E is for Exercise (women take note)

Standard medical practices for the prevention, detection and treatment of heart disease do not always yield the same results for women as for men.

Research by epidemiologists who have studied health outcomes for representative samples of women or men over many years indicates that on average, women are older when diagnosed with heart disease.

The severity of disease also is greater. Why? Women may have to exhibit more severe symptoms to receive a proper diagnosis of their life-threatening condition. They tend to have a greater number of other health problems at the time of diagnosis as well.

Moreover, there may be biological differences between men and women in the relative amounts of the molecules that interact to help clog arteries. Because, on average, women are smaller than men, their hearts and blood vessels are usually smaller.

Anatomical or physiological differences such as these might contribute to differences in treatment outcomes. For instance, women, especially women under 50 years old, are three times as likely to die in the immediate aftermath of bypass surgery as men.

UCSF cardiologist Rita Redberg investigates factors that may contribute to, or help prevent, heart disease in women. Among the factors associated with lower heart disease incidence and greater overall survival in both men and women is fitness. In a study of 250 women that has been under way for eight years, Redberg is investigating how fitness, as measured by the ability to exercise on a treadmill, might be associated with other known or suspected risk factors for heart disease.

Despite the aforementioned differences between men and women, most studies of drugs for heart disease have been conducted on men, meaning that their effects on women may be less well understood.

But Redberg is specifically interested in exploring the potential value of interventions, especially exercise, to fend off heart disease in women. She serves as the director of the Scientific Advisory Group for "Choose to Move," a 12-week educational program developed by the American Heart Association. More than 40,000 women nationwide have enrolled in the program since its inception in 1998.

The goal of the program, which is based on principles of social psychology, is to get women to increase their levels of physical activity and to make healthy diet choices — but only when they have reached the correct stage of readiness. In a 2001 study, Redberg and her colleagues found that three months after completing Choose to Move, 67 percent of the women who returned surveys reported exercising for at least 2.5 hours, or five times a week, in comparison to 32 percent of the respondents before enrollment.

In addition, many more women made healthier diet choices, with a better understanding of heart disease.

"I think physical activity is a very underutilized and overlooked intervention to promote health and reduce heart disease," Redberg says. "Exercise is the fountain of youth."

by Jeffrey Norris