An Affair of the Heart

By Margaret Lewin, MD, FACP – Medical Director, Cinergy Health (www.cinergyhealth.com)

February is National Heart Month and not just because of Valentine’s Day. According to the American Heart Association, one in 2.4 American women will lose their lives to heart disease and stroke – the first and third biggest killers of women. In comparison, breast cancer kills one in 29. So let’s look at V.A.L.E.N.T.I.N.E.S. Day from another vantage point: reducing our risk of heart disease.

Vitamin D plays a significant role in the cellular structure of the heart and its pumping ability, and deficiency can lead to heart disease and stroke. Although Vitamin D is created after direct exposure to sunlight, our appropriate efforts to protect our skin from cancer can block this path. It’s difficult to get enough Vitamin D from food, short of drinking four glasses of milk daily. Ask your doctor to check your blood level of Vitamin D and ask whether supplements are appropriate.

Avoid “bad fats” like hydrogenated and saturated, and eliminate trans-fats altogether. Replace them with vegetable oils such as olive, canola, corn and soy, and those supplemented with omega-3’s. Do recognize that all fats have the same number of calories, so use even “good” fats sparingly.

Lose that belly fat as it increases your risk of heart disease, diabetes and certain types of cancer. Belly fat is usually the first area to shrink with moderate-intensity aerobic exercise and strength training with weights.

Exercise has other heart-healthy benefits: it can help control blood lipid abnormalities, blood pressure and diabetes, as well as make the heart work more efficiently during exercise and rest. Even after suffering a heart attack, people who embark on a graduated exercise program have better rates of survival, as well as a better quality of life.

Note package labeling in prepared foods and look for the types and amounts of fats and sugars. Choose foods absent in trans-fats and low in other ‘bad fats’; and look for “no added sugar” or “unsweetened” products.

Take time each day for relaxation. Stress contributes to heart disease by turning on hormones that cause a rapid heartbeat, rise in blood pressure, increased turbulence in the bloodstream, and – some scientists believe – speed up the process of fatty material collecting in the coronary arteries. Relaxation techniques such as yoga, meditation and t’ai chi can break the cycle.

Be Informed about your blood pressure, blood sugar and lipids (cholesterol and triglycerides). If you’re not in optimum ranges, discuss with your doctor how to get there.

Nix sugars. The American Heart Association recommends no more than 6 teaspoons of added sugar daily for women (9 for men). This isn’t much – for example a bottle of cola with 44 grams of sugar contains 10 teaspoons! (Be aware that “naturally sweetened” products often contain added fruit juice or lactose from milk, which are added sugars.) These recommendations do not include natural sugars, like in fruit.

Eat a diet high in fruits, vegetables and grains.

Stop smoking – the major preventable risk factor for heart disease. It increases blood pressure, decreases exercise tolerance and increases the risk of abnormal blood clots leading directly to heart attacks and strokes.

Don’t just limit healthy heart habits to National Heart Month – extend them to every day of the year. But, on Valentine’s Day, you’re allowed to have that one piece of chocolate!

Cervical Cancer

By Margaret Lewin, MD, FACP – Medical Director of Cinergy Health (www.cinergyhealth.com)

Last year, 11,270 new cases of cervical cancer were diagnosed and another 1.2 million women will develop dysplasia, a condition which left untreated can turn into cervical cancer. Cervical cancer is a malignancy that develops in tissues of the cervix: the organ which connects the uterus to the vagina. It is preventable, slow-growing (so that it can be detected and cured early in its course), and is nearly always caused by infection from the human papilloma virus (HPV).

Cause: Most cases of cervical cancer are caused by HPV – a highly contagious virus which can be transmitted easily by skin to skin and sexual contact.

At least half of all sexually active Americans contract HPV during their lifetimes
About 20 million Americans between the ages of 15 and 50 carry the virus.
There are more than 100 types of HPV – of which more than a dozen (termed “high risk types”) can cause cervical cancer.
Most often, a person’s immune system kills off the virus without intervention
Exposure to high risk types of HPV is more likely to lead to cancerous changes of the cervix in women who smoke or whose immune system is impaired.
Prevention: Cervical cancer can be prevented by

Having no intimate contact with either men or other women
Obtaining the HPV vaccine – which can immunize against two high risk types of HPV (types 16 and 18), which cause about 70% of cervical cancers. It is given as a series of three injections over a period of six months. The vaccine is now FDA-approved for females and males between the ages of 9 and 26, although many physicians recommend the vaccine up to age 50 for sexually active women and men who have sex with men.
Screening and treatment for early evidence of pre-malignant changes to the cervix

Screening: The “pap smear” (Papanicolaou test) is used to screen for cervical cancer as part of the gynecological examination. It can reveal early, pre-malignant changes to the cervix. It is done by gently scraping the cervix with a wooden or plastic spatula and then by inserting a very small brush into the opening of the cervix. The cells thus obtained are then evaluated by a commercial laboratory. For maximum accuracy, your provider should be submitting a liquid-based preparation (not the old-fashioned smear submitted on glass slides). The same cells can be evaluated for the presence of HPV.

Lately, when and how often to screen has become controversial. Consensus among the various guideline commissions is still pending, but it is likely that recommendations will be as follows:

The first Pap test should be done at Age 21, then repeated every two years.
At Age 30, the Pap test and HPV screen (done using the same cells collected for the Pap) should be done; if both are negative and you’ve had at least three consecutive normal Pap smears, screening can be reduced to every three years.
If the Pap is normal but high risk HPV is present, Paps should be repeated at least yearly.

If the Pap is abnormal, further testing is necessary – starting with ‘colposcopy’. This procedure starts like a regular gynecologic examination, with the speculum inserted into the vagina. The doctor then brushes a material on the cervix to highlight any abnormal areas. The ‘colposcope’ – a large microscope positioned about a foot away – shines light into the vagina so the abnormal areas can be seen through the microscope. These areas are then biopsied and evaluated by a special laboratory.

Note: You should continue to see your doctor at least yearly for general gynecologic check-ups, even though the Pap test might be done less frequently.

Of all cancers, cervical cancer is almost unique in that it is preventable. Ask your healthcare provider whether you should consider the HPV vaccine. Cervical cancer can be detected early, treated, and cured. Ask your provider how frequently you should be screened.