Health related information and news from around the world.

In the summer television season in Britain in 1995, a series of weekly programs about women’s health was shown. Called The Ladykillers, it concentrated on the diseases that the producers felt were killing women in the last decade of the twentieth century. It highlighted cervical, ovarian, and breast cancer, post-partum depression, rheumatoid arthritis, ectopic pregnancy, and pregnancy toxemia. These are all very worthwhile disorders to show, but they fade into insignificance when compared with the deaths in women as a result of heart disease.

Coronary artery disease is now the most common cause of death in women in most developed countries, including the United States and Britain. This is mainly because the coronary death rate rises steeply after menopause: by the age of sixty-five, as many women as men are dying from heart attacks, and over the age of eighty, heart attacks are much more common in women, proportionately, than in men.

However, heart attacks do occur in younger women. Of the deaths caused by heart attacks in women aged under sixty-five, one in four is in a woman aged under forty-five. Therefore it is clear that women and their doctors must know the risks and try to avoid them.

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If you have diabetes as well as angina, then keeping your blood pressure under excellent control is even more important. Diabetes and hypertension go hand in hand; more people with diabetes than without it have hypertension. In people with both diseases, many have angina, and they are at much higher risk of a heart attack than everyone else. Treatment to lower their blood pressures is very much more effective at reducing their risks of heart attack and kidney failure than even the most rigorous control of their diabetes itself.

Your Blood Pressure Target

One of the first large studies of the results of blood-pressure lowering, the United Kingdom Medical Research Council Trial, concluded that in high-risk subjects (defined as those with mildly raised diastolic and a high systolic blood pressure, male, smokers, and people with a high blood cholesterol), treating the blood pressure would prevent one stroke per four patients over five years. In a low-risk person, with only a mildly raised diastolic pressure and no other risk factors, the saving would be one stroke per 242 patients in the same time period.

That trial used a combination of antihypertensive drugs that is now outdated, and has been superseded by newer drugs, so that treatment for hypertension is even more effective now, and with better chances of saving lives.

How far do you need to bring your blood pressure down? Studies show that lowering the average blood pressure by 6 to 8 mm Hg could reduce the incidence of coronary heart disease in the U.S. by 25 percent. This is true whether the initial blood pressure is extremely high or just moderately raised.

This finding was surprising to the researchers, who expected the benefit to be less in patients with less severe hypertension. It has meant that the target figures for a satisfactory blood pressure have been changed. The old target was a diastolic pressure of 90 mm Hg. Then it became 85 mm Hg. The current blood pressure target is 80 mm Hg or less, and the savings in illness and deaths continue to increase. It appears, for diastolic pressure, that the lower it is, the better.

You can lower your blood pressure to some extent by changing to the healthier lifestyle of good eating and exercise described earlier, but this is not enough for many people with angina and hypertension. These people also need blood pressure-lowering (antihypertensive) drugs.

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Exercise won’t kill you, but choose it wisely. Don’t opt for explosive exercise, such as weightlifting. The action of lifting weights or straining muscles while holding your breath, known as the Valsalva maneuver, is harmful, not beneficial. If you are not a fully trained weightlifter, it can cause a sudden drop in the blood returning from the lower body to the heart. At best it can make you dizzy; at worst it can make you unconscious. If you already have a poor flow of blood through a coronary artery, the Valsalva maneuver can be the final insult, bringing on a heart attack. The same may occur in explosive sports like squash. Golf is more leisurely, and probably better for you.

If you are thinking of taking up a sport, take a few lessons from a professional first. It will give you an idea of how you will like it, and make it much easier to enjoy.

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Norwegians, like Scots, feature highly in studies of heart disease. The Oslo Study Group screened 16,202 men aged forty to forty-nine years for Coronary risk factors. They then selected 1,232 healthy men at high risk (because of smoking and high cholesterol levels) to see whether lowering serum cholesterol and stopping smoking would reduce their heart attack rate. The men had initial blood cholesterol levels of 290-380mg/dl and 80 percent of them smoked cigarettes. Half were given health advice (the treatment group), and half (the control group) were not.

After five years, the cholesterol levels were 13 percent lower, and the number of cigarettes smoked each day 45 percent lower in the treatment group than in the control group. These were linked with a 47 percent reduction in fatal and nonfatal heart attacks in the treatment group. The statistics were clear: There were twenty-two nonfatal heart attacks per one thousand men over the five years in the treatment group, and thirty-five in the controls. The corresponding figures for deaths were twenty-six and thirty-eight.

Detailed analysis of the Oslo study suggested that the improvement in the rate for heart attacks and deaths were mainly due to cholesterol lowering, and less linked with smoking cessation.

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So far I have listed elements within the circulating blood that can heighten your risk of angina, but changes in the blood vessel walls also play a part. If your blood vessels remain wide open and their lining is smooth, blood flow within them remains fast and adequate. If they become narrowed, then the flow through them slows down. The change can be dramatic. Halve the diameter of a blood vessel and the flow of blood through it decreases by nine-tenths! That may still provide enough oxygen and glucose for a heart at rest, but not when you are running or even walking briskly or climbing stairs.

I have already mentioned one cause of narrowing of these blood vessels—atheroma. However, an artery’s diameter is also governed by the tone in the muscles in its walls. Every artery has in its walls muscles that encircle it. When they contract, the artery narrows, and blood flow through it slows; when they relax, the artery opens up, and the flow increases. If your arteries are in a state of contraction, so that they are narrower than they should be, the blood flow through them is either less, or the pressure to keep the flow normal must rise. In the first instance, the supply of oxygen from that artery is diminished, and in the second, the demand on the heart is increased. Often, both occur together. Obviously, this is yet another set of circumstances that can promote angina.

The combination of a high level of fibrinogen, stiffened red cells, high cholesterol, high blood pressure, hyperactive aggregated platelets, and increased arterial muscle tone, all on top of atheroma in the coronary arteries, is a lethal one. Each element of that combination contributes either to lowering the supply of oxygen and glucose to the heart muscle or to increasing the demand of the heart for oxygen, and therefore to the onset of angina.

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