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Keys to a Woman’s Heart
A new program at Johns Hopkins Bayview provides multifaceted care for women with cardiovascular disease.

blank Pamela Ouyang and Nisha Chandra-StrobosPamela Ouyang and Nisha Chandra-Strobos believe that heart disease in women is still under-recognized.

Sharon Harvison had her first brush with death in 1995. Then 42, she’d taken off a few days from work to catch up on household chores. As she scrubbed her kitchen floor, she felt a wave of indigestion. Or so she thought. She took an antacid, rested and went to visit a friend. En route home, recalls the medical office coordinator for Johns Hopkins Bayview’s Burn Center, “It suddenly felt like someone had my chest in a vise grip.” A doctor at the nearest emergency department told her she’d had a heart attack. Harvison was admitted to the intensive care unit, where she remained for five days.

No one was more surprised than Harvison. First, she thought, most women don’t suffer heart attacks—certainly not in their 40s. Second, though Harvison was a smoker and had elevated cholesterol, she wasn’t overweight and had no family history of heart disease. Looking back, however, she thinks stress likely played a role. At the time she was a bank project manager in charge of an entire department and was a single mother of three. “And I rarely went to a doctor,” she says.

So typical is Harvison’s experience, says Nisha Chandra-Strobos, chief of cardiology at Bayview, that she and her colleague Pamela Ouyang felt compelled last year to launch a women’s heart program within their clinic.

“Many women,” says Chandra-Strobos, “find it very hard to be evaluated when they have to juggle house, family and career. We want to address the total cardiovascular wellness needs of women.” To that end, the fledgling program, located in Bayview’s A building, is a “one-stop shop.” After a comprehensive evaluation, patients consult with a nutritionist, cardiologist and psychologist.

The need is critical, says Chandra-Strobos, because heart disease is the leading cause of death in women, a fact that is still little known. And, because heart disease has a different trajectory in women versus in men, symptoms are under-recognized. Though men typically present with heart problems about a decade earlier in life than women, Ouyang and Chandra-Strobos are seeing more women with heart problems in their 40s. Some of their patients are even in their 20s. Most have a common denominator: strong family history, smoking, diabetes and obesity.

“We want women to understand that they’re at risk,” says Ouyang, “not only because of classic factors like these, but also if they have rheumatoid arthritis, renal disease or vascular disease.” Adds Chandra-Strobos, “We’re looking at women’s health from all aspects—young and old, pregnant women and perimenopausal women.”

While Chandra-Strobos’ research explores how women with heart disease are receiving care, Ouyang’s studies focus on how hormone therapy affects the heart and blood vessels, a subject that gynecologists have only recently begun to recognize. “Lots of changes occur in women as they enter menopause,” she says. “Blood pressure starts to rise and the lipids become less optimal.” But the nuances of heart disease can escape a gynecologist’s notice, she says, which is worrisome because women are more likely to visit their gynecologist than their primary care physician.

Hopkins trained, both Ouyang and Chandra-Strobos have more than 25 years of experience in cardiology. They’ve held various posts at the American Heart Association, co-authored the organization’s position paper, “Women’s Guidelines for Cardiovascular Health,” and have published extensively on the topic.

Efforts like the AHA’s Go Red for Women Day, which falls this year on Feb. 6, help raise awareness about women and cardiovascular disease, but they’re not enough, says Chandra-Strobos. Indeed, even after suffering a heart attack, Harvison ignored her symptoms in 2007. “Again, I just thought I had bad indigestion.” She took a break, until a sharp pain in her arm reminded her that something more serious was occurring. Harvison, who has been Ouyang’s patient since 2003, learned that she had angina and needed cardiac catheterization. “Women like me have been trained to downplay our pain,” she says. “That’s why I’m thrilled about this program.”

Plans for a designated women’s heart center are under way. Meanwhile, Chandra-Strobos and Ouyang say they will champion their cause one woman at a time. “We’ve woken up to the fact that we have to do it better,” says Chandra-Strobos. “It’s not just because we’re women, but because we see that women and even many doctors just don’t get it. We see the higher mortality. None of it’s intentional. It’s just simply that people don’t know. A program like this will educate and empower women to seek the kind of care each of them deserves.”

–Judy F. Minkove



Johns Hopkins Medicine

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