Women's Heart Advisor July 2015 Issue

Ask The Doctors: July 2015 Women's Edition

Q. My 48-year-old sister had a heart attack last fall and hasn’t recovered. She has no energy. She is helping raise her grandchildren, and her husband is serving in the Middle East. She attended cardiac rehab, but dropped out because she had to babysit. What’s going on?

A. Stress may be affecting your sister’s ability to recover from a heart attack. Mental stress is known to adversely affect the heart. It can also be a factor in noncompliance with treatment, which could explain why your sister never completed rehab.

Your sister is not alone. Women, especially young and middle-aged women, tend to be more stressed than men, no doubt due to the heavy burdens they often carry. Women often sacrifice their own health needs to take care of their families, and this can precipitate a serious health crisis.

A study published in Circulation earlier this year examining the role of stress in young and middle-aged adults with heart attack found differences between men and women. At the time of their heart attack, the women uniformly perceived greater stress than men in all areas of life and showed poorer coping skills. Compared with men, they also had higher rates of diabetes, lung disease, kidney dysfunction, depression and cancer. They were far more likely than men to have children or grandchildren living in their home and to be financially insecure.

One month after their heart attack, the women’s recovery lagged behind the men in symptoms, function and quality of life. In other words, the stress they felt before their heart attack continued to affect their recovery after the event.

Your sister would benefit from learning how to cope with her stress. If she can’t afford counseling, perhaps she can find a mental health clinic that charges on a sliding scale. She should also have a frank discussion with her cardiologist to see if she might benefit from a medication to lift her spirits. Once she perceives her burden to be lighter, her heart should respond favorably.

Q. My cholesterol is a little higher than normal, and my doctor wants me to take a statin. Do statins work in women?

AStatins are one of the most effective drugs we have in preventing heart disease. They lower the incidence of heart attack, stroke, death from heart disease and need for stenting or cardiac bypass surgery by about 30 percent for every 40 mg/dL reduction in LDL cholesterol they achieve. The good news is that they appear to work as well in women as in men.

How do we know this? Although many clinical trials included too few women to draw conclusions, grouping 27 clinical trials into a meta-analysis produced a pool of 170,000 participants, about 46,000 of whom were women. After a year of statin therapy, the reductions in all areas of cardiovascular risk were comparable for men and women.

Q. I have been looking at health-related apps for my Smartphones. Can you recommend any?

A. Apps are sprouting up like grass in the spring. We can’t recommend specific apps, but we can tell you what we know about health apps in general.

An estimated 60 percent of Americans have at least one app that measures blood pressure, glucose level, heart rhythm or health function. They can be lots of fun to use, but your expectations need to be realistic: Some may not do what you expect them to do.

A study published in the Journal of the American Society of Hypertension last December reviewed 107 apps for monitoring blood pressure. None of the iPhone apps and only seven of the 50 Android apps were capable of calculating blood pressure. However, many of the apps had other useful features, such as the ability to track weight and body-mass index, salt intake and calories. If this makes you pay attention to your health, then the app might be beneficial.

There’s another type of app that allows you to take certain tests your doctor orders at your convenience. These have tremendous potential. But because the technology is so new, there are some logistical and security issues surrounding how your personal information is transmitted and stored.

For now, your best bet is to choose an app connected with a major healthcare institution or university or approved by a national medical organization.

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