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Coronary heart disease

Coronary heart disease (CHD), also called coronary artery disease (CAD) and atherosclerotic heart disease, is the end result of the accumulation of atheromatous plaques within the walls of the arteries that supply the myocardium (the muscle of the heart). While the symptoms and signs of coronary heart disease are noted in the advanced state of disease, most individuals with coronary heart disease show no evidence of disease for decades as the disease progresses before the first onset of symptoms, often a "sudden" heart attack, finally arise. After decades of progression, some of these atheromatous plaques may rupture and (along with the activation of the blood clotting system) start limiting blood flow to the heart muscle. more...

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Atherosclerotic heart disease can be thought of as a wide spectrum of disease of the heart. At one end of the spectrum is the asymptomatic individual with atheromatous streaks within the walls of the coronary arteries (the arteries of the heart). These streaks represent the early stage of atherosclerotic heart disease and do not obstruct the flow of blood. A coronary angiogram performed during this stage of disease may not show any evidence of coronary artery disease, because the lumen of the coronary artery has not decreased in caliber.

Over a period of many years, these streaks increase in thickness. While the atheromatous plaques initially expand into the walls of the arteries, eventually they will expand into the lumen of the vessel. As the plaques expand into the lumen of the vessel, they can affect the flow of blood through the arteries. While it was originally believed that the growth of atheromatous plaques was a slow, gradual process, some recent evidence suggests that the gradual buildup of plaque may be complemented by small plaque ruptures which cause the sudden increase in the plaque burden due to accumulation of thrombus material.

Atheromatous plaques that cause obstruction of less than 70 percent of the diameter of the vessel rarely cause symptoms of obstructive coronary artery disease. As the plaques grow in thickness and obstruct more than 70 percent of the diameter of the vessel, the individual develops symptoms of obstructive coronary artery disease. At this stage of the disease process, the patient can be said to have ischemic heart disease. The symptoms of ischemic heart disease are often first noted during times of increased workload of the heart. For instance, the first symptoms include exertional angina or decreased exercise tolerance.

As the degree of coronary artery disease progresses, there may be near-complete obstruction of the lumen of the coronary artery, severely restricting the flow of oxygen-carrying blood to the myocardium. Individuals with this degree of coronary heart disease typically have suffered from one or more myocardial infarctions (heart attacks), and may have signs and symptoms of chronic coronary ischemia, including symptoms of angina at rest and flash pulmonary edema.

A distinction should be made between myocardial ischemia and myocardial infarction. Ischemia means that the amount of oxygen supplied to the tissue is inadequate to supply the needs of the tissue. When the myocardium becomes ischemic, it does not function optimally. When large areas of the myocardium becomes ischemic, there can be impairment in the relaxation and contraction of the myocardium. If the blood flow to the tissue is improved, myocardial ischemia can be reversed. Infarction means that the tissue has undergone irreversible death due to lack of sufficient oxygen-rich blood.


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Health hotline - coronary heart disease
From Ebony, 3/1/03


Coronary heart disease, more than all forms of cancer combined, is the leading cause of death among African-American women in the U.S. According to the National Black Women's Health Project, African-American women are 30 percent more likely to die of a heart attack and 79 percent more likely to die of a stroke than White women. More than any other group, Black women are more likely to be affected by heart disease due to the presence of risk factors such as high blood pressure, high blood cholesterol, diabetes, smoking, physical inactivity and obesity. The more risk factors that are present, the greater the likelihood for developing heart disease.

Statistics from the Centers for Disease Control and Prevention reflect the prevalence of risk factors within the African-American community, specifically among Black women. More than 30 percent of African-American women suffer from high blood pressure, more than 50 percent are overweight, and 46 percent have high cholesterol levels. Diabetes, the fastest-growing risk factor for heart disease in the United States, is considered an epidemic, and Black women are 1.7 times more likely to suffer from diabetes than White women.

A family history of heart disease or stroke, previous heart attack, stress and age are also possible risk factors. Additionally, doctors say loss of estrogen following menopause contributes to the risk of heart disease.

Although one in two American women will die of heart disease, only 8 percent of women in the United States recognize heart disease as their greatest health threat, according to a recent survey by the American Heart Association. "Heart disease has long been considered a disorder which principally affects men in our society," says cardiologist Dr. Richard Allen Williams. "Consideration of the occurrence of heart attacks in females has been largely an afterthought."

To minimize the risks of heart disease, doctors urge women and men to maintain a healthy diet, exercise, eliminate tobacco use, reduce salt and cholesterol intake, and monitor alcohol intake.


Breast cancer is the most common cancer among African-American women, with the latest statistics indicating that 19,300 new cases of the disease are diagnosed annually.

Although White women develop breast cancer at higher rates than Black women, doctors say African-American women are more likely to die from the disease. Death rates among Black women are approximately 28 percent higher than those among White women, primarily, experts say, because they are often diagnosed when the disease is at a more advanced stage.

Every year breast cancer kills about 5,600 African-American women, making the disease the second highest-ranked cause of cancer death among Black women, topped only by lung cancer, according to the American Cancer Society. Although breast cancer cannot be prevented, it can be detected at an early, treatable stage. Five-year survival after treatment for early-stage breast cancer is 96 percent.

Early detection, regular checkups and routine mammograms will increase breast cancer survival, experts add. And although there has been a barrage of recent reports debating the effectiveness of screening mammography, medical authorities continue to assert that mammograms save lives. "Breast cancer, if found early, is a very treatable disease," says American Medical Association Board of Trustee John C. Nelson, M.D., an obstetrician/gynecologist in Salt Lake City. The AMA says that many women are still not incorporating mammograms into their yearly health care routine, and the problem is worse among minorities, older and low-income women. "[Mammograms] can be uncomfortable," Dr. Nelson says, "but not as uncomfortable as losing a breast, or losing one's life. Mammograms can be lifesaving."

The American Cancer Society recommends:

* Women aged 40 and older should have a screening mammogram every year.

* Between the ages of 20-39, women should have a clinical breast examination by a health professional every three years. After age 40, women should have a breast exam by a health professional every year.

* Women aged 20 or older should perform breast self-examination every month. By doing the exam regularly, women can get to know how their breasts normally feel and can more readily detect any change.


Lung cancer kills more Black women than any other type of cancer, including breast cancer. It is the second most common cancer afflicting African-American women, but brings with it a higher mortality rate, according to the American Cancer Society.

The most recent statistics show that lung cancer caused an estimated 21 percent of all cancer deaths among Black women in 2001. That same year, there were about 7,600 projected cases of lung cancer reported in African-American women, which accounts for 12 percent of all cancer cases.

Cancer specialists agree that prevention is key--avoiding risk factors and making sure that annual checkups are a part of your health maintenance routine. Doctors say that smoking, exposure to asbestos, radon, diesel exhaust and fuels such as gasoline are risk factors for lung cancer. Some recent studies have shown that women who smoke or are exposed to tobacco smoke are more likely to develop lung cancer than men. In addition, air pollution in some cities may also slightly increase cancer risk.

Treatment options vary, depending on the location, size and type of cancer, specialists say. Surgical treatments include resection, in which a small part of the lung is removed; lobectomy, where a whole lobe or section of the lung is removed; and pneumonectomy, removal of an entire lung.

Other treatments include chemotherapy, radiation and laser therapy. New treatments are in clinical trials conducted by the National Cancer Institute. Two of those treatments are photodynamic therapy, a treatment with drugs that become active when exposed to a certain kind of light and kill cancer cells; and chemoprevention, the use of drugs, vitamins and other agents to try to reduce the risk of or delay the growth or recurrence of cancer.


There are three types of cancers of the uterus--uterine corpus (body of the uterus), uterine cervix and ovarian. Together, these cancers make up approximately 11 percent of all cancer cases, and accounted for 10 percent of cancer deaths among Black women in 2000.

As a result of these cancers, Black women die at a much higher rate (after diagnosis and treatment) than White women, according to cancer specialists.

"There's not a definitive reason [for the discrepancy]," says Dr. Dineo Khabele, an OB/GYN and gynecologic oncologist at Montefiore Medical Center in New York City. "It could be sociological conditioning, treatment options offered or treatment options taken, or a lack of access to health care."

With each form of uterine cancer, signs and symptoms vary. Annual Pap tests and pelvic exams can aid in the early detection of cancerous tumors, doctors say. You should consult your doctor if you experience persistent symptoms, such as abnormal uterine or vaginal bleeding, spotting or discharge, pain, enlargement of the abdomen or stomach discomfort.

Treatment options have improved greatly over the years, and vary depending on the type, location and size of the tumor. Doctors say ovarian cancer has the highest mortality rate among all female reproductive system cancers because it is usually diagnosed after it has spread. It is generally treated with a combination of surgery to remove all or part of the uterus, one or both ovaries and the fallopian tubes.

Additionally, chemotherapy and radiation are used to destroy the cancerous cells. Radiation therapy is not as common. There are promising clinical trials underway that focus on chemotherapy.

Uterine corpus cancers are treated with surgery, chemotherapy, radiation and hormones, depending on the stage of the disease.

For pre-invasive lesions, cervical cancer may be treated by cryotherapy (the destruction of cells by extreme cold), electrocoagulation (the destruction of tissue through intense heat by electric current), by laser or by local surgery. Invasive cervical cancers usually are treated by surgery and/or radiation, and chemotherapy.

For more information about risk factors, diagnosis and treatment, consult your physician or contact the American Cancer Society at 1-800-ACS-2345 (or online at


Often called "the Black woman's epidemic," fibroid tumors, non-cancerous tumors of the uterus, affect 1.6 million women in the United States each year and more than 50 percent of African-American women. In a random study by the National Institutes of Health, more than 80 percent of Black women and 70 percent of White women had developed uterine fibroids by their late 40s, with African-American women more likely to have multiple tumors and larger fibroids.

Although most women have no symptoms and only 10 to 20 percent of women require treatment, others may suffer from heavy and painful bleeding, prolonged menstrual cycles, pain in the back or legs, blood clots, painful intercourse, pelvic pressure, miscarriage, infertility or infant malnutrition during pregnancy. Depending on the size and location of the fibroids, the tumors can place significant pressure on the bladder and bowel, causing constipation, bloating, enlarged abdomen, urine flow blockage, discharge or hemorrhage.

According to scientists at the National Institutes of Health, risk factors for fibroids include age, African-American ethnicity, early menstruation and obesity. They outline menopause, giving birth, and exercise as possible risk reducers.

While fibroid tumors account for one-third of the 600,000 hysterectomies in the United States, less invasive alternatives are available. With a myomectomy, fibroids are excised using laparoscopic or open surgical techniques, and with fibroid myolosis, the fibroid is zapped with electricity. Endometrial ablation, removal of the uterine lining, reduces excessive bleeding, but does not treat many symptoms related to fibroid size. However, uterine fibroid embolization decreases fibroid size through insertion of a catheter that deposits tiny particles of polyvinyl alcohol into the blood vessels, restricting the blood flow to the fibroid and causing tumors to shrink.

Doctors say Lupron, an estrogen-production blocker administered by monthly shots or as a nasal spray, is the most common drug used to treat fibroids, but has menopause-like side effects that may include loss of bone density, hot flashes and anemia.

The Uterine Fibroids Research and Education Act, currently being considered by Congress, would allocate $10 million for fibroid research, public information and education.


Arthritis, an annoying, painful disease that erodes the joints, affects women two to three times more than men. Approximately 43 million Americans have some form of arthritis and 8.4 million of them are between the ages of 18 to 44. Indications that arthritis is present include joint swelling, decreased movement and joint pain or tenderness.

Contrary to popular belief, arthritis is not a single disease. More than 170 types exist, including osteoarthritis, rheumatoid arthritis and fibromyalgia. Although the term arthritis means "inflammation of the joint," the joints are not inflamed in all types of arthritis.

Most people over age 65 with arthritis have the most common form of the disease known as osteoarthritis, which most likely victimizes those who are either female, obese or those who have a family history of the disease.

Joint pain and swelling can often be relieved with nonsteroidal, anti-inflammatory drugs such as ibuprofen and Celebrex. Acetaminophen is used to alleviate pain, while steroid medications are recommended to reduce inflammation. More advanced cases of arthritis call for surgery to repair or replace joints. Reducing excess weight relieves pressure on knees, and exercise helps to keep joints flexible.

To alleviate the effects of arthritis, doctors suggest:

* Losing weight to cut the risk of osteoarthritis in the knees.

* Getting an early diagnosis to decrease joint damage and pain.

* Wearing sunglasses, a hat and sunscreen to reduce vulnerability to the sun's rays, which negatively affect some forms of arthritis and medication.

* Getting adequate calcium in your diet to decrease the risk of osteoarthritis.

* Taking a warm bath before bed to help relieve muscle tension and joint pain.

* Stretching to loosen stiff joints and sore muscles.

* Stopping smoking to decrease the risk of developing osteoarthritis and rheumatoid arthritis.


Lupus is a chronic form of arthritis that accounts for nearly 15 percent of all arthritis-related deaths, and the death rate is more than three times higher for Blacks than Whites, doctors say. In the past 20 years, the number of deaths due to lupus increased by 70 percent among Black women aged 45 to 64.

Women, who die of lupus five times more often than men, usually are diagnosed with the disease between the childbearing years of 15 to 40. According to a report by the Centers for Disease Control and Prevention, 4 million Americans suffer from lupus, which causes the immune system to attack connective tissues, creating joint pain, fatigue, rashes, sensitivity to light, hair loss, weight loss, swollen lymph glands and low-grade fevers. More advanced cases can cause infections, hardening of the arteries and damage to the kidneys, heart and nervous system.

Late diagnosis, not following medical advice and inadequate access to health care are primary factors for the development of lupus in Blacks. Other causes include having a genetic predisposition, certain infections, some medications and exposure to ultraviolet sunlight. Studies also have linked people with lupus to being two to three times more likely to have a variation of the gene called PDCD1.

Unfortunately, there is no cure for lupus. But relaxation therapies--massage, yoga and guided imagery--along with exercise, nonsteroidal anti-inflammatory drugs and avoiding the sun can help improve the quality of life, doctors say.


Chronic Fatigue Syndrome (CFS) is a complicated flu-like illness that zaps the strength and can continue for weeks, months or even years. It is a chronic illness and, according to experts, it has no clear cause. The disease is not improved by bed rest and may actually be worsened by physical or mental activity, doctors say.

Twice as many women as men develop the syndrome, and an estimated 500,000 people in the United States have a CFS-like condition. It is most common in people 25 to 45 years of age, although it can affect people of all ages. The disease's symptoms are similar to many viral infections. In addition to persistent fatigue not caused by other known medical conditions, CFS has eight possible primary symptoms. These include:

* Loss of memory or concentration

* Sore throat

* Painful and mildly enlarged lymph nodes in the neck or armpits

* Unexplained muscle soreness

* Pain that moves from one joint to another without swelling or redness

* Headache of a new type, pattern or severity

* Sleep disturbance

* Extreme exhaustion after normal exercise or exertion

In order to be diagnosed with CFS, according to the Centers for Disease Control and Prevention, a patient must have four or more of the above-noted symptoms and chronic fatigue of six months or longer, with other known medical conditions excluded by clinical diagnosis.

A CDC study found that the disease was most common among women, among Blacks and among persons with household annual incomes of under $40,000. Additionally, the study found that the disease was least common among Asians and Whites. Risk factors can include extreme stress or anxiety, a flu-like illness that doesn't completely go away and poor eating habits.

Although physicians suggest reducing stress and anxiety as part of the treatment, having the illness may actually increase both conditions. It is important to discuss the treatment plan thoroughly with your health provider and to get support from friends and family. Symptoms may not improve immediately.

Treatment programs are primarily directed at relieving symptoms to help the patient regain some level of pre-existing function and can include anti-depressants and drugs to boost the immune system. Pain relievers and anti-inflammatory drugs can help relieve muscle and joint pain, while support groups and stress-management techniques can increase a patient's coping ability.

COPYRIGHT 2003 Johnson Publishing Co.
COPYRIGHT 2003 Gale Group

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