What is the number one killer of women in the United States? The answer may not be what you think it is. Despite the focus on cancer prevention and treatment in the media, cancer is not the number one killer. Rather, heart disease and stroke are responsible for more deaths among women than all forms of cancer combined. So why haven’t we heard about it?
A lack of physician and patient awareness is one major factor that has contributed to the problem. While heart attack symptoms are widely recognized in men, the symptoms are much more subtle in women. These symptoms are often mistaken for other conditions like indigestion and doctors may be reluctant to point out the risk for some women. In addition, they may be hesitant to proactively treat the issue and provide helpful recommendations about prevention. While much research has been done on men’s heart health, knowledge and prevention strategies in the field of women’s cardiovascular health is sorely lagging behind.
Incidence of heart disease death rates across the U.S.
While most people realize that both genders suffer from heart attacks and strokes, they often don’t realize that these cardiovascular problems affect men and women differently. A crushing pain in the chest that radiates down one arm is a classic heart attack symptom in men. However, women suffering from a heart attack may not experience this symptom. Rather, a heart attack manifests itself in these easily missed signs: fatigue, sweating, shortness of breath, nausea, stomach pain, and pain in the arms, neck, back, or jaw. Some women may feel pain or discomfort anywhere in their chest that can be described as a “squeezing or fullness”.
Women often miss these vague symptoms but even if they recognize them, they may be hesitant to report them; a recent heart association national survey reported that even if women believe they are having a heart attack, 36 percent do not call 911. This startling statistic raises concern about what steps we are currently taking to combat a deadly disease, long thought of as solely a men’s health problem. In a time of rising rates of obesity and hypertension, cardiovascular health demands more attention and a careful consideration of the multitude of factors that are putting American women at risk.
Contributing factors to cardiovascular disease can be categorized as genetic, environmental, and lifestyle. While genetic and environmental factors can significantly influence an individual’s heart health, lifestyle factors such as diet, exercise, and smoking have been linked very closely to heart attack and stroke risk. A diet rich in saturated fat and poor exercise habits can lead to abnormal cholesterol and triglyceride levels, resulting in high blood pressure. Hypertension has consistently been shown to be the number one risk factor for stroke. Poor exercise habits may also lead to obesity and a predisposition to Type 2 diabetes. An individual with Type 2 diabetes is twice as likely to develop cardiovascular disease as an individual without the condition.
Not surprisingly, tobacco and marijuana use significantly increases the risk of cardiovascular disease as well. Research has revealed that women on birth control pills who regularly use tobacco are especially at risk of cardiac problems. Stress is another lifestyle factor that many women and even physicians may overlook when considering heart disease. Stress can stem from a whole host of sources, including marital and work problems, loss of a loved one, social isolation, and depression.
Fortunately, the factors listed above fall under the category of “modifiable” risk factors. Unlike the risks tied to family history, ethnicity, and age that cannot be modified, lifestyles can be changed. Major lifestyle changes can offer huge benefits, foremost among them being a significantly lower risk of cardiovascular trouble in the future. In order to combat the prevalence of cardiovascular disease in the United States, physicians and other organizations must promote healthy lifestyle options from the start, thereby preventing problems in the future.
When considering prevention strategies, diet and exercise are the first place we should start. These two lifestyle factors play a major role in not only cardiovascular health, but also in mental and overall health. A recent New York Times article titled “One Twin Exercises, the Other Doesn’t” discussed a study that offers insight into the effects of exercise. In a study involving ten identical male twins, researchers uncovered a variety of significant differences between the active and sedentary twins. The active twins possessed lower BMIs, lower body fat percentages, more grey matter in the brain, and no signs of insulin resistance or metabolic problems. Clearly, aerobic exercise contributes to a healthy heart and an overall healthy body.
Diet may exert an even more profound influence on cardiovascular health. Eating a diet rich in fruits and vegetables, which contain important antioxidants, can make a substantial impact on heart health by keeping LDL (or “bad”) cholesterol levels low and preventing the onset of Type 2 diabetes. Along with diet and exercise, sleep and taking the time to relax play an important role in heart health. Getting the recommended amount of sleep as well as having a positive outlook on life significantly lowers heart attack and stroke risk.
Heart healthy foods; diet is an essential component of cardiovascular risk.
Like infectious disease, cardiovascular disease can be characterized as being silent and deadly, impacting those who least suspect that they are at risk. However, the two classes differ in this important fact: cardiovascular disease largely depends upon lifestyle choices. This is good news for the current problem in the United States. However, physicians and other organizations like the American Heart Association must take action to stave off the future cardiovascular crisis. Starting in medical school, future physicians must learn more about how to recognize heart attacks in women and how to better prevent them from even occurring. Current physicians must strive to take these risks seriously and convey the message to their female patients. Diet, exercise, and abstention from smoking should be emphasized especially. Other organizations like the AHA can bring the issue to national attention by promoting heart health awareness, through programs designed to educate and inform American women on cardiovascular wellness. By redefining cardiovascular issues as a problem that affects both genders, we can lower the incidence of heart attacks and strokes among women.
For my last Passion blog post, I have picked one of my favorite novels to discuss: Jane Eyre. You may recognize the name as the title of a recent (and might I say disastrous) movie that was released in the United States in 2011. While I certainly do not condone watching the film, I highly recommend the novel. In one of her finest works of classic English literature, Charlotte Bronte recounts the story of brazenly independent Jane Eyre while simultaneously critiquing the oppressive nature of 19th century Victorian England.
To better appreciate the context in which the novel was conceived, we can first learn more about the author. The early life and development of Charlotte Bronte, the author of Jane Eyre, is a story so interesting that it has inspired novels of its own. Born in 1816, Charlotte became the eldest of four sisters (two of whom would not survive childhood) and a brother. As was fairly typical at the time, the sisters received a smattering of schooling from various sources before gaining employment as teachers and governesses. The three sisters collectively published a poetry volume in 1846; they had all began writing stories at an early age. Under pseudonyms (Charlotte’s was Currer Bell), the sisters would go on to publish a multitude of novels.
A watercolor portrait of the Bronte sisters, a trio of classic English literature authors.
While many of the sisters’ novels would earn notoriety as classic works, Charlotte’s Jane Eyre was successful from the start. The novel can be classified as a Bildungsroman, a novel that focuses on the experiences and emotional growth that mark the main character’s transition from childhood into adulthood. Specifically, the novel depicts conflicts between the protagonist, Jane Eyre, and societal values and beliefs. Born an orphan, Jane endures a childhood that is far from happy. From an abusive aunt to a harsh school where she loses her sole friend to typhus, Jane confronts the injustices that are inseparable from her lowly position in society. She later accepts a governess position at Thornfield manor, where she falls in love with owner Mr. Rochester.
As Jane finds out, Mr. Rochester has some sizable ghosts in his closet. However, their social positions make their union even more unlikely. As a scorned and pitiable governess, making advances toward an aristocrat like Mr. Rochester was viewed as completely inappropriate. Not only did she face strict social class standards, but she also struggled to attain equality in the eyes of the novel’s male figures—even her beloved Mr. Rochester. While Jane was his intellectual equal, she could not match his social position and therefore, could not always express her thoughts and feelings.
A famous quote from Charlotte Bronte’s most successful novel, Jane Eyre.
Through Jane’s character, Bronte addresses the injustice inherent in Victorian England’s social class customs and gender standings. She uses the relationship between Jane and Mr. Rochester to highlight the divide that could easily be bridged were it not for strict social order. Bronte’s original creation of Jane, a strong-willed and highly intellectual feminine character, makes her novel an enduring classic. Although the novel was largely popular at the time of its publishing, early critics argued that the novel painted an unrealistic and even shocking portrait by giving a female protagonist and governess such a strong voice—an intellectual and social independence that ran contrary to common views of what was proper behavior for a woman at that time. In addition to being a classic work, Jane Eyre serves as a poignant reminder of the progress that has been made in a fight for gender equality that has spanned centuries.
The CDC estimates that “superbugs” cause 23,000 deaths every year in the United States. While these antibiotic resistant bacteria have been on the scientific community’s radar for years, the recent outbreak in California has brought the issue back into the national limelight. Recently, the Ronald Reagan UCLA Medical Center in Los Angeles announced that more than one hundred patients had been exposed to a superbug between October of 2014 and this January. But just what are superbugs?
The term superbug refers to a class of bacteria or other microorganisms that have developed resistance to the antibiotics typically used to treat them. Microbes develop this resistance after extended exposure to an antibiotic: a situation that occurs all the time in hospitals or other places that offer medical care. Once the superbug makes its way into the bloodstream, it causes new infections while it also transfers its unique antibiotic resistance to other germs via common cellular mechanisms like transformation.
A diagram explaining the antibiotic resistance process.
Hospitals like the UCLA Medical Center offer prime locations for the bacteria to cause infections, as superbugs involved in the most recent outbreak often require close contact with a wound, a vulnerable part of the body. The recent California superbug is called Carbapenem-Resistant Enterobacteriaceae, or CRE for short. Patients at Ronald Reagan were exposed to CRE during a standard endoscopy procedure in which the recently purchased endoscopes were not properly sanitized. While doctors can use other, stronger antibiotics in an attempt to combat CRE, the infection is extremely difficult and sometimes even impossible to treat.
Naturally, one of the most alarming properties of superbugs like CRE is the mortality rate. Because superbugs rarely respond to other antibiotic treatments, they typically take a deadly toll on those infected. While these rates differ according to each superbug, CRE is known to kill over half of infected patients. These bacteria are so worrisome that Tom Frieden, current director of the Centers for Disease Control, called them “nightmare bacteria” that often do not respond to even the strongest of last-resort drug treatments, leaving patients with untreatable infections.
High mortality rates for superbugs coupled with increasing numbers of drug-resistant bacteria demand swift action in terms of prevention and research. The issue requires a multi-faceted solution that addresses the volatile nature of superbugs. First and foremost, researchers agree that antibiotics must be used wisely. While this idea is certainly not new to the medical community, its implementation is not easy. Refusing to write a prescription for a patient who is suffering from a common virus or who wants pain medication after a minor surgery can lead to conflict and patient frustration. However, using drugs as sparingly as possible is an essential part of the superbug prevention approach. If bacteria are not repeatedly exposed to an antibiotic, they are much less likely to develop dangerous resistance.
Hospitals and other medical care facilities also must play a key role in reducing superbug exposure and illnesses. By taking careful precautions to sterilize all medical equipment and controlling infection, hospitals can minimize the risk of patient exposure during standard procedures like endoscopies. During an outbreak, hospitals must be quick in their responses and group CRE affected individuals in one location with their own rooms, equipment, and staff. Communication among hospitals and medical care facilities can also stem the spread of superbugs via infected patients.
A picture of the CRE superbug, magnified under a microscope.
The government also plans to play a major role in superbug prevention, as made evident by President Obama’s recently announced national plan aimed at preventing infections. The proposed five-year plan, which dons a price tag of $1.2 billion dollars (nearly twice the current funding), calls for the establishment of a DNA database of resistant bacteria as well as extensive research on new antibiotics and vaccines. The plan highlights the need for better testing, reporting, and cooperation in order to slow the growth of superbugs. Perhaps most notably, the plan urges a 50% reduction in unnecessary antibiotic prescriptions in private practices and a 20% reduction in hospitals. While supporters of the plan acknowledge the necessity of the antibiotic cutback, many doctors are left asking unresolved questions: who determines what is inappropriate antibiotic use? And how should doctors deny a patient’s request for antibiotics while still making them feel like they are receiving good care?
Another major part of Obama’s plan includes eliminating the widespread use of antibiotics to boost animal growth in the food industry. Critics of the plan commend the idea but argue that the proposed limits are too flexible and too narrow in scope. The regulation of antibiotic use in food industry would require wide-scale cooperation and commitment from the FDA, as industry producers heavily rely upon a wide variety of antibiotics to improve product quality. With a reliance that has gone without strict regulation for decades, voluntary participation in Obama’s plan is certainly no guarantee.
While many details of the proposed plan have yet to be resolved, the plan is still a step in the right direction. In an age of increasing global transit and interaction, the superbug issue has no easy solution. Much like vaccines, antibiotic resistant bacteria are part of a much larger network of global interconnectedness: a network where the actions of one nation create ripple effects that can be felt in other nations. By taking steps towards prevention and research now, we can help prevent the spread of superbugs before the problem becomes more serious. This “prevention first” geared approach may perhaps encourage other nations facing a similar problem to contribute to the fight against superbugs.
Despite the scary statistics and mortality rates, the CDC director believes that the problem can largely be fixed. In countries like Israel, where CRE infections are even more prevalent, coordinated efforts by nearly 30 hospitals led to an impressive 70% decrease in CRE rates. Similar efforts made by isolated hospitals throughout the U.S. have yielded similar results. Clearly, steps can be taken to combat superbug prevalence. While success does not look like complete eradication of antibiotic resistant bacteria, it can mean significantly lower numbers of superbugs and an overall safer, healthier nation.
