Friday, November 12, 2010

Thank you very much for inviting me to speak with you today.  It’s a great honor to help out such a great cause, and it’s inspiring to join such a caring and upbeat group of people.  Heart health is one of the most important issues of the day, and I am very happy to support the efforts of the “Go Red for Women” campaign and to share a little bit about my own family’s history with heart disease—something that I have not done publicly before.

A popular song that we often heard around Mother’s Day when I was growing up was “M-O-T-H-E-R.”  The words were written by American lyricist Howard Johnson, and I’m sure you know this acronym-based tune in honor of motherhood—the one that begins, “M is for the million things she gave me.”  Right in the middle of “mother” and the song is the letter “H,” and of course that could be nothing else but “heart”:  “H is for her heart of purest gold.”

We’re going red rather than gold for women today, but that image of the heart at the center of motherhood resonates for me in many ways.  Of course, I loved my mother and she loved me, so the emotional metaphor of the heart in our relationship was and remains very strong.  But when I think about my mother’s heart, I also think of the physical meaning.  And I’ve been thinking about my mother’s heart a lot, especially this year.

This year, I turned 60 years old.  These days, 60 is, what, the new 50?  The new 40?  Regardless, 60 is certainly not the “ripe old age” that it used to be, and I feel strong, healthy, full of life, and full of things still to accomplish both personally and professionally.

But as I reached this milestone, I could not help but think about my mother, Alberta.  She died when she was 60 years old—of heart disease.  I was only 28 at the time.  This was not a lingering death nor the end of a long decline.  One night, my mom complained about indigestion and decided to sleep on the couch.  My dad tried to wake her up in the morning, but it was too late.  In the language of physicians at that time, her doctor said my mother’s heart just “gave out.”

Sadly, this was not the first time something like this happened in our family.  My grandmother Bertha also died unexpectedly of heart disease when I was a preteen.  She was—60 years old.

So I think you can see why my own 60th year has raised the awareness of good heart health even more than usual for me.  This awareness was brought home in dramatic fashion once again just a couple of weeks ago when one of our most vibrant and beloved professors, Rex Honey, passed away unexpectedly from a sudden heart ailment.  Rex was a Professor of Geography and co-founder of the UI Center for Human Rights.  He was only 65, and you could hardly find another 65-year-old who was more active and more full of life and vigor.  We were—and still are—shocked at this sudden loss.

Although not every single heart attack or instance of heart disease can be stopped, many things are fortunately different today than they were in my mother and grandmother’s time.  One of the biggest—and most important—differences is widely available information.

The biggest factor in my mother’s disease and ultimate passing was no doubt smoking.  My mom left her home in Indianapolis at age 17 to live the exciting life of working in the fashion industry in New York.  This kind of life included smoking, which she took up as a teenager.  To be in the fashion world meant to be chic, and to be chic meant to smoke.  In the 1940s and 50s, smoking was not only more accepted, but it was almost expected in certain circles.  Many of you may be viewers of the television series Mad Men, which focuses on Madison Avenue advertising executives in the 1960s.  The show tries hard to be historically accurate, so you see constant drinking and smoking, even during work hours.  We now know, of course, that smoking is one of the greatest risk factors for heart disease.

Stress is another.  And that’s no doubt what ailed my grandmother.  She was a non-smoker, but she lived through the Great Depression, experienced miscarriages, and endured other highly stressful situations.

With the information we have available to us today, prevention is our best defense against heart disease, and I’d like to talk a bit about that.  But before I do that, let me briefly discuss one other important way in which more information can save lives, for women specifically.

From the time we’re small children, we know that men and women are different physically, no matter how much our parents may or may not have taught us about the birds and the bees.  But that consciousness of gender differences hasn’t always transferred over to our medical understanding.  Fortunately, our health care professionals and medical researchers are focusing more and more on the different ways in which heart disease presents itself in men and women, as well as the different ways in which it might be treated.

In fact, we have faculty and researchers at the University who are looking into these very issues.  Dr. Kathryn Lamping from Internal Medicine and Pharmacology focuses her research on gender differences in vascular mechanisms and reactivity under normal conditions and diabetes.  Dr. Ellen Gordon from Internal Medicine focuses her work on women and heart disease, too, with a special interest in preventive cardiology.  These are just two of the talented UI community members who are advancing our knowledge of women and heart disease, which will ultimately become the information we all need to keep ourselves healthy and heart-aware.

One of the major newer understandings we now have is that heart disease—and even heart attacks—may not present themselves in women in the same ways they do in men.  According to the Cleveland Clinic, women develop symptoms of heart disease an average of 10 years later than men.  According to the National Institute of Nursing Research of the National Institutes of Health, each year about 88,000 women ages 45 to 64 and about 372,000 women aged 65 and older have a heart attack.

And their symptoms may not be typical “heart” symptoms.  In a multi-center study of 515 women who had an acute heart attack, the most frequently reported symptoms were unusual fatigue, sleep disturbances, shortness of breath, indigestion, and anxiety.  The majority of women—78 percent—reported at least one symptom for more than one month before their heart attack.

According to the Mayo Clinic, the most common symptom of a heart attack in both men and women is some type of pain, pressure, or discomfort in the chest.  But it's not always severe or even the most prominent symptom, particularly in women.  In the study cited by the Cleveland Clinic, only 30 percent of the women reported chest discomfort, which was described as an aching, tightness, pressure, sharpness, burning, fullness, or tingling.

The most common symptoms of heart attack in women are shortness of breath, weakness, unusual fatigue, cold sweat, dizziness, pain or pressure in the back or high chest, pain or discomfort in one or both arms, a burning sensation in the chest or upper abdomen, irregular heartbeat, and nausea.  My mother certainly did have many of the classic symptoms of heart disease that we should have paid attention to, but, as I said, the symptom immediately before she passed away was indigestion.

As the Mayo Clinic says, the problem for women has been that “these signs and symptoms are more subtle than the obvious crushing chest pain often associated with heart attacks.  “This may be because women tend to have blockages not only in their main arteries, but also in the smaller arteries that supply blood to the heart—a condition called small vessel heart disease.  Many women tend to show up in emergency rooms after much heart damage has already occurred because their symptoms are not those typically associated with a heart attack.”

I am an educator, so I certainly advocate education as one of the most tried and true methods of prevention.  By learning and recognizing the symptoms of heart disease and heart attacks that are specific to women, we can know better when to go to the doctor or emergency room.  And perhaps even more importantly, armed with knowledge and information, we can become better advocates for ourselves and be more assertive in our treatment if necessary.

Of course, we all hope that it never comes to ending up in the emergency room, or even being treated for heart disease if we are not already.  Prevention is essential.  Almost all heart disease is preventable.  Yet ironies abound.  Despite being mostly preventable, heart disease is the number one killer of women—one out of three women, in fact.  A further irony is that, according to the American Heart Association, nine out of ten women in Iowa have at least one risk factor for cardiovascular disease.  That is virtually every single one of us in this room.  A still further irony is that 80 percent of these risk factors are preventable.

So what are we to do?

I’m sure the basic prevention techniques are familiar to all of us, but I challenge everyone here today to really think seriously about them and to make a resolute commitment to a healthier lifestyle.  We probably all know them, but here are those prevention techniques again:   Exercise 30 to 60 minutes a day on most days of the week, or at least 150 minutes each week, according to the American Heart Association.  Maintain a healthy weight.  Quit or don't start smoking.  Eat a diet that's low in saturated fat, cholesterol, and salt.

These are the guidelines for good health generally.  Many other health problems result from not following a healthy lifestyle, and indeed these ailments are often the biggest risk factors for heart disease.  The NIH’s National Institute of Nursing Research notes what they call the “deadly quartet” of chronic conditions that elevate the risk of heart disease for post-menopausal women:  diabetes, obesity, high blood pressure, and high cholesterol.

I am here today to speak with you at age 60, whereas my mother and grandmother would not have been.  And I have every intention of being able to accept invitations to speak—and do many other things—at age 61, 65, 70, and beyond.  So I am very conscious of leading the healthiest lifestyle I can.

First, I do not smoke.   Unfortunately, 20% of American women still smoke.  And we know that quitting smoking works.  One of the “Top 10 Research Advances for 2009” from the American Heart Association was a National Cancer Institute-funded study published in the Journal of the American Heart Association which showed that “heart attacks decline after smoke-free laws [are] passed. . . . One year after passing smoking bans, communities in North America and Europe had 17% fewer heart attacks compared to those without smoking restrictions, and the number of heart attacks kept decreasing with time.”  Here in Iowa City, we have heard complaints about people’s freedoms in recent years regarding smoking bans in local restaurants and bars, on the University campus, and most recently on Iowa City’s Pedestrian Mall.  But the fact is, smoking bans save lives.

In many ways, my job as University President is not the most conducive to heart health.  Eat right?  Well, going to multiple luncheons, dinners, and banquets each week comes with the presidential territory.  But I make sure I am careful that I choose my selections and portions well, even if the Rotary Club has an elaborate buffet.

Stress?  I’ve got plenty of that.

Time to exercise?  I don’t have plenty of that.  But I still understand the importance of relaxation and exercise.  Although I don’t have time to take a jog around the Pentacrest during the day, I do try to work out at home every night.  I visit my recumbent bike and elliptical machine as often as I can.  I’ve even entered the world of video games for my heart health.

Last Christmas, my husband, Ken, gave me a Wii Fit game system.  In fact, the American Heart Association has partnered nationally with Nintendo because of the proven health benefits of playing active games on the Wii.  The AHA notes that 70% of Americans don’t get the recommended amount of physical activity.  Any exercise program that you stick with is a good one!  And Wii does make it fun—I can tell you that firsthand.  So remember:  Nintendo—it’s not your grandson’s videogame system.

Having a great relationship with your doctor is a crucial piece of the puzzle, too, even if it only means that you visit her frequently.  I both like my doctor personally and visit often.  I am able to talk freely and frankly with her, and I trust her judgment.  I have regular checkups and ensure my cholesterol is in check—and, again, I make sure I pace myself at all the wonderful luncheons like these that I get to go to.

I hope you’re all making these regular, smart lifestyle choices.  If you in fact have developed some of the health problems that can lead to heart disease, be sure that you’re doing everything your physician is asking you to do, whether it’s exercising regularly, eating right, taking your blood pressure medication, or whatever the case may be.

Paying attention is the key.  Yes, listen to your body and pay attention to physical symptoms that may indicate heart disease or, heaven forbid, a heart attack.  Pay attention to your lifestyle, your simple daily choices—such as whether it’s a better idea to take a walk or watch TV.  Small decisions and everyday actions can lead to major health benefits.

I pay close attention to these things to make sure I don’t end up with the same fate as my mom and grandma.  I model myself on many of the excellent qualities they exhibited and shared throughout their lives, but I have to part ways with them in a number of lifestyle areas.

Of course I don’t blame them for their heart disease.  Today, we know so much more than we did in the 40s, 50s, 60s, and 70s.  We know much more today than we did even ten years ago.  At the University, our stock-in-trade is creating and sharing new discoveries and new knowledge.  We all need to keep abreast of the new understandings and the new information that we are fortunate to have in this day and age.

Today, we are asking everyone here to “Go Red for Women.”  We can all do that by “going red” for ourselves individually, and for our own sisters, mothers, grandmothers, daughters, nieces, and aunts.  And, as a University educator, I think one of the most powerful ways that we can “go red” is by learning all we can about how to live a heart-healthy life—and sharing it with our loved ones.

Thank you again for inviting me to speak with you.  I thank everyone involved in the “Go Red for Women” campaign, the American Heart Association and its regional affiliates, and all of you here for caring—and doing—so much about heart health for women, and for everyone.