[Congressional Record Volume 155, Number 29 (Thursday, February 12, 2009)]
[Senate]
[Pages S2230-S2232]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Ms. STABENOW (for herself, Ms. Murkowski, Mrs. Feinstein, Ms. 
        Collins, Mrs. Lincoln, Mr. Chambliss, Ms. Mikulski, Mr. 
        Cochran, Ms. Landrieu, Mrs. Boxer, Mrs. Shaheen, Mr. Cardin, 
        Mr. Kerry, Mr. Whitehouse, Mr. Akaka, Mr. Sanders, Mr. Inouye, 
        Mr. Begich, Mr. Casey, Mr. Menendez, Mr. Bayh, Mr. Carper, Mr. 
        Wyden, and Mr. Conrad):
  S. 422. A bill to amend the Federal Food, Drug, and Cosmetic Act and 
the Public Health Service Act to improve the prevention, diagnosis, and 
treatment of heart disease, stroke, and other cardiovascular diseases 
in women; to the Committee on Health, Education, Labor, and Pensions.
  Ms. STABENOW. Mr. President, I rise today to discuss a critical 
health issue affecting too many women: heart disease, a disease that 
surprisingly affects more women than men.
  As women, we tend to be great at taking care of everyone around us--
our children, our spouses, our aging parents. Unfortunately, we do not 
do nearly as well taking care of ourselves sometimes. I suspect we all 
know women who have been to their doctors or to emergency rooms 
exhibiting symptoms of heart attack, only to be told they were 
suffering from ``stress'' or indigestion.
  For women, there are a lot of misconceptions about heart disease, but 
here are the facts.
  Heart disease and stroke actually kill more women each year than men.
  Heart disease, stroke, and other cardiovascular diseases are the 
leading cause of death for women in the United States and in Michigan. 
According to the Michigan Department of Community Health, a third of 
all deaths in women are due to cardiovascular disease.
  One in three adult women has some form of cardiovascular disease.

[[Page S2231]]

  Minority women, particularly African American, Hispanic and Native 
American women, are at even greater risk from heart disease and stroke.
  These reasons are why Senator Lisa Murkowski and I are reintroducing 
the HEART for Women Act in the Senate today to turn these startling 
statistics around. Our bill is a three-prong approach to fighting heart 
disease by raising awareness, strengthening research, and increasing 
access to screening programs for more women. I am so pleased that 
nearly a quarter of the Senate is joining us today in sponsoring this 
legislation, and that that Congresswomen Lois Capps and Mary Bono Mack 
are introducing companion legislation in the U.S. House of 
Representatives.
  Mr. President, I ask unanimous consent that support material be 
printed in the Record.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

                American Heart Association, February 12, 2009.

     Heart Disease and Stroke. You're the Cure.

     Hon. Debbie A. Stabenow,
     U.S. Senate,
     Washington, DC.
     Hon. Lisa Murkowski,
     U.S. Senate,
     Washington, DC.
       Dear Senator Stabenow and Senator Murkowski: On behalf of 
     the American Heart Association and our approximately 22 
     million volunteers and supporters nationwide, we applaud you 
     for your re-introduction of the HEART for Women Act.
       As your legislation recognizes, too many American women and 
     their healthcare providers still think of heart disease as a 
     ``man's disease,'' even though about 50,000 more women than 
     men die from cardiovascular diseases each year. And 
     unfortunately, while we as a nation have made significant 
     progress in reducing the death rate from cardiovascular 
     diseases in men, the death rate in women has barely declined 
     (17 percent decline in men versus a 2 percent decline in 
     women over the last 25 years). Even more alarmingly, the 
     death rate in younger women ages 35 to 44 has actually been 
     increasing in recent years.
       The American Heart Association and its American Stroke 
     Association division is a strong supporter of the HEART for 
     Women Act because it would improve the prevention, diagnosis, 
     and treatment of heart disease, stroke, and other 
     cardiovascular diseases in women and ultimately help end the 
     disparity that women face. Your legislation is particularly 
     important in the current economic recession, where Americans 
     are losing their jobs and their health insurance coverage and 
     women may be foregoing needed screening that could aid in the 
     early identification and treatment of heart disease and 
     stroke.
       More specifically, your legislation would: 1) authorize the 
     expansion of the Centers for Disease Control and Prevention's 
     WISEWOMAN program, which provides free heart disease and 
     stroke screening and lifestyle counseling to low-income, 
     uninsured and underinsured women, to all 50 states; 2) 
     educate women and healthcare professionals about the risks 
     women face from cardiovascular diseases; and 3) provide 
     clinicians and their women patients with better information 
     about the efficacy and safety of new treatments for heart 
     disease and stroke.
       Thank you again for your leadership on this important 
     legislation. We look forward to working with you to get the 
     HEART for Women Act enacted into law in this Congress.
           Sincerely,
                                               David A. Josserand,
                                            Chairman of the Board.
                                     Timothy J. Gardner, MD, FAHA,
     President.
                                  ____


               [From the Chicago Tribune, Dec. 29, 2008]

 Women's Heart Disease: It's the Leading Killer, but Patient Care Lags 
That for Men--as Cardiac Science Advances, Women Find Treatment Lagging

                           (By Judith Graham)

       Heart disease is the leading cause of death for women in 
     the U.S., yet a wealth of data shows female cardiac patients 
     receive inferior medical care compared with men.
       Too many physicians still discount the idea that a woman 
     could be suffering from heart disease, delaying or denying 
     needed medical interventions, experts note. Most community 
     hospitals in the U.S. still are not following guidelines for 
     treating women with heart attacks. And primary care doctors 
     don't do as much as they could to emphasize prevention.
       As a result, women are failing to reap the full benefits of 
     enormous advances in cardiovascular medicine.
       The point was underscored this month by a study published 
     in the journal Circulation finding that women who have heart 
     attacks receive fewer recommended treatments in hospitals 
     than men, including aspirin, beta blocker medications, 
     angioplasties, clot-busting drugs and surgeries to re-
     establish blood flow. Women with the most serious heart 
     attacks, known as STEMIs, were significantly more likely to 
     die at a hospital than men.
       ``We need to do a better job of defining women's symptoms 
     and treating them aggressively and rapidly, as we do for 
     men,'' said Dr. Hani Jneid, the study's lead author and 
     assistant professor of medicine at the Baylor College of 
     Medicine in Houston.
       In Israel, when guidelines have been applied much more 
     rigorously, the mortality difference between the sexes all 
     but disappeared, according to a July study in the American 
     Journal of Medicine.
       Outside hospitals, too few internists, family doctors, 
     obstetricians and gynecologists are implementing 
     recommendations for preventing heart disease in women, 
     experts say. Eighty percent of heart attacks in women could 
     be prevented if women changed their eating habits, got 
     regular exercise, managed their cholesterol and blood 
     pressure, and followed other preventive measures.
       Although death rates from cardiovascular disease have 
     fallen, the condition killed 455,000 women in 2006, according 
     to data from the American Heart Association. Heart disease 
     causes about 72 percent of cardiovascular fatalities; the 
     rest are strokes and other related conditions.
       The next decade could see major advances as scientists 
     better understand how the biology of heart disease differs in 
     women, said Dr. Joan Briller, director of the Heart Disease 
     in Women program at the University of Illinois Medical Center 
     at Chicago.
       Already, for example, researchers have learned that plaque 
     deposits tend to be spread more widely in women than in men, 
     resulting in fewer big blockages in the arteries. That means 
     standard therapies such as angioplasty are often less 
     effective in women. Also, women metabolize certain heart 
     drugs at a different rate than men.
       Women should learn about the symptoms of acute heart 
     disease--which can differ from those in men--respond promptly 
     if they sense something is wrong, and ``find physicians who 
     care about them,'' said Dr. Annabelle Volgman, medical 
     director of the Heart Center for Women at Rush University 
     Medical Center.
       ``Ask your doctor: Are you familiar with the guidelines for 
     the prevention of heart disease in women published in 2007? 
     Do you follow them? If they say 'no,' find yourself another 
     doctor,'' she said.
       These Chicago-area women learned the importance of that 
     advice the hard way:
       Elizabeth Hein of Chicago was 27 when she began feeling a 
     tight, squeezing feeling in her chest, ``like a bone was 
     stuck in my heart,'' she said.
       When it didn't go away, Hein visited her primary-care 
     doctor. ``You're young and healthy; don't worry,'' she 
     remembers him saying. Take aspirin, he advised.
       The disturbing sensation sent Hein to the doctor four more 
     times over the next six months. She was fine, he repeated. 
     Hein was in good shape and running 3 to 5 miles daily.
       One day at work, Hein felt numbness spread up her arm and 
     into her neck. Breathing became difficult. ``I'm sitting 
     there thinking my doctor doesn't believe anything is wrong; 
     what should I do?'' said Hein, now 38.
       At a nearby hospital, Hein remembers, a triage nurse 
     briefed a skeptical emergency room doctor on her 
     electrocardiogram.
       ``She's too young. It can't be a heart attack,'' she heard 
     the doctor say behind a curtain.
       When he examined Hein, he asked what drugs she took. 
     (Cocaine can simulate heart attack symptoms.) After several 
     hours, the doctor sent Hein home. She later learned from her 
     primary-care physician that she had, indeed, had a heart 
     attack.
       ``My overwhelming feeling was relief: Finally he 
     acknowledged something was really wrong,'' said Hein, who 
     soon changed doctors.
       ``If your doctor won't listen, fire him and find one who 
     will,'' she said.
       That lesson was brought home painfully three years ago when 
     Hein's mother began to suffer lower back pain and fatigue. 
     Her Minnesota doctor sent her to a masseuse. A month later, 
     when she returned to the doctor because she was retaining 
     water, he reportedly told her: ``You're an older woman. It's 
     normal.''
       Weeks later, Mabel Hein died of a massive heart attack.
       ``They missed it because they dismissed her too,'' her 
     daughter said. ``What I tell other women now is don't let it 
     happen to you.''
       In March 2007, a screening test told Michelle Smietana of 
     Gurnee her blood pressure and cholesterol levels were 
     excellent.
       ``I thought that's fantastic, no problems there,'' said 
     Smietana, 35.
       Eight hours later, she was in a hospital emergency room 
     with a heart attack.
       It began at dinner with a friend, when the computer 
     specialist felt an achy pain at the right shoulder blade. By 
     the time she got to her car, the feeling had crept up into 
     her throat, where it settled in the soft spot under her chin.
       ``At first I thought I'd hurt a muscle. Then I thought: `Am 
     I having an allergic reaction?' '' Smietana said. ``All the 
     time, I felt, whatever this is, I really don't like it.''
       Doctors at an urgent care center sent Smietana to Condell 
     Medical Center after a test for a cardiac marker came back 
     positive. There Smietana received aggressive treatment and 
     ultimately discovered that a prolonged coronary artery spasm 
     had interrupted blood flow through her narrower-than-usual 
     arteries.

[[Page S2232]]

       ``My first reaction was a weird feeling of shame, because I 
     was only 33 and this wasn't supposed to be happening,'' 
     Smietana said. ``Then, I felt kind of guilty, because I'm a 
     little heavy and a little underexercised.''
       Moving on from the episode was terrifying, she said. 
     ``Because it came out of nowhere, you're not sure if it's 
     going to come back again and if you'll survive the next 
     time,'' she said.
       She credits three months of cardiac rehabilitation with 
     defeating that fear and learning how to move again and take 
     better care of herself.
       Today, Smietana tells women: ``If your body tells you 
     something doesn't feel right, listen to it and take it 
     seriously. I did and I got lucky.''
       Helen Pates' grandmother died in her sleep of a massive 
     heart attack around age 40. Her mother also suffered from 
     heart disease, as did several maternal relatives.
       All this was detailed in her medical records. Yet when 
     Pates developed persistent fatigue and occasional bouts of 
     nausea, not one of seven Chicago doctors she consulted 
     ordered cardiac exams.
       Instead, they scanned her liver, her brain, her 
     gastrointestinal tract. ``They all said the same thing: 
     `We're not finding anything. You have a demanding career, a 
     busy life. It's probably stress-related,' '' said Pates, who 
     lives in Chicago and manages money for people with high net 
     worth.
       Then in 2005 Pates awoke at 3 a.m. with excruciating pain 
     on the left side of her back and severe shortness of breath. 
     Crawling out of bed, she managed to drive to Rush University 
     Medical Center.
       A few hours later, surgeons told Pates she had a large 
     aortic aneurysm--a bulge in her body's main blood vessel--
     that was about to rupture. Doctors inserted a stent that 
     caused the aneurysm to shrink and eventually vanish.
       Within three months Pates' energy began to return, and a 
     year later she was feeling like herself again.
       Now 43, Pates said she's upset so many doctors dismissed 
     her symptoms.
       ``As a woman, you need to stay on top of your health,'' she 
     said. ``Make yourself a priority. And if you have a family 
     history, like I did, and don't feel well, ask your doctor if 
     you could be having problems with your heart.''
       The first time Debbie Dunn collapsed, doctors diagnosed 
     pneumonia. A high fever, they said, had caused her cold 
     sweats and thumping heart.
       The next three times Dunn felt on the verge of collapse, 
     her heart racing wildly, medical providers told her she was 
     having panic attacks.
       Eventually a cardiologist gave her a new diagnosis: 
     supraventricular tachycardia, an abnormally rapid heart 
     rhythm. ``It's benign,'' Dunn says he told her.
       For years, Dunn visited the cardiologist occasionally but 
     primarily relied on a technique he taught her to control 
     symptoms. Still, more and more often, she said, ``My heart 
     felt like tennis shoes in the drier doing flip-flops.''
       In 2002, at a restaurant with her husband, Dunn felt what 
     she calls a ``ripping, burning sensation above my breast.'' 
     Her left arm went numb, then started to ache.
       At a nearby hospital, after hours of waiting, a nurse 
     casually told Dunn she'd had a massive heart attack. A 
     cardiologist said her heart was profoundly damaged and 
     operating at about 30 percent of capacity. Dunn was 
     prescribed medications but felt perpetually exhausted.
       ``I tried to be a good mom, a good wife, and go back to my 
     activities but I couldn't keep up,'' said Dunn, 52. Her 
     cardiologist prescribed another medication for inflammation, 
     but it didn't help either.
       A turning point came when Dunn read an article in O 
     magazine on women and heart disease. Seeing herself in the 
     story, she went to see Oprah Winfrey's cardiologist. In the 
     physician's office, having a cardiac stress test for the 
     first time, Dunn had another heart attack.
       Today, the Libertyville resident has a pacemaker. 
     Channeling anger over her mistreatment into activism, Dunn 
     runs a support group for women with heart disease at 
     Glenbrook Hospital in Glenview and Condell Medical Center and 
     is starting another at Lake Forest Hospital.
                                 ______