NOW YOU KNOW

Heart disease is the number one killer of women in this country. Number. One. It kills more women than the next four diseases combined, including all forms of cancer.

But it didn’t kill me. At age 37 and in training for a marathon, I had a heart attack. With no risk factors save a family history of high cholesterol, I thought I knew enough to stay safe. I didn’t, but you should.

February is American Heart Month and I really want you to take it seriously. Not for me, because I survived and I’m healthy and thriving. But for the 500,000 other mothers, daughters, sisters, nieces, wives, lovers, and friends who will have a heart attack this year, and the 300,000 who will die from it.

Did you know that:

• 8 million American women are living with heart disease; 35,000 are under 65.
• The biggest risk factors are high cholesterol, high blood pressure, obesity, diabetes, smoking, and family history.
• Women’s hearts respond better than men’s to healthy lifestyle changes.
• 80 percent of cardiac events could have been prevented through healthier choices.

And if you knew the dangers and knew your risks, would you make the changes necessary to protect your heart? Would you:

• Talk to your doctor and get a lipid profile to check your cholesterol levels.
• Know your Body Mass Index and lose weight if you need to.
• Know if your blood pressure is high and take steps to improve it.
• Stop smoking.
• Make sure your doctor knows if you have a family history of heart disease or high cholesterol.

I knew that I had a family history of heart disease. I knew I had high cholesterol. I knew that women often explain away their symptoms: "I must have lifted something funny, hurt myself in yoga, maybe its heartburn," all excuses I used for days as the pain steadily grew worse for two days beforeI went to the hospital. And I knew that women's heart attacks present differently than men’s and seem somehow, inexplicably, hard for doctors to spot. I knew all that and I still never imagined this could happen to me.

But it can, it could, and it did, and it could happen to you or someone you love. And now you know.

FIND OUT MORE

The Heart Truth is the National Heart, Lung, and Blood Institute’s women’s awareness campaign, and the original Red Dress campaign. Check it out for videos, prevention tips, warning signs, and information about how you can participate in and promote national Wear Red Day in February. www.hearttruth.gov.

Check out Go Red for Women, a program of the American Heart Association, for its great nutritional center, free risk assessment tool, and a social tool “Tell 5 to Save Lives.” Go Red for Women also produced the Elizabeth Banks short video “Just a Little Heart Attack.” www.goredforwomen.org

Sources: American Heart Association, National Institutes of Health, Women’s Heart Foundation.

STRESS RELIEF

I got the results of my first post-heart attack stress test today, and the news is good. Very good.

My total cholesterol went from 230 to . . . (drumroll) . . . 106!
My LDL (bad) cholesterol went from 180 to . . . 58!!
My HDL (good) cholesterol also dropped a little, from 39 to 35, which is not the greatest news but expected, since my overall number is so low.

And even better news than that, my heart itself is in great shape. It has enough blood flow at rest and at peak exercise. It is not damaged or compromised from my heart attack. I wish you could have heard the nurse's voice on the phone when she said "and there's not even a scar!" with that little lilt of incredulity, like she didn't really believe what she was seeing.

I didn't expect this much progress either. True, I've been eating like a model heart patient, exercising 4-5 times a week, learning all I can, and taking all my bitter pills, with or without a spoonful of sugar. And though I expected some results (dammit), I didn't think it would be this dramatic. I really thought my DNA would have been more determinate.

So when you see articles and TV talk shows and PSAs where the doctors say "heart disease is largely preventable," that's really true. While I will always have it, if you know your numbers and commit to the necessary changes, you won't. Because all this stuff -- diet, exercise, and medication and focus and sacrifice and love and prayer -- actually works.

ALL IN THE FAMILY

I can't begin to imagine what it is like to be a person close to me. I don't know what it's like to watch someone you love or care about have a heart attack, and I hope I never do. There's something about being the person who's in crisis, the subject of the drama, that feels, well, kinda normal. Even in the ER, the ICU, in rehab -- all along I'm thinking, feeling, acting, living. I'm just . . . me.

But what is it like to be the man driving a kid to camp, knowing only that I'm in the ER and that they gave me nitrogen? The man who sat in the waiting room through three surgeries. The man who had to go back to work and back to school, and then could do nothing more than watch and worry and wish for normalcy.

What is it like to be my friend? The one thousands of miles away but close enough to have nightmares about me. The one up at 3 a.m. with her newborn and reading my text from the ICU alone in the dark. The ones who fed me and pampered me and made me laugh, but who look in the mirror and wonder if they are in danger. I will never know.

My brother Mike and me, after
the 2009 Twin Cities Marathon.

What is it like to be my parents? This is one to which I can at least relate; I've stood by my child's hospital beside before. If you are a parent in that place, you think the world should simply stop moving until your child is safe. And you're bewildered when faced with evidence that it doesn't.

How about my brother and sister, who share not only memories of our treehouse and summers at the lake, but also my DNA? Are they scared for me? Are they scared for themselves? Well I should hope so. I was still in the ICU when I suggested, in the bossy way only big sisters can, that their doctors might be interested in the fact that I just had a heart attack and they'd better give him or her a call.

They did and they were. Both had consultations, blood work, and more testing. My brother had a stress test and my sister a calcium CT scan. I'm happy to report that both tests were normal, though Mike's cholesterol is sky-high. My sister's cholesterol numbers are actually the same as mine: higher than normal but not outrageous, especially by our family's standards. Both are now on medication, and their families already eat healthy and exercise plenty.

My dad (red hat) and sister, Anna, (holding my son Noah), with
our brother Dylan (left), my nieces Lydia and Alayna, nephew
Isaiah, my sister-in-law Kimi, and my son Owen at one of his
baseball games this summer.

But knowing that my brother, my sister, and I are the Three Musketeers of Shared DNA makes me want to know more about how familial hypercholesterolemia is inherited. Between us, my siblings and I have 10 children. I've already had my older son's lipid profile checked (he's 10 years old; it was normal), but I'm worried about all of them. Will they all get it? When should we start checking? What changes should we make in their lives now?

So here's our family history: My father has high cholesterol and heart disease. He's had two angioplasties but never an actual heart attack. He's super-fit and exercises every day and has been managing his disease for 20 years. His father, my grandfather, has high cholesterol, but no angioplasties or any blockage that we're aware of; he's also very fit and has watched his diet for 47 years and counting.

My mom and me.

My dad's mother, my grandmother, had angioplasty and a stent to clear a 90 percent blockage five years ago (she made it to the hospital in time to avoid a heart attack). She's never been other than super-fit and healthy. My dad's grandfather died at age 45 of heart disease.

My mother does not have high cholesterol or heart disease and neither did her mother. Her father had three heart attacks, all in his 50s and 60s, but he died at 79 of Parkinson's disease.

So you see, I come by this condition very honestly.

Familial hypercholesterolemia is inherited in an autosomal dominant manner, meaning you only need one copy of this gene to get it. It is caused by a mutation on gene 19 (in case the super-detail-oriented among you are wondering) and can be passed from one parent to some or all his or her children. Each child of a parent with familial hypercholesterolemia has a 50% chance of inheriting the disease.

That does not mean that five of our 10 will have it.It could mean two of them, all of them, or none of them will. But since I had no other risk factor for heart attack besides family history, it definitely means vigilance starts now.

According to Scott Kahan, MD, MPH, a preventive medicine specialist at the George Washington University Weight Management Program, many adult diseases begin in childhood,often early childhood.



Running cousins after the
Twin Cities Marathon family races.

“Heart disease, in particular, has been shown to begin quite early in life in many cases," he states in an article on WebMD. "Many children have blood pressures and cholesterol levels high enough to warrant treatment with adult medications."

The American Association of Pediatrics recommends screening for children with a history of high cholesterol or blood fats, or a family history of premature heart disease (age 55 or younger for men, age 65 or younger for women). The first screen should be after age 2 but before age 10; if it is normal, it should be repeated every 3-5 years.



Treatment and prevention, of course, is about as common sense as it gets: feed your children well and make sure they exercise. Set a good example with what you eat and how active you are. Don't smoke so they don't start. And with our genetic history, lipid screening starting at a young age.

These are the wonderful children who share my DNA. Being Aunt Jenny is one of my favorite identities, and I love my nieces and nephews second only to my own sons. I'm so grateful to share in their lives.

All 10 awesome kids, ages 17 to one month. This was taken in May 2010.

I'm also grateful that my sister's family, my brother's family, and mine have years of practice raising healthy families; these changes would be so much harder if we didn't. My brother and I started running in 2008 and my sister recently treated her family to "a month from scratch" cooking. Everyone has farm shares or gardens and cooks from whole foods. The cousins run races together, play sports, ride bikes, and play at the park. They eat their fruit, veggies, and grains, eagerly tucking into things like black beans, pumpkin pancakes, quinoa, and plain yogurt, all of which I'm positive I would not have touched as a child. Of course they like their candy and Doritos and video games too, and I've had to cut out my son's favorite salami and nearly all red meat. But the foundation is in place for healthy eating now, and in the future.

While I don't really want these kids to know enough about what happened to me to worry, I do want them to know. I want them to tell their doctors, when they are young men and women and on their own, that they have a family history of heart disease. That their mother or aunt had a heart attack. I want them to know their cholesterol numbers. I want them to know the risk factors and symptoms.

I want them to know. So their brothers and sisters and parents and friends never have to.