Doctor fights the No. 1 killer of women

When it comes to women and heart disease, UC Irvine Medical Center cardiologist Dr. Dawn M. Lombardo can recite some sobering statistics.

Cardiovascular
disease kills six times more women than breast cancer, she says. In
fact, twice as many women die of it as die of all cancers combined.

“It’s the No. 1 killer of women,” Lombardo says. “It kills more women than the five other leading
causes of death combined: cancer, chronic obstructive pulmonary disease, Alzheimer’s, diabetes and accidents.”

Perhaps
most surprising: Although men are at greater risk of heart attack,
overall cardiovascular disease — including stroke — kills more women
than men.

“Heart
disease has been defined as a male disease,” Lombardo says. “When it
comes to research and treatment, women have been overlooked. There’s a
huge need we’re working to fill.”

A UCI assistant professor of medicine and director of the medical center’s heart failure program,
Lombardo is raising awareness of the issue through workshops and
seminars and is trying to increase the role of women in cardiovascular
disease clinical trials.

The
UC Irvine heart failure program is unique in that there are two women at
the helm — Lombardo and Nathalie De Michelis, cardiovascular program
manager — in a field dominated by men.

Together, they’ve built a program that develops new treatments for
heart disease; delivers inpatient and outpatient care for both men and
women; and educates patients and the public about prevention. It’s the
first heart program in Southern California to be certified by The Joint Commission, earning a Gold Seal of Approval for quality. Recently, it also received the American Heart Association’s Get With The Guidelines — Heart Failure Silver Plus Award for meeting high care standards.

“We’re trying to ensure that every time a patient comes to us, we have the best evidence-based therapy,” Lombardo says.

Shirley
Moore of Fullerton suffered a heart attack 30 years ago, at age 59.
“I’ve had a triple bypass and some stents implanted,” she says, “but I’m
doing O.K.” She’s been in UC Irvine’s heart failure program for several
years.

“Dr.
Lombardo has diagnosed me beautifully, and the recommended treatments
have all worked. I feel she’s keeping me alive,” Moore says. “All the
doctors take the time to listen to you and explain everything that’s
going on. The whole program is marvelous.”

While
many heart disease causes, symptoms and treatments are shared by men
and women, there are important differences. The warning signs of a heart
attack, for instance, are often more subtle in women; the fatigue,
nausea and shortness of breath can be mistaken for depression, anxiety
or side effects of medication.

Unlike
most men, Moore didn’t experience severe pain with her heart attack.
“It just felt like a weight on my chest, and it was hard to breathe,”
she recalls.

That’s
typical for women, according to Lombardo. “It’s not necessarily a
crushing pain in the chest — as many as 40 percent of women experience
no chest pain at all,” she says. “Treatment can be delayed because the
care provider doesn’t recognize the patient’s symptoms are cardiac.

“Then, once she’s finally diagnosed, certain interventions such as
angioplasty and stents may not be as effective for women. The
conventional wisdom is that women should be treated the same as men, but
now we’re starting to challenge this.”

Lombardo
conducts clinical trials to assess the effectiveness of various
medications and devices in treating women. But her real hope is to keep
both men and women from needing the services of a heart program in the
first place.

“Lifestyle
plays the most important role in preventing heart disease,” she says.
“People tend to think a little cholesterol or high blood pressure
doesn’t mean anything, but according to the World Health Organization,
cardiovascular disease is essentially preventable. And that means taking
care of mind, body and soul.”

Stress
reduction, daily activity, smoking cessation and weight loss all could
help people avoid heart disease. Controlling hypertension — or high
blood pressure — can lower the risk of developing heart failure by half,
Lombardo says.

“Survivors
of a heart attack or stroke face a high risk of recurrence or death,”
she says. “Once you have an episode, you have an established disease
that warrants lifelong monitoring by cardiologists, since the risk can
be substantially lowered with a combination of medications, education
and follow-up.”

To educate patients and the community, UC Irvine Healthcare offers “Living Well with Heart Failure,” “Heart Healthy Diet” and other classes.

“Millions
of people are walking around with weak hearts and don’t know it. We’re
trying to raise their awareness,” Lombardo says. “This is all evolving.”