Health News Review

Go Red for Women.jpgAlmost as if the American Heart Association felt it must compete for some of the pinkwashing attention given breast cancer in October, it presents its “Go Red for Women” campaign with the message, “Make it your mission to fight heart disease in women.”

As with so many disease awareness campaigns, this is, at its conceptual core, a noble goal.

But as with so many disease awareness campaigns, it is the framing of the message that can be problematic.

AHA features a video of actress Elizabeth Banks – who some online sources say is 37 years old in real life – having a heart attack. Many TV viewers may associate her most recently as being of childbearing age after her pregnant portrayal on NBC’s “30 Rock.”

Why would the American Heart Association choose to profile such a young actress in its featured video?

We went to the Risk Assessment Tool for Estimating 10-year Risk of Developing Hard CHD (Myocardial Infarction and Coronary Death) of the National Cholesterol Education Program of the National Heart, Lung and Blood Institute. We entered the following data points for Ms. Banks’ character in the video. (Let’s not quibble about the numbers we pulled out of thin air. The video gave us no details about the hypothetical character it chose to feature. If anything, we chose some risk numbers that were worse than what would be supported by anything in the video.)

Age: 37
Female
Total cholesterdol 250 mg/dL
HDL cholesterol: 25 mg/dL
Nonsmoker
Systolic blood pressure: 170 (unmedicated)

So what is this hypothetical character’s 10 year risk of having a heart attack?

2%

Should the American Heart Association choose to feature – for all women to see – someone who – at worst – has a 2% risk over the next 10 years of having a heart attack?

We could debate that for a long time. But we think it’s disease-mongering. They could have made the point every bit as effectively by featuring a more representative/realistic demographic in an equally appealing and humorous leading lady.

Heart disease in women is a very important problem – one that often doesn’t receive enough attention. But why not give it proper attention? Not presenting an unrepresentative risk profile as the featured case study in a featured video.

Note that the department store Macy’s and the drugmaker Merck are key sponsors of the campaign. Both would love to reach a younger female demographic with their “Go Red” (see green $$$) support of this campaign. Macy’s would love the shoppers. Merck would love the heart drug business.

There seems to be no end to the disease awareness disease-mongering.

Comments

Marilyn Mann posted on October 6, 2011 at 1:20 pm

I agree, presenting such a young woman having a heart attack seems silly.

BD posted on October 6, 2011 at 8:53 pm

Ok, I get the point. But if you want to increase awareness and positively affect health behaviors, it’s a lot easier to grab attention of potential audiences with pretty young blond women (PYBW). It may sound crass, but if you’re on the PR team of the AHA, you really really want people to see your campaign and PYBW will simply draw more eyeballs. Besides, you missed the truly offensive/distressing part of the video. They crafted a storyline where the child is smart enough to recognize his mom may be having a heart attack and then they script him LEAVING HER ON THE FLOOR! After picking up her phone and NOT dialing 911, but rather doing a google search for heart attack symptoms. Ick.

Carolyn Thomas posted on October 9, 2011 at 9:50 am

Marilyn, a comment like “presenting such a young woman having a heart attack seems silly” simply makes you seem unaware.
I’m a heart attack survivor who was misdiagnosed with acid reflux and sent home from the E.R. in mid-heart attack despite presenting with textbook heart attack symptoms like chest pain, nausea and pain radiating down my left arm. I left the E.R. feeling so embarrassed because I had “made a fuss over nothing”. And I’m not alone. A study of over 10,000 patients presenting to the E.R. with cardiac symptoms reported in the New England Journal of Medicine found that women under age 55 are SEVEN TIMES more likely to be misdiagnosed and sent home from Emergency compared to men with the same symptoms – with often deadly results. Being sent home doubles a woman’s risk of death. “You’re too young to be having a heart attack” is an all-too-common and potentially fatal response to far too many of us.
And that’s if you can somehow convince women to take their symptoms seriously enough to actually seek help in the first place! This is the real beauty of the Elizabeth Banks film – “I can’t be having a heart attack!” is such a tragically common response among women, young AND old. In fact, Oregon researchers have even identified six ‘treatment-seeking delay’ behaviours in women heart attack survivors that are illustrated in every single frame of this film.
Women’s unwillingness to seek help despite cardiac symptoms is happening because heart disease – all heart disease! – is still widely considered a man’s problem. When the American Heart Association surveyed physicians in 2005 to see how many were aware that heart disease kills more women than men every year (a stat that’s been true since 1984), the results were astonishing: only 8% of family doctors were aware of this fact, but – even more alarming! – only 14% of CARDIOLOGISTS knew it. Before you slam another public awareness campaign like this, please visit WomenHeart: The National Coalition for Women With Heart Disease at http://www.womenheart.org for some actual facts.
I work very hard every day through my public presentations about women’s heart health and my blog, Heart Sisters, trying to convince women to take their cardiac symptoms seriously. Most women don’t. We need to somehow convince women – yes, Gary, especially younger women – to pay attention to ALL cardiac symptoms and then more importantly to seek immediate help. Women are already experts at denying and ignoring danger signs – we don’t need blanket dismissals like yours to further encourage us to ignore symptoms.

Gary Schwitzer posted on October 9, 2011 at 10:15 am

Carolyn,
Thanks for your note, but please don’t miss this key part of my original post:
“Heart disease in women is a very important problem – one that often doesn’t receive enough attention. But why not give it proper attention? Not presenting an unrepresentative risk profile as the featured case study in a featured video.”
You refer to another site “for some actual facts.” But I didn’t blog about that other site. I blogged about this video on the AHA site.
This video didn’t include facts. It was clever and well-produced. But as THE featured video in this campaign, does it convey a representative portrait of heart disease in women?
I don’t think so. A possible portrait? Yes. Representative? No. So why was it used?

Marilyn Mann posted on October 9, 2011 at 10:32 am

Carolyn
Actually, I am aware of the phenomenon you speak of — women’s heart-related symptoms not being taken seriously. My mother-in-law had that happen to her when she had her first heart attack at age 58.
My point was simply that they should have used a woman who was more representative of women who have heart attacks. It is very rare for a woman in her thirties to have a heart attack.
I might add that I don’t appreciate the tone of your comment. I am quite aware of the seriousness of heart disease both in terms of morbidity and mortality. For many years I watched helplessly as my mother-in-law suffered the pain and discomfort of heart failure, severe coronary artery disease, atrial fibrillation and peripheral artery disease (including painful leg ulcers). I can only assume that you don’t know me.
Marilyn

Carolyn Thomas posted on October 9, 2011 at 10:58 am

Hi Gary and thanks for your response to my comment.
“Why was it used?” Simple. Same reason that all successful public awareness campaigns work.
First, they need to grab the attention of their target market. This one does that by being both “clever and well-produced” and by showing a scenario (the harried, multi-tasking mom trying to get her family out the door on time every morning) that will instantly resonate with most mothers, no matter what age. Making it both hilarious yet compelling works.
Second, this video DID in fact include a number of important facts in beautifully illustrating women’s most common cardiac symptoms: neck pain, jaw pain, sweating, nausea, chest pain, dizziness, weakness – all there in spades and portrayed in a very memorable fashion. Please rewatch the film as it appears you missed those “facts”.
Lastly, was it “a representative portrait of heart disease in women”? I guess the AHA could have instead chosen for you a star who was more “representative” for your liking (fat? middle-aged? smoking? which would you have recommended?) but would that choice have been any more helpful than all the clinical literature gathering dust in your doctor’s office, all of it ignored by the very people who most need to know about it? The truth is that many 30-something women DO have deadly cardiovascular issues including but not limited to heart attack. (Elizabeth Banks herself has both a sister and mother diagnosed with serious cardiac arrhythmias).
Gary, we’re fighting a losing battle here when it comes to convincing women (and their physicians!) that heart disease is not just a man’s issue, and we’re having an even harder time convincing younger women.
The common reality of women’s refusal to seek medical help even in mid-heart attack is so serious that any and all attempts to help educate us to take our cardiac symptoms seriously clearly outweigh any criticism you may personally harbour about how realistic a 37-year old having a heart attack may or may not be. Please believe me, it is entirely realistic.

Gary Schwitzer posted on October 9, 2011 at 11:37 am

Carolyn,
Entirely realistic – but unrepresentative. I feel as if we are going in circles with this discussion.
The video featured a woman who – according to NHLBI’s risk calculator – may have something like a 2% risk over the next 10 years of having a heart attack – and that’s using some fairly negative risk factor estimates. Since the video didn’t give any background on the hypothetical woman’s risk factors – even though it had plenty of time to do so in its more than 3 minutes (except for the stressful situation we saw her in), all we can do is pick hypothetical cholesterol and blood pressure numbers.
So, yes, it may be a realistic portrayal – for a woman who represents a minority of the overall cardiovascular health burden in women. I am not dismissing the prevalence of that problem. Yet, on the AHA’s Go Red For Women website home page at this moment (I just rechecked), almost every face featured is that of a young woman. This presents a skewed picture. Period. Anyone who has followed my work knows that I have devoted my career to accurate, balanced and complete information on health care. This video didn’t meet those standards.
We’re also often “losing a battle” in elevating the discussion about health care issues and in helping people to critically analyze the framing of health care messages from any source.

Laura Haywood-Cory posted on October 9, 2011 at 12:14 pm

Gary, as I’m sure you’re aware, around 80% of heart disease is preventable. Heart attacks are on the rise in younger women, while the prevalence of heart disease among younger men is falling. And the mortality rates among younger women who have heart attacks is higher than it is for men in the same age group. Furthermore, only around 27 percent of the heart disease research in the US is currently done on women, despite the fact that heart disease kills more women than men every year.
We need to grab women’s attention EARLY and start making them think about developing a heart-healthy lifestyle, before it’s too late. Speaking just for myself, as a 43 year old woman who had a heart attack at age 40, heart disease was NOWHERE on my radar. Nowhere. I was concerned about my family history of diabetes, but heart disease? No way. That’s something for old people. (Boy, was I wrong.)
I can tell you, again, from my perspective, that if I’d been able to see this Elizabeth Banks video a few years ago, it would have been a real eye-opener to me. And messages like the one in this video resonate more with me, because the person in them is someone I can relate to.
If, as you suggest, they’d made the video with a “typical” (what would that be, exactly, anyway?) female heart disease patient, who would you suggest? A fat, gray-haired smoker? Being none of the above, I can tell you that I would have *completely* tuned out the message, because it’s clearly not relevant to me.
The incidence of heart disease is on the rise in younger women, and as I said above, we need to catch their attention now, using someone whom they can relate to, so that the message doesn’t get brushed aside. I don’t feel like that’s an unworthy goal.

Gary Schwitzer posted on October 9, 2011 at 12:34 pm

Laura,
Thanks for your note.
You wrote: “We need to grab women’s attention EARLY and start making them think about developing a heart-healthy lifestyle, before it’s too late.”
But this video didn’t do anything to educate young women about a heart-healthy lifestyle. As journalist Larry Husten, who writes about cardiovascular topics fulltime on his Cardiobrief blog, wrote:

“Although heart disease is indeed the #1 killer of women, it is almost certainly NOT the #1 killer of women of child-bearing age like Elizabeth Banks. In the absence of hypertension or diabetes, an otherwise healthy woman like Elizabeth Banks is extremely unlikely to have a heart attack.

In targeting this population, wouldn’t it make much more sense to recommend risk factor screening and modification (where appropriate and indicated, of course) rather than instilling fear in the wrong population? Or, as Gary suggested, wouldn’t it be better to use an older actress who is closer in age to the women who actually get the most heart attacks?

It’s easy to imagine young, healthy women, after seeing a video like this, returning from the gym after a hard workout and mistaking their sore muscles for a heart attack. That strikes me as a step backward rather than a step forward in women’s health.

Like everyone else, young women need to know about the various risk factors for heart disease, but for the most part they can also take comfort in the thought that they have enough time to do something about their risk.”

As you can see from some of the comments left already on this blog, the message of this video is perceived very differently by different people. It might behoove those who craft such messages to take some of these criticisms into account. Of course, you can ignore the criticisms, but perhaps women need “convincing” and perhaps this has been “a losing battle” because messages like this one don’t achieve their well-intentioned attempt at education.

Tina posted on October 9, 2011 at 12:46 pm

Gary and Carolyn, I felt compelled to leave a comment after reading your discussions.
Gary you stated, “I am not dismissing the prevalence of that problem. Yet, on the AHA’s Go Red For Women website home page at this moment (I just rechecked), almost every face featured is that of a young woman. This presents a skewed picture.”
Are you serious! A skewed picture!
What type of picture would you rather be depicted, someone, who is 65 years old, a previous smoker, overweight, with poor eating habits? I’m sure you’re aware of the numerous forms of heart disease that affect YOUNG Women daily.
I understand that you feel, based on the numbers, this film does not accurately portray a women with risk factors for having a heart attack. However, I feel this video is not just restrictive to heart attacks, but rather is being used to inform women, specifically young women, that they are at risk for heart issues “in general.”
Personally, I am a 37 year old mother of two boys ages 17 and 9. Through high school and during my college years I was athletic and very active. I’ve never been a smoker or drinker (not even casually). However, 4 months after giving birth to my 9 year old son I found myself hospitalized with post-partum dilated cardiomyopathy, congestive heart failure, and an ejections fraction of 27%. I was 28 years old at the time!
I have battled this disease for 9 years, my EF is now 10%, I received an implantable defibrillator in 2008,and while being evaluated to be put on the transplant list in 2010 they discovered blood clots in both legs, my heart, and lung cancer of all things. I am sitting at home with a PICC Line receiving vital meds on a 24/7 continuous pump. I am praying that I in fact will not need an LVAD (left ventricular assist device). You see, due to the cancer I can’t even be listed for transplant for 5 years; and my cardiologist and heart failure team do not believe my heart will last that long.
You see Gary, even now people I encounter have a hard time BELIEVING I have heart disease. I must admit my outward appearance in no way shows the turmoil and strain my heart places on my body daily. More importantly my attitude and zest for life will never show that I am a Stage 3 Heart Failure patient.
How did this happen to me? I was a healthy, active, 28 year old woman. Just as a result of childbirth? NO, I later found out I may have had an underlying risk factor! There was a family history of heart disease on my father’s side that I was not aware of.
Articles such as yours is one of the reasons we are still fighting what seems to be a losing battle; and that is to bring AWARENESS! There is no Red vs. Pink, ALL women’s health issues are important to us!
Your comments were INSULTING to myself, and the many YOUNG women I have met at my Heart Failure Clinic, while being hospitalized, and on support group websites living with Heart Disease(yes, we’re blogging about this article and you).
So please, do not dismiss ANY attempt to inform YOUNG women to know the facts; and more importantly that they may be at risk!
Tina

Laura Yates posted on October 9, 2011 at 12:47 pm

I agree with Laura’s comment. If it had been another individual other than Elizabeth Banks in the video I would have probably just ignored it too. I never thought that I would have be in my 40′s with heart disease either but I am. Women do more now than our earlier counter parts. We’re more than just mother’s, most of us are working mother’s who squeeze more into our days than humanly possible.
The AHA video depicts just a small piece of what we our daily lives are like but I could so relate with it. The sad part of all of this is that when we as women go the the ER for a possible heart attack we still get brushed off. Too many doctors still have the old school of thought that women don’t have heart attacks. Too many times we are told that it’s just reflux or heart burn. Heart disease is more on the rise among younger women and this needs to be addressed.

tina posted on October 9, 2011 at 2:29 pm

Marilyn,
You stated, “I agree, presenting such a young woman having a heart attack seems silly.” Please explain what is so silly about this.
And then in your second post you stated, “Actually, I am aware of the phenomenon you speak of — women’s heart-related symptoms not being taken seriously. My mother-in-law had that happen to her when she had her first heart attack at age 58. My point was simply that they should have used a woman who was more representative of women who have heart attacks. It is very rare for a woman in her thirties to have a heart attack.”
First of all it is not rare for a woman in her thirties to have a heart attack. Being that you’ve had personal experience in coping with a loved one directly affected I urge you to volunteer at a local Heart Failure Clinic to get a true picture of how many YOUNG woman are affected by heart attacks and heart disease.
Tina

Marilyn Mann posted on October 9, 2011 at 3:17 pm

It is very odd to be criticized for not taking heart disease seriously. Usually what I encounter on the internet is the opposite!
You see, my 18-year-old daughter has heterozygous familial hypercholesterolemia (FH), the same disease that my mother-in-law had. This is a genetic disease caused by a mutation. My husband inherited the mutation but only has a mild version of the disease (geneticists call this incomplete penetrance). Both my husband and daughter are on a statin. I have often been criticized for allowing my daughter to be put on a statin a few years ago. I have been told that I am a drug company shill, etc etc.
I think what is shown in the video is a myocardial infarction (MI) due to atherosclerotic heart disease. This is what laypersons call a heart attack. MI is rare (although not unheard of) in women in their 30s. The reason for that is that MI is generally caused by the rupture of plaque in the coronary arteries. Plaque builds up slowly over decades starting in childhood and usually does not cause symptoms until middle age or later.
Of course, there are other types of heart disease such a congenital heart disease that even newborns can have. Unfortunately, we don’t have good ways of preventing those disorders, so far as I know.
In any case, I never said there were no young people with heart disease. Obviously, there are children and young adults who suffer from various types of heart disease. However, the event depicted in the video — acute myocardial infarction — occurs *mostly* in men over 45 and women over 55.

tina posted on October 9, 2011 at 4:16 pm

Marilyn, I was only commenting in response to your statements. As I stated before, ANY awareness bringing attention to the fact that heart attacks, as well as other forms of heart disease, affects YOUNG women should be embraced.
Reading that your own 18-year old daughter is battling a congenital disease leaves me confused as to why you feel it was silly to portray a young woman having a heart attack. You stated, “Of course, there are other types of heart disease such a congenital heart disease that even newborns can have. Unfortunately, we don’t have good ways of preventing those disorders, so far as I know.”
Personally, I had risk factors that I WAS NOT aware of. Could I say my life may be different right now? I couldn’t imagine my life without my boys, but maybe I would have considered adoption, or maybe I would have been insistent on additional testing during my high risk pregnancy instead of my symptoms being brushed off as pregnancy related by my OB. Only God knows in my case, but I do know this; the problem is many young women DO NOT know they are at risk so one good way of preventing those disorders is by knowing your risk factors.
Therefore we should support ANY efforts to bring AWARENESS, instead of attacking them.

Mary B. posted on October 9, 2011 at 7:30 pm

To respond to Marilyn’s and other’s comments, I have a couple of comments to add, and hopefully, others who doubt women’s risk factors may also make note. I, too, have LP(a) – Lipoprotein a, a familial genetic factor (about 25% of the population has this, and it also has implications in APOE genotype to Alzheimers in some cases..maybe you should check yours!). Why didn’t anybody check? Because they fell victim to the stereotypes they learned in medical school that I was a young, attractive, 38 year old menstruating woman – so they didn’t think to check beyond the normal LDL/HDL/Triglycerides (which were normal).
After 4 GPs, 4 cardiologists and around upteen years, we ascertained that my angina which started in my late 30s was indeed, angina. Microvascular Ischemia to be exact. I was finally believed by age 52 or so, and I’m damn lucky I didn’t die before I was diagnosed. Some doctors say it won’t kill you, but many of my fellow sufferers have had MIs. Some die. I think this has something to do with the statistic that in excess of 50%, women die with the first heart attack. Perhaps they die because they are not recognized in the ER, due to being “too young”, menstruating, athletic, too anxious (hm, would you be anxious with regular chest pain that was as bad as any heart attack?) and they doubt themselves. Doctors are trained in the paradigm of symptoms based upon male presentation of heart disease, which is OCCLUSION.
My angiogram was clean as a whistle. No visible occlusion. But many women have occlusion in the MICRO vasculature, which feeds the heart and it is seen with IVUS – intra vascular ultrasound performed as a specialized diagnostic procedure, if the doctor is progressive enough to order it. Also, the “challenge cath” using acetycholine will demonstrate paradoxical vessel spasm – it constricts when it shouldn’t, which is the tip off that the heart is not getting the blood flow it needs under exertion or emotion (both male and female provocation). It is now known that some of these MIs erupt from WITHIN the vessel wall, not a breaking off piece, like an iceberg of occlusion as is common in males and in (some) post-menopausal females. It is also becoming more well known that Diastolic Dysfunction (which doctors don’t normally test for during the angiogram) is more common to some degree. Whether Diastolic or Systolic, Dysfunction is Dysfunction – and it results in an ischemic heart. Ischemia leads to oxygen starvation and if not diagnosed and managed, heart attack, heart failure and the like. And yes, the pain cannot be seen with typical measurements such as an EKG, etc. Later, as pain exists and the MI is evolving, a blood test can (FINALLY) show damage occurring to heart muscle, so doctors don’t have tests to always indicate pre-MI, only tests that show post MI Damage (if you survive that is).
As a follow on comment; Heart disease is often a combination of genetics and behavior. You can have the genes and ideal behavior and STILL get disease. You can have perfect genes and terrible behavior, and you might get away scott-free. Most of us live in the grey zone of some genes and some behavior, so don’t assume that one has to be a fat, McDonalds eating, non-exercising smoker. I know several women with my condition who are fit, vegan athletic professionals – and they don’t smoke. In fact, they look a lot like Elizabeth Banks!
So, please don’t quibble with how attractive and supposedly atypical Elizabeth Banks is. What I have described is only ONE of the many conditions which could bring on a heart attack. Elizabeth Banks is a hero to me, and doing that video SHOULD shake up the paradigm – including yours. I wish good health to you and yours, and if you want to support women with heart disease, then support (don’t criticize) the message or the messenger? OK?

Marilyn Mann posted on October 9, 2011 at 8:02 pm

tina
I agree with you that young people should be educated about their risk factors. However, the video we have been discussing did not do that.
Everything has to be looked at in context. The context of this video is an awareness campaign aimed at the general public. The video is not aimed at people like my daughter, who has a condition that occurs in only 1 out of 500 people. Nor is the video aimed at people like yourself who have dilated cardiomypathy and heart failure. Rather, the video seems to be showing a garden variety myocardial infarction (heart attack), but in a very atypical patient. Most MIs occur in men over age 45 or women over age 55. Younger people do have MIs but not nearly as often as older people.
So, in the context of a campaign aimed at the general public, if you are going to have a video showing a woman having a heart attack, I think it would make more sense to have an older woman than was shown.
I am very sorry about your heart problems and other medical issues. Life really sucks sometimes.
Marilyn

Laura Haywood-Cory posted on October 9, 2011 at 9:02 pm

Marilyn, you’re saying that the video doesn’t educate young women about their risk factors — do you have any research or numbers to back that up? At the end of the video, viewers are directed to Go Red’s website, http://www.goredforwomen.org/ , where right on the front page, there’s “Five Minutes to Know your Risks,” and more. Are you sure that none of the women who watch the video will say, “Hmmm. Maybe I *do* need to pay attention to my heart,” go to the GRFW website, and get educated?

Gary Schwitzer posted on October 10, 2011 at 8:19 am

After 4 days and 17 comments left, the comments section on this post is now closed.
Reasons:
1. Comments on this blog are moderated to delete spamming, profanity, product pitches and personal attacks. I don’t want to ignore commenters, but I also can’t devote endless hours moderating comments. I wish I had a better system, more hours or more help to do this, but I don’t.
2. Some of the comments submitted, at the very least, bordered on personal attack and lack civility in tone. This blog’s comments policy – clearly stated above – advises all users that such comments will not be accepted.
3. We seem to be going in circles rehashing the same arguments anyway. We stand by what we wrote and those who criticize what we wrote obviously feel strongly about their point of view. I only wish we could disagree with respect and civility.
Thanks for your understanding.

emmy posted on February 5, 2012 at 3:26 pm

In 2010 I had my daughter drive me to the local hospital that specializes in heart care when I thought that I might be having a heart attach. I have been diagnosed with an arrhythmia and the 2 cardiologists that I see are associated with this heart program. I went in and they immediately did a 12 lead ecg, They even had a recent 12 lead ecg to compare it to. They told me they saw substantial changes. Still, because I am a woman who was not presenting with classic symptoms, I sat in the emergency room for 7 hours before being taken back to the emergency room. I was having a heart attach and the damage was worsened by the wait. My cardiologists were furious. It happens all the time. I think the point of using such a young woman is to point out that not every heart attack presents as a classic case. The thing that bugged me was that the kid looked up a website and left his mother alone instead of calling 911, and the husband knowing that his wife was not alright left all of them to fend for themselves.