A Blog from The Panel of Experts
By Dr. Michael L. Smith – Functional Medicine – Nutrition and Chiropractic HEALTHcare.
I remember growing up in the sixties and seventies hearing and seeing the ubiquitous Virginia Slims ads with those famous words, “You’ve come a long way, baby”. In many ways, that has proved to be true. Sadly, there continues to be a sex biased approach when it comes to identifying and treating heart disease in women versus men in this country.
Here are some facts:
- Heart disease is the leading cause of death of women in the USA, whereas, cardiovascular deaths in men have declined and the number of cardiovascular deaths in women remains unchanged or is increasing.
- The onset of symptoms and clinical manifestations of coronary heart disease (CHD) in women start as much as 10-20 years later for myocardial infarction (heart attack (MI)) and sudden cardiac death. Despite the fact that women live longer than men, each year since 1984, more USA women than men die of cardiovascular disease (CVD). The sex gap in mortality continues to widen.
- The landmark 2001 IOM (Institute of Medicine) 2001 report clearly stated the pervasive level of sex bias in medical research. It also stated that women have been under represented in research studies. In fact much of the evidence in the medical literature for prevention, testing and treatment for (CHD) has been gathered from studies on predominantly middle aged men.
- Women have received fewer interventions to prevent and treat heart disease. Less cholesterol screening, less lipid (cholesterol and triglyceride) lowering therapies, fewer referrals to cardiac rehabilitation and fewer implantable cardioverter-defibrillators compared to men with the same recognized indications
- More women who have had heart attacks die within 1 year compared to men and 39% do not survive their first MI.
- 61% of deaths due to stroke occur in women.
- AND HERE MAY BE THE MOST IMPORTANT FACT: 60% of women who die of CHD do not have the classic symptom presentation: upper back pain or neck pain, dyspnea (difficulty breathing), palpitations, indigestion and fatigue rather than jaw, chest or arm pain are the presenting symptoms.
- 38% of women will die within the first year after a first MI vs. 25% of men.
It is imperative that women be included in all aspects of health related research and extra care should be given as to how men and women differ respectively in their expression of cardiovascular diseases and treatment strategies. It should be the responsibility of the doctor to better educate the female patient as to the importance of the prevalence of CVD as the #1 potential problem to women’s health in this country. Although 1 of 29 deaths in women is due to breast cancer, most women perceive breast cancer as their major health concern even though 1 in 2.4 deaths in the USA will result from CVD.
Changing these attitudes of women should include a comprehensive evaluation of a woman’s lifestyle that should include a program of prevention strategies to eliminate the underlying causes of cardiovascular disease. These programs should include a detailed history, identification of those patients at highest risk, implementing patient specific nutritional, dietary and exercise programs and follow up laboratory testing of causative factors that now show up as disease. Avoidance of therapies without benefits or where risks outweigh benefits.
A newer model of medicine has emerged that addresses the bodies altered processes that precede the onset of what has been named as a disease. Functional Medicine is a dynamic approach to assessing, preventing, and treating complex, chronic disease by identifying and eliminating breakdowns to the physiology and biochemistry of the human body with the primary goal of optimizing the patient’s health. Chronic disease is almost always preceded by a lengthy decline in function in many of the bodies organ systems. Returning patients to health requires reversing or improving those specific problems that have contributed to the disease. Those dysfunctions are the result of lifelong exposure with the environment, lifestyles, and our genetic background. Each patient represents a unique history that presents itself as disease or the maintenance of health. Functional Medicine tries to answer the question of why rather than treating a group of symptoms.
In honor of this month’s theme, let us continue to strive together with the goal of improving women’s health so you can look in the mirror and shout, “You’ve come a long way, baby!”