Matters of the heart

Dr. Dawn M. Lombardo directs a program to combat cardiovascular disease — the No. 1 killer of women

When it comes to women and heart disease, UCI Health cardiologist Dr. Dawn M. Lombardo can recite some sobering statistics.

Cardiovascular disease kills six times more women than breast cancer, she says. In fact, twice as many women die of it as die of all cancers combined.

"It's the No. 1 killer of women," says Lombardo, director of the Heart Failure Program at UC Irvine Medical Center. "It kills more women than the five other leading causes of death combined: cancer, chronic obstructive pulmonary disease, Alzheimer's, diabetes and accidents."

Perhaps most surprising: Although men are at greater risk of heart attack, overall cardiovascular disease—including stroke—kills more women than men.

"Heart disease has been defined as a male disease," Lombardo says. "When it comes to research and treatment, women have been overlooked. There's a huge need we're working to fill."

As an associate professor of cardiologist at UC Irvine, Lombardo is raising awareness of the issue through workshops and seminars and is trying to increase the role of women in cardiovascular disease clinical trials.

The heart failure program is unique for having two women at the helm — Lombardo and Nathalie De Michelis, cardiovascular program manager — in a field dominated by men.

Together, they've built a program that develops new treatments for heart disease; delivers inpatient and outpatient care for both men and women, and educates patients and the public about prevention.

It also is the first heart program in Southern California to be certified by The Joint Commission, earning a Gold Seal of Approval for quality. Recently, it also received the American Heart Association's Get With The Guidelines—Heart Failure Silver Plus Award for meeting high care standards.

"We're trying to ensure that every time a patient comes to us, we have the best evidence-based therapy," Lombardo says.

Shirley Moore of Fullerton suffered a heart attack 30 years ago, at age 59. "I've had a triple bypass and some stents implanted," she says, "but I'm doing OK." She's been a patient of the heart failure program for several years.

"Dr. Lombardo has diagnosed me beautifully, and the recommended treatments have all worked. I feel she's keeping me alive," Moore says. "All the doctors take the time to listen to you and explain everything that's going on. The whole program is marvelous."

While many heart disease causes, symptoms and treatments are shared by men and women, there are important differences. The warning signs of a heart attack, for instance, are often more subtle in women; the fatigue, nausea and shortness of breath can be mistaken for depression, anxiety or side effects of medication.

Unlike most men, Moore didn't experience severe pain with her heart attack. "It just felt like a weight on my chest, and it was hard to breathe," she recalls.

That's typical for women, according to Lombardo. "It's not necessarily a crushing pain in the chest—as many as 40 percent of women experience no chest pain at all," she says. "Treatment can be delayed because the care provider doesn't recognize the patient's symptoms are cardiac.

"Then, once she's finally diagnosed, certain interventions such as angioplasty and stents may not be as effective for women. The conventional wisdom is that women should be treated the same as men, but now we're starting to challenge this."

Lombardo conducts clinical trials to assess the effectiveness of various medications and devices in treating women. But her real hope is to keep both men and women from needing the services of a heart program in the first place.

"Lifestyle plays the most important role in preventing heart disease," she says. "People tend to think a little cholesterol or high blood pressure doesn't mean anything, but according to the World Health Organization, cardiovascular disease is essentially preventable. And that means taking care of mind, body and soul."

Stress reduction, daily activity, smoking cessation and weight loss all could help people avoid heart disease. Controlling hypertension—or high blood pressure—can lower the risk of developing heart failure by half, Lombardo says.

"Survivors of a heart attack or stroke face a high risk of recurrence or death," she says. "Once you have an episode, you have an established disease that warrants lifelong monitoring by cardiologists, since the risk can be substantially lowered with a combination of medications, education and follow-up."

To educate patients and the community, UCI Health offers "Living Well with Heart Failure," "Heart Healthy Diet" and other classes.

"Millions of people are walking around with weak hearts and don't know it. We're trying to raise their awareness," Lombardo says. "This is all evolving."

— Kathryn Bold, University Communications