Young women and heart disease? It’s not on everyone’s radar screen, but it should be . The number one killer of women in the United States, also impacts women of child bearing age. Over 40,000 have heart problems during pregnancy, while others have pre-existing conditions – obesity, Type II diabetes, high blood pressure – that affect pregnancy and the health of children born of those pregnancies. Overall, 47 million women are at risk for heart disease. Over a half million women die from heart disease annually.
A panel of experts showcased these problems in New York on Tuesday during a media briefing on women and heart disease sponsored by Mayo Clinic and the Paley Center for Media. Moderator Soledad O’Brien of CNN emphasized that this topic is critical for journalists to understand and wondered why people aren’t “screaming about it in the streets,” given the number of people who die every year.
Dr. Heidi Connolly of Mayo Clinic told the audience that many women with heart disease can have successful pregnancies provided they have proper medical care. One type of problem, congenital heart disease – a condition present since birth – is one that doesn’t preclude pregnancy with proper care, but a small percentage of those mothers can pass on the condition. She pointed out that far too many women with coronary symptoms do not seek care early in pregnancy…which adds increased risk to both mother and baby. In fact, most women don’t think about their heart when considering potential problems during pregnancy. The most common symptom for these women (and sometimes the only one) is a shortness of breath. She cautioned that experiencing chest pain during pregnancy may not mean indigestion…it may be a heart problem and should be mentioned to a physician. Dr. Connolly emphasized the need for cross disciplinary care if heart disease is diagnosed. For instance, in women in a heart condition, the preference is to deliver naturally and NOT by caesarian, as it is risky for the mother. She advises women to think about heart health prior to pregnancy.
Dr. Elizabeth Ofili of Morehouse Medical School in Atlanta caught everyone’s attention with her first statement: “One woman dies of heart disease for every minute we are sitting here.” Why? And why especially is the risk greater during pregnancy? She pointed to the growing prevalence of heart complications due to high blood pressure and obesity. She also emphasized the need to take care of women across the medical specialties. An OB-Gyn specialist may recognize hypertension, but should also consult with a cardiologist on the case. African Americans are at increased risk when pregnant. She explained that while 1 in 4 in a general population may be at risk during pregnancy due to these factors, it’s 1 in 3 in African American populations. She says the familiar case is a women who goes into a pregnancy with high blood pressure and overweight, then the stress of the pregnancy itself – plus medical, family, and social stressors – can cause a cascade of problems. However, she says now enough is known that doctors can effectively treat blood pressure and not harm the fetus. Likewise women who develop toxemia..or preeclampsia – can have a normal outcome of pregnancy if treated properly. In preeclampsia something happens to the blood vessels, making them more likely to retstrict in reaction to stress and toxins develop around vessels. Unfortunately we still don’t know all of the predictors, but research is ongoing. Another warning sign: the death rate among women aged 35-55 is increasing due to obesity. Gestational diabetes, seen in 2-12 percent of pregnancies, is higher in minorities. This is dangerous if it’s undetected, as it can cause fetal abnormalities. Her bottom lines: Manage care with a multi-disciplinary team can help avoid medication later on.Women should talk about how they feel to the primary physician, keep to a heart healthy diet and the best way to help pregnant women with heart problems is an early diagnosis.
Dr. Nakela Cook of the National Heart, Lung and Blood Institute shared her concerns about health care delivery, making the point that not all improvements in cardiac care are being shared equally across the country or across disparate populations. In other words, where you are living can impact your care. Risk factors in pregnancy go up White – 6.9 percent, but 7.8 for African Americans. Poverty, income, housing , Insurance, health education and education levels, are all limitations, as are the quality of patient-provider relationships and how quickly research findings are applied to medical practice in one area over another. Responding to a question, she said that solutions have to be complex because the situation is complex. What’s needed is a systemic, broad integrated approach. She said there is some indication that overall quality improvements in hospitals, and moves toward evidence-based care (care approaches based on science) can help minorities as well. One of her biggest priorities is racial and gender equality in heart health care.
The fourth panelist, Dr. Rakesh Suri, talked about the advantages of minimally-invasive surgery for repairing heart defects in women. Robotic techniques can save women a long recuperation, avoid breaking the breast bone, avoid a disfiguring scar, and limit pain and discomfort. The new techniques and technology has been available for only a decade or so, but they are still not widely available. The option exists only at major medical centers or research hospitals, and, again, is probably less likely to be offered as an option to women in disparate populations. The surgery uses incisions “the size of a finger, rather than a hand” and can allow a patient to be back to normal activities in six weeks rather than six months.
Overall this panel went a long way to highlight how vulnerable women are – at a very young age – when undetected heart disease and pregnancy multiply risk. Awareness and education is critical and young women need to understand that heart problems is not necessarily a problem of age.