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Heart Disease Leading killer of women over 55 By Celena E. Kusch
Dr. Michael R. Weitekamp, associate professor of medicine and vice president and regional director of the Penn State Geisinger Health Plan, presented research on “Gender Issues in the Management of Dyslipidemias.” Dr. Marianne J. Legato praised efforts like the Rural Women’s Health Initiative conference that pursue women’s health as a collective goal. “Women’s health is in danger of a backlash. We can already see a noticeable skepticism among physicians, but those of you gathered here have made a real commitment to this kind of gender-specific inquiry. All the interest in coronary disease among women forms a valuable paradigm for research that looks at gender as a determining factor for how the normal body and diseased body work. We are working to challenge male models of what is normal human function and the pathology of disease. This line of research is important for women, as well as for men.” Dr. John Milner, head of the Department of Nutrition at Penn State, discussed “Foods as Promoters of a Healthy Heart.” The role of diet in maintaining good health was a recurring theme of the Rural Women’s Health Initiative conference. In her presentation “Here’s to Your Health—The Role of Fat and Alcohol,” Dr. Penny Kris-Etherton, Distinguished Professor of Nutrition at Penn State, addressed the impact of new research on both benefits and dangers of different sources of fat and alcohol. Dr. Ralph Damiano, chief of cardiothoracic surgery for the Penn State Geisinger Health Care System and The Milton S. Hershey Medical Center, presented new research about minimally invasive cardiac surgery during the Rural Women’s Health Initiative conference. After the conference, he demonstrated the revolutionary use of robotic arms in the operating room on CBS This Morning. These robotic arms are designed to hold long surgical instruments perfectly still as they enter the chest cavity through small incisions in the patient’s side. Procedures like these cut down on surgical risks and recovery time associated with open heart surgery.	Health is in the headlines. Highly publicized medical studies offer contradictory advice and caution about everything from dietary supplements to exercise, hormone replacements to red wine, olive oil to prescription medicines, literally from soup to nuts. For the more than 80 percent of American women who rely on the media for their medical information, this confusion can have a serious impact on their health. Among health professionals still in the initial stages of understanding the importance of gender difference in medicine, these studies are a constant source of dialogue and debate. The Penn State Rural Women’s Health Initiative is the University’s latest project to improve the quality of life for women of all ages by enhancing the knowledge and skills of the professionals who provide their health care. The initiative is a collaborative effort to integrate Penn State teaching, research and service to address a need for greater care and prevention among Pennsylvania’s rural populations. The 1998 conference on Cardiovascular Disease: Prevention and Disease Management for Women is the first in a series planned to improve women’s health. With speakers of national and international repute, the conference combined the research of cardiovascular specialists from leading universities nationwide. “Cardiovascular disease, which includes coronary heart disease, hypertension and stroke, is the primary cause of death in America, claiming 955,000 lives at a cost to society of $259 billion,” according to conference co-chair Dr. Luanne Thorndyke, assistant professor of clinical medicine and assistant dean of continuing medical education at the Penn State College of Medicine at The Milton S. Hershey Medical Center. “We are just now beginning to recognize it as an equal opportunity killer of both men and women. In reality, it is the leading killer of women over 55. One in two women will experience it, and 45 percent of women will die from heart disease.” The Rural Women’s Health Initiative, the School of Nursing, the College of Health and Human Development, the College of Agricultural Sciences, the Penn State College of Medicine and the Penn State Geisinger Health Care System co-sponsored the conference which was jointly delivered by Continuing Education and Cooperative Extension. This partnership demonstrates a University-wide commitment to bringing together leaders in medicine, health care and consumer education. “The Rural Women’s Health Initiative conference is an excellent example of collaboration among the academic colleges and the outreach delivery units to share important research and scholarship with the people who need it,” Dr. Patricia A. Book, associate vice president for outreach and executive director, Division of Continuing Education, said. “Penn State’s outreach programs are dedicated to addressing the needs of our society, and we have long seen the necessity for an interdisciplinary approach in meeting these needs. By assembling physicians and researchers from many fields of expertise, this conference enabled a productive dialog and critical information sharing among all its participants.” The conference drew more than 80 health care professionals from within the Commonwealth and beyond, including physicians, nurses and nurse practitioners, health educators, nutritionists and Penn State School of Nursing students taking the conference for credit. “The College of Health and Human Development is committed to helping women in rural Pennsylvania work closely with their health care providers to address the health concerns they face today,” said conference co-chair Dr. Sara Parks, associate dean for outreach and Cooperative Extension and international programs for the College of Health and Human Development. “We want to encourage professionals and consumers to make certain that women are given better health information. This conference has been a good first step in meeting this challenge.” “In gathering together health professionals from rural counties, the University hopes to break down the barriers of isolation and provide a network to improve health for women,” Robin Bagby, program coordinator in the College of Health and Human Development, said. Conference participant Dr. Jeanne Spencer, assistant program director for the Conemaugh Health System, found the conference beneficial. She said, “Our area hasn’t had a conference like this before, so it has been nice to have access to new ideas. In this conference, I also served on a panel about rural women’s health initiatives across Pennsylvania. The panel offered some good networking opportunities, as well as creative solutions.” Conference speakers discussed the latest research from nutrition, surgery, clinical medicine and biobehavioral health and its applications for both male and female patients at risk for or diagnosed with cardiovascular disease. Keynote speaker Dr. Marianne J. Legato, professor of clinical medicine and founder and director of the Partnership for Women’s Health at Columbia University College of Physicians and Surgeons, stressed the particular challenge of cardiovascular disease for women. “Every aspect of this disease is different in women than in men, but much of the foundational research used only male subjects,” Legato said. “While the death rate for men has been decreasing since 1960, women have not seen as much progress. These differences can be attributed to underdiagnosis, less aggressive interventions and treatments and fewer referrals to cardio-rehabilitation centers. Furthermore, we are not doing well at understanding the risk factors, particularly as those factors differ based on gender.” Throughout the conference, speakers addressed issues of risk factors, diagnosis and treatments, emphasizing their specific ramifications for women. Gender-specific challenges include growing rates of smoking in women, insufficient gender-based testing of hypertension treatments, gender differences in stress factors and their treatments, higher incidence of diabetes in women, lower sensitivity and accuracy rates for women using standard diagnostic tools and increased complications with or patient resistance to treatments as a result of side effects like weight gain. The breadth of this discussion demonstrated a spirit of innovation and interdisciplinary problem solving among conference participants. Dr. John Milner, professor and head of the Department of Nutrition at Penn State, cautioned against dismissing potentially beneficial, nonpharmaceutical treatments from other fields, like the benefits found in certain foods. At the same time, he called for new clinical studies and demonstrated possible avenues for new research. “Especially in areas like functional foods, where medical science is just now embracing the health benefits of certain foods, we need to commit to new research, looking for the impact on the delivery of health benefits due to subtle differences in food processing and preparation, the timing of food consumption and the role of individual factors like weight and gender,” Milner explained. Dr. Michael R. Weitekamp, associate professor of medicine and vice president and regional director of the Penn State Geisinger Health Plan, called further attention to the newest, gender-specific clinical trials under way. The most important of these is the National Institutes of Health Women’s Health Initiative, a randomized study of 27,000 women aged 50 to 79 followed for 10 years. One phase of this study will test the effects of hormone replacement therapy in curbing heart disease. Both Weitekamp and Legato are looking forward to hearing the results as early as two years from now and predict these results will bring about significant strides in improving women’s health. Weitekamp and Milner, along with many of the other speakers, agreed that health professionals working with women at risk for heart disease ought to focus on prevention using measures like diet and exercise. “We are most effective with early primary prevention in otherwise healthy people,” Weitekamp said. “By reducing the risk in everyone, we reduce the incidence of cardiovascular disease. This means treating a significantly higher number of people than if we waited for the onset of disease. To do this, we really ought to be addressing the issue of diet more effectively, in addition to the pharmacological treatments. Medicines clearly work only when taken together with a low-fat diet and exercise, and I think physicians have to emphasize that.” Solutions like these made the conference a great success, according to Dr. Diane V. Brown, associate director of Penn State Cooperative Extension in the College of Agricultural Sciences. “Our extension educators indicated it was one of the very best conferences they have ever attended and will find the information extremely valuable in future programming around the state.” The Rural Women’s Health Initiative conference series continued in June with a program addressing the issues of osteoporosis. An outreach program of the colleges of Medicine, Health and Human Development and Agricultural Sciences and the Penn State Geisinger Health Care System