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Walk out of the Room Bohdan Ihor Antonych, 1933 Walk out of the room, walk out of the room open the window. The moon is full, the wind has wings the night - heady like strong wine. Look: circles of darkness embrace the land. Listen: the leaves rustle, delicate as silk. The glimmering distance, a silver necklace of sparkling stars. The unknown calls mysteriously, returning eternity's glance. Walk out of the room, walk out of the room open the doors. Into the infinite blue of the sky the cool breeze blows away bad dreams. (Translated by Virlana Tkacz and Wanda Phipps) A Woman's Heart by Ihor Magun, M.D., F.A.C.P. Despite the increased knowledge of cardio vascular disease, heart disease remains the leading cause of death of women in the United States and in other developed countries of the world. One of the major problems encountered by women with cardiac problems is that they do not experience chest pain. This delays treatment or worse, forgoes it altogether. Nearly two thirds of women die suddenly without any recognizable symptom of heart disease. The American Heart Association, in colla boration with eleven other professional and govern ment organizations, has recently published the first set of guidelines for the prevention of cardiovascular dis ease in adult women. This publication is unprece dented. The published guidelines are built on the prem ise that cardiovascular disease is a continuum of risk factors which develop over time. No longer can one assume that either heart disease is present or is not present. The panel that compiled the guidelines estab lished categories for heart disease risk: high, interme diate, or low risk. These categories determine the in tensity of the appropriate preventive therapy with re commendations dependent on the level of risk. High risk women are women who already have established coronary heart disease, diabetes, chronic kidney di sease, abdominal aortic aneurysm, carotid (neck) ar tery disease. Intermediate risk factos include subclini- cal coronary artery disease (e.g. coronary calcifications as seen on an ultrafast CAT scan), relatives with an early onset of atherosclerotic coronary artery disease (age 55 or lower in a male relative and age 65 or lower in a female relative). Low risk factors include obesity, smoking, and elevated cholesterol. Obviously there is some overlapping within these categories. Lifestyle changes are recommended across all risk categories both as prevention and as a means of reducing existing heart disease. These include smoking cessation, adequate weight reduction/maintenance and improved nutrition. The optimal diet should include a variety of fruits, vegetables, grains, low-fat or nonfat dairy products, fish, legumes and sources of protein low in saturated fat (lean meats). Saturated fat should be limited to less than 10 percent of calories and cho lesterol should be limited to less than 300 milligrams per day. It is a good idea to read labels for information. Remember, any product that comes from a plant has no cholesterol. Any product that comes from an animal has cholesterol unless it has been artificially removed. Control of lipids (fats) is recommended for both intermediate and high-risk women. Using medica tions to lower cholesterol (statins) is now recom mended for high-risk women who have favorable cho lesterol numbers. The objective is to get the numbers even lower. Many recent studies have shown the bene fit of lower numbers. Women who have an irregular heart beat called atrial fibrillation should be on a blood thinner called warfarin (coumadin). Individuals with diabetes should have lifestyle and pharmacologic interventions to obtain an optimal glucose level. Aspirin is recom mended for high-risk women and not recommended for low-risk women. Hormone therapy and antioxidant vitamin supplements are not recommended because of unproven benefits; they may even have adverse ef fects. A campaign called Go Red For Women has been launched to raise awareness of heart disease in women. The symbol for the campaign is a red dress pin that attracts attention and serves as a reminder for women to think seriously about heart health. Let us all join in the nationwide effort for a greater awareness and get proactive about this timely subject. For more information, log on to www.americanheart.org 20 “НАШЕ ЖИТТЯ”, БЕРЕЗЕНЬ 2004 Видання C оюзу Українок A мерики - перевидано в електронному форматі в 2012 році . A рхів C У A - Ню Йорк , Н . Й . C Ш A.
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