Extrait
chapter one
Smart at Heart
It’s a Monday night, a few weeks before Christmas. Around 5:30, thirteen women file into a conference room at the Massachusetts General Hospital (MGH) Revere Health Center in Revere, Massachusetts. Some grab a clementine from a table of healthy snacks, while others peel off the layers they’d been wearing to protect themselves from the bitter wind coming off the Atlantic Ocean one hundred yards away. Of the thirteen, nine are participants in HAPPY Heart, a two-year-old program that integrates all the facets of a woman’s life (including, among other things, physical health, emotional well-being, stress levels, and relationships) to minimize her cardiac-related issues. Three of the women are nurses (or health coaches, in HAPPY-Heart speak) and one is a daughter of a participant. As the group begins to settle into seats around the table, Isabel, one HAPPY Hearter, announces that she’s going to gather clothes for the homeless in the next week and pass them out and is looking for donations of any size. Another participant, Jenny, mentions that her daughter is taking finals, and that those tests have the whole house stressed out. A third subject, Kim, has an ankle that’s hurting, and Donna Peltier-Saxe, one of the health coaches, promises to take a look at it later.
Donna Slicis, another health coach, sets up her computer, and the first PowerPoint slide shows on a screen. “Family: The Good, The Bad, and The Ugly,” it reads, “Holiday survival!” After a few introductory remarks, Slicis, who has a great sense of humor and an even bigger sense of compassion, shows a YouTube video, which is called “Family Survival Kit.” The infomercial parody “sells” such helpful items as criticism-canceling headphones and Dr. Phil in a can. (“You can’t change what you don’t acknowledge,” the bald doc preaches from within the aluminum walls.) Laughter and nods of, “So true, so true” fill the room. The mood is light as Slicis focuses on the bulk of her presentation: creating a holiday experience that is low on conflict and bad health habits, and high on self-care.
Self-care is a relatively new topic for the women here tonight. “I’ve never taken care of my health,” says Lucy, echoing the sentiments of many in the group. “I just hoped for the best.” Revere is a blue-collar town, and for most of these women’s lives, the natural order of basic human needs--food and water, a safe place to live and sleep, a steady income--dictated that their energy and effort be put toward simply surviving as opposed to thriving. One woman is dealing with a foreclosure on her house; another, at age forty-nine, has had to move back in with her mother because she lost her job and can’t afford her own place. One was shot by a former boyfriend and still has three bullets in her body, while another woman has a son who is a heroin addict. Understandably, self-care hasn’t been a priority for these women; they’ve been too busy figuring out how to pay the bills, put food on their tables, deal with abusive relationships, and just generally navigate the messy details of life. “My life has never been about me,” says Heather, mother of the addicted son. “I’ve spent it taking care of my mother, my siblings, my children, my husband. I never thought to put myself first.”
Those life circumstances, combined with their family health histories, put most of them at risk for cardiovascular disease. To be a participant in the HAPPY Heart study, candidates have to have at least two major risk factors for cardiovascular disease: high blood pressure, abnormal cholesterol levels, diabetes, obesity, cigarette smoking, sedentary lifestyle, and genetic history of cardiac issues in the family. Over 80 percent of the sixty-five women in the program have at least three risk factors; the most common are obesity, low levels of HDL (the good kind of cholesterol), and a sedentary lifestyle.
Unfortunately, the women are in good company. The American Heart Association (AHA) issued new guidelines for the prevention of cardiovascular disease in women in early 2011, and the statistics cited in the introduction are troubling--to say the least. Two in three women over the age of thirty are either overweight or obese. More than twelve million American women have diabetes, a disease that is so tightly linked to cardiovascular disease that doctors often treat the two conditions simultaneously. Many physicians now refer to diabetes and obesity as “diabesity,” because of their frequent coexistence. High blood pressure is on the rise, especially among African-American women; an overwhelming 44 percent of that population has high blood pressure.
Although two of the most popular American pastimes--eating fast food and spending extended periods of time in front of a screen--might lead you to think otherwise, the epidemic of cardiovascular disease is not limited to the United States. “Heart disease is the leading cause of death in women in every major developed country and most emerging economies,” the 2011 AHA report proclaims.1
Given that heart disease is the number one killer of women--in the United States in 2006, over 430,000 women died from cardiovascular disease while about 270,000 died from various forms of cancer--the public awareness is still disturbingly low.2 In the AHA guidelines, researchers found that only 53 percent of women polled said that the first thing they would do if they suspected they were having a heart attack would be to call 911.3 That lack of awareness, combined with the rise of obesity, is contributing to a trend that shouldn’t be happening in the twenty-first century: death rates from cardiovascular disease for women under the age of fifty-four are, amazingly, rising. For the first time in forty years, the number of U.S. women between ages thirty-five and fifty-four who die from heart-related issues is actually increasing.4
As is true for many women across the world, the threat of a cardiac event stares down the HAPPY Heart participants daily. “My father died of arterial sclerosis at sixty-two,” says Christie, sixty years old, one of the participants who heard about the program from me when she came to my office with heart palpitations. “And my mother was a diabetic who had a triple bypass and a pacemaker. Seven of her siblings died of heart problems before [heart disease] took her at age eighty. Those thoughts just live in the back of my head.”
Daily challenges don’t loom so large tonight, though. Tonight, these women--like most of America--are preparing for two weeks of holiday excess: large, rich meals; champagne, eggnog, and plenty of other drinks; intense family time; additional cooking and cleaning; and unspoken, and often huge, expectations. The situation is a recipe for total meltdown for anybody, so Slicis encourages people to forget about perfection. “Be realistic about your expectations,” she says. “If the potatoes don’t come out perfectly, nobody will notice but you.” Then she moves on to talk about more important matters, which include how to protect yourself and your feelings around a group of people who might not always be the most supportive and loving. “You get to be happy even if everybody else around you isn’t,” she says, adding that it’s important to walk away from negative conversations and take a time-out if need be. “The bathroom is a great place to hide,” she says with a laugh. After touching on some budget-minded gifts (a family cookbook, certificates for closet organizing), Slicis reminds everyone to go for walks, get enough sleep, and to remember that a holiday is one day. “It’s not a holi-week or a holi-month, so celebrate accordingly,” she says. The group laughs in agreement.
The holiday survival tips, the hummus and other healthy snacks, and the women who are here tonight are all part of a common goal: building a heart that is strong and healthy in every respect. Although it may seem like cardiovascular disease is best treated by doctors in white coats, medical care is just one piece of the puzzle. Sure, doctors can monitor your cholesterol and your glucose levels, your weight and your blood pressure, but your cardiovascular--and overall--health depends on so much more than simple measurements.
I firmly believe--and science has proven--that getting smart at heart is about evaluating your whole life, from your relationships to your environment to your mental state. “Medications alone aren’t enough. Surgical procedures aren’t enough. Stents aren’t enough,” says Kate Traynor, a colleague of mine and the program director at the Cardiovascular Disease Prevention Center at MGH in Boston. “How many times have you heard that somebody needs to go back for another stent? Where the rubber hits the road--and what will keep you and your heart healthy--are lifestyle changes.”
In addition to the more obvious factors like diet and exercise, research shows that your cardiac health is influenced, among other things, by how much stress is in your life, and more importantly, how you deal with it; the strength of your friendships and family connections (or the lack of them); the quality of the sleep you do or don’t get; your perspective on the world. In other words, defusing toxic relationships is as important to your heart as easing up on the butter in the mashed potatoes. And getting your house in order to receive guests is as key to good health as taking daily walks.
When I care for a patient, I don’t treat a number, a heart, or a disease; I treat a person. Similarly, when I put together the premise for HAPPY Heart, I wanted to address individuals and all the aspects of their complicated, challenging lives--not just the ones that usually get discussed in my cardiology office. I can only see a handful of patients daily, though, and the HAPPY Heart ladies are in the greater Boston area; I wanted to share my message with as many people as possible, which is how this book came to be.
A Quick Course in Human Physiology
Before we discuss heart health any further, I want you to have a basic idea of how the heart functions, as well as how the rest of your body reacts to everyday emotions and life. I am a big believer that knowledge is power, and many of the patients I see have not taken ownership of their health, which means they’ll never feel empowered enough to believe they can make meaningful, effective changes. “Some women take more time and better care of their fingernails than they do of their heart,” says Slicis with a laugh. “They spent ten minutes picking out a polish color and can tell you the whole process of acrylics, but they don’t understand what their cholesterol levels mean.”
The heart, which is technically a muscle, starts to beat not long after conception and continues working until the very last breath somebody takes; over the course of an average lifetime, it will beat over 2.5 billion times. The heart consists of four chambers: two atria, which receive blood, and two ventricles, which pump blood. Between the chambers are valves, which serve as doors, opening and closing to keep the blood moving forward. Blue blood, or oxygen-depleted blood, flows from the body to the right atrium, through the tricuspid valve, and into the right ventricle. Exiting through the pulmonary artery, it heads to the lungs to lose the carbon dioxide it’s carrying and to become oxygenated and red. It returns to the left atrium, through the left ventricle, and on to the aorta, which sends it out into the body. The aorta is the tree trunk of the body; many arteries, arterioles, and capillaries branch off it, getting progressively smaller in size so that blood can be delivered to all the organs and tissues in the body. The blood then returns to the heart via venules that lead into veins.
The pumping of a heart is an incredibly intricate process. By using new detailed imaging techniques, doctors have learned that it doesn’t just squeeze with every beat--it also twists and untwists. Those motions, in combination with electrical signals and blood pressure, combine to form a rhythm that cycles blood through your heart seventy times a minute while you’re at rest and sends roughly one hundred gallons of blood every hour through your body.
We are born with arteries that are clean and clear, but over time we intentionally and unintentionally expose ourselves to substances that encourage the formation of blockages or plaques within the arteries (or as my grandmother used to call it, “hardening of the arteries”). Plaques are composed of lipids, fat, and scar tissue. A few factors known to initiate and worsen plaque development include high cholesterol, smoking, diabetes, and high blood pressure. In many cases the plaque lining the arteries is filled with a soft fatty core, which makes the plaque highly susceptible to rupturing. When that happens, that inner core attracts blood platelets and blood cells and a clot appears, which results in partial or complete blockage of the artery, which in turn leads to a heart attack. In some people--and in women in particular--the plaque doesn’t rupture entirely but instead erodes or is scraped open. In these situations, platelets still accumulate, but the buildup doesn’t necessarily obstruct the blood flow through the artery. It does, however, decrease the flow enough to cause some degree of heart muscle damage and symptoms of chest discomfort.
The organ with the four chambers that I just described? That’s your physical heart. As you might guess, it’s not the only heart I consider when I examine a patient. Harder to quantify but just as integral to good health is what I call the emotional heart. This side of the heart gets brought up regularly in everyday conversations, through common phrases like you have a big heart; let’s get to the heart of the matter; she is the heart and soul of this business; that was heart wrenching; he has hardened his heart. Translating that language, it’s clear we believe that the heart signifies a place where spirit lives, where purpose is found, where emotion begins and settles. The love, disappointment, contentment, fear, and euphoria we feel deeply within our hearts seems to ricochet through the body; while watching a frightening movie or hearing unbelievably good news, your heart seems to beat so rapidly, it almost echoes in your ears.
While the physical heart is the team captain for the circulatory system, the emotional heart is more of a team player--its health is influenced by other parts of the body, and vice versa. An important teammate to the emotional heart is the brain. Your brain responds to emotions by activating systems in your body that release various compounds and create a change in how your body is functioning.
For instance, when you’re watching that scary movie, your body shifts into the fight-or-flight response, a natural reaction that happens when you feel threatened. In fight or flight, the brain signals the adrenal glands to send out adrenaline, noradrenaline, dopamine, and cortisol that cause your heart to beat faster and your blood pressure and blood glucose levels to rise. These phenomena put your body into an aggressive, ultraprepared mode, even though the bigg...
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