Angina

Angina

The Pain You Can't Ignore

The pain stabs your arm, lasts about a minute, then disappears. In a man, it's probably a cramp. But in a woman, it might be angina.

Statistics show that more than 1.3 million women of all ages experience the pain of angina. Sometimes it flashes up an arm, other times it radiates toward the neck. Less often it occurs directly under the breastbone, as it typically does in men.

Since angina may show up differently in women than in men, physicians sometimes fail to diagnose it. Nonetheless, studies conducted by the National Institutes of Health in Bethesda, Maryland, show that twice as many women as men between the ages of 25 and 54 actually get it.

"Nobody knows for sure why more women than men in this age group have angina," says C. Noel Bairey Merz, M.D., medical director of the Cedars-Sinai Prevention and Rehabilitation Cardiac Center in Los Angeles. "Women may just be more body-aware. But there's also reason to think that estrogen may cause the heart's blood vessels to be more constrictive."

Healthy Women Can Have Angina

Scientists used to think that angina, which is triggered when the heart doesn't get enough oxygen, was caused by coronary artery disease, a condition in which arteries stiffened and clogged by a lifetime of fatty food and no exercise are so narrow that the flow of oxygen-rich blood is significantly reduced. In the early stages, the narrowed arteries might not be much of a problem. But when a particular activity--running up a flight of stairs, lugging 25 pounds of kitty litter in from the car, shoveling snow, even eating a heavy meal--suddenly increases the heart's workload, the heart doesn't get enough oxygen to do its job. And angina is the result.

But coronary artery disease in women under 40 is rare, doctors say. And new research indicates that angina in younger women may be caused by a wide variety of substances that actually act directly on arterial walls to constrict arteries and shut down the flow of oxygen-rich blood to the heart.

Doctors have known for years that in rare cases angina could be triggered by a spasm of the coronary arteries. What they are only just beginning to understand, however, is that women's arteries may very well be predisposed to it.

What triggers this type of angina in women? "Estrogen, stress and smoking," says Dr. Bairey Merz. And all three can cause angina in perfectly healthy women with perfectly healthy arteries.

Preventing Twitchy Arteries

Having a set of spastic coronary arteries that are likely to twitch shut at any moment may be not only disconcerting but disabling as well. In a 3 ½ -year study of 159 women, this type of angina caused almost half of the women to limit their activities.

Complicating the problem is the growing awareness among scientists that many substances in the body, such as estrogen, can constrict arteries under some circumstances and dilate them under others.

So how can you prevent arterial spasms? Here are some suggestions.

Avoid smoke. Once your doctor has proved that it's arterial constriction and not coronary artery disease that's provoking the angina, avoiding cigarettes and smoky rooms is one way to help keep your arteries open, says Dr. Bairey Merz.

Some doctors feel that women's arteries are actually more reactive to cigarette smoke than men's. What's more, smoking actually provokes angina in different ways, says Jo Dalal, M.D., a cardiologist at Johns Hopkins University School of Medicine in Baltimore. It promotes the deposit of cholesterol within your coronary arteries, thereby narrowing the arteries themselves, and it triggers arterial spasms.

Women who do have heart disease are put in real jeopardy by cigarette smoke. "Smoking causes blockages in the arteries of your heart," says Dr. Dalal. With smoking, "new blockages are created and old blockages are made worse," she says.

Identify the pressures in your life. A second way to prevent arterial spasm or reduce the angina caused by coronary artery disease is to identify everyday situations in which you feel pressured. Try to avoid them, recommends the American Heart Association. Cut down on rushing around and trying to do everything yourself. Let other people prove they've got the "right stuff," while you move on to other tasks.

Relax and breathe. When it's not possible to avoid all of life's pressures, learn to handle them gracefully with meditation and relaxation techniques. Some doctors suggest you breathe deeply and concentrate on a pleasant thought or experience when you're feeling stressed. Other experts suggest you totally concentrate on relaxing all your muscles--head to toe--for 20 minutes twice a day.

Consider medication. If you still experience angina, your doctor can prescribe calcium channel blockers or nitroglycerin tablets to prevent it, says Dr. Bairey Merz.

Get Your Arteries in Shape

Focus on preventing the coronary artery disease that can cause angina in the decades ahead, says Dr. Bairey Merz, or if you already have angina from blocked arteries, try to keep your arteries from getting worse. In either case, your strategy should be the same.

Keep your arteries clean. "That means don't smoke, eat a low-fat diet and try to get some exercise every day," says Dr. Bairey Merz.

Hit the road. Exercise can be of particular help, she adds. Results from over 40 studies show that inactive individuals are almost two times more likely to develop heart disease than are active people. And these findings are independent of other risk factors for heart disease, such as smoking, high blood pressure, obesity, family history or high cholesterol levels. This means that inactivity carries a risk almost as high as the relative risk of smoking a pack of cigarettes a day. Studies show that even light to moderate exercise, such as walking, climbing stairs and gardening, is associated with lower risk for heart disease.

Exercise does two things, explains Dr. Bairey Merz. It conditions the cardiovascular system so that it requires less oxygen as a whole, and it dilates and tones the arteries themselves, giving clogged or spastic arteries an extra margin for error.

How much exercise would it take for a woman to achieve those kinds of results? "Nobody's done the research," says endocrinologist Irma Ullrich, M.D., professor of medicine at West Virginia University in Morgantown. But there is some evidence in men that regular high-intensity exercise such as running can literally restructure the coronary arteries.

A study conducted at Stanford University compared 11 long- distance runners, who ran at least 40 miles a week, to 11 physically inactive men of equal age. The coronary arteries in the runners' hearts could expand to 265 percent of the original size when dilated as much as possible, compared to the inactive men's hearts, which could only expand to 134 percent. That means that the increase in area in the runners' coronary arteries would lead to about twice the increase in the flow of blood.

No one knows whether this occurs in women, says Dr. Ullrich. But we do know that even moderate amounts of exercise--brisk walking three or four times a week, swimming laps or biking--can help women prevent angina.

And we know that, combined with low-fat eating and avoiding smoking, exercise can also reduce your chances of developing high cholesterol, high blood pressure and diabetes--a deadly trio that is known to interfere with your arteries' natural ability to prevent constriction.