Stalking the Ladykillers

Cardiovascular Disease, Rush University Medical Center

As the medical director for the Heart Center for Women at Rush, Annabelle Volgman knows firsthand the heavy toll that heart disease takes on women today. "We don't want to wait for the disease," says Volgman, 50. "We want to prevent the disease. So I would like every doctor to become a preventive doctor."

Q. Heart disease is the number one killer of women in America, isn't it?
It has been ever since we've started tracking the numbers. The annual [U.S.] mortality rate in the late 1970s was about 500,000 men dying from some sort of cardiovascular disease, and about 460,000 women. It wasn't that women weren't dying of it; it's just that there were 40,000 more men dying of heart disease. But the damage was done. Women stopped worrying about themselves as much as they worried about men—and the same goes for physicians. It was ingrained in us that the male gender was a risk factor for heart disease. And that was really an erroneous thing. It's not just that you are a male; it's just that women tend to get heart disease ten years later than men.

Q. What are the statistics today?
There are now 460,000 women dying of heart attacks and stroke and about 420,000 men. There are 80,000 fewer deaths in men [than in the 1970s], but the women are exactly where they were.

Q. How can people prevent heart disease?
The most important thing is physical activity. The simplest way is walking 30 minutes a day. It's not a stroll; it's a brisk walk to get your heart pumping a little harder. If you're looking to lose weight, you have to do a lot more and eat less. It's the same old advice that we've been giving for decades.

Q. What kind of dietary changes can women make to improve their heart health?
Oatmeal is probably as good a medication to lower your blood cholesterol as some statins. It's one of the best things you can tell your patients, and a lot of doctors don't know that.

Q. Is there anything else on the preventive side?
Don't even think about smoking. And know your family history. Find out what your risk factors are. Don't wait for that first symptom, because your first symptom could be your last.

Q. What about alcohol consumption?
If you are a woman, the most you should drink is one glass a day; for men, two glasses. The studies for heart disease demonstrate that there is a little bit of a benefit if you maintain that restriction. However, beyond that the benefits disappear and it starts becoming a risk factor for arrhythmias and heart muscle problems.

Q. Are heart scans a useful diagnostic tool?
One of the most incredible ways to diagnose coronary artery disease is the 64-slice CT scan, which is a rapid scanning of the heart. But the scan is the equivalent of 100 chest x-rays. So for a woman, you are exposing your breasts to 100 chest x-rays. Is it really worth scanning your heart with that risk? I tend not to recommend the 64-slice CT unless there is a real need.

Q. What should women know about cholesterol?
If your HDL [high-density lipoprotein, the "good" cholesterol] is less than 30, you are a heart attack waiting to happen. And guess what makes HDL go up? Exercise.

It's the only nonmedication activity or thing you can do to make your HDL go up.

Photograph: Katrina Wittkamp