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WOMEN FIGHTING HEART DISEASE TOO
When most of us think of Betty Ford, we remember the often-outspoken former first lady as the courageous survivor of both substance abuse and breast cancer. It’s far less known that her most life-threatening fight was with heart disease. I had an opportunity to chat with her, and I’m happy to report that it’s a fight she’s winning in her own characteristically upbeat and positive way.
When Mrs Ford first felt chest pains and shortness of breath, she had no idea the discomfort originated from cardiovascular disease. Climbing the steps of the family’s Colorado home and walking up and down the hilly trails would put a strain on anyone, she felt. But an examination revealed serious problems.
Both arteries supplying blood to the brain were clogged. Surgical procedures called endarterectomies were performed to clear the blockage.
Later treadmill testing indicated oxygen insufficiency to the heart as well, owing to obstruction of the coronary arteries.
As luck would have it, the Fords were in Rancho Mirage, California, where they spend most of their time. That put her into the hands of Dr Jack Sternlieb of the Heart Institute of the Desert. Mrs Ford needed a quadruple bypass. Recovery following that traumatic year was difficult. Simply walking from the study to the living room was an ordeal. She found it hard to remember words to complete a sentence, and feared she would never be able to speak publicly again. But recover she did.
“Once you get beyond the physical recovery following surgery, how do you put together all those individual steps toward a full recovery and return to life? They come in small bits and pieces. A very supportive family and cardiac care system was important.”
Mrs Ford took it one day at a time. “When I’d get discouraged, my husband would say ‘Look how much better you are today than you were even two days ago.’ ”
At first the short walk from the study to the living room was a challenge. Then it was the study to the living room to the dining room. Next she began walking to the pool outside. Afraid she wouldn’t make it all the way around the tennis court, Mrs Ford had three chairs set out so she could have places to rest. And soon the progress was coming in leaps and bounds. “I got to the point I was walking a mile. I was so proud of myself.”
But that recovery demonstrates the importance of taking it slowly, not expecting too much too soon. “I never set any goals I thought would be too difficult,” she says. That way her efforts were paid off with success rather than failure.
Mrs Ford was 69 years old when she had the surgeries in 1987 and 1988. Today she leads an active life crammed with appointments, commitments and travel that would tire a person years younger. And she looks wonderful!
The former first lady never has played the role of victim. On the one hand, she’s a take-charge person who’s very much in control of herself and her surroundings. And on the other hand she takes the philosophy that ultimately she has no control whatsoever, that God has determined her destiny, and that she has to live and enjoy every day since none of us really knows which day will be our last.
Rather than being angry or hostile when cardiovascular disease struck, Mrs Ford took it in stride. It’s not so much that she has the patience of Job or that she plays the martyr role. Rather, there’s an acceptance of life, the good and bad.
Today, her efforts at living a heart-healthy lifestyle aren’t really focused so much on her former cardiovascular problems. Instead, both she and former president Gerald Ford live a life of moderation that benefits the entire body and would suit anyone striving to fully enjoy the senior years.
At first she apologises for not being as structured “as 1 should be, as my husband is” about her exercise. But when she starts describing her day, it’s apparent that she’s doing things right. While President Ford swims laps twice a day religiously and does formal callisthenics and stretching exercises, his wife keeps moving throughout the day. “I walk a lot.”
For her 70th birthday, shortly after her surgeries, the Ford children presented their mother with a cocker spaniel that needs a brisk walk four times a day. She takes that responsibility very personally, knowing the walks are good for both her pet and herself.
The dog goes with the Fords to Colorado, where they enjoy mountain hikes, and Mrs Ford experiences no chest pains or discomfort at all. She revels in the fact that she can walk the stairs of the four-storey home and can do all the preparations and tree trimming when her four children and five grandchildren come for the Christmas holidays.
Taking great pride in her appearance, the still-photogenic former first lady watches what she eats as much to maintain her figure as to keep her cholesterol count down. The Fords use margarine, never butter. They eat very little red meat, relying on salads, fresh fruit, chicken and seafood. Both enjoy cereal for breakfast, with skim milk.
Each day begins with 10 to 15 minutes of meditation. While not a regular church-goer, Mrs Ford professes a strong belief in God, in a higher force or being. Her daily meditations help put life into proper perspective and get the day off to a good start.
“I believe in God’s will. 1 believe I’m powerless, but I have to take the steps to make things happen. That relieves me of a lot of responsibility.
“My spiritual strength has carried me through all my recoveries. Trust in God is very important. Whatever higher power. You have to have trust. Sometimes it’s hard to feel that way.
“If you get to a point when you start feeling sorry for yourself? ‘Why me?’ and so forth?usually you can look around and see someone who has things much worse.
“The way I have been able to handle depression?though that doesn’t happen too often?is to get busy and find someone I can help. That takes me out of myself, and I get well again.”
Her cardiovascular ordeal has happily strengthened the Fords’ relationship. “When I had my heart surgery, my husband was so frightened that I had a life-threatening thing that he realised he wanted to spend more time together. He’s a very supportive person. We’ve both tried to cut back and spend more time together.”
While many couples make such promises during the times of crisis, the Fords have carried theirs out. Each year they spend a week alone in New York City where they take in a few plays, do some shopping for the upcoming Christmas holidays, and see some old friends. Holidays are shared time in the sun, perhaps in Hawaii or on a cruise.
And although not everyone has the wherewithal to enjoy the lifestyle of a former president of the United States, each of us could benefit from the real heart of the Fords’ pleasure: spending time together, nurturing each other and appreciating one another. I’ve had the pleasure of being with the Fords at fund-raising events for the Heart Institute of the Desert Foundation. One can’t help notice how they care for each other, exchanging a glance here and a touch there.
Love is terrific medicine. Maybe that’s why Mrs Ford takes only a mild anti-hypertensive drug, with no other medications. Today she gives very little thought at all to heart disease. Actually, her only complaint is about her arthritis, which wakes her once or twice every night.
During our interview in the offices of the Heart Institute of the Desert, we discussed the problems many women have with the inevitable scarring that follows surgery. She was surprised when I told her that many women go into depression about this, and hide their bodies from their husbands, undressing in the bathroom or under the covers.
Yes, Mrs Ford wears dresses that fully cover the front. But she explains that that’s more because of her breast surgery in 1974; she never had the breast reconstructed. And she passed on a wonderful anecdote about how she dealt with the issue.
After the breast surgery, Mr Ford told her, “Well, honey, if you can’t wear dresses cut low in front any more, wear dresses cut low in the back.” She started to do just that, and with a twinkle in her eyes she says that, “Sometimes I think that’s sexier than gowns cut low in front!”
And this isn’t just a solution to the issue of scarring. It’s a marvellous example of the kind of communications and positive attitudes that can strengthen rather than weaken a relationship and speed along one’s recovery.
Mrs Ford provides a living testimony to the potential for a full recovery from heart disease. She has incorporated all the vital steps into a vibrant, productive and enjoyable life. Annual physical examinations find her in excellent health, and each year her cardiac evaluation is a bit better than the year before. Women can beat heart disease and become former patients!
But Betty Ford’s successful recovery from cardiovascular illness and surgery belies the grim statistics faced by women. The main problem stems from the surprise that Mrs Ford showed when she was told she had cardiovascular disease. She had dismissed those chest pains and shortness of breath. After all, she was a woman, and women don’t get heart disease. Right? Wrong.
Asked what they fear most, the majority of women would quickly cite cancer. We hear a lot about breast cancer and ovarian cancer as diseases that threaten women. But the little-recognised fact is that heart disease, not cancer, is women’s number-one killer.
A woman’s risk of developing breast cancer is one in nine. The chances of dying of heart disease are 50-50. While our society normally pictures the heart attack victim as a middle-aged man, just about 50 per cent of the yearly fatal heart attacks strike women.
Statistics from the American Heart Association put the matter into proper perspective.
Between the ages of 45 and 64, one in nine women has some form of cardiovascular disease. After 65, the numbers jump to one in three.
Each year heart attacks kill 247,000 women in America.
Women who have heart attacks are twice as likely as men to die within the first few weeks.
During the first year after a heart attack, more women die than men.
Blacks are at even greater risk. Black women have 22 per cent more heart attacks and 75 per cent more strokes than do whites.
If you’re a woman who’s had a heart attack or cardiac surgery, you are far from alone. If you’re the wife of a man with heart disease, take this information personally. It could save your own life.
Women aren’t the only ones who live in blissful ignorance of the risks of heart disease. Their doctors very often don’t take it into account either. A doctor presented with a man complaining of chest pains will immediately investigate the possibility of heart disease. A woman with the same symptoms might be checked for indigestion or dismissed with a prescription for a tranquilliser to ease family or career stress.
Then again, it’s not entirely the doctor’s fault. It’s true that women do have protection against heart disease prior to menopause. Heart attacks in younger women are much rarer than those in young men. Doctors are trained to look for things they’re likely to find. They don’t think they’re going to find heart disease in their young female patients.
The fact is that women’s heart disease poses an increasingly massive problem. After menopause, especially, women begin to catch up with men in occurrence. After years of protection, seemingly through their unique hormonal balances, women pour fuel on the fire through their lifestyle risk factors.
Many, like Mrs Ford, have a family history of cardiovascular disease. Her mother died of a cerebral haemorrhage, her brother died of a heart attack, and another brother also had to have bypass surgery. Yet despite that history, she never gave her symptoms a thought. And her doctors didn’t catch the disease until it had progressed to life-threatening stages. Remember: this wasn’t 20 or 30 years ago; she had heart surgery in 1988. And this wasn’t just an ordinary citizen; we’re talking about the wife of the President of the United States.
Up until very recently, research dollars in heart disease were spent almost exclusively on men. The Multiple Risk Factor and Intervention Trial was aptly nicknamed Mr Fit. It involved about 350,000 men in a massive, long-term research study. No women. The information we have about the use of aspirin to prevent heart attacks was gleaned from a study of thousands of male physicians. No women. Today, however, studies getting underway include both men and women, and one major study that we’ll look at in detail focuses on women exclusively.
While the information will take time to trickle into every medical office, doctors are becoming more aware of the problem. In the meantime, women face far greater risks than men when heart disease does strike.
A study published in the February 1991 issue of Circulation, the official publication of the American Heart Association, shows that female heart attack patients have a significantly higher chance of dying before leaving the hospital than males. The report scrutinised data on nearly six thousand heart attack patients. After adjusting for age, the death rate one year after hospitalisation was 12 per cent for women, compared with 9 per cent for men. During hospitalisation, 23 per cent of women and 16 per cent of men died.
Women fare more poorly on the surgical table as well. The risk of death during or immediately after bypass surgery for men is 2 per cent or less, while that for women is at least double.
And coronary angioplasty, the procedure by which the blockage in the heart’s arteries is reduced by a balloon at the end of a catheter, produces poorer long-term results in pre-menopausal women than in either post-menopausal women or men. A study at Duke Medical Center showed that arteries closed up again after angioplasty in 46 per cent of pre-menopausal women, compared with 38 per cent of postmenopausal women and 35 per cent of men. The researchers feel that pre-menopausal women may have a more aggressive form of heart disease which calls for stricter attention and more stringent control measures.
Amid such negative statistics, however, you should know that, in the long run, women do as well as men in the years following their initial recovery from either angioplasty or bypass surgery. The problem is getting through the crisis.
But why do women face greater odds of survival and recovery than men? A number of factors enter the equation.
Ignorance is not bliss. Women who don’t pay heed to warning signals such as chest pains and shortness of breath allow their condition to degenerate. Thinking that they aren’t as prone as men to heart disease, women largely aren’t as cautious as men might be regarding the factors that accelerate the process, such as cigarette smoking and cholesterol levels.
Yes, women do have greater protection against heart disease, in most individuals, prior to menopause. But that means that female victims of heart attack tend to be older than their male counterparts. Age itself puts women at greater risk of death and weighs against success in intervention efforts including bypass surgery.
Very often the disease has progressed much further in women who finally get medical attention than in men. More severe disease is more difficult to treat, with poorer results.
Obesity and diabetes are frequently complicating factors, more often seen in women than in men. Both are discussed in detail later in this book.
To make matters even worse, it’s far more difficult to diagnose heart disease in women than in men. Treadmill exercise tests, used very successfully in men to determine the heart’s ability to get enough oxygen through the arteries, results in a disturbingly high rate of false positives in women.
Fortunately, another form of testing, which utilises a radioactive drug called thallium injected into the bloodstream to measure the heart’s oxygen uptake, is quite accurate for women. Unfortunately, the test often is not administered until quite late in the progress of the disease.
And when heart disease is finally diagnosed in women, the tendency is to treat conservatively with medication rather than angioplasty or coronary bypass surgery. The reason doctors give is that women don’t do as well in those interventions. We’ll look at that rationale in just a moment. But because doctors don’t plan to do either procedure for their female patients, they don’t do the definitive test, the angiogram. Only an angiogram can provide a direct look at the interior of the coronary arteries in order to determine the exact percentage of blockage. Everything else gives only an estimation of the severity of the problem.
Why do doctors feel that women don’t do as well at bypass surgery? They point to female patients being older and sicker, thus poorer candidates for any surgery. They say that women have smaller arteries and smaller hearts that are harder to work on than men’s. But they seldom talk about surgical skill.
Bypass surgery has become so commonplace, performed in hospitals in virtually every town and city, that we tend to take it for granted. But not every surgeon has equal success rates. Mortality and complication rates vary widely from surgeon to surgeon. And to make matters worse, with fewer female patients doctors have less opportunity to hone their skills on these more difficult cases.
Most hospitals show double the mortality rate for women when compared with that for men. But that’s not always the case. Both Dr Michael DeBakey at Baylor University’s Methodist Hospital in Houston and Dr Jack Sternlieb at the Heart Institute of the Desert report no differences in mortality rates based on sex. And I’m sure there are other surgeons and institutions with excellent case histories.
If you have been diagnosed as having heart disease, perhaps having suffered a heart attack, you may be a future candidate for bypass surgery. You owe it to yourself to check out the surgeon and the hospital prior to subjecting yourself to this potentially risky procedure. This is even more important for women than men, although neither should blithely accept a surgeon without investigating his or her skills first.
Ask about their numbers, how many women have been operated on and what the success rate has been. Ask how that compares to the numbers for men. Don’t settle for less than the best.
*35/85/2*