Keep the Beat ...

American doctor who led the way by raising the issue of heart disease in women

By Cathy Stovell

Dr. Lori Mosca is the woman who put women's heart disease
on the American map.

Fresh out of medical school, the medical establishment laughed
at her when she suggested studies looking at the incidence of
heart disease in women and also by ethnicity, were needed.

Today, with heart disease being the number one killer of
women in America, she's well respected.

These days she works just as hard campaigning for heart
disease prevention programmes as she does working
as a cardiologist.

In fact she's dubbed herself a preventative cardiologist and
is Columbia University's Director of Preventive Cardiology at
New York Presbyterian Hospital (Columbia University's Medical Center) in New York City.

She also runs her own private clinic in midtown Manhattan and is frequently in Washington DC lobbying hard for various health bills
and amendments.

She squeezed time into her busy schedule recently to speak to doctors and investors in Bermuda on the importance of having a facility dedicated to preventing heart disease.

The Bermuda Heart Foundation (BHF) has revealed plans to open a prevention and intervention centre for cardiac patients and those at risk for heart disease with help from New York Presbyterian Hospital.

The charity said its goal is to reduce heart disease in the Island by 25 percent over six years. Dr. Mosca said the goal was worthwhile and could have a meaningful impact on the community.

BHF Executive Director Simone Barton said the charity decided to change its tack in addressing heart disease because the incidence in Bermuda was steadily rising.

She said the Foundation's aim was to make the prevention centre a place where those with heart disease will come for education, support and training about the illness.

While we hear so much about heart disease that we may think we know how to avoid it or what to do if we get it, Dr. Mosca said we're very likely to be wrong.

"In my experience a lot of patients say 'doc, I know what I have to do, I just have to do it'. People tend to think it's a will power issue but it's not," she said. "It's really an issue of having the right support and the right skill set to know how to make the better choices."

She said simple things like cooking classes where people learn exactly what they should be eating and how to prepare it can be a significant help. Learning how to read food labels, and instruction on correct exercise are other skills cardiac patients may need to be taught.

"We have to be careful after patients have a cardiac event," she said. "The centre that Simone is trying to get started is going to be a resource for patients after they have heart disease as well as for patients trying to prevent heart disease. So those are different situations.

"People, after they have a heart problem, need to be monitored more closely and they need to build confidence to get back into their normal routine and that takes expert support staff exercise physiologists that can help retrain them, nutritionists that can help them learn to make better choices, learn to read food labels, learn to use the proper cooking oils. People think it's so easy but it's not," she said.

Through the media, especially television and the internet, Bermudians are exposed to a multitude of health messages, but if you're not a scientist, it's easy to be fooled. Much of the confusion is perpetrated deliberately by the food industry in an effort to sell their products. For example Dr. Mosca said the notion that cholesterol is bad and something that should not be in your diet at all is completely wrong.

"If you reduce the cholesterol in your diet that doesn't really do much for you," she said. "The cholesterol you eat doesn't really affect the cholesterol in your body. The saturated fat that you eat does. It's very confusing. In the US we've had to have a new labelling law because products would say: 'no cholesterol', but they would be full of saturated fat.

"There are a lot of things people think they know but they don't know it to the level where it allows them to make the best choices," she added.

And then there are people who know exactly what to do but just cannot do it on their own. Quitting smoking alone greatly reduces a person's chance of heart disease, but many smokers are addicted to cigarettes.

According to Dr. Mosca behavioural training where people learn the cues they use to make poor choices, is very important.

"For example people might tend to smoke when they are drinking coffee," she said. "They need to be aware that that's a cue for them. Maybe this happens when they are in a social setting, so they need to have a preventive mindset that 'I'm not going to put myself in that situation' so that they won't be enticed to smoke.

"And then, if they do have the urge, they go for a quick walk or something that will replace the smoking. We call it replacement behaviour."

Looking at the high rate of obesity on the Island (two thirds of adults, according to statistics from the Department of Health) and its links to hypertension, diabetes and heart disease, Dr. Mosca said it was vitally important that people exercise and that they do the right types of exercise.

Belly fat is the most dangerous fat to have in terms of heart disease. But Dr. Mosca said many people try in vain to reduce their stomach size, with exercises like sit-ups.

"You think it's simple go out and exercise, said Dr. Mosca. "Many women don't know that if they lift weights twice a week with their upper arms, that will decrease their waist size. People think doing sit-ups helps but it doesn't.

"When we age, our bodies naturally replace our muscle with fat," she added. "Our metabolism declines and so even if we eat the exact amount of food for the rest of our lives, we are going to just naturally get heavier."

The way to combat that is to eat less or burn more calories. According to Dr. Mosca, most people try to burn off calories because eating less is too difficult.

"The way to burn more calories without doing anything is to develop more muscle mass," she said. "When women lift weights twice a week, they actually develop more muscle and muscle is a great way to burn fat, even when you are asleep.

"I tell my patients even if you spend 20 minutes, two days a week, your body is going to be naturally benefitting from that because it will be naturally burning more calories."

Tips and information like this are what clients at the cardiac prevention and intervention centre would learn. And because heart disease is the number one killer in Bermuda, Dr. Mosca said an investment in such a facility, can bring about results, saving the lives of Bermudians and improving our quality of life.

She said: "It will be a really great community resource to help people achieve those goals that they know that they want to do."

Heart Month Wrap-up

The beginning of March brought to a close one of the most exciting Heart months BHF has ever experienced! Literally every week was jammed packed with events, free screenings, conferences and all sorts of fun ways to get your heart pumping.

International chef Michael Hammond, baited our appetites with a series of Healthy Cooking Demos - proof that healthy cooking is delicious. While local families and students hopped over to the Bermuda College for our Jump Fit skipping event.

Because we believe that what you don't know can kill, BHF scheduled dozens of free health screenings all over the Island. We also hosted several lunch and learn information sessions at various companies and locations to help give you the best chance at preventing and reducing heart disease-related illness.

It must be noted that we could not have experienced such success without the help of various organizations, companies and individuals throughout the community. So, as final wrap-up, we hosted a Red Wine & Chocolate Cocktail reception to say a big thank you to all who helped support our cause!

February may be over, but our hearts are still into advocating for the best cardiac care and education available to Bermuda. Bermuda Heart Foundation is committed to raising heart health awareness one beat at time! Be Heart Smart Bermuda.
 

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