Wednesday, March 11, 2015

From the Third Metric Straight to the Heart

As some of you may know, I am a spokesperson for The Go Red for Women movement, spearheaded by the American Heart Association. This movement started 11 years ago, with its mission of educating and empowering women about their heart risks and heart health.



Each year around the country, there are events to help with this mission. Ours is a luncheon with education, awareness-building, and a little bit of glamour thrown in (because...why not?). We have 1300 people in attendance and we do everything we can to shed light on all that we know about women's hearts, and the gaps in knowledge and practice that we still need to fill. On this tiny island of Manhattan, hospitals and cardiologists and physicians dealing with women's hearts come together to make a difference at this one event.



This year's Go Red for Women Luncheon in New York City was extraordinary, with the passion in the room palpable and the sea of red a sign of support and that times are changing. There was something about this year's celebration for women and heart disease awareness, education, and empowerment that feels serendipitous. Maybe it was the fact that our keynote speaker was Arianna Huffington. Arianna Huffington, author of The Third Metric: Redefining Success Beyond Money and Power, gave us an understanding of the importance of the intangible in her important book. She wrote about how essential it is to live with energy and vitality. Unlike so many other business books, she puts a value on happiness. This is similar to the concept in my book, when I talk so often about the importance of "living from the heart." We use different terminology, but the sentiment is the same: There are things we cannot possibly measure that make a big difference in the quality of our lives (and the health of our hearts!).



All of this has led me to think in great detail about what I want to say. During this event, I was the moderator of a panel discussion before the formal luncheon, and my intention is always to educate the audience about some aspects of women's hearts prior to the awards and hoopla of the day. Besides discussing the basic risk factors for heart disease (high blood pressure, high cholesterol, diabetes, smoking, sedentary lifestyle, smoking, obesity, family history, and stress) and how to counteract them (diet, exercise, quitting smoking, and meditation), I decided that this year, I really wanted to tap another space: the Third Metric.



We know through the research on women's hearts that what leads to heart disease in women is do not have the same effects as they do on men's hearts. Doctors know the standard and usual risk factors, but when it comes to women, there are other risk factors that tend to have a greater impact. We know through the studies that sometimes women's heart risks lie in the same location as the Third Metric. They lie in the metaphorical heart. They lie in our minds and in the way we approach our lives. How do you prescribe a medication to heal issues that come from an intangible place -- a place you cannot test or measure or see? This is our newest and greatest challenge.



This is what I want to talk about, both at the event and with every woman who reads my articles. Although we may not be able to measure it, we know the role that stress and depression and heartache can play in the development of heart disease in women. The data prove that this is real, and if we ignore it, we do so at our own peril.



So let's go there, to this "land" beyond the tangible, beyond the list of oft-recited heart disease risk factors, where risk thrives. In this space, our brains can wither or flourish and our hearts can sing or sigh. This is a place where heart disease can be born, or where it can be thwarted. It is a place that creates sadness and also joy, and although emotions can't necessarily be measured, they certainly have a measurable influence on our bodies. They influence (either increasing or decreasing) blood pressure, arterial plaque accumulation, inflammation, and the release of stress hormones as well as the release of pleasure hormones. If we don't pay attention to what is happening in this place, then we are missing a major risk factor that many doctors may never mention.



Yet we know what happens here. Anxiety, hostility, social isolation, depression, and pessimism are risks that we know lead to heart disease, and often play a significant role in the development of heart disease, especially in women. In the American Heart Association's Women and Heart Disease guidelines, originally written in 2005, then again in 2007, with an update in 2011, there is finally some discussion about the role of these other risk factors, and that's great news. These guidelines also discuss how women and their heart disease risk is unique. I believe this is a sign that the medical profession may finally be waking up to the Third Metric -- that place beyond the standard guidelines, that place that lives inside of us, in our metaphorical and also (I believe) our literal hearts.



With Arianna in the house, I believe the conversation this year needs to reflect an awareness of the Third Metric. And it looks like that might happen. This year's panel is going to talk about living with passion and with a purpose and how the incidence of heart disease decreases when someone lives, as I say, from "the center of her own personal universe." In one study, those with a high purpose for living had a decreased risk of dying during the study by about 57 percent compared to those with a low purpose. Simply "living from the heart" can decrease your rate of dying from heart disease. On an intuitive level, that makes sense, as we know how we feel when we are doing something we love to do compared to being forced to do something we don't like.



On the flip side, living without passion and purpose often leads to depression. In one study published in the Journal of the American Heart Association, depressed women were 14 times more likely to die of heart problems compared to those who were not depressed. In this study, 58 percent with moderate to severe depression had heart disease compared to 38 percent with mild or no depression. Depression is a critical piece that cannot be ignored, and should be addressed. The reality is, it could be hidden and masked within the doctor's office or to the people that might be able to help. Behind closed doors, though, we also know that often leads to other unhealthy behaviors and a decrease in someone's ability to care for herself.



I don't want to over-simplify matters like depression, nor do I want to tell you that getting a hobby will cure your heart disease. I understand the complexity of the body, the heart, and the mind. However, what I want you to understand is that we cannot ignore the inner life of a woman when evaluating her heart disease risk. If she is socially isolated, without having friends or family who are confidantes and companions, who give emotional support and concern, that is an independent risk. There is no doubt. In a study of 3,432 heart attack survivors, ages 18-55 years old from the VIRGO trial, analyzing heart attacks especially in younger women, those with low social support tended to smoke, abuse alcohol and have other risk factors for heart disease such as high blood pressure, diabetes and depression. It is clear that we all need to be surrounded by support to allow us to share our lives, our thoughts, our feelings, and to help nurture our needs. In women, the need to connect with people, to "tend and befriend" in order to manage stress, is absolutely essential to maintaining a healthy heart.



What this all comes down to is stress. Passion, purpose, and social support relieve stress. Isolation, frustration, overextension, depression, and a perceived lack of meaning in life increase stress. We know this. In women less than 55 years old, job stress has been associated with a 35 percent increases in heart disease risk. Stress hormones increase heart rate, blood pressure, inflammation, clotting, and decrease the immune response. Heart disease is the natural progression of chronic stress over time with stress management techniques like meditation, yoga, breathing, relaxation, and exercise. This is critical because especially in women, stress can kill you before cholesterol even has a chance to cause a problem.



The short version is that when it comes to the heart, we need to look at the big picture. "Risk" is a big word with a definition that goes far beyond what we once believed in the medical profession. It involves everything that drives our lives and fills our minds. All of that affects our hearts. How you perceive your life and how you wake up each day and approach the world has an impact on the health of your heart.



So let's reassess. Let's talk about this. Let's wake up and welcome the day, smell the flowers, laugh at the rain, or chuckle at traffic. Smile at your neighbor and thank your lucky stars. Head to work with a skip in your step and the feeling that you are doing what you are meant to do. Be thankful for your friends and your family and take a moment to breathe. Live in a way that feels simple and easy and good to you, and maybe reach out to support the other women in your life, so they can find their way, too.



Add a quick jog around the block, a bowl of oatmeal or a square of dark chocolate, and something you love to do, and you've taken a major leap towards a healthier heart. You've reduced your risk in a big way. Have a little faith in the goodness and power of your own life, and then get out there and live it. And, that's where the Third Metric begins...



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