LECTURES

Ottawa Heart Institute Alumni Fall Lecture
October 14, 2008

The Heart of a Woman: What Every Woman Must Know to Stay Heart Healthy
Dr. Louise Laramée

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Dr. Laramée delivers an excellent and informative presentation on heart disease in women

Did you know that heart disease presents differently in women from men? That mortality rates from heart disease in women are going up even as the mortality rates for men are steadily coming down? That the symptoms in women are more vague, more difficult to pinpoint and easier to miss? That statistically a woman is more likely to die from heart disease (1 in 3) than breast cancer (1 in 27)? That heart disease in women knows no age or ethnicity? That there are specific risk factors which can point to trouble ahead? That all too many women don't realize they are at risk? And, most importantly, that heart disease is preventable?

Some of the 120 attendees

The issue of heart disease in women is very topical these days, judging by the record turnout (and on election night too!) at the Alumni Fall Lecture.

Dr. Laramée making a point

The presenter was Dr. Louise Laramée, MD FRCP (C), a highly experienced University of Ottawa Heart Institute cardiologist and Fellow who performs cardiac interventions at the catheterization lab, in particular angiogram and angioplasty. After graduating from the Université de Montréal, she joined the UOHI, having been attracted by the opportunity to study under the leadership of Dr. Donald Beanlands.

Dr. Laramée's presentation was a timely and sobering wake-up call. Yes, women are at risk of heart disease, but luckily they can do a great deal to prevent it and, when needed, to control it. Unfortunately there is still no cure available. Dr. Louise Laramée making a point Coronary heart disease affects the arteries of the heart. It begins in childhood and develops over years. The arteries harden as cholesterol, fat and other substances build up on the artery walls. The heart gets less and less nutrient-rich blood. Blockages can result in angina or heart attack.

It was through a project that Dr. Laramée undertook in the early 1980s that she realized that coronary heart disease is not the same in women as in men. This information seems to have trickled down to the general population, but the gravity of the situation still has yet to be grasped.

What are some of the main differences? In men the blockages are localized and therefore easier to treat. In women the plaque deposits are spread throughout the artery, making treatment more difficult.

Most interestingly, the symptoms in women are quite different from men. While men tend toward a more dramatic, sharp, squeezing pain in the chest, women's heart disease can manifest itself in a wide variety of ways, though the most important are still chest pain or discomfort. But coronary heart disease in women can also feel like pressure or even just a "feeling" and is not limited to the chest. In fact, one must pay close attention to the whole area from the ears to the navel. Discomfort when walking, a sore arm(s) or little finger(s), pain in the back, throat, neck, teeth or back of the jaw, shortness of breath, nausea, dizziness, weakness, sweating, "feeling sick" or thinking of calling the dentist can all be signs. It can feel like a stomach pain, burning or even a fullness sensation. If it is exertional, in other words starts when you are doing something (e.g. walking) and stops when you rest, this is an important warning. If it starts when you are emotionally stressed and stops when you turn your thoughts to other things, take note.

With fewer classical symptoms, women often hold-off going for help. They also tend to be conditioned not to put themselves first, and to minimize their symptoms. Being selfeffacing may lead to delays in diagnosis in Emergency. The medical questionnaire at presentation is centered on the presence or absence of squeezing chest pain, so the diagnosis of angina can easily be missed. These can all lead to later diagnosis and loss of valuable time.

If you suspect a problem, don't drive yourself to hospital, call 9-1-1 so that emergency medical personnel can begin treatment at once. Don't be embarrassed by a false alarm. Plan ahead and heed the warning signs. The present profile of women's risk factors is alarming. Does it surprise you to learn that half of Canadian women have 3 to 5 risk factors and that many others have at least a few? Some risks are non-modifiable, such as family history of early-onset heart disease, and age. It seems that even when parents, uncles and other close relatives have died early, lots of people fail to identify this as one of their risk factors. Other risk factors are modifiable such as smoking, physical inactivity, excess weight, high cholesterol, diabetes, high blood pressure and high stress levels.

Unfortunately, risk factors multiply their effect. By way of example, Dr. Laramée showed that if you have hypertension, high cholesterol and smoke you are 11 times as likely to develop heart disease! Sadly it is not at all uncommon to have a woman with a bit of high cholesterol, somewhat high blood pressure and who smokes. Individually these are problematic, together they can be explosive. Also, risk factors are interdependent. Hypertension, diabetes, high triglycerides, and low HDL often accompany obesity. Weight gain around the "middle" is especially dangerous as that fat is toxic and becomes one of the most active glands in your body, with secretions which can cause diabetes, hormonal changes and plaque eruptions.

How can heart disease be prevented or controlled? Treatment includes lifestyle changes, management of risk factors, medication if needed and revascularization to bring more blood flow to the heart through angioplasty with stents (PCI) or bypass surgery. High blood pressure can be improved with weight control, limited salt intake, exercise and decreased stress. Blood sugar control can be improved with proper food choices and weight control. Lipid levels can be improved with healthy eating and exercise. Keeping your body mass index (BMI) between 18.5 and 24.9 and your waist circumference under 35 inches is imperative.

On the controversial question of hormone replacement therapy (HRT), Dr. Laramée outlined the latest recommendations. In short, HRT is the most effective treatment to control menopausal symptoms such as hot flashes, night sweats or mood swings but not heart disease. Therefore, HRT should be used to manage moderate to severe menopausal symptoms, using the smallest effective dose for the shortest possible period of time.

Dr. Laramée left the audience with the message that coronary heart disease is largely preventable. It is strongly associated with the presence of known coronary risk factors. The presence of multiple risk factors requires a more aggressive approach. The best strategy remains the optimal control of all risk factors.

So make healthy lifestyle changes. Reduce excess weight or maintain a healthy weight, be physically active, eat a healthful diet, balance calories taken in with those expended. Quit smoking and exposure to secondhand smoke, control high blood pressure, maintain healthy cholesterol levels, control or delay the onset of diabetes, take medication as prescribed, exercise for 30 minutes each day, drink in moderation or not at all, limit salt and saturated fats, learn to relax and deal with your stress, get friends and family to join you in healthy living, and begin today!

Following the presentation, attendees posed many questions. Dr. Laramée graciously answered them all.

This Fall Lecture venue was also used to present the Alumni's prestigious Keon Award to co-recipient Dr. Joel Price. Dr. Price received his medical degree from the University of Western Ontario in 2004 and is completing a Master of Public Health degree at Harvard University. During his many years of studies, he received some 14 scholarships and recognitions. He also found time to publish in excess of 20 articles.

He is in his fifth year as a trainee in Cardiac Surgery, has been a leader in education as the supervisor of academic activities of the residents, and has worked tirelessly with medical students at the University. He is highly regarded and well liked by his patients and fellow healthcare professionals. Dr. Price is truly a worthy recipient of the Keon Award.

Dr. Joel Price receives the Keon Award from President John Herzog

All told, the evening was a resounding success as the attendees gratefully applauded Dr. Laramée and cheered Dr. Price. As the curtain fell at 9 pm, people scurried to get home just in time to learn the early election results.

(Reported for The Bulletin by Angie Herzog)

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