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More Women Die From Heart Disease Than Cancer

“Cardiovascular disease is responsible for half of all deaths among women aged 50 and older in Canada and the United States,” says an article in the Canadian Medical Association Journal (CMAJ March 13, 2007). Heart attacks and strokes account for more deaths in women than all cancers combined.

We know heart disease is a number one killer in men and women. We also know sudden cardiac arrest is the leading cause of death in Canada, claiming about 40,000 people each year. About 95 per cent of them die before reaching the hospital. Can you imagine two-thirds of Medicine Hat’s population dying each year from heart attack? Scary, eh! So, if you are going to have a heart attack then you better be in the hospital or pretty close to it. The other options – stay healthy.

Most women worry about cancer of the breast, ovary, uterus and cervix. It is natural to worry about these cancers but it is also important to take care of your heart health. Scientists bear some of the blame for ignoring women’s heart health issues in the past. Most research studies previously were restricted to men. But in the last few years there has been significant interest in women’s heart health issues.

So, ladies, heart month of February is not over yet. Start a plan for yourself and your family. Make a list of things you can do to prevent heart disease.

Let us start with obesity. We are a nation of too many obese people. Central obesity is a more important risk factor for heart disease than body mass index in both sexes. So losing body fat is important. There are two things to do to lose excess fat: exercise and eat less. This isn’t rocket science but you need the discipline and determination of an astronaut.

It has been found that diabetes increases the risk of cardiovascular disease among women to a greater extent than it does among men. If you are a diabetic then make sure it is under control. Discuss with your doctor if you need to take any medications to prevent heart disease.

Differences in cardiovascular presentation – one recent study suggests that men report more severe chest pain and sweating and that women report less severe pain and more nausea. Does that mean man get more attention than women? Quite likely. Women with atypical symptoms and no severe chest pain are more likely to remain undiagnosed. Women have more silent heart attacks than men. Physicians should remember this and pay more attention to women’s chest symptoms.

It has also been shown that women with acute heart attack are less likely than men to receive thrombolysis (clot busting immediate therapy) or revascularization (bypass surgery).

Women’s heart health is getting more attention now. Hopefully, this will reflect in the future studies in a positive way. So, ladies, do your part and stay healthy that means your family will be healthy as well.

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Good News About Cancer in Canada

Almost every household has had a brush with cancer. That means nobody is immune to it. Diagnosis of cancer brings with it tremendous psychological and physical burden to the patient and patient’s loved ones. Therefore, it is important for each one of us to learn something about the common cancers and how to prevent them.

Good news about cancer is that half of all new cancer cases and cancer deaths worldwide are preventable. The second good news is the 5-year relative survival ratio was 62 per cent for all cancers combined from 2001 to 2003. Some years ago it used to be around 50 per cent.

Each year, Canadian Cancer Statistics review the changing size and nature of the cancer burden in Canada. An article in the Canadian Medical Association Journal (CMAJ • November 18, 2008) reviews the major findings from the 2008 edition of Canadian Cancer Statistics.

The article says, “In Canada, cancer will develop in 45 per cent of men and 39 per cent of women during their lifetime, and about one in four Canadians will die of the disease.” There is a higher incidence of cancer among women aged 20-59 years. The mortality rates among women in their 30s and 40s are higher than among men of a comparable age.

Breast cancer is the most prevalent cancer among Canadian women, about one per cent of women. Among men, prostate cancer is the most prevalent cancer, about 0.8 per cent of men.

Thyroid cancer had the highest estimated 5-year relative survival ratio, and pancreatic cancer had the lowest. In general, the incidence rate has been stable for all cancers combined since 1979. In contrast, the mortality rate is decreasing for all cancers combined and for most specific types of cancer. That means we are making slow progress. But we can do more to decrease the incidence of cancer and increase survival if we take more care of our health, take preventative measures and participate in screening protocols.

Breast cancer

The incidence of breast cancer has fluctuated in the last 20 to 30 years due to screening mammography picking up cancer not previously detected. Now the incidence is stabilized to pre-screening years. Good news for women is that in the last 23 years the mortality rate for breast cancer has fallen by more than 25 per cent. Thanks to screening mammography and use of chemotherapy after surgery. Isn’t that wonderful?

Prostate cancer

The incidence rate of prostate cancer continues to increase moderately. Since the mid-1990s, mortality rates have declined by 2.9 per cent per year, likely because of a combination of earlier detection and improved treatment.

Colorectal cancer

The incidence rate of colorectal cancer, particularly among women, has recently begun to decline. The mortality rate has been falling among both men and women over the past two decades, likely as a result of improvements in chemotherapy.

The article says that screening for colorectal cancer can reduce both the incidence and mortality. Limited screening activity has already been occurring in some provinces, which may account for some of the decline in mortality.

Lung cancer

Among men, the incidence and mortality rates began to decline in the mid-1980s. Among women, incidence and mortality rates have been increasing since at least 1979, and continue to do so (each by 1.2 per cent per year). Overall, the incidence continues to be higher among men than among women. The mortality is also higher among men than among women.

The review shows the 5-year relative survival for cancer has been improving over time. Two of the most common types of cancer, lung and colorectal cancer, the survival rates are poor to fair. Most lung cancers are preventable if you do not smoke. For colorectal cancer, implementation of screening programs in many provinces is expected to improve survival.

Start reading the preview of my book A Doctor's Journey for free on Amazon. Available on Kindle for $2.99!

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What Is New In Preventing Heart Disease?

So, here we are, into February. An important month after you have recovered from Christmas and New Year celebrations. Valentine’s Day, Family Day and heart month fall into February. And as a bonus, this year the Valentine’s Day falls on the same long weekend as the Family Day. It should be a good weekend for the whole family to bond and have fun and have lots of chocolates……yum!

Ok, let us get back to our heart. If you do not have a good heart or a strong heart then you cannot have much fun. That is why for me each month is a heart month. The reason for that is quite simple – heart disease and stroke is the number one killer.

So, today I will devote this space to see if there is anything new to report about preventing heart disease. I will summarize the American Heart Association’s Scientific Sessions Report (November 8-12, 2008, New Orleans, Louisiana) published by the Canadian Medical Association.

How do you assess cardiac risk factors in individuals whose risk is not readily apparent? Do we have a scoring system, biomarkers of cardiovascular risk or genetic testing which would determine their life-time risk of cardiac disease?

No, we don’t. Lot of research is going on but clinically useful data is yet to come. But management is clear in patients who are obviously at high or low risk. These patients are identified by their age, body mass index, cholesterol levels, smoking and family history.

Is there any justification for the use of Statins to prevent heart disease in people with average or low levels of cholesterol to prevent heart disease?

In a study called JUPITER (Justification for the Use of Statins in Prevention: an Intervention Trial Evaluating Rosuvastatin), patients with normal cholesterol levels were tested for high-density C-reactive protein (hsCRP). They found the rates for a first major cardiovascular event and death from any cause were significantly reduced among those who received rosuvastatin compared with those who received placebo. The clinical implications and cost effectiveness needs further investigations before this can be recommended to the general public.

Other important presentations at the conference were:

-After a heart attack, early intervention within 24-hours (angiography, angioplasty, coronary artery bypass) is just as safe and effective as delaying treatment more than 36-hours for low-risk unstable angina patients and those without ST-elevation heart attack. They also found there was a trend toward better outcomes among those receiving early treatment. So, if possible, it would be nice to get on the table for an angiogram within 24-hours of a heart attack.
-Regular intake of vitamin C and E failed to protect against major cardiovascular events. These vitamins are among the most widely used by the general population. So spend your money carefully.
-A large trial involving heart attack survivors has confirmed the safety of folic acid and vitamin B12, but failed to show that they have a protective effect against heart disease or stroke.

Well, February is a good month to get back into regular exercise, laughter, meditation, organic/healthy food, stress relief and to stop smoking. That sounds like my favourite pet ELMOSS. And February is a good month to consume my favourite dark chocolates….yum.

Start reading the preview of my book A Doctor's Journey for free on Amazon. Available on Kindle for $2.99!

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No Science Behind Colon Cleansing and Detox Diets

Colonoscopy cartoon. (Hemera/Thinkstock)
Colonoscopy cartoon. (Hemera/Thinkstock)

Much has been written about colon cleansing and detox diets as a way of “detoxifying” your body. On Friday, January 30, Medicine Hat News published a letter to the editor (Take ‘proactive/preventive’ wellness approach) which says the following:

“Articles in American Medicine and others state colonic irrigation is the most effective measure to relieve chronic constipation, nervous diseases, especially neurasthenia, chronic bone diseases of joints, diseased blood and forms of chronic nephritis. Systematic colon treatments and dietary changes are definitely effective in the control of high blood pressure as well. Other journals including the Ohio State Medical Journal, New England Journal of Medicine also corroborate cures of many other diseases with the use of colonic irrigation.”

Now, that is a very strong statement. But the letter writers do not provide any specific references so people like me can look them up and learn something new. I would certainly like to prescribe these treatments to my patients if somebody can show me scientific evidence that colon irrigation and detox diets do help and cause no harm.

I googled American Medicine and was unable to find a journal of that name. I was unable to find any scientific articles on the therapeutic effects of colon irrigation and detox diets in two other journals mentioned in the letter.

In my desire to find something positive about colon cleansing and detox diets, I went to three reliable sources on the Internet: the Mayo Clinic website (www.mayoclinic.com), the Harvard Medical School website (www.health.harvard.edu), and WebMD (www.webmd.com).

The Mayo Clinic gastroenterologist, Michael Picco, M.D., says, “Although doctors may recommend colon cleansing in preparation for a medical examination of the colon, most don’t recommend colon cleansing for better health or to prevent disease.”

He says it is unnecessary and it may be harmful because your colon absorbs water and sodium to maintain your body’s fluid and electrolyte balance. Some colon-cleansing programs disrupt this balance, causing dehydration and salt depletion. Long-term or excessive cleansing programs can lead to problems such as anemia, malnutrition and heart failure.

He further says that if constipation is your concern, you can help prevent constipation without colon cleansing. Drink plenty of water and eat a diet rich in fiber.

On detox diets, Dr. Picco says, “There is no evidence, however, that detox diets actually remove toxins from the body. Most ingested toxins are efficiently and effectively removed by the kidneys and liver and excreted in urine and stool.”

The doctor on the Harvard University website says, “The human body can defend itself very well against most environmental insults and the effects of occasional indulgence. If you’re generally healthy, concentrate on giving your body what it needs to maintain its robust self-cleaning system – a healthful diet, adequate fluid intake, regular exercise, sufficient sleep, and all recommended medical check-ups. If you experience fatigue, pallor, unexplained weight gain or loss, changes in bowel function, or breathing difficulties that persist for days or weeks, visit your doctor instead of a detox spa.”

WebMD website reflects what has been already said. I need to see something very scientific about the benefits of colon cleansing and detox diets before I will tell my patients that these “treatments” are safe.

Start reading the preview of my book A Doctor's Journey for free on Amazon. Available on Kindle for $2.99!