Women: Listen to your history

When a man suffers a heart attack at a young age, klaxons sound and red flags flutter for his son. Pointing to a son’s inherited risk of going down the same road, physicians will probably urge him to stay away from cigarettes, watch his weight and exercise regularly. And there’s growing evidence that that advice prompts many of these men to take heed -- especially the recommendation to exercise.

But do alarm bells sound for the female child of a premature heart attack victim -- and does she hear them? A study in the September issue of the American Heart Journal suggests the answers are no and no. The study establishes that although the daughters of families with premature heart disease are indeed at higher risk of developing heart disease themselves, they are either failing to get that message or not bothering to heed it.

Between the ages of 30 and 50, these women are more likely to be overweight and to smoke than are their female peers without a family history of heart disease. Further, they are only slightly more likely to exercise and, overall, appear less inclined than are men to shape up when an immediate blood relative is stricken with heart problems.

“Women seem to feel they have a get-out-of-jail-free card when it comes to heart disease,” says Dr. Alexis Anvekar, a Pasadena-based internist and American Heart Assn. spokeswoman. “They seem to feel that it’s a man’s disease.”

The American Heart Journal study looked at data collected on 2,400 people as part of the Dallas Heart Study, which surveyed and examined some 6,000 Texas residents to track the incidence and development of heart disease. University of Texas Southwestern Medical Center internal medicine specialist Dr. Amit Khera and colleagues looked at how men and women, with and without histories of heart disease, compared on measures of cardiovascular risk factors (such as high blood pressure or cholesterol), arterial blockage as detected on scans, and their own reports of exercise activity and tobacco use.

The data supported the long-held belief that women generally have lower levels of plaque and fatty buildup in their arteries than do men. But closer inspection showed that among those women with a family history of premature heart disease, the concentration of arterial plaque and fatty deposits was twice that of women with no such family history. And these women’s atherosclerosis was on par with that of men with no family history of heart disease. A family history of heart disease, in effect, wiped out the biological protection against heart disease most females enjoy.

“Having a family history kind of turned a woman into a man biologically,” said Khera, senior author of the study.

Along with vulnerable genes, parents with heart disease tend to pass down to their children unhealthful habits such as smoking, overeating and failing to exercise. As a result, both men and women with a family history of heart disease were more likely than their same-sex peers without such a history to smoke, weigh too much and (for women but not men) to be sedentary. But for men, the differences were typically narrow, suggesting that many men with family histories of heart disease had rejected unhealthful family habits in an effort to reduce their risk. Men with a family heart disease history, for instance, were almost twice as likely to exercise than men without heart disease in the family.

There was little evidence that women in the same situation had made such changes. Of all the groups looked at, the women with a family history of early heart disease had the highest rates of tobacco use (40% compared with 25.2% of females without family heart disease histories) and were most likely to be overweight or obese (51% compared with 44.4% for females without histories). They were just a little less likely than women without a family history of heart disease to be sedentary (40.1% compared with 43.9%).

Khera suggests that, with major public campaigns to educate women to heart disease risks, things may be a little different now than three to five years ago, when the Dallas snapshot was taken. But he said women with family heart disease history -- as well as their doctors -- still have far to go.

“People are finally getting the message, and women are often more compliant” when told they must change their ways, Khera says. But if a woman is to be saved from her father’s disease, he adds, she needs to get the message, get the treatment and make the changes that could make the difference.