In Heart Disease, the Focus Shifts to Women

William Wagner wrote:
http://www.nytimes.com/2006/04/18/he...hear.html?8dpc

In Heart Disease, the Focus Shifts to Women

By DENISE GRADY
Published: April 18, 2006

Kim Kachmann-Geltz did everything right. She ran five miles a day,
dutifully ate oatmeal and wheat toast, stayed slim, never smoked. Her
blood pressure was perfect. Her genes, she thought, were lucky: her
great-grandmother had lived to 102.

No such thing as luck.

"The lot is cast into the lap, but its every decision comes from the
LORD." (Proverbs 16:33)

Perry Baker for The New York Times

"I'm the last person in the world I could ever imagine having heart
disease," said Ms. Kachmann-Geltz, of Hilton Head, S.C., who is 39 and
the mother of three children.

But since 2003 she has suffered from angina, chest pain caused by
inadequate blood flow to the heart. In addition, one chamber of her
heart has shown signs of enlargement, and her heart valves do not work
properly. She takes four heart medicines and may eventually need more.
Even with the drugs, chest pain keeps her from running. She walks
instead, and does yoga.

"It's not a death sentence," she said. "You don't have to live your life
depressed."

But her outlook is a mixed message. She describes her prognosis as good
and yet also says the disease may shorten her life.

"We just don't know," she said. "That much has been made clear to me."

Her case is unusual: angina more often strikes older women. Still,
coronary artery disease is the leading cause of death in women over 25,
killing more than 250,000 a year in the United States. Before they reach
their 60's, women are less likely than men to develop heart problems,
but once the disease does occur, women often fare worse than men.

Since 1984, more women than men have died each year from heart disease,
and though overall coronary death rates have dropped in recent decades,
most of the improvements have been in men.

Lately it has been on the upswing in both men and women presumably
because of increasing rates of obesity leading to more metabolic
syndrome (MetS).

Puzzling differences have emerged between men and women with heart
disease, making it plain that past studies, mostly done on men, do not
always apply to women. Researchers have come to realize that to improve
diagnosis and treatment for women, they must sort out the differences.

"Every time we turn around, we find more gender differences, so it's
important to study," said Dr. C. Noel Bairey Merz, a cardiologist at
Cedars-Sinai Medical Center in Los Angeles.

Among the differences are these:

¶Women with chest pain and other heart symptoms are more likely than men
to have clear coronary arteries when tests are performed, a surprising
result that suggests there may be another cause for their problems.

Those who have watched Morgan Spurlock's documentary "SuperSizeMe" are
aware that visceral adiposity from rapid weight gain from overeating
can lead to such chest pains (endothelial dysfunction -- coronary
spasm -- variant angina aka atypical chest pain). Women are
encouraged to "eat for two" when they become pregnant thereby achieving
massive weight gains on the scale of "SuperSizeMe."

¶When women do have blocked coronary arteries, they tend to be older
than men with similar blockages and to have worse symptoms, including
more chest pain and disability. These women are also more likely to have
other problems like high blood pressure, high cholesterol and diabetes,
which may make surgery riskier.

This triad arises from years of metabolic syndrome (MetS).

And they are more likely than men to
develop heart failure, a weakening of the heart muscle that can be
debilitating and ultimately fatal.

¶When women have bypass surgery or balloon procedures for coronary
blockages, they are less likely than men to have successful outcomes,
and they are more likely to suffer from bad side effects.

This is presumably because their coronary arteries are significantly
smaller.

¶Blood tests that reliably pick up signs of heart damage in men do not
always work in women.

Actually, this is not true...

¶Women seem much more likely than men to develop a rare, temporary type
of heart failure in response to severe emotional stress.

...nor is this... making the source of this article rather suspect.

"We don't have good explanations for these gender differences," said Dr.
Alice K. Jacobs, a cardiologist at Boston University.

She said that one reason women have not fared as well as men after
bypass surgery and balloon procedures may be that women are smaller, and
so are their blood vessels, and the vessels may tend to clog up again
more easily after the procedures.

Thankfully, there is EECP as a viable alternative for women that
provides angina relief with a response rate of greater than 85%:

http://tinyurl.com/rbeyd

In addition, surgeons performing bypasses in women have been less likely
to use an artery from inside the chest wall, because it is smaller and
harder to work with ‹ even though using the chest artery instead of a
leg vein gives most patients better odds of long-term survival.

In the past, Dr. Jacobs said, cardiologists had only big balloons and
bulky tubing to open blocked vessels, and some of the equipment may have
been too large for women.

"Now we have tiny wires, balloons and stents, and it's less of an
issue," she said, adding that success rates in women were improving.

Women like Ms. Kachmann-Geltz have become an important focus of study.
Her doctors believe she has an insidious type of heart disease, more
common in women than men, that researchers are just beginning to
understand.

These patients have chest pain and abnormal stress tests. Their heart
muscle is starved and aching for oxygen ‹ and yet their coronary
arteries look wide open on an angiogram, the test in which doctors
inject the vessels with dye and then X-ray them to spot blockages.

Someone who looks trim can still have metabolic syndrome (MetS) because
of significant visceral adiposity leading to endothelial dysfunction in
smaller coronary vessels (cardiac syndrome X).

Some of these women also score poorly on a simple survey ‹ the Duke
Activity Status Index ‹ that gauges their strength and ability to
exercise by asking questions like whether they can walk up a flight of
stairs or run a short distance. A low score is a reliable predictor of
more heart problems to come.

For those with symptoms, the real, underlying problem may be a disorder
called microvascular disease, a narrowing or stiffening of the smaller
arteries that nourish the heart, vessels too tiny to show up on an
angiogram.

"These little arterioles are deciding where relatively low and higher
blood flow should occur," said Dr. Bairey Merz, explaining that the
smaller vessels are more muscular than large ones, and their walls
contract or relax to regulate blood flow.

In microvascular disease, the small vessels lose their ability to dilate
and increase blood flow to the heart. The cause does not seem to be
fatty deposits like the ones that can block the coronary arteries.

Rather, the muscles in the arterioles thicken, a process called
remodeling, and the walls may stiffen and begin to close in. The result
is ischemia, lack of blood flow. Over time, it increases the risk of
heart failure and heart attacks.

Three million women in the United States may have microvascular heart
disease, said Dr. Bairey Merz, chairwoman of a government-sponsored
study of the disorder, called Wise, for Women's Ischemia Syndrome
Evaluation.

That study, begun in 1996, included 936 women who had angiograms because
of symptoms like chest pain. Their average age was 58, but a quarter
were younger and premenopausal.

The angiograms found that only a third had blockages in their coronary
arteries. In men with similar symptoms, three-quarters or more would
have had severe blockages, said Dr. Carl J. Pepine, an investigator in
the study and the chief of cardiovascular medicine at the University of
Florida.

Another third of the women had no blockages but did have low blood flow
to the heart, most likely a result of microvascular disease. The
deficiency was found by a test in which doctors first measured blood
flow through the heart and then injected a drug that should have made
the arteries dilate and increased the flow. If the flow did not rise,
the patient most likely had microvascular disease.

Among those judged to have the disorder, the rate of deaths or heart
attacks was 10 percent after four years ‹ much higher than would be
expected for women with normal angiograms.

The findings call for a major shift in the treatment of women with chest
pain or other symptoms and normal angiograms, said Dr. George Sopko of
the National Heart, Lung and Blood Institute. "Instead of tossing aside
the angiogram and saying you're O.K., let's make sure we are not missing
anything."

Doctors should use the Duke survey and consider other tests that can
pick up signs of ischemia. And since recent studies have also suggested
that women who score high on measures of hostility have an increased
risk of heart problems, Dr. Sopko said: "If a woman comes in and has
symptoms, let's be careful when we evaluate her. Let's listen to her,
look at all the risk factors and include the psychosocial evaluation."

High cholesterol and high blood pressure are almost certainly among the
causes of microvascular disease, and it is essential to treat them
aggressively in women with chest pain, Dr. Pepine said, and to urge
women to exercise, avoid smoking and lose weight if they are too heavy.

Reducing visceral adiposity is the key to addressing this microvascular
disease in women.

Recent studies have found that high blood pressure ‹ particularly high
readings in the top number, the systolic pressure ‹ is a more serious
risk factor in women before menopause than after, and researchers say it
should be monitored and treated.

"You don't want to be disabled and lead a miserable life," Dr. Pepine
said. "Women who develop heart failure tolerate it much more poorly than
men, and they tolerate heart attacks and bypass surgery more poorly than
men. We don't want them to get to that stage."

The meaning of other findings is less clear, Dr. Sopko said, adding that
researchers were debating what if anything to do for women who had high
levels of a substance called C-reactive protein, a marker for
inflammation, which is thought to play a role in heart disease.

"We know it appears to be a marker for atherosclerosis," Dr. Sopko said,
"but that is far from saying we have to act on that marker with such and
such strategies. Simple, fairly appealing strategies may not work out
that well. We have to go back and get better knowledge."

Why microvascular disease might be more common in women than men is
unknown.

Actually, this is not true. There is more metabolic syndrome (MetS) in
women than in men here in the U.S.

Inflammation and anemia, both more common in women, have been
suggested as possible factors, along with hormonal fluctuations, but
none have been proved.

Some researchers think microvascular disease may help explain some of
the other gender differences ‹ why, for instance, women tend to have
worse symptoms than would be expected based on the condition of their
coronary arteries.

But microvascular disease is not easy to detect. When doctors see clean
coronary arteries on an angiogram, they may not take a patient's chest
pain seriously or recommend more tests or treatment.

"I was treated like a crazy woman," Ms. Kachmann-Geltz said, noting that
one doctor offered her tranquilizers, implying that her problems were
all in her head.

Her symptoms began during her third pregnancy, and her heart function
deteriorated so much that she nearly died during labor, she said,
recalling that a nurse in the delivery room actually asked whether she
was an organ donor.

Women generally gain too much weight during their pregnancies
especially here in the U.S.

After her son was born, she suffered from angina for almost two years
and had attacks that woke her up at night, before she found her way to
Dr. Pepine.

Tests showed a blood flow deficit in her heart.

"It was 30 seconds that changed my life," she said. "It was the first
time I felt acknowledged. This is real, it's not in my head, it's not
some pregnancy thing. I shake when I think about it."

It is impossible to say why the disease developed, but she noted that
her mother also has heart disease.

It is written what is impossible for man is possible for GOD.

In any case, Ms. Kachmann-Geltz she
began treatment with a diuretic and other medicines to control her blood
pressure and cholesterol.

"My world started coming back to me," she said. "It took about four
months. I started to regain energy, and stopped having nighttime sweats
and chest pain. I was able to start living my life again."

She would be wise to reduce her food intake to the optimal amount (one
omer per day) to become hungrier and lose the visceral adiposity.

Will be available to "glow" and chat about this and other things like
cardiology, diabetes, Bird Flu, the Lamb's opening of the 6th seal
(Rev. 6:12), cooking and nutrition that interest those following this
thread here during the next on-line chat(04/20/06) from 5 to 6 pm EST,
LORD willing:

http://tinyurl.com/8w7uq

For those who are put off by the signature, my advance apologies for
how the LORD has reshaped me:

http://tinyurl.com/7mcuo

Prayerfully in Christ's amazing love,

Andrew
http://tinyurl.com/zlaml

Mr. Chung,

since you quote scripture so well, let me remind you that " anyone who
causes another to stumble" has the greater sin. So your constant presence
only serves your self and not the one that sent you. I would ask that you
seek forgiveness and remove yourself from where you are not welcome, for you
only serve to case others to sin.

You know who I am and the one who sent me.


"Andrew B. Chung, MD/PhD" wrote in message
oups.com...
William Wagner wrote:
http://www.nytimes.com/2006/04/18/he...hear.html?8dpc

In Heart Disease, the Focus Shifts to Women

By DENISE GRADY
Published: April 18, 2006

Kim Kachmann-Geltz did everything right. She ran five miles a day,
dutifully ate oatmeal and wheat toast, stayed slim, never smoked. Her
blood pressure was perfect. Her genes, she thought, were lucky: her
great-grandmother had lived to 102.

No such thing as luck.

"The lot is cast into the lap, but its every decision comes from the
LORD." (Proverbs 16:33)

Perry Baker for The New York Times

"I'm the last person in the world I could ever imagine having heart
disease," said Ms. Kachmann-Geltz, of Hilton Head, S.C., who is 39 and
the mother of three children.

But since 2003 she has suffered from angina, chest pain caused by
inadequate blood flow to the heart. In addition, one chamber of her
heart has shown signs of enlargement, and her heart valves do not work
properly. She takes four heart medicines and may eventually need more.
Even with the drugs, chest pain keeps her from running. She walks
instead, and does yoga.

"It's not a death sentence," she said. "You don't have to live your life
depressed."

But her outlook is a mixed message. She describes her prognosis as good
and yet also says the disease may shorten her life.

"We just don't know," she said. "That much has been made clear to me."

Her case is unusual: angina more often strikes older women. Still,
coronary artery disease is the leading cause of death in women over 25,
killing more than 250,000 a year in the United States. Before they reach
their 60's, women are less likely than men to develop heart problems,
but once the disease does occur, women often fare worse than men.

Since 1984, more women than men have died each year from heart disease,
and though overall coronary death rates have dropped in recent decades,
most of the improvements have been in men.

Lately it has been on the upswing in both men and women presumably
because of increasing rates of obesity leading to more metabolic
syndrome (MetS).

Puzzling differences have emerged between men and women with heart
disease, making it plain that past studies, mostly done on men, do not
always apply to women. Researchers have come to realize that to improve
diagnosis and treatment for women, they must sort out the differences.

"Every time we turn around, we find more gender differences, so it's
important to study," said Dr. C. Noel Bairey Merz, a cardiologist at
Cedars-Sinai Medical Center in Los Angeles.

Among the differences are these:

¶Women with chest pain and other heart symptoms are more likely than men
to have clear coronary arteries when tests are performed, a surprising
result that suggests there may be another cause for their problems.

Those who have watched Morgan Spurlock's documentary "SuperSizeMe" are
aware that visceral adiposity from rapid weight gain from overeating
can lead to such chest pains (endothelial dysfunction -- coronary
spasm -- variant angina aka atypical chest pain). Women are
encouraged to "eat for two" when they become pregnant thereby achieving
massive weight gains on the scale of "SuperSizeMe."

¶When women do have blocked coronary arteries, they tend to be older
than men with similar blockages and to have worse symptoms, including
more chest pain and disability. These women are also more likely to have
other problems like high blood pressure, high cholesterol and diabetes,
which may make surgery riskier.

This triad arises from years of metabolic syndrome (MetS).

And they are more likely than men to
develop heart failure, a weakening of the heart muscle that can be
debilitating and ultimately fatal.

¶When women have bypass surgery or balloon procedures for coronary
blockages, they are less likely than men to have successful outcomes,
and they are more likely to suffer from bad side effects.

This is presumably because their coronary arteries are significantly
smaller.

¶Blood tests that reliably pick up signs of heart damage in men do not
always work in women.

Actually, this is not true...

¶Women seem much more likely than men to develop a rare, temporary type
of heart failure in response to severe emotional stress.

...nor is this... making the source of this article rather suspect.

"We don't have good explanations for these gender differences," said Dr.
Alice K. Jacobs, a cardiologist at Boston University.

She said that one reason women have not fared as well as men after
bypass surgery and balloon procedures may be that women are smaller, and
so are their blood vessels, and the vessels may tend to clog up again
more easily after the procedures.

Thankfully, there is EECP as a viable alternative for women that
provides angina relief with a response rate of greater than 85%:

http://tinyurl.com/rbeyd

In addition, surgeons performing bypasses in women have been less likely
to use an artery from inside the chest wall, because it is smaller and
harder to work with even though using the chest artery instead of a
leg vein gives most patients better odds of long-term survival.

In the past, Dr. Jacobs said, cardiologists had only big balloons and
bulky tubing to open blocked vessels, and some of the equipment may have
been too large for women.

"Now we have tiny wires, balloons and stents, and it's less of an
issue," she said, adding that success rates in women were improving.

Women like Ms. Kachmann-Geltz have become an important focus of study.
Her doctors believe she has an insidious type of heart disease, more
common in women than men, that researchers are just beginning to
understand.

These patients have chest pain and abnormal stress tests. Their heart
muscle is starved and aching for oxygen and yet their coronary
arteries look wide open on an angiogram, the test in which doctors
inject the vessels with dye and then X-ray them to spot blockages.

Someone who looks trim can still have metabolic syndrome (MetS) because
of significant visceral adiposity leading to endothelial dysfunction in
smaller coronary vessels (cardiac syndrome X).

Some of these women also score poorly on a simple survey the Duke
Activity Status Index that gauges their strength and ability to
exercise by asking questions like whether they can walk up a flight of
stairs or run a short distance. A low score is a reliable predictor of
more heart problems to come.

For those with symptoms, the real, underlying problem may be a disorder
called microvascular disease, a narrowing or stiffening of the smaller
arteries that nourish the heart, vessels too tiny to show up on an
angiogram.

"These little arterioles are deciding where relatively low and higher
blood flow should occur," said Dr. Bairey Merz, explaining that the
smaller vessels are more muscular than large ones, and their walls
contract or relax to regulate blood flow.

In microvascular disease, the small vessels lose their ability to dilate
and increase blood flow to the heart. The cause does not seem to be
fatty deposits like the ones that can block the coronary arteries.

Rather, the muscles in the arterioles thicken, a process called
remodeling, and the walls may stiffen and begin to close in. The result
is ischemia, lack of blood flow. Over time, it increases the risk of
heart failure and heart attacks.

Three million women in the United States may have microvascular heart
disease, said Dr. Bairey Merz, chairwoman of a government-sponsored
study of the disorder, called Wise, for Women's Ischemia Syndrome
Evaluation.

That study, begun in 1996, included 936 women who had angiograms because
of symptoms like chest pain. Their average age was 58, but a quarter
were younger and premenopausal.

The angiograms found that only a third had blockages in their coronary
arteries. In men with similar symptoms, three-quarters or more would
have had severe blockages, said Dr. Carl J. Pepine, an investigator in
the study and the chief of cardiovascular medicine at the University of
Florida.

Another third of the women had no blockages but did have low blood flow
to the heart, most likely a result of microvascular disease. The
deficiency was found by a test in which doctors first measured blood
flow through the heart and then injected a drug that should have made
the arteries dilate and increased the flow. If the flow did not rise,
the patient most likely had microvascular disease.

Among those judged to have the disorder, the rate of deaths or heart
attacks was 10 percent after four years much higher than would be
expected for women with normal angiograms.

The findings call for a major shift in the treatment of women with chest
pain or other symptoms and normal angiograms, said Dr. George Sopko of
the National Heart, Lung and Blood Institute. "Instead of tossing aside
the angiogram and saying you're O.K., let's make sure we are not missing
anything."

Doctors should use the Duke survey and consider other tests that can
pick up signs of ischemia. And since recent studies have also suggested
that women who score high on measures of hostility have an increased
risk of heart problems, Dr. Sopko said: "If a woman comes in and has
symptoms, let's be careful when we evaluate her. Let's listen to her,
look at all the risk factors and include the psychosocial evaluation."

High cholesterol and high blood pressure are almost certainly among the
causes of microvascular disease, and it is essential to treat them
aggressively in women with chest pain, Dr. Pepine said, and to urge
women to exercise, avoid smoking and lose weight if they are too heavy.

Reducing visceral adiposity is the key to addressing this microvascular
disease in women.

Recent studies have found that high blood pressure particularly high
readings in the top number, the systolic pressure is a more serious
risk factor in women before menopause than after, and researchers say it
should be monitored and treated.

"You don't want to be disabled and lead a miserable life," Dr. Pepine
said. "Women who develop heart failure tolerate it much more poorly than
men, and they tolerate heart attacks and bypass surgery more poorly than
men. We don't want them to get to that stage."

The meaning of other findings is less clear, Dr. Sopko said, adding that
researchers were debating what if anything to do for women who had high
levels of a substance called C-reactive protein, a marker for
inflammation, which is thought to play a role in heart disease.

"We know it appears to be a marker for atherosclerosis," Dr. Sopko said,
"but that is far from saying we have to act on that marker with such and
such strategies. Simple, fairly appealing strategies may not work out
that well. We have to go back and get better knowledge."

Why microvascular disease might be more common in women than men is
unknown.

Actually, this is not true. There is more metabolic syndrome (MetS) in
women than in men here in the U.S.

Inflammation and anemia, both more common in women, have been
suggested as possible factors, along with hormonal fluctuations, but
none have been proved.

Some researchers think microvascular disease may help explain some of
the other gender differences why, for instance, women tend to have
worse symptoms than would be expected based on the condition of their
coronary arteries.

But microvascular disease is not easy to detect. When doctors see clean
coronary arteries on an angiogram, they may not take a patient's chest
pain seriously or recommend more tests or treatment.

"I was treated like a crazy woman," Ms. Kachmann-Geltz said, noting that
one doctor offered her tranquilizers, implying that her problems were
all in her head.

Her symptoms began during her third pregnancy, and her heart function
deteriorated so much that she nearly died during labor, she said,
recalling that a nurse in the delivery room actually asked whether she
was an organ donor.

Women generally gain too much weight during their pregnancies
especially here in the U.S.

After her son was born, she suffered from angina for almost two years
and had attacks that woke her up at night, before she found her way to
Dr. Pepine.

Tests showed a blood flow deficit in her heart.

"It was 30 seconds that changed my life," she said. "It was the first
time I felt acknowledged. This is real, it's not in my head, it's not
some pregnancy thing. I shake when I think about it."

It is impossible to say why the disease developed, but she noted that
her mother also has heart disease.

It is written what is impossible for man is possible for GOD.

In any case, Ms. Kachmann-Geltz she
began treatment with a diuretic and other medicines to control her blood
pressure and cholesterol.

"My world started coming back to me," she said. "It took about four
months. I started to regain energy, and stopped having nighttime sweats
and chest pain. I was able to start living my life again."

She would be wise to reduce her food intake to the optimal amount (one
omer per day) to become hungrier and lose the visceral adiposity.

Will be available to "glow" and chat about this and other things like
cardiology, diabetes, Bird Flu, the Lamb's opening of the 6th seal
(Rev. 6:12), cooking and nutrition that interest those following this
thread here during the next on-line chat(04/20/06) from 5 to 6 pm EST,
LORD willing:

http://tinyurl.com/8w7uq

For those who are put off by the signature, my advance apologies for
how the LORD has reshaped me:

http://tinyurl.com/7mcuo

Prayerfully in Christ's amazing love,

Andrew
http://tinyurl.com/zlaml

James DeMoss wrote:
"Andrew B. Chung, MD/PhD" wrote in message
oups.com...
William Wagner wrote:
http://www.nytimes.com/2006/04/18/he...hear.html?8dpc

In Heart Disease, the Focus Shifts to Women

By DENISE GRADY
Published: April 18, 2006

Kim Kachmann-Geltz did everything right. She ran five miles a day,
dutifully ate oatmeal and wheat toast, stayed slim, never smoked. Her
blood pressure was perfect. Her genes, she thought, were lucky: her
great-grandmother had lived to 102.

No such thing as luck.

"The lot is cast into the lap, but its every decision comes from the
LORD." (Proverbs 16:33)

Perry Baker for The New York Times

"I'm the last person in the world I could ever imagine having heart
disease," said Ms. Kachmann-Geltz, of Hilton Head, S.C., who is 39 and
the mother of three children.

But since 2003 she has suffered from angina, chest pain caused by
inadequate blood flow to the heart. In addition, one chamber of her
heart has shown signs of enlargement, and her heart valves do not work
properly. She takes four heart medicines and may eventually need more.
Even with the drugs, chest pain keeps her from running. She walks
instead, and does yoga.

"It's not a death sentence," she said. "You don't have to live your life
depressed."

But her outlook is a mixed message. She describes her prognosis as good
and yet also says the disease may shorten her life.

"We just don't know," she said. "That much has been made clear to me."

Her case is unusual: angina more often strikes older women. Still,
coronary artery disease is the leading cause of death in women over 25,
killing more than 250,000 a year in the United States. Before they reach
their 60's, women are less likely than men to develop heart problems,
but once the disease does occur, women often fare worse than men.

Since 1984, more women than men have died each year from heart disease,
and though overall coronary death rates have dropped in recent decades,
most of the improvements have been in men.

Lately it has been on the upswing in both men and women presumably
because of increasing rates of obesity leading to more metabolic
syndrome (MetS).

Puzzling differences have emerged between men and women with heart
disease, making it plain that past studies, mostly done on men, do not
always apply to women. Researchers have come to realize that to improve
diagnosis and treatment for women, they must sort out the differences.

"Every time we turn around, we find more gender differences, so it's
important to study," said Dr. C. Noel Bairey Merz, a cardiologist at
Cedars-Sinai Medical Center in Los Angeles.

Among the differences are these:

¶Women with chest pain and other heart symptoms are more likely than men
to have clear coronary arteries when tests are performed, a surprising
result that suggests there may be another cause for their problems.

Those who have watched Morgan Spurlock's documentary "SuperSizeMe" are
aware that visceral adiposity from rapid weight gain from overeating
can lead to such chest pains (endothelial dysfunction -- coronary
spasm -- variant angina aka atypical chest pain). Women are
encouraged to "eat for two" when they become pregnant thereby achieving
massive weight gains on the scale of "SuperSizeMe."

¶When women do have blocked coronary arteries, they tend to be older
than men with similar blockages and to have worse symptoms, including
more chest pain and disability. These women are also more likely to have
other problems like high blood pressure, high cholesterol and diabetes,
which may make surgery riskier.

This triad arises from years of metabolic syndrome (MetS).

And they are more likely than men to
develop heart failure, a weakening of the heart muscle that can be
debilitating and ultimately fatal.

¶When women have bypass surgery or balloon procedures for coronary
blockages, they are less likely than men to have successful outcomes,
and they are more likely to suffer from bad side effects.

This is presumably because their coronary arteries are significantly
smaller.

¶Blood tests that reliably pick up signs of heart damage in men do not
always work in women.

Actually, this is not true...

¶Women seem much more likely than men to develop a rare, temporary type
of heart failure in response to severe emotional stress.

..nor is this... making the source of this article rather suspect.

"We don't have good explanations for these gender differences," said Dr.
Alice K. Jacobs, a cardiologist at Boston University.

She said that one reason women have not fared as well as men after
bypass surgery and balloon procedures may be that women are smaller, and
so are their blood vessels, and the vessels may tend to clog up again
more easily after the procedures.

Thankfully, there is EECP as a viable alternative for women that
provides angina relief with a response rate of greater than 85%:

http://tinyurl.com/rbeyd

In addition, surgeons performing bypasses in women have been less likely
to use an artery from inside the chest wall, because it is smaller and
harder to work with even though using the chest artery instead of a
leg vein gives most patients better odds of long-term survival.

In the past, Dr. Jacobs said, cardiologists had only big balloons and
bulky tubing to open blocked vessels, and some of the equipment may have
been too large for women.

"Now we have tiny wires, balloons and stents, and it's less of an
issue," she said, adding that success rates in women were improving.

Women like Ms. Kachmann-Geltz have become an important focus of study.
Her doctors believe she has an insidious type of heart disease, more
common in women than men, that researchers are just beginning to
understand.

These patients have chest pain and abnormal stress tests. Their heart
muscle is starved and aching for oxygen and yet their coronary
arteries look wide open on an angiogram, the test in which doctors
inject the vessels with dye and then X-ray them to spot blockages.

Someone who looks trim can still have metabolic syndrome (MetS) because
of significant visceral adiposity leading to endothelial dysfunction in
smaller coronary vessels (cardiac syndrome X).

Some of these women also score poorly on a simple survey the Duke
Activity Status Index that gauges their strength and ability to
exercise by asking questions like whether they can walk up a flight of
stairs or run a short distance. A low score is a reliable predictor of
more heart problems to come.

For those with symptoms, the real, underlying problem may be a disorder
called microvascular disease, a narrowing or stiffening of the smaller
arteries that nourish the heart, vessels too tiny to show up on an
angiogram.

"These little arterioles are deciding where relatively low and higher
blood flow should occur," said Dr. Bairey Merz, explaining that the
smaller vessels are more muscular than large ones, and their walls
contract or relax to regulate blood flow.

In microvascular disease, the small vessels lose their ability to dilate
and increase blood flow to the heart. The cause does not seem to be
fatty deposits like the ones that can block the coronary arteries.

Rather, the muscles in the arterioles thicken, a process called
remodeling, and the walls may stiffen and begin to close in. The result
is ischemia, lack of blood flow. Over time, it increases the risk of
heart failure and heart attacks.

Three million women in the United States may have microvascular heart
disease, said Dr. Bairey Merz, chairwoman of a government-sponsored
study of the disorder, called Wise, for Women's Ischemia Syndrome
Evaluation.

That study, begun in 1996, included 936 women who had angiograms because
of symptoms like chest pain. Their average age was 58, but a quarter
were younger and premenopausal.

The angiograms found that only a third had blockages in their coronary
arteries. In men with similar symptoms, three-quarters or more would
have had severe blockages, said Dr. Carl J. Pepine, an investigator in
the study and the chief of cardiovascular medicine at the University of
Florida.

Another third of the women had no blockages but did have low blood flow
to the heart, most likely a result of microvascular disease. The
deficiency was found by a test in which doctors first measured blood
flow through the heart and then injected a drug that should have made
the arteries dilate and increased the flow. If the flow did not rise,
the patient most likely had microvascular disease.

Among those judged to have the disorder, the rate of deaths or heart
attacks was 10 percent after four years much higher than would be
expected for women with normal angiograms.

The findings call for a major shift in the treatment of women with chest
pain or other symptoms and normal angiograms, said Dr. George Sopko of
the National Heart, Lung and Blood Institute. "Instead of tossing aside
the angiogram and saying you're O.K., let's make sure we are not missing
anything."

Doctors should use the Duke survey and consider other tests that can
pick up signs of ischemia. And since recent studies have also suggested
that women who score high on measures of hostility have an increased
risk of heart problems, Dr. Sopko said: "If a woman comes in and has
symptoms, let's be careful when we evaluate her. Let's listen to her,
look at all the risk factors and include the psychosocial evaluation."

High cholesterol and high blood pressure are almost certainly among the
causes of microvascular disease, and it is essential to treat them
aggressively in women with chest pain, Dr. Pepine said, and to urge
women to exercise, avoid smoking and lose weight if they are too heavy.

Reducing visceral adiposity is the key to addressing this microvascular
disease in women.

Recent studies have found that high blood pressure particularly high
readings in the top number, the systolic pressure is a more serious
risk factor in women before menopause than after, and researchers say it
should be monitored and treated.

"You don't want to be disabled and lead a miserable life," Dr. Pepine
said. "Women who develop heart failure tolerate it much more poorly than
men, and they tolerate heart attacks and bypass surgery more poorly than
men. We don't want them to get to that stage."

The meaning of other findings is less clear, Dr. Sopko said, adding that
researchers were debating what if anything to do for women who had high
levels of a substance called C-reactive protein, a marker for
inflammation, which is thought to play a role in heart disease.

"We know it appears to be a marker for atherosclerosis," Dr. Sopko said,
"but that is far from saying we have to act on that marker with such and
such strategies. Simple, fairly appealing strategies may not work out
that well. We have to go back and get better knowledge."

Why microvascular disease might be more common in women than men is
unknown.

Actually, this is not true. There is more metabolic syndrome (MetS) in
women than in men here in the U.S.

Inflammation and anemia, both more common in women, have been
suggested as possible factors, along with hormonal fluctuations, but
none have been proved.

Some researchers think microvascular disease may help explain some of
the other gender differences why, for instance, women tend to have
worse symptoms than would be expected based on the condition of their
coronary arteries.

But microvascular disease is not easy to detect. When doctors see clean
coronary arteries on an angiogram, they may not take a patient's chest
pain seriously or recommend more tests or treatment.

"I was treated like a crazy woman," Ms. Kachmann-Geltz said, noting that
one doctor offered her tranquilizers, implying that her problems were
all in her head.

Her symptoms began during her third pregnancy, and her heart function
deteriorated so much that she nearly died during labor, she said,
recalling that a nurse in the delivery room actually asked whether she
was an organ donor.

Women generally gain too much weight during their pregnancies
especially here in the U.S.

After her son was born, she suffered from angina for almost two years
and had attacks that woke her up at night, before she found her way to
Dr. Pepine.

Tests showed a blood flow deficit in her heart.

"It was 30 seconds that changed my life," she said. "It was the first
time I felt acknowledged. This is real, it's not in my head, it's not
some pregnancy thing. I shake when I think about it."

It is impossible to say why the disease developed, but she noted that
her mother also has heart disease.

It is written what is impossible for man is possible for GOD.

In any case, Ms. Kachmann-Geltz she
began treatment with a diuretic and other medicines to control her blood
pressure and cholesterol.

"My world started coming back to me," she said. "It took about four
months. I started to regain energy, and stopped having nighttime sweats
and chest pain. I was able to start living my life again."

She would be wise to reduce her food intake to the optimal amount (one
omer per day) to become hungrier and lose the visceral adiposity.

Will be available to "glow" and chat about this and other things like
cardiology, diabetes, Bird Flu, the Lamb's opening of the 6th seal
(Rev. 6:12), cooking and nutrition that interest those following this
thread here during the next on-line chat(04/20/06) from 5 to 6 pm EST,
LORD willing:

http://tinyurl.com/8w7uq

For those who are put off by the signature, my advance apologies for
how the LORD has reshaped me:

http://tinyurl.com/7mcuo

Prayerfully in Christ's amazing love,

Andrew
http://tinyurl.com/zlaml


Mr. Chung,

since you quote scripture so well, let me remind you that " anyone who
causes another to stumble" has the greater sin.

Actually and interestingly, the **only** Gospel reference to "greater
sin" comes during Jesus' conversation with Governor Pontius Pilate after
the Governor stated that he had the power of life and death over Jesus.
"You would have no power over me if it were not given to you from
above. Therefore the one who handed me over to you is guilty of greater
sin." -- LORD Jesus Christ (John 19:11)

This is a reference to Judas' betrayal of Christ which is indeed a
greater sin because it would not be pardoned by Jesus' death on the
cross. Simply look around at how those with satan's mark on their
foreheads have chosen to raise Judas up as their standard.

And, so you stumble James, not because of me but because of your choice
to be a stumbling block for someone who has chosen to bring praise and
glory to GOD.

"We all stumble in many ways. If anyone is never at fault in what he
says, he is a perfect man, able to keep his whole body in check."
(James 3:2)

So your constant presence
only serves your self and not the one that sent you.

In truth, the LORD continues to guide me in everything I say, do, and
write.

I would ask that you
seek forgiveness and remove yourself from where you are not welcome, for you
only serve to case others to sin.

Without the LORD, your requests and opinions are meaningless
(Ecclesiastes).

You know who I am

Actually I do not know who you are. Moreover, I believe if you asked
LORD Jesus Christ, Whom I love with all my being, HE would also say HE
does not know who you are.

and the one who sent me.

Nor do I know the one who sent you other that what my LORD has said
about him.

You will be in my prayers, dear James whom I love in Jesus' most exalted
and holy name.

Will be available to "glow" and chat about this and other things like
cardiology, diabetes, Bird Flu, the Lamb's opening of the 6th seal (Rev.
6:12), cooking and nutrition that interest those following this thread
here during the next on-line chat(04/20/06) from 5 to 6 pm EST, LORD
willing:

http://tinyurl.com/8w7uq

For those who are put off by the signature, my advance apologies for how
the LORD has reshaped me:

http://tinyurl.com/7mcuo

Prayerfully in Christ's amazing love,

Andrew
http://tinyurl.com/zlaml

Don Kirkman wrote:

It seems to me I heard somewhere that Andrew B. Chung, MD/PhD wrote in
article :

James DeMoss wrote:
"Andrew B. Chung, MD/PhD" wrote in message
oups.com...
William Wagner wrote:
http://www.nytimes.com/2006/04/18/he...hear.html?8dpc

[. . .]

Mr. Chung,

since you quote scripture so well, let me remind you that " anyone who
causes another to stumble" has the greater sin.

Actually and interestingly, the **only** Gospel reference to "greater
sin" comes during Jesus' conversation with Governor Pontius Pilate after
the Governor stated that he had the power of life and death over Jesus.
"You would have no power over me if it were not given to you from
above. Therefore the one who handed me over to you is guilty of greater
sin." -- LORD Jesus Christ (John 19:11)

It's too bad you didn't take my suggestion years ago and really
**study** the Bible in its own context.

Actually, it remains my choice to study the Holy Bible in its entirety
in the context of my own life.

If you had, you wouldn't
continue to pervert what is clearly written.

Without the LORD, your opinion remains meaningless (Ecclesiastes).

Matthew 27, Mark 15, Luke 22 & 23, and John 18 all agree that the High
Priest Caiaphas was the official who sent Jesus to the governor, Pontius
Pilate.

Just as Governor Pilate had the GOD-given authority to order
crucifixions, Priest Caiaphas had the GOD-given authority to turn people
over to Governor Pilate for consideration of possible execution.

Judas Iscariot had no such GOD-given authority to betray Christ Jesus.
His betrayal of LORD Jesus Christ arose from the free will that GOD had
generously given him and revealed that instead of choosing to worship
GOD, that he had chosen to worship money.

Judas betrayed Jesus to the priests and scholars, but did not hand him
over to them as Caiphas handed him over to Pilate.

In the same way that a wife who hires someone to kill her husband is
guilty of a greater crime (1st degree murder and the contempt of her
peers) than the assassin she hired, the disciple that betrays his
Teacher has committed a greater sin than the authorities collectively
involved in crucifying HIM.

Truth is simple.

Still praying for you, dear Don whom I love in Jesus' most awesome and
holy name.

Will be available to "glow" and chat about this and other things like
cardiology, diabetes, Bird Flu, the Lamb's opening of the 6th seal (Rev.
6:12), cooking and nutrition that interest those following this thread
here during the next on-line chat(04/20/06) from 5 to 6 pm EST, LORD
willing:

http://tinyurl.com/8w7uq

For those who are put off by the signature, my advance apologies for how
the LORD has reshaped me:

http://tinyurl.com/7mcuo

Prayerfully in Christ's love,

Andrew
http://tinyurl.com/zlaml