Health for life

Chest pain is not a frequent early warning symptom of a heart attack in women.

But what is?

In a study funded by the NIH that appeared in the journal Circulation in 2003,¹ the most frequent early warning symptom of heart attack in women was unusual fatigue ... not a tiredness that you might link to overwork or stress, but a fatigue so severe some women gave the example of not being able to make a bed without resting.

Most Women Have Early Warning Symptoms

Of the 515 women studied, 95% of them reported experiencing symptoms a month or more before a heart attack.

The most frequent symptoms reported were:

• unusual fatigue (70.7% of women experienced)
  
• sleep disturbances (47.8%)
  
• shortness of breath (42.1%)
  
• indigestion (39.4%)
  
• anxiousness (35.5%)

The minority of women who did report chest discomfort in the weeks leading up to a heart attack "used descriptors such as aching, tightness, or pressure, not pain" to explain it.

Even during a heart attack, 43% of women in this study "did not experience any type of chest discomfort."

The lead author of the study, Jean C. McSweeney, PhD:²

"McSweeney said her best advice is for women who have risk factors for heart disease such as smoking, high blood pressure, high cholesterol, diabetes or a family history of heart disease and who are experiencing [early warning] symptoms should contact their doctor before seeking emergency treatment."

________
¹ For the study (full free access):
Women’s Early Warning Symptoms of Acute Myocardial Infarction

² For a summary, provided by Yale-New Haven Health:
Signs Of Impending Heart Attacks Among Women

In a large prospective study published online in the British Journal of Cancer, researchers looked at the association between nut consumption and risk of pancreatic cancer among 75,680 women in the Nurses Health Study, with no previous history of cancer. Consumption of nuts, including tree nuts (such as almonds, Brazil nuts, cashews, hazelnuts, macadamias, pecans, pine nuts, pistachios and walnuts), was inversely associated with risk of pancreatic cancer, independent of other potential risk factors for pancreatic cancer.

Women who consumed a one-ounce serving of nuts two or more times per week had a significantly reduced risk of pancreatic cancer (RR, 0.65; 95% CI, 0.47-0.92; P=0.007) compared to those who largely abstained from nuts. "This reduction in risk was independent of established or suspected risk factors for pancreatic cancer including age, height, obesity, physical activity, smoking, diabetes and dietary factors," stated lead author, Ying Bao, MD, ScD, from the Department of Medicine, Brigham and Womens Hospital and Harvard Medical School, Boston, MA.

Pancreatic cancer is the fourth most common cause for cancer-related mortality in the U.S., yet very few modifiable risk factors have been identified. According to the 2009 World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) report, aside from cigarette smoking, body fatness was the only convincing modifiable risk factor for pancreatic cancer.

While there may be concern that frequent nut consumption may result in weight gain and thereby increase the risk of developing pancreatic cancer, the opposite seems to be true. "In our cohort women who consumed the most nuts tended to weigh less," reported Dr. Bao. Moreover, in a recent analysis of this same cohort, higher nut consumption was associated with a slightly lower risk of weight gain and obesity.

Nut intake has also been associated with a reduced risk of diabetes mellitus, which is a risk factor for pancreatic cancer. "Nuts contain a variety of important vitamins, minerals and phytochemicals," states Maureen Ternus, M.S., R.D., Executive Director of the International Tree Nut Council Nutrition Research & Education Foundation (INC NREF). "This exciting, new study provides yet another reason to encourage people to eat a handful—or 1/3 cup—of tree nuts every day."

Women who exercise regularly spend as much time sitting as women who don’t, according to a new Northwestern Medicine study.

Emerging research shows that prolonged sitting has significant health consequences---and the new Northwestern study suggests that being a dedicated exerciser doesnt prevent women from spending too much of their day sitting.

This research is the latest indication that public health recommendations should be established to encourage Americans to limit the amount of time they spend sitting every day, said Lynette L. Craft, first author of the study and an adjunct assistant professor in preventive medicine at Northwestern University Feinberg School of Medicine.

“We all know someone who gets a good workout in every day, but then spends a large portion of their day sitting in front of a computer with few breaks,” Craft said. “If these people could replace some of the sitting with light activity---just getting up, moving around, maybe standing up when talking on the phone, walking down the hall instead of sending an email---we do think they could gain health benefits.”

The Northwestern research was done in collaboration with Ted Zderic, of the Pennington Biomedical Research Center and was published in the International Journal of Behavioral Nutrition and Physical Activity.

Past studies have shown that people who sit for extended periods of time---even those meeting exercise recommendations---are more likely to develop chronic conditions such as diabetes, obesity, cardiovascular disease and some cancers.

This was the first study to use an objective measuring device to examine the relationship between the type of exercise recommended in the government’s Physical Activity Guidelines for Americans and sitting. The guidelines recommend adults engage in a minimum of 150 minutes of moderate intensity aerobic activity every week. Previous studies on physical activity and sitting have primarily relied on self-reported data.

While many of the women in the study met or exceeded 150 minutes of physical activity per week, in reality only a fraction of the women’s days were spent being physically active. The women in the study spent an average of nine hours a day sitting. That number is consistent with previous results from much larger studies that examined the number of hours Americans spend sitting every day.

“I think some people assume, ‘If I’m getting my 30 to 40 minutes of physical activity a day, I’m doing what I need to do for my health,’” Craft said. “Of course, exercise is very important and is associated with many positive health benefits, but negative health consequences are associated with prolonged sitting, and this study shows that just because you’re physically active doesn’t mean you’re sitting less.”

For the study, 91 healthy women ranging in age from age 40 to 75 wore an activPAL activity monitor device during waking hours for one week. The device, which was worn on the thigh, recorded time spent sitting, standing and stepping, and engaging in sustained 10-minute bouts of moderate-to-vigorous physical activity.

Trying to replace some sitting time with more light activity throughout the day---along with the recommended bouts of moderate and vigorous exercise---is an approach more Americans should try to take, Craft said.

Future studies are needed to further examine the relationship between the type of exercise recommended in the Physical Activity Guidelines for Americans and sitting. For example, various subgroups such as men, children and the elderly should also be studied, Craft said.

The Lynn Sage Breast Cancer Foundation, the Avon Foundation and the Edward G. Schlieder Educational Foundation supported the study.

National guidelines recommend that at-risk women be screened for elevated cholesterol levels to reduce their chances of developing cardiovascular disease. But who is ‘at risk?’ The results of a study by investigators at the Centers for Disease Control and Prevention (CDC) to estimate the proportion of women young and old who have cholesterol levels that meet the definition of being at-risk are reported in an article in Journal of Women’s Health, a peer-reviewed publication from Mary Ann Liebert, Inc., publishers. The article is available on the Journal of Women’s Health website.

In "Cholesterol Screening for Women: Who is At Risk?" Cheryl Robbins, Patricia Dietz, Shanna Cox, and Elena Kuklina, from the CDC, Atlanta, GA, analyzed data for a representative sample of 1,781 U.S. women not previously diagnosed with elevated cholesterol.

More than half (55%) of younger women (ages 20-44 years) and 74.2% of older women (>45 years) were at-risk for high cholesterol as defined by U.S. Preventive Services Task Force guidelines. Nearly all of the women in both age groups had at least one risk factor that would make them candidates for cholesterol screening according to the American Heart Association risk definition. The authors suggest the need for future research to determine whether screening and treatment of young women with high cholesterol will help to decrease subsequent deaths due to cardiovascular disease.

“The high prevalence of dyslipidemia reported in this study even among younger women is striking and supports the need for increased education about the risks for cardiovascular disease in women,” says Susan G. Kornstein, MD, Editor-in-Chief of Journal of Women’s Health, Executive Director of the Virginia Commonwealth University Institute for Women’s Health, Richmond, VA, and President of the Academy of Women’s Health.

Women eating a high-calcium diet and taking calcium supplements adding up to more than 1,400 milligrams a day may be running nearly twice the risk of dying from heart disease, a large Swedish study suggests.

Both men and women take calcium supplements to prevent bone loss. The new findings come on the heels of another recent study that found a similar increased risk of death related to calcium intake among men.

"Many older adults increase dietary intake of calcium or take calcium supplements to prevent bone loss and there had been speculation that increased calcium intake with or without vitamin D could improve cardiovascular health," said Dr. Gregg Fonarow, an American Heart Association spokesman who wasnt involved in the study.

However, a number of recent studies have suggested that higher dietary intake or calcium supplementation may not only not improve cardiovascular health -- they may be associated with increased risk for cardiovascular events and mortality, said Fonarow, a professor of cardiology at University of California, Los Angeles.

The new report was published in the Feb. 12 online edition of the BMJ.

To see if calcium supplements raised the risk of dying from heart disease, a team led by Dr. Karl Michaelsson, a clinical professor in the department of orthopedic surgical sciences at Uppsala University in Sweden, analyzed data collected on more than 61,000 women enrolled in a study on mammograms.

Over 19 years of follow-up, nearly 12,000 women died -- almost 4,000 dying from cardiovascular disease, about 1,900 from heart disease and 1,100 from stroke, the researchers found.

The highest rates of death were seen among women whose calcium intake was higher than 1,400 milligrams a day, the researchers noted. On the other hand, women who took less than 600 milligrams of calcium a day were also at an increased risk of death.

Moreover, women taking 1,400 milligrams of calcium a day and also using a supplement had even a higher risk of dying than women not using supplements, Michaelssons group found.

All in all, women getting more than 1,400 milligrams of calcium a day were more than twice as likely to die than women getting 600 to 999 milligrams a day, the researchers said.

The U.S. Office of Dietary Supplements recommends 1,000 to 1,200 milligrams of calcium a day for most adults.

According to the study authors, diets very low or very high in calcium can override normal control by the body, causing changes in blood levels of calcium.

Rather than worry about increasing calcium intake of those getting enough through their diet, emphasis should be placed on people with a low intake of calcium, the authors suggest.

Taylor Wallace, a representative of the supplement industry, faults this study because, he said, it was not specifically meant to address calcium supplements and heart disease.

"We are comparing apples and oranges," said Wallace, who is senior director for Scientific & Regulatory Affairs at the Council for Responsible Nutrition. He noted that in the new study, the data that researchers used to draw their conclusions looked at diet and cancer, not whether calcium supplements were bad for the heart.

"Still, there is not a single human cause-and-effect study that demonstrates a hazard for calcium either from the diet or supplements and cardiovascular disease," he said.

Although the new study tied total calcium intake to increased risk of death from heart disease in women, it didnt establish a cause-and-effect relationship.

Wallace did say its important to know how much calcium a person is getting from diet and supplements. "It is important to talk with your doctor to make sure you are getting the right amount for you," he said.

For his part, heart association spokesman Fonarow said: "While further studies are needed, calcium supplements should be used only after caul consideration of whether the potential benefits in terms of bone health outweigh the potential cardiovascular risks."