v Dr. Patricia Nahormek>in terms of its power as a predictor for cardiovascular disease. <v Dr. Patricia Nahormek>One of the important questions that is asked, however, <v Dr. Patricia Nahormek>is what aspect of the family history is predictive <v Dr. Patricia Nahormek>of an individual's cardiovascular disease risk? <v Dr. Patricia Nahormek>Just because your grandmother had a heart attack at the age of 79 <v Dr. Patricia Nahormek>does not mean you are at risk for developing premature <v Dr. Patricia Nahormek>or any cardiovascular disease. <v Dr. Patricia Nahormek>If your grandmother had a heart attack at the age of 50, that

<v Dr. Patricia Nahormek>would be an important family history risk factor for you because <v Dr. Patricia Nahormek>of age. <v Cathy Lewis>The younger the age. <v Cathy Lewis>I see. <v Dr. Patricia Nahormek>So generally speaking, a family history <v Dr. Patricia Nahormek>of heart disease that's important for a man is if <v Dr. Patricia Nahormek>a first degree relative had the expression of <v Dr. Patricia Nahormek>coronary artery disease before the age of 55, for a woman it <v Dr. Patricia Nahormek>would be 50. <v Dr. Patricia Nahormek>It's interesting that a- a younger age is required for a woman [Cathy Lewis: <v Dr. Patricia Nahormek>right] in terms of family history. <v Cathy Lewis>It's really fascinating. I want to be sure to get to our to our panelists who have <v Cathy Lewis>experienced heart disease also. <v Cathy Lewis>And I want to remind you that we're here tonight taking your calls, questions and <v Cathy Lewis>comments all evening long at 489-2700 or 1 <v Cathy Lewis>800 3 4 4 7, 7, 6, 4. <v Cathy Lewis>And our panelists are standing by. We are getting an unbelievable number of questions and <v Cathy Lewis>some some very general, some very specific.

<v Cathy Lewis>But I wanted to be sure that we concentrated a little bit on the issues of symptoms, <v Cathy Lewis>how you knew what was going on and if you have any particular warnings <v Cathy Lewis>or women out there. You yourself, Mayor Killgore said that you never thought you had <v Cathy Lewis>heart disease. <v Ann Kilgore>No, but I have always been overweight and I developed adult onset <v Ann Kilgore>diabetes, which I'm sure contributed to the heart disease. <v Ann Kilgore>And so I think, you know, if I could have gotten skinny at age 20 maybe it would have <v Ann Kilgore>happened. <v Cathy Lewis>I see so but- but- but you still had no idea that this was done at all. <v Cathy Lewis>You didn't have pains in advance. <v Cathy Lewis>Just felt fine. So, you know, if we're talking to other women out there, you really <v Cathy Lewis>cannot necessarily say you'll have a shooting paying down your left arm. <v Ann Kilgore>And that's what it is. I just had the pain in the back of my neck. <v Cathy Lewis>And you wouldn't ordinarily, I wouldn't think most people would associate that with heart <v Cathy Lewis>problems. <v Ann Kilgore>Not at all. The being out of breath made me think I might have something, <v Ann Kilgore>but I didn't dream I would have bypass in three days. <v Cathy Lewis>I could imagine not. I can imagine not. <v Cathy Lewis>Margaret Wanca. What advice would you have for women out there who who

<v Cathy Lewis>may have this silent killer? <v Margaret Wanca>If I had known to look for specific symptoms, I would <v Margaret Wanca>have perhaps been in a better condition. <v Margaret Wanca>I had very high tryglicerides at one point due to a thyroid problem. <v Margaret Wanca>I was a smoker, uh. <v Cathy Lewis>Ok.You had a big risk factor there. <v Margaret Wanca>Yes, so you know, the big thing is to get as much information as you <v Margaret Wanca>can and specific information. <v Margaret Wanca>This type of program is excellent in that regard. <v Margaret Wanca>And pay attention to the things they hear tonight. <v Cathy Lewis>Couldn't have said it better. <v Ann Kilgore>My cholesterol was low when I had the bypass. <v Cathy Lewis>Interesting, I couldn't of said it better. <v Cathy Lewis>Thank you. And as we go back to the network for the last segment of Heart to Heart, let <v Cathy Lewis>me remind you that again, we are taking your questions and comments here in the studio <v Cathy Lewis>all evening. So please be sure to call us at 4 8, 9, 20, 700 or 1 <v Cathy Lewis>800 3 4 4 7 7, 6 4. <v Cathy Lewis>When we return for our last discussion here. <v Cathy Lewis>We'll speak with two exercise physiologists, a nutrition professional and an internist

<v Cathy Lewis>about healing our hearts and trying to ensure that we'll never need to have to. <v Cathy Lewis>Please stay tuned. [music] <v Dr. William Castelli>Welcome. Welcome back. <v Dr. William Castelli>We're now going to look at some of the lifestyle changes we think that people can <v Dr. William Castelli>do that will change their risk factors. <v Dr. William Castelli>And one of the first things we're going to talk about is diet and losing weight. <v Dr. William Castelli>You wonder why more people don't go on a diet and lose weight. <v Dr. William Castelli>It's so much fun and it's so easy. <v Dr. William Castelli>[laughter]When we learned about gaining weight, <v Dr. William Castelli>we learned that all the risk factors got worse. <v Dr. William Castelli>Then we learned. [video cuts out] <v Speaker>There are many, many ways to reframe stress.

<v Speaker>But in particular, one of the greatest ways is to celebrate life <v Speaker>right now. Thank you. [applause] <v Dr. William Castelli>We'd like to thank you all for coming tonight. <v Dr. William Castelli>And we hope that you've been able to learn a little bit about <v Dr. William Castelli>why people get heart attacks. But better than that we would hope that you've learned <v Dr. William Castelli>a way now that you could go home and prevent your heart attack and your stroke, <v Dr. William Castelli>and you would not only live a little longer, but the quality of your life <v Dr. William Castelli>would be a lot better. Thank you very much for coming. <v Dr. William Castelli>[applause] [music] <v Cathy Lewis>You're watching an evening of programing about women and heart disease here on WHRO

<v Cathy Lewis>TV 15. It is part of the Women's Health Initiative on public television. <v Cathy Lewis>I'm Cathy Lewis and we're taking your comments and requests for our women's health <v Cathy Lewis>information packets. The numbers to call are <v Cathy Lewis>489-2700, or 1 800 3 4 4 7 7 6 4. <v Cathy Lewis>On the program you've just been watching called Heart to Heart. <v Cathy Lewis>You've heard a lot about lifestyle changes as the way to healing our hearts. <v Cathy Lewis>And that's what we're going to talk about here in our studio tonight. <v Cathy Lewis>We have a number of guests that I'm sure will give us all we need to know about diet, <v Cathy Lewis>nutrition and exercise. <v Cathy Lewis>Debbie Waldschmidt is an exercise physiologist from Mary Immaculate Hospitals Women in <v Cathy Lewis>Focus Center. Katherine Tate is a dietitian and nutrition specialist <v Cathy Lewis>with Sentara Norfolk generals' Cardiac Services. <v Cathy Lewis>And Nancy Suttles is an exercise physiologist with Riverside Hospital's cardiac <v Cathy Lewis>services. We want to get more specific information on just what we must do <v Cathy Lewis>to protect our hearts from this number 1 killer of women in America.

<v Cathy Lewis>Now, as we heard on Dr. Castelli's talk on Heart to Heart we <v Cathy Lewis>begin to set this course toward heart disease in childhood. <v Cathy Lewis>Those fast food, hamburgers and taking our children to the ones that I can tell you, by <v Cathy Lewis>the way, all the little prizes that come [laughter]. <v Cathy Lewis>Any parent of a child under five knows all the prizes at which fast food restaurants they <v Cathy Lewis>are. But really, that's not a terrifically healthy way to get started for a child to get <v Cathy Lewis>started in life, is it? <v Katherine Tate>That's right. Well, I think bad habits are learned and we start out very young taking <v Katherine Tate>them to these places that are so convenient. <v Katherine Tate>And what ends up is they end up eating a lot of fat and a lot of sodium through their <v Katherine Tate>lives. And that's what they continue to do and therefore, obesity. <v Cathy Lewis>Do they develop a taste for it actually? Is that? <v Katherine Tate>Yeah, sure. We- we like what we're used to eating. <v Katherine Tate>And fat does taste good. And so that's where it starts. <v Katherine Tate>And there's no doubt about it. They really do go for the burgers and fries right <v Katherine Tate>over the fruits and vegetables. But it's fine to have a treat once in a while. <v Katherine Tate>It's not that we have to start little children on diets.

<v Katherine Tate>And in fact, I don't want anybody to be on a diet. <v Katherine Tate>I think we need to develop a healthier lifestyle. <v Katherine Tate>And that starts younger. <v Cathy Lewis>When you talk about starting young, you talk about children and heart disease issues. <v Cathy Lewis>There is0 there is some thinking out there that, well, gosh, if they;re were children, I <v Cathy Lewis>mean, we don't really have to be worried about cholesterol and fat and all that sort of <v Cathy Lewis>thing, because that's not something we really need to be concerned about until we're <v Cathy Lewis>older. True or false? <v Katherine Tate>Well, the thing is, this is prevention we're trying to do. <v Katherine Tate>So again. It's not going on a diet when you're five years old. <v Katherine Tate>It's starting out eating a healthier diet, eating, you know, including fruits and <v Katherine Tate>vegetables and not living at the fast food places. <v Katherine Tate>And we need to start those habits earlier, but not obsessing <v Katherine Tate>about it where you say you cannot have it. <v Katherine Tate>It's got so many grams of fat in it. <v Katherine Tate>You know, we need to just learn healthier eating and that way they will not become <v Katherine Tate>obsessed. <v Cathy Lewis>It was interesting. I was in one of those places about a week or so ago and they were <v Cathy Lewis>actually doing a survey of parents about what types of food to include and <v Cathy Lewis>whether people would respond well to the inclusion of fruit and vegetables in some of

<v Cathy Lewis>those meals. So maybe some of that is starting to make a difference. <v Cathy Lewis>Well, you also know of a national organization that's trying to make changes in the whole <v Cathy Lewis>fast food nutrition arena. <v Katherine Tate>Absolutely. The Center for Science in the Public Interest is it started out very small, <v Katherine Tate>but it's grown into a very powerful group that has really put the pressure on <v Katherine Tate>the fast food industry and the popcorn and the movie theater industry and <v Katherine Tate>making a lot of changes because it's gotten people's attention. <v Katherine Tate>We're now starting to see. Well, there's a lot of fat in this. <v Katherine Tate>Right. And they probably knew that. <v Katherine Tate>You know, the whopper with cheese was probably not the healthiest thing. <v Katherine Tate>But when you see in comparison how bad it is it makes you think. <v Cathy Lewis>It sure does. The popcorn survey really got my attention. <v Cathy Lewis>Debby, we were talking a little bit about exercise, too, during the last segment. <v Cathy Lewis>One of the things we keep hearing is no pain, no gain and work until it burns and <v Cathy Lewis>all that sort of thing. And you said, well, I can talk forever on that because I don't <v Cathy Lewis>like that stuff a bit. <v Debbie Waldschmidt>Right. I think when we say no pain, no gain, it scares people away.

<v Debbie Waldschmidt>Most of us don't enjoy pain. <v Cathy Lewis>[laughter] Most of us don't, that is true. <v Debbie Waldschmidt>Anytime your body is moving, you're exercising and something I <v Debbie Waldschmidt>like- it was in that segment a couple about half hour back was <v Debbie Waldschmidt>that doesn't matter if you run a mile, walk a mile or crawl a mile <v Debbie Waldschmidt>as long as you're moving and you're getting out and doing something that your body is <v Debbie Waldschmidt>getting the benefit of the exercise. <v Cathy Lewis>You don't need special outfits in the health club memberships and all of that. <v Debbie Waldschmidt>You don't need to dress for it. Pay for it. <v Debbie Waldschmidt>Sometimes you even need to shower after it if you don't work up a real good sweat. <v Debbie Waldschmidt>[laughter] [Cathy Lewis: Wonderful!] It's just something that anybody can really do, no <v Debbie Waldschmidt>matter where you are, what your lifestyle is. <v Cathy Lewis>We talked a little bit about recovery programs and the importance of recovery programs to <v Cathy Lewis>heart patients. One of the things that was very impressive to us in the last segment <v Cathy Lewis>where we dealt with patients, too, too recovering heart patients, as they said, they <v Cathy Lewis>really don't think they could have done it without the recovery program. <v Cathy Lewis>In fact, Nancy, you see that every day, the importance of those recovery. <v Nancy Suttles>The patients that I work with are more long term.

<v Nancy Suttles>I work in a maintenance cardiac rehab program and I've had patients there for as long as <v Nancy Suttles>7 years. And those people find that they need the support. <v Nancy Suttles>Most of them actually have exercise equipment in their home. <v Nancy Suttles>I mean, I feel like we should go to their house and exercise, but they don't use it <v Nancy Suttles>because I'm not there checking their name off. <v Nancy Suttles>So they're not accountable to anybody, and it is so easy to find <v Nancy Suttles>other things to do at your house or whatever. <v Nancy Suttles>So they come to a program where somebody is checking them off and it <v Nancy Suttles>just makes them more disciplined. And again, these folks have been coming for years and <v Nancy Suttles>years and they've made tremendous improvements in their quality of life. <v Nancy Suttles>Some of them have continued to have heart related problems here and there. <v Nancy Suttles>But their quality of life is one- is- is wonderful. <v Nancy Suttles>They come in and they tell me they've gone dancing last night, oh, I got to mow my yard <v Nancy Suttles>yesterday and those kinds of things that, you know, they can come <v Nancy Suttles>in my yard, too. [laughter] But, you know, those are things that people want to be <v Nancy Suttles>able to function in their everyday lives, and they can do that.

<v Cathy Lewis>Just the gift of those simple everyday things. <v Nancy Suttles>Exactly. <v Cathy Lewis>That they do become a gift when you've had something like this happen to one of the <v Cathy Lewis>things that we talked about a little bit earlier tonight. <v Cathy Lewis>Certainly we discussed in the last segment was the was the issue of stress and good <v Cathy Lewis>stress and bad stress and and how that impacts on us. <v Cathy Lewis>Do you think that's a myth or do you think that stress is a real factor in terms <v Cathy Lewis>of heart disease? <v Debbie Waldschmidt>I think stress is a very big factor. <v Debbie Waldschmidt>There is a big mind body connection that was also mentioned earlier. <v Debbie Waldschmidt>And if we can learn to relax and learn not necessarily ignore things <v Debbie Waldschmidt>that are going on in our lives, but accept them and deal with them, learn relaxation <v Debbie Waldschmidt>techniques a lot with breathing, take- if everyone could take a few minutes during every <v Debbie Waldschmidt>day to relax, truly relax. <v Debbie Waldschmidt>Clear the mind love the body to just absorb some good feelings. <v Debbie Waldschmidt>I think we'd all be better off for it. <v Cathy Lewis>And yet that's such an alien concept in our culture. <v Debbie Waldschmidt>It really is. <v Cathy Lewis>I mean if you go to the boss and you say 'I'd like to take a five minute relaxation <v Cathy Lewis>break.' [laughter] Are you crazy? <v Cathy Lewis>I mean, that's not what we consider the most upwardly mobile strategy.

<v Cathy Lewis>Right. That's right. It almost seems like we need a whole re-engineering of the workplace <v Cathy Lewis>in some respects. <v Speaker>Right. And a lot of workplaces are doing that now. <v Speaker>Occupational medicine is real big. Getting in and teaching people how to be healthy on <v Speaker>the job as well as at home. <v Speaker>Certain relxation techniques can be done very briefly. <v Speaker>Even a deep breath can be very relaxing. <v Speaker>Doing some shoulder movements is like giving yourself a massage <v Speaker>that can be done sitting at a desk no matter where you are, getting that done. <v Cathy Lewis>One thing done is just getting up, walking around the room or around the office and just <v Cathy Lewis>taking a break and just seeing that that life is not necessarily about what's happening <v Cathy Lewis>right at that moment. <v Debbie Waldschmidt>Yes. <v Cathy Lewis>Perspective is an important tool, isn't it? <v Cathy Lewis>We talked a little bit as we talked about diet and exercise, about health, food stores. <v Cathy Lewis>And we've had a lot of questions from viewers tonight about different items that are <v Cathy Lewis>available in health food stores. <v Cathy Lewis>One of which was omega fatty acids. <v Cathy Lewis>Did I get that right? <v Katherine Tate>Omega 3 fatty acids. <v Cathy Lewis> We hear about these kinds of things all the time.

<v Cathy Lewis>What's your take on that? <v Katherine Tate>Well, the thing about omega 3 fatty acids that kind of hit the news a couple of years <v Katherine Tate>ago, and they showed different studies which show that it would help do things from lower <v Katherine Tate>blood pressure to lower cholesterol. <v Katherine Tate>And it did seem promising. But people <v Katherine Tate>taking capsules of this, I'm not so sure is the smartest thing to do. <v Katherine Tate>And it's really there's no recommendation on this right now. <v Katherine Tate>So I think that we need to get it the good old fashioned way, which is just by eating <v Katherine Tate>more fish. <v Katherine Tate>Which is true of a lot of supplementation. We're learning now that it's not just the pill <v Katherine Tate>form that's really giving us the true benefits, like the beta carotene, <v Katherine Tate>for example. You get much better benefits from eating the fruits and vegetables rather <v Katherine Tate>than the supplement. <v Cathy Lewis>What about the issue of diet for high cholesterol? <v Cathy Lewis>We've had a couple of calls about that this evening. The idea that I've been told they <v Cathy Lewis>have high cholesterol. What do I do now? <v Katherine Tate>Well, years ago, if you had high cholesterol, the doctor would say go on a low <v Katherine Tate>cholesterol diet. So everyone was watching cholesterol.

<v Katherine Tate>And now it's you know, you go in the grocery store and you know that the picture <v Katherine Tate>has changed into watching the fat content. [Cathy Lewis: Exactly] And we <v Katherine Tate>really need to just simply watch, you know, the fat content, watch the saturated fat, <v Katherine Tate>which is found primarily in our animal foods. <v Katherine Tate>And that really has a stronger effect on your cholesterol level. <v Cathy Lewis>That's uh- when you talked about making that trip to the grocery store, which I think is <v Cathy Lewis>almost as confusing as the whole cholesterol issue. <v Cathy Lewis>And we had story problems on that earlier this evening trying to get all those numbers <v Cathy Lewis>straight. When you talk about going to the grocery store, there's a new designate.