Resources

Comprehensive guide to heart disease in women

WOMEN ARE NOT SMALL MEN. LIFE-SAVING STRATEGIES FOR PREVENTING AND HEALING HEART DISEASE IN WOMEN

Author: Nieca Goldberg
Ballantine Books, c/o Random House of Canada, Ltd, 2775 Matheson Blvd E, Mississauga, ON L4W 4P7
2002/453 pp/$38.95
OVERALL RATING Very good
STRENGTHS Comprehensive and insightful
WEAKNESSES Too long, referencing is sporadic, and recommended resources are sparse
AUDIENCE Middle-aged women, cardiologists, family physicians, and those in cardiac rehabilitation

Dr Goldberg is a woman with a mission: to give women the information they need to understand and address their heart disease or potential for it. In this book, she explains clearly both cardiology and cardiac rehabilitation and demonstrates an engaging empathy for the common experiences of women who either have or are at risk of heart disease. The book is written in the first person; it is as if the author is having a “heart-to-heart” talk with other women. It is full of stories of women’s lives and the facts they need to know.

The book begins with Goldberg’s own experience as a resident, where she witnessed the underdiagnosis of heart disease in women, in part due to the incomplete understanding that women with heart disease often present differently than men. She then describes the symptoms of a heart attack, followed by a comprehensive chapter on “Are you at risk?” and discusses classic risk factors, emerging risk factors, and less known risk factors for heart disease in women younger than 40 (eg, polycystic ovary syndrome).

Stress and heart disease in women is emphasized more than usual. Nonetheless, the author also cites research on depression as a possible risk factor and the importance of social support. There is a long chapter on hormone replacement therapy that carefully reviews its known risks and benefits, as well as the recent evidence from the Heart and Estrogen/progestin Replacement Study (HERS) against using hormone replacement therapy for primary or secondary prevention of heart disease.

The book alternates between chatty stories about women whose lives have been touched by heart disease and technical information. It explains simply the anatomy and basic physiology of the heart, common diagnostic tests, and cardiac and related medications. In describing ß-blockers, for example, there are subsections on “what they are prescribed for,” “potential side effects,” and “possible interactions,” followed by a table entitled “commonly used ß-blockers,” which identifies their generic name, brand name, and dosages.

The best part of the book is the section on the Women’s Healthy Heart Program, which begins with a chapter on “Your Commitment.” Lifestyle change is difficult and not always successful. Goldberg notes that many women see heart disease as something they should hide. She suggests that what underlies the “mountain of excuses” is denial and that the first challenge for women is to simply face the reality that they have heart disease or are at high risk of it. She notes women’s tendency to put the needs of others first and makes an impassioned pitch for women to take time for themselves and to cultivate healthy lifestyles, which in turn benefits families.

The book is full of practical suggestions to help make heart-healthy lifestyle changes. She shares her own tips, such as walking to and from work, eating whole-grain cereal with skim milk and fresh fruit for breakfast, and her penchant for grilled tuna sandwiches. She offers numerous stress reduction techniques, from prayer to meditation, identifies the need for women to verbalize their feelings and experiences, and recommends group activities or support groups.

There is an excellent section on “supplements,” including everything from garlic to ginseng to ephedra. Goldberg acknowledges that women might have an aversion to medications and often have an interest in “less toxic” alternative therapies. She gives examples of women who have used these treatments, reviews the evidence, and then offers some “bottom line” advice. For example she notes: “Although I do not discourage my patients from using Co-enzyme Q-10... it is not a cure.” In the section on ephedra, however, after citing reports from the Food and Drug Administration of injuries and deaths she notes: “If you are at risk for heart disease or have high blood pressure, do not take these supplements.”

A good glossary explains common cardiology terms, and a good index makes it easy for women to find what they want. There is some reference to the medical literature, but this is inconsistent. The HERS study, for example, has its own section and is referenced. The Heart Outcomes Prevention Evaluation (HOPE) study (that casts doubt on the benefit of vitamin E), is mentioned but not referenced. Most disappointing was the resource section at the end, which identifies only the websites for the American Heart Association and the National Coalition for Women with Heart Disease, and one exercise video.

This book is a very good resource. Like any book in a rapidly changing field, however, it risks becoming dated and will need to be updated in a few years. Doctors might want to get this book to illustrate or explain common cardiac problems and procedures to their patients, to recommend that their patients read it, and to read it themselves to gain fresh insights into effectively addressing the needs of women in preventing and treating heart disease.

—Patricia Huston, MD, MPH

Dr Huston is an Assistant Professor in the Department of Family Medicine at the University of Ottawa in Ontario.

Straight talk about depression

DEPRESSION AND BIPOLAR DISORDERS

Author: Virginia Edwards
Key Porter Books, 70 The Esplanade, 3rd Floor, Toronto, ON M5E 1R2; telephone (416) 862-7777; website www.keyporter.com
2002/160 pp/$19.95
OVERALL RATING Very good
STRENGTHS Concise, comprehensive overview of depression with a matter-of-fact tone
WEAKNESSES None
AUDIENCE Depressed patients and their families

This is a good book for family doctors to recommend to depressed patients or their families. It is clearly written, packed with information, and covers many topics doctors might not have time to discuss during office visits. The book would also help patients develop specific questions to ask their treating or referring physicians. It offers relevant eye-opening statistics and clinical illustrations; addresses highly specific contexts for depression, such as infertility and abortion; and offers bullet lists of practical guidelines. As well, there is a helpful “Further Resources” list for reference.

In chapter 1, there is no mention of the Beck Scale for depression nor of the Diagnostic and Statistical Manual of Mental Disorders, although many readers will find these on the Web. The Hamilton Scale is mentioned, but a chart or graphic aid would help.

In chapter 5, “Psychosocial Therapies,” the author includes this valuable comment: “When we change the way we think and feel, we change what is happening chemically in the brain. When we change the chemical balance in the brain with drugs, we change how we think and feel.” Short-term therapy is mentioned repeatedly, but the necessity for long-term work in chronic unresponsive depression is omitted.

Chapter 6, “Medications,” might be one of the more valuable chapters for patients to demystify jargon, neurochemistry, and side effects, but lacks an important distinction between agitation as a side effect and the more dangerous akathisis, which could play a role in suicidal impulsivity.

This book is considerably useful for patients who want an overview of depression and enough detail to help them further discuss depression with their doctors. The book is also useful for doctors to scan for concise explanations of a complex area or to loan to depressed patients.

—Michael S. Cord, MD

Dr Cord is Toronto Psychoanalytic Society and Psychotherapy Guest Mentor for the Ontario College of Family Physicians and General Practice Psychotherapy Association.

Clinical topics in cardiology

HEART FAILURE IN PRACTICE

Authors: Bernard S.P. Chin, Michael K. Davies, Gregory Y.H. Lip
The Royal Society of Medicine Press Limited, 1 Wimpole St, London, UK W1G 0AE; telephone +44 (0)20 7290 2900; fax +44 (0)20 7290 2929; website www.rsm.ac.uk
2002/76 pp/£14.95
OVERALL RATING Very good
STRENGTHS Up-to-date and detailed, summary notes highlight important points
WEAKNESSES None
AUDIENCE Family physicians, internists, cardiologists, and hospitalists

Heart Failure in Practice is a companion book to Atrial Fibrillation in Practice (see below). It is intended for all those who treat heart failure. It is well written and aims to provide a concise overview of heart failure.

The book has chapters on etiology, pathophysiology, clinical features, investigation, and treatment of heart failure. There is an entire chapter on management pathways for heart failure. There are also excellent appendices on primary care heart failure guidelines and hospital heart failure management guidelines. Very helpful summary notes illustrate the most important points.

Heart Failure in Practice is up-to-date and discusses modern medications. It has a discussion of systolic and diastolic heart failure. Most of the important recent clinical trials are presented and reviewed. There is also a discussion of cardiac transplantation in adults with heart failure.

Heart Failure in Practice is a fine book that achieves its goal of providing an overview of this condition. It is current and useful, and I will continue to refer to it regularly during the course of my clinical practice. I recommend this book highly to all those who treat heart failure.

—Doug MacIver, MD, CCFP

ATRIAL FIBRILLATION IN PRACTICE

Author: Gregory Y.H. Lip
The Royal Society of Medicine Press Limited, 1 Wimpole St, London, UK W1G 0AE; telephone +44 (0)20 7290 2900; fax +44 (0)20 7290 2929; website www.rsm.ac.uk
2002/68 pp/£14.95
OVERALL RATING Good
STRENGTHS Short, readable, and detailed with frequent summary notes highlighting important points
WEAKNESSES At times, too heavy on presenting raw data
AUDIENCE Primary care physicians

Atrial Fibrillation in Practice is intended for general practitioners. At only 68 pages, busy primary care physicians can read it cover to cover.

The book is organized logically, with chapters on epidemiology, etiology, pathophysiology, and investigations, and several chapters on treatment. Each chapter has helpful summary tables highlighting the important points detailed in the text. The text itself frequently refers to clinical trials. The author provides many figures showing the results of the various clinical trials he discusses. This provides more than enough detail for family physicians but slows reading down.

The chapter on antithrombotic therapy is disappointing. It provides a relatively detailed overview of risk stratification for prevention of stroke with acetylsalicylic acid or warfarin. The author, however, does not give his opinion as to which patients are most suitable for taking ASA alone instead of warfarin. In a table taken from his own article published in the Lancet in 1999, he says that, for moderate-risk patients, “treatment may be decided on individual cases.” Aside from stating that patients who have contraindications to warfarin therapy should be given ASA, and patients not on warfarin need to be periodically reevaluated, he does not elaborate further on this important point.

The author provides a good overview of atrial fibrillation. His purpose is to improve management of this most common cardiac rhythm disorder. This book is well suited for this purpose. I recommend it to any physician who sees and treats atrial fibrillation.

—Doug MacIver, MD, CCFP

Dr MacIver practises family medicine in St Albert, Alta, and is on active staff at the Sturgeon General Hospital.