OnlineHost: CharLibov has entered the room. Dearest: It is with great pleasure that I welcome back to Power Surge journalist, author, women's health advocate, speaker and founder of Women's Heart Health Day (Feb. 1st) . . . . CHARLOTTE LIBOV Charlotte Libov is the co-author of "The Women's Heart Book:The Complete Guide To Keeping Your Heart Healthy and What To Do If Things Go Wrong. Charlotte has also written, "50 Essential Things To Do When The Doctor Says It's Heart Disease." (Plume) and her book to be released later this year, The Migraine Book" Charlotte also helped create and is featured in "Women's Hearts At Risk," a one hour documentary broadcast by PBS. Charlotte is currently working on a book about cancer. Charlotte, welcome and in your opening remarks, can we address the importance of heart disease among women after menopause? CharLibov: Thanks, Dearest, and thank you for inviting me back. As some of you know, I am an advocate for women, particularly as pertaining to heart disease. I underwent heart surgery myself, which is how I got involved in women's health issues. I recently completed a manuscript for a book focusing on risk factors for many diseases including several types of cancer. I started on this road in part because of all the questions I was getting about hormone replacement therapy. I believe that heart disease is a very big concern for women who are past menopause, and we need to focus more on it. So feel free to ask me anything you'd like. MARCEY B: What is the significance of frequent bloody nose attacks? I do not have high blood pressure--normal or low. CharLibov: In my research, I have not come across anything heart related in terms of frequent bloody noses. Perhaps that is something you should ask your doctor about? I am assuming you are not on any blood thinners, are you? MARCEY B: No, I am not any anything. DWill6171: Char, I have major family history of heart disease. My grandfather had a myocardial infarction at age 42. I am only 43 and the doctors won't test say women do not get heart problems. CharLibov: Other than your family history, are you experiencing anything that leads you to believe you may have a heart problem? DWill6171: I get chest pains and the doctor says it is stress, costalchondritis, and cricopharyngeal spasm. I have had no blood work. CharLibov: Has he done any type of work-up or testing on you at all? Dearest: DWill, you and I can share our Costochondritis stories in e-mail. CharLibov: One of the things that makes it difficult for doctors to diagnose heart disease in women is that women tend to get more chest related pain that turns out not to be heart disease than men do. However, any possible symptoms in women deserve to be taken seriously, especially when a woman has risk factors, as you do. This is not to say that you have anything to worry about; you very well may not. However, in my humble opinion (I am not a doctor, although I play one in cyberspace) I think that if you believe your doctor is not taking you seriously, you should find one who does. DWill6171: How to tell the difference, Char? CharLibov: DWill, if you want to e-mail me, we can talk more. I would also suggest you check your local library for "The Woman's Heart Book" by Dr. Fredric Pashkow and me because we go into a lot of detail about what to expect from a doctor, tests, etc. ArtMom3: I have had cancer and I cannot take hormone replacement therapy (HRT). Is there anything else I can do to combat complications? Dearest: Char, do you want to address the HRT question? CharLibov: Yes and no. There is a good book entitled WOMEN'S CANCERS that has some information on this. I would be glad to give the title and more information if anyone wants to e-mail me. This is a very important topic. With the growing population of female cancer survivors, it is one that will be addressed more and more. ConWoman 7: In September my doctor put me on blood pressure medicine due to a gradual increase in blood pressure. Is this common due to entering menopause? CharLibov: Blood pressure does tend to increase with age. I am not certain if enough research has been done to link it with menopause; but since we reach menopause as we age, it is a logical connection. Nifty2b50: There are many heart attacks and strokes in my mother's family. I am watching my fat intake, my blood pressure is normal, and so is my cholesterol. What else should I be doing? CharLibov: You are already taking a big step by paying attention to your family history. Important things would also be not smoking (or quitting if you do) and getting involved with a regular program of exercise. Congratulations on looking upon your family history as a motivating factor. FBriggs113: Is hypothyroidism a predisposition to heart disease? CharLibov: Hypothyroidism is not linked to heart disease, at least in terms of anything I have come across. Dearest: Char, during menopause it is very common for a woman's cholesterol to skyrocket and it does not automatically indicate any heart issues. What would you suggest to women who otherwise eat well and exercise moderately, but have found that their cholesterol is high during menopause? CharLibov: You are absolutely right. It is believed that one of the positive things that estrogen does is keep a healthy balance between the so-called "good" cholesterol and the so-called "bad" cholesterol. The first thing I would suggest is that a woman make certain that her doctor is doing a cholesterol profile instead of just giving her a total cholesterol number. As you mention, cutting down on fat and exercise is really important. A woman also might need to take cholesterol-lowering drugs, but this depends on other factors including how high her cholesterol is, whether she has other risk factors, and whether or not HRT would be a good idea, if that could help the balance. VBrando101: Do anxiety and panic attacks (severe heart palpitations) cause heart disease? CharLibov: That is a complicated question so my answer will be a little long. When we talk about heart disease we are generally referring to coronary heart disease, meaning the narrowing of blood vessels and the formation of blood clots that can lead to a heart attack. I know of no evidence that anxiety or panic attacks can increase the risk for that type of heart disease. However, your question also leads into questions about the role of stress and heart disease, and that is not that well understood. The function of your heart is partly governed by hormones; and when you are stressed or anxious, there is a release of hormones into your body. This can increase your blood ure and heart rate. After the Los Angeles earthquake, it was found that more people experienced heart attacks than normal. However, whether an anxiety attack would fall under that category or whether your body would already be accustomed to it, I do not know. It is a fascinating question, though! Dearest: Wouldn't you think in most of those cases in California that those people already had heart conditions or were predisposed? CharLibov: That is a good question, but it still demonstrates the effect of sudden stress, something that the medical establishment has been slow to recognize. It is getting more focus now. Mlklm3: Is hypertension considered a heart disease? CharLibov: For general purposes, it is not. It might be considered so for health insurance purposes or included in the American Heart Association's statistics. Mostly, hypertension (high blood pressure) is considered important vis-a-vis heart disease because having it increases the risk for heart disease and stroke. Lori4hlth: I was diagnosed with minor pulmonary stenosis at 18 (now 51) by heart catheterization. All echoes are negative. Can echo diagnose valvular disease conclusively? CharLibov: Lori, in your case I would probably wonder how accurate the catheterization was at 18 since I would I imagine the techniques have improved greatly since then. Echocardiograms are generally the gold standard in diagnosing heart valvular disease. If yours is negative, I would ask your doctor if perhaps that old cath result was incorrect. Please note that it is impossible for me to say this with any certainty as (the usual disclaimer) I am not a doctor. Even doctors shy away from making diagnoses in cyberspace. GET7339: I am 57, and I have been on Corgard for high blood pressure for ten years. It is working well. I have been on Estrace and Provera for five years for menopause. I feel fine. My doctor says stay on HRT indefinitely for the heart's health. Is this true? CharLibov: I cannot answer your specific questions as I never get intodiscussions with people on medications. It is way out of my realm and most doctors would not discuss it either. However, you do bring up an important issue regarding HRT. If you have high blood pressure or other risk factors for heart disease and that is the disease that you are most at risk for, then the general feeling is that HRT is protective against heart disease. The risk of heart disease increases as you get older and that is the reason for advising you to stay on HRT indefinitely. Feel free to ask me about risk factors as I just finished a book about them. Cynsofyne: I have frequent nosebleeds. I have been getting them for the last 8 years. They always happen one week before my period starting though my doctor says I do not have high blood pressure. He said it is a hormonal imbalance caused by the ovulation cycle. I worry because as my weight dropped so did the frequency of nose bleeds and conversely as my weight goes up they occur more frequently. I am 39 years old. CharLibov: Gee, I am stumped. Sorry. Dearest: Thanks for sharing, Cyn. WJCum: Does HRT increase the chance of blood clots? CharLibov: My understanding is that it may have in the old days when the hormones used were higher, but this danger has been reduced similarly to the way it has been with oral contraceptives. Z J Gragg: I had a small irregularity on an EKG, but improved during stress test. Is this common? My father had a mitral valve prolapse. CharLibov: Let me give you a two part answer. One of the reasons that it is difficult to diagnose heart disease in women is that more irregularities show up on women in EKG's and stress tests. These often turn out to be false positives. Nothing is significantly wrong. If this is what happened in your case, you can relax. Concerning the mitral valve prolapse, it gets into a somewhat dicey area. The medical experts I tend to adhere to who are the traditional medical experts, believe that mitral valve prolapse is a fairly benign anomaly as opposed to a heart problem that is not dangerous. Having a parent with it would not increase your risk at all. The only time that mitral valve prolapse is considered clinically problematic is in five percent of the cases (as opposed to 95 percent) where there is regurgitation or leakage of blood which means blood is not going through the heart the way it should. Dearest: Please remember ladies: The information disseminated in Power Surge is for informational and educational purposes and is never meant as a substitute for a visit to your own personal physician. (That doesn't mean that Char doesn't know more than many physicians - just part of Power Surge's disclaimer) Gypsey9088: I am 37 with heart disease in the family. I am on HRT, retaining ater, and blood pressure is increasing steadily. Should I be concerned? CharLibov: I gather that since you are on HRT you went into menopause early? Gypsey9088: Yes, I had a hysterectomy. CharLibov: Do you have high blood pressure? Gypsey9088: It runs about 180 over 100 at stress times. CharLibov: Has your doctor diagnosed you with high blood pressure? Has he taken your blood pressure at different times to make sure it is not a reaction to stress, but actually is higher than it should be? Gypsey9088: No CharLibov: Also, be a little more exact about your family history. One of the things about family history and heart disease is that having a grandmother who was diagnosed with heart disease in her 70's does not increase your risk as compared to having a parent who was diagnosed with it in their 40's. Gypsey9088: My paternal grandfather started having heart attacks in his 40's. Eventually he died in his 60's. My maternal grandfather had a heart attack in his 50's. CharLibov: That is why when it comes to heart disease we speak of an early family history of heart disease. CharLibov: Do you have diabetes, do you smoke or have any other risk factors for heart disease that you know of? Are you overweight or sedentary? (I am just running down a list of risk factors for the information of everyone.) Gypsey9088: I have low blood sugar problems, but I do not smoke. I am overweight, but I am trying to lose weight by watching fat intake and walking. Dearest: Ladies, feel free to ask your doctor to retake your blood pressure about 15-20 minutes later. Remember you are paying for his services and can ask for anything you feel you need. A doctor should never go by a pressure taken right after you walk into his office. CharLibov: I congratulate you on taking those steps. I think that you should make your doctor aware of your family history and that you should continue the healthy steps you have taken already. Also, feel free to e-mail me if you want. Dearest brings up a very good point. There is a condition known as white coat hypertension which means that some people simply experience their blood pressure going up when they are at a doctor's office. This can happen even if they do not think they feel nervous. Also, another little known fact is that there are two sizes of blood pressure cuffs. If you have a wide forearm and a doctor uses an average sized cuff, it will get wrapped too tightly and presto-- instant high blood pressure. If the larger cuff is used, the high blood pressure vanishes. My doctor who is board certified in hypertension tells me I would not believe the number of people misdiagnosed with high blood pressure and treated. Dearest: Oh, my pressure goes up, Char, as he squeezes that bulb thing. I sometimes think my blood pressure must be so high he has to keep squeezing that bulb to read it :). I bet other women are shaking their heads, too. Maya Moon: What are some heart disease symptoms that women (and not men) may suffer? CharLibov: Great question! It is possible that women can suffer the same symptoms that men do, i.e., crushing chest pain, pain radiating down the arm and into the jaw, etc. It has also been found that the symptoms in women can be much more subtle. There can be chest pressure as opposed to pain, pain in the back, nausea, a flu-like feeling, fatigue and (a big symptom) shortness of breath. Some of these symptoms are vague, so it is not surprising that heart disease in women can be difficult to diagnose. That is also why it is important that you know your own body,how you usually feel, and that you educate your doctor to take the issue of heart disease in women seriously! MVMeckel: What about older women who persist in smoking? What is their risk factor for heart attack? I realize that there are many uncontrolled variables. CharLibov: All women who smoke, no matter what their age, increase their riskof a heart attack or developing heart disease. It is one of the greatest risk factors around. Smoking damages your heart in so many ways, including damaging the blood vessels themselves and making the blood more likely to clot. I have also just finished a manuscript that talks about lung cancer; and I am struck by the fact that lung cancer kills 20,000 more women a year than breast cancer does and the number is mounting because women are paying the price for starting to smoke and inhale as much as men did, even though we did a couple of decades later. Lori4hlth: What do you think of taking an aspirin a day to prevent clots? CharLibov: Initially, the research that was done on aspirin was done on men. There has since been research done which shows this benefit is true in women as well. There is still a debate over whether aspirin prevents heart attacks in women who are not diagnosed with heart disease. I could be wrong, but I do not think that has been established yet. There are some people who should not take daily aspirin. I think it is something you need to ask your doctor about. ZevonManic: What exactly is an enlarged heart? I am 39, morbidly obese, and diabetic. I have hypothyroidism and arthritis. I will be having gastric bypass surgery, hopefully. I had a cardiac episode two years ago. Tests showed I had an enlarged heart. Lately, I have been feeling sick to my stomach and I am having vague chest pains including pains in my shoulder. CharLibov: When a heart becomes enlarged it may also become weaker and not able to function as efficiently as it used to. As a diabetic, you are prone to heart problems, as you have discovered. Another problem with diabetes is that this is an illness that can be particularly dangerous because it can mask symptoms of an impending heart attack or other heart problems. Diabetics are prone to neuropathy, which means they can feel pain that is not there or they can not feel pain that is there. An enlarged heart can be the result of damage from a silent heart attack of heart event you were not aware of. I would talk to your doctor immediately about any sensations that you are having so that a possible heart problem can be ruled out. If you feel your cardiologist is not meeting your needs, I would consider getting another one. MARCEY B: With regard to a mitral valve prolapse, one should be pre-medicated with antibiotics prior to any dental work. Dearest: Okay, thanks, Marcey. Sue Lacy: What is the most important thing or things a woman can do to prevent heart disease? CharLibov: The most important thing is to be aware that heart disease can happen to a woman. You should know your family medical history from both sides of the family and what risk factors might predispose you to heart disease such as high blood pressure, diabetes, obesity and all the other things we have been talking about. You should eat in a moderate manner, try to maintain a healthy weight (easier said than done for me, alas!), get involved in an exercise program, have your cholesterol profile checked, and, if you smoke, quit. Also, be sure to laugh a lot, and sex is good, too. BLovedAmI: Can the damage done by smoking be reversed? I gave it up 14 years ago. I also have diabetes, but it's under control. CharLibov: Congratulations on both those things, neither one of them is easy. One of the best things is that tests have shown that the damage from smoking begins to reverse itself immediately after you stop. Although there is some quibbling about whether you can undue all the damage, you certainly lower your risk tremendously. Even though your diabetes is under control, heed what I said earlier. Make sure that you have a doctor who recognizes that diabetics (even those under control) are at greater risk for heart disease and that you are watched closely. PGilmar167: A few years ago I failed a regular stress test and a thalliumstress test and ended up having a heart catheterization. My heart was fine. I have since read that stress tests may not work as well for women. What is your view? CharLibov: It is true that stress tests are less sensitive in diagnosing heart disease in women, but that refers to the stress or treadmill test being done without an imaging agent, such as thallium. Thallium was added in your case to try to make it a more effective tool. Unfortunately, sometimes this is not 100 percent effective either. This can happen in men, although less frequently. Unfortunately, you had to be put through a catheterization to make sure everything was absolutely okay. It sounds as if the right tests were done in the right order. Dearest: Char, please give us the names of the books you have written, how to obtain them and something about the book you are currently writing. CharLibov: I would be glad, too. Both of my books are in paperback. THE WOMAN'S HEART BOOK, by Dr. Fredric J. Pashkow and Charlotte Libov is the first book and the best one for women who do not have a heart problem but are seeking to prevent one and for women who do have heart problems. It is a lengthy book that goes into a lot of detail and gives the information that women need. Our second book by the same authors, 50 ESSENTIAL THINGS TO DO WHEN THE DOCTOR SAYS IT'S HEART DISEASE is geared for both men and women, and IT is an easy-to-follow program for people who have been diagnosed with heart disease or have had a heart attack. It Is short, pithy and to the point. They can be found or ordered at your local bookstore or by calling 1-800-253-6476. The publisher is Plume. I have just finished a manuscript which will be about beating your odds and preventing the 10 Top Killers of Women, including breast cancer, lung cancer, heart disease, osteoporosis, diabetes, and more. That will be out next year; and I will be discussing it here, I hope. Currently I am working on a book about migraine. Dearest: Thanks for that information, Charlotte. Msrivs: I am wondering how good the cholesterol lowering drugs are? What are the side effects? CharLibov: The cholesterol drugs have been found to be effective and their side effects vary. Dearest: Suggest to your doctors to advise you of natural ways to reduce cholesterol before starting medication. CharLibov: Absolutely. Dearest: Charlotte, can you tell us something about angina? CharLibov: Angina is the term generally used to refer to pain caused by heart disease. There are different types. Classic angina, which was the type diagnosed initially in men, refers to pain in the chest that comes on after exercise. There is another type called Variant or Prinzmetal's angina that can come on at rest or even wake one up. That is known also as atypical angina. Interestingly, it tends to affect more women than men. Obviously, angina is a cardiac condition that should be addressed by a doctor. How it is treated can range from medication to surgery. Sue Lacy: What is the difference between heart arrythymias and palpitations? CharLibov: They are almost used synonymously. A heart arrhythmia means an irregular heartbeat and it can be felt as what we consider to be a palpitation. Everyone has missed beats, skipped beats, and extra beats. Some people are more sensitive to them than others. Arrhythmia fall into two categories: those which are harmless and those which are potentially serious. If these have occurred suddenly, if they disrupt what you are doing (if you get dizzy, black-out) or if they cause you concern, you should ask a doctor about them. In addition to palpitations occurring more at menopause, apparently so does chest pain that is not necessarily cardiac related. This all seems to berelated to the profound effect that estrogen has on the heart. Sue Lacy: Yes, especially during menopause. Thank you, Char! Z J Gragg: Are there as many false negatives as false positives with the treadmill stress test? CharLibov: If a treadmill stress test is negative, that means that youdo not have heart disease. The problem in diagnosing heart disease in women is that women tend to have false positives, not false negatives. It all has to do with irregularities that show up in the EKG tracings when you have the test taken. There is some evidence that these irregularities may be due to estrogen fluctuations. See, it all comes back to estrogen. Lori4hlth: I love THE WOMEN'S HEART BOOK. It is the most clearly written, easy to understand book on the subject that I have ever read! Dearest: Char, can you tell us about the trigger foods like wine, aged cheese, etc., that should be avoided for things like palpitations? CharLibov: When you first asked me that question, I thought you were getting into migraines. Dearest: Those, too. CharLibov: Everyone varies, of course, but the substance that seems to cause problems the most with palpitations is good old caffeine. Not for everyone, but for some people. Z J Gragg: Describe how palpitations feel. CharLibov: Usually, it is one of those things that, if you have them, you know it, like skipping in your chest, thumps and things like that. GET7339: I am on estrogen 25 days and then off five days a month. I get heart palpitations all five days. When I go back on the estrogen, they go away. Is estrogen that powerful? CharLibov: Estrogen is absolutely that powerful. Msrivs: Is there any connection between leg cramps and heart disease? CharLibov: Not to my knowledge, unless you have circulation problems or you are diabetic? Dearest: Char, for those of us who do not choose to or cannot take HRT, other than diet, not smoking, avoiding stress and exercise what natural things can you recommend to avoid any heart problems as we pass through menopause? CharLibov: If you look at the studies on exercise and its effect on reducing heart disease, you will have a difficult time seeing the difference between it and HRT. Personally, I think that regular exercise is one of the most potent things we can do to reduce our risk of not only heart disease but also osteoporosis and possibly even stroke as we age. I am not Jane Fonda or anything close so I am not necessarily thrilled about it. I do it because it is really, really good for you. Dearest: What about vitamin E? CharLibov: Ouch! I forgot Vitamin E. The studies on vitamin E look really promising. In medicine it is never a done deal until the big clinical trials are done comparing people who take vitamin E with those who take a placebo. Those studies have not been done yet or the results are not in; but all the other studies find really good effects from vitamin E. There is also biology going for it, the antioxidant theory. Many doctors I know as well as scores of health writers and me, dutifully take our vitamin E. The amount my doctor co-author recommends is 400 IU daily. PBrandySol: I have a high cholesterol, but what is considered a good profile. My doctor says the profile will change with menopause. Is that true? CharLibov: What your doctor is getting at is that when you reach menopause, your good cholesterol generally goes down. Your profile could then become less favorable. If you trim the saturated fat in your diet and get involved in an exercise program, this could help counteract that. A cholesterol profile does bear watching after menopause. That is why a profile in women is so important. We tend to have more good cholesterol. If you just get a total cholesterol level, it can look too high when it is really good. MARCEY B: Charlotte, I walk briskly during my lunch hour about 3 times per week. Is that enough? I walk for about 30 minutes. I also take 1600 units per day of vitamin E. Is that too much? CharLibov: There are conflicting views on exercise. What you are doing has been shown to reduce the risk of heart disease and diabetes. Studies on women who do more exercise show added benefit. If you want to consider adding to your exercise program, you should. You should swing your arms briskly or consider adding some exercise where you work out with some weights to increase your upper body strength. That wards off osteoporosis. Dearest: Marcey, would you e-mail me your questions about vitamin E, please? CharLibov: I would definitely ask my doctor if 1600 IU's of vitamin E is too much. I do not know if it is or is not, but sometimes we have the tendency to think that just because something is natural that it is risk-free. That is not always the case. LSunder895: I am 30 years old in surgical menopause and I am taking the lowest dosage of HRT. I have terrible side effects. If I stop HRT, will I have a higher chance for heart disease. CharLibov: Well, the short answer to that is probably yes for heart disease and osteoporosis as well. Estrogen is essential for building bone and 30 is very young for menopause. However, there are non-hormonal things you can do to reduce your risk for both of these diseases which we have been talking about like exercise and taking calcium to prevent osteoporosis. Do those things reduce your risk as much as with HRT? That I could not tell you. You might want to look further at your risks, figure out your risk for heart disease, and have bone density testing to check on the strength of your bones before making your decision. CharLibov: Dearest would better than I what HRT alternatives are becoming available such as those with micronized progesterone. Dearest: Please remember that menopause is fraught with all sorts of strange events in your bodies and that every palpitation does not indicate heart disease. CharLibov: Oh, is that what those strange events are? Dearest: :) CharLibov: My Web address is at www.libov.com Dearest: Charlotte, thanks for sharing this time with us in Power Surge tonight, and for so excellently fielding our questions about heart disease, et al. We hope you return to Power Surge again very soon, and wish you the best of luck with your new book, and with all future endeavors you may undertake :) End Of Feb 2, 1997 Log Of Charlotte Libov's Guest Visit To Power Surge Dearest aka Alice Stamm Power Surge Founder, Host, Facilitator Power Surge E-mail Dearest Copyright©1994-1997 by Power Surge. All Rights Reserved.