Matters of the heart

On the first day of this month it was hard not to see red. After all, each year Feb. 1 is National Wear Red Day, a rallying point in the fight against heart disease and the effort to raise awareness about it. Signified by the now well-known red dress, the event focuses attention on what used to be an overlooked topic -- heart health among women.

It also is the kickoff of American Heart Month, thereby encompassing themes beyond those that are age- or sex-specific to communicate and reiterate well-established risk factors and strategies for prevention.

Such messages offer a reminder for the medical community and a wake-up call for patients.

Heart disease is the leading cause of death and disability in the United States, according to the Centers for Disease Control and Prevention. In 2008, a projected 770,000 Americans will have a new coronary attack, and 430,000 will have a recurrent one. This estimate translates into a coronary event about every 26 seconds and a death every minute.

One of the reasons behind these high numbers is the continuing lack of information. Many people don't grasp their risk. They also tend to imagine heart attack symptoms like those in the movies -- sudden and intense pain, often shooting up the arm and gripping the chest. But most start slowly, with mild pain or discomfort, and people often fail to realize what is happening and wait too long to get help.

In this regard, women tend to be the worst at failing to recognize early-warning signs, mainly because heart disease still is sometimes thought of as a "man's disease." In actuality, it's the leading cause of death in the U.S. for both women and men. CDC statistics indicate that women accounted for 51% of the nation's total heart disease deaths, nearly 356,000, in 2002. In the same year, about 340,933 men died from this cause.

The incorrect notion that heart disease only affects older women also continues to find traction among the public. Indeed, it is the leading cause of death among women 65 and older, but it is also the third leading cause of death among those 25 to 44 and the second leading cause for those 45 to 64.

There can be oversights even when a patient sees a doctor. The AMA Women Physician's Congress notes that women, for example, have a good track record when it comes to going to the doctor for routine gynecologic care. But if they are not seeing an internist or family doctor, they need to tell their gynecologist -- so opportunities to intervene are not missed.

Signs of progress are evident, though. According to American Heart Assn. surveys, the percentage of women who spontaneously identified heart disease as their gender's No. 1 killer increased from 30% in 1997 to 46% in 2003. Still, only 13% of women in the 2003 survey perceived heart disease as their own greatest health threat. While this amount represented an increase from 7% in 1997, it still reflected a "not-me" attitude.

Also, the CDC's National Center for Health Statistics reported last month that the age-adjusted CHD death rate across the board declined 25.8% from 1999 to 2005. Stroke decreased 24.4%. But these figures are no reason for complacency. Heart association experts say the trend line may not be sustainable because rates for risk factors -- hypertension, hyperlipidemia, inactivity and tobacco -- are not declining as fast, and type 2 diabetes and obesity continue to be significant challenges.

These realities underscore the imperative of prevention. That's why the American Medical Association has a long track record of striving to help physicians -- both in their practices and in their communities -- help patients of either gender with the issues of obesity, healthy eating, salt intake, tobacco use, sedentary behaviors and many other related concerns. Just last month, it released a 328-page book for patients, the American Medical Association Guide to Preventing and Treating Heart Disease: Essential Information You and Your Family Need to Know about Having a Healthy Heart, which is on sale in bookstores and online.

Bottom line: Thinking about the unnecessary and enormous toll of lives adversely affected by coronary heart disease makes it hard not to see red. But much can be accomplished. February's focus on health matters of the heart offers a reminder that should last all year long about the importance of prevention and timely treatment.