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Heart attack risk looms large, silent for women

You're coming down from a long day at work, a stressful day, and you're just feeling tired.

No energy, it's too hot to do much, you can't walk the dog as fast as you usually do. It's like there's a weight on your chest. And as tired as you are, you can't seem to fall asleep.

Would you think heart attack? All right, the weight-on-chest was a giveaway. Or was it? Would you run to the emergency room (where they may or may not diagnose you correctly), or just chug another latte and keep going?

Face it. As Lisa Marinik is fond of saying, "Women are not small men." Our heart attacks do not happen "Hollywood-style." Often they feel more like caffeine jitters, the flu or, as in Marinik's case, plain fatigue.

You might survive that first one. But odds are good the second one will kill you.

Marinik learned all of this the hard way, of course. It happened after a highly stressful meeting on a consulting job that had stretched her schedule to the max.

Her husband noticed her color was off. But she kept on task, went to get her teeth cleaned the next morning and visited her family doctor just to be sure.

It was two hospitals later before she knew the full story.

She was shocked. At 52, Marinik seemed the picture of health. She didn't smoke, had no known heart disease in her family, good cholesterol, the whole nine.

She was a healthy eater and a faithful gym-goer, with a lean and toned body. She started joking (flirting, it sounds like) with the guys in the ambulance.

"I really almost felt like I was in a soap opera," she said.

Today she is fully recovered, thanks to good fortune, a careful rehabilitation and, we're betting, the healthy habits she has practiced all her life.

She couldn't ask for a better part-time job: Marinik is now clinical recruiter for the Women's-Only Cardiac Rehab Study.

Run by Dr. Theresa M. Beckie at the University of South Florida and funded by the National Institutes of Health, the study compares a control group of women in co-ed cardiac rehab with an experimental group who attend a women-only program.

"The goal is to reduce the high incidence of anxiety and depression that happens with women in heart disease and improve their exercise behavior," Beckie said, "because they are less likely to put their health first above family members and everyone else."

For lower-income women, the prospect of a proper rehab (again, assuming the woman even knew she had had a heart attack) is even more daunting. How do you get to the rehab center, and who does your job for you while you're there?

Marinik, who lives in Cheval, had trouble even getting into rehab. Her doctors thought she didn't need it. Her son-in-law, a physician in Ohio, pushed the issue. At Marinik's insistence, her local doctor gave her the referral.

That's not unusual, Marinik and Beckie said. For reasons no one can explain rationally, doctors tend not to refer female patients into cardio rehab.

The differences between rehabilitating yourself and going to a center are significant, Marinik said, and the women's program raises the bar even higher.

Instead of designing your own exercise program, scared to death that you'll push yourself too hard, you work out in a gym with other heart patients, strapped to heart monitors with health care professionals reading the data.

Participants in the women's group also get use of another monitor that you can wear outside the center. It gives you readings, like a wristwatch. Marinik was fascinated to see how a seemingly innocent business conversation caused her heart rate to spike.

There is psychological counseling to treat the depression and one-on-one sessions with a dietitian.

"Women who have heart disease have unique emotional and psychological needs," Beckie said.

She believes the program she designed is more appropriate and provides women with the social support that they need "because men are not socialized to be good caregivers for women."

Beckie is seeking to study 400 women who have suffered the effects of heart disease, including heart attacks, angina or coronary artery bypass surgery.

She's 260 women short. Some participants can even be paid for their time. When it's over, Beckie will compare the two groups' physical and psychological outcomes, including depression, cholesterol levels and weight.

If her theories stand the test of science, perhaps more women can one day get the treatment they need.

Said Beckie, "This is probably the most rewarding work I've ever done."

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Did you know?

- Heart disease is the No. 1 killer in the United States for women.

- One in 29 women will die of breast cancer. One in two women will die of heart disease.

- Eight-million American women are living with heart disease.

- Thirty-eight percent of women will die within a year after having a heart attack.

- Fewer than 10 percent of American women are aware of the above facts.

Source: University of South Florida, Women's-Only Cardiac Rehabilitation Study.