European Stars and Stripes (Newspaper) - September 10, 1991, Darmstadt, Hesse                                Continued from Page 14 a answers to questions doctors ask in a medical history and on data from electrocardiograms blood tests special a rays and other tests treatments include aspirin and other drugs that reduce the risk of future heart attacks lower High blood pressure and dissolve the blood clots that trigger attacks As Well As bypass surgery and angioplasty to replace or reopen narrowed arteries. Most of the tests and treatments were not known in 1948, when pioneers such As or. Paul Dudley White helped launch the Framingham heart study. The study still under Way has followed More than 5,200 men and women who were 30 to 62 years old when the study began. It has identified risk factors and charted the course of heart disease in the Massachusetts Community. The researchers added 5,000 daughters and sons in a second generation study beginning in 1970. The Framingham study was one of the most comprehensive heart studies Ever undertaken and its findings have been extremely influential. But because two thirds of the women studied were pre menopausal the initial reports found that Tow women had evidence of heart disease. Quot the first reports out of Framingham buttressed the conviction that heart disease was an affliction of men in this Middle aged population Quot or. Millicent Higgins an epidemiologist at the National heart lung and blood Institute has written. The initial Framingham findings contributed to a false sense of Security about heart disease in women. Also because relatively fewer women have heart disease Many More of them must be studied to produce the same amount of information on disease which can greatly increase the Cost of research. As a result scientists conducted their studies principally among men. Efforts to emphasize the need for women to take the same preventive Steps As men were delayed. As More data was collected Many americans followed recommendations to Cut fat consumption exercise More lose weight and treat High blood pressure so fewer people had heart attacks and More of those who had them survived. Meanwhile however women picked up some heart risk factors of men like smoking. A variety of factors have shaped the Way doctors care for women with heart disease. One is what patients Tell them. A prime manifestation of heart disease in women is Chest pain called angina. Yet the pain from angina is so varied that it can also be Felt in the jaw and Arm. But because there has Little Public education about angina in women there is a feeling among doctors that Many women experience the pain or discomfort without suspecting that it might be due to heart disease. In interviewing patients doctors can have difficulty i readers action linear sergeant questions promotion test scores it would like a satisfactory explanation on How the air Force decided How Many of the total eligible e-6s, e-5s and e-4s it would promote this Cycle. I feel desert shield storm made the system unfair to All lets say the air Force needed 20 new master sergeants in a particular career Field to satisfy its requirement under Normal conditions the e-6s who made the cutoff based on the top 20 scores would be selected for promotion since it s impossible to know what the top 20 scores will be until everybody has tested How could a cutoff be established i was told stripes promotions were saved for those who tested after desert shield storm if nobody from the group of late testers made the pre established cutoff score what happens to those stripes the Only answer i received from our Capo consolidated base personnel office was that the air Force does t have to meet established requirements i missed promotion to master sergeant by a score of 0.02. I believe if we were in Normal conditions i would Page 16 a the stars and stripes women and heart disease identifying the pain of angina and correlating its Onset with such Well known precipitating factors As climbing stairs or suffering emotional upsets. One reason is that Many older women May not exert themselves enough to bring on angina. And others who do feel discomfort May Cut Down on physical activity without Ever recognizing Why or. Myron l. Weisfeldt a cardiologist who is leaving Johns Hopkins Hospital in Baltimore to become chief physician at Columbia presbyterian medical Center in new York City said he was puzzled when his 76-year-old Mother in Law recently stopped playing Tennis. After lengthy questioning he determined that she had angina. She is now returning to the courts after a coronary bypass operation. Are women More stoical than men about pain and suffering or. Valentine Fuster chief cardiologist at Massachusetts general Hospital in Boston believes so saying Quot it is a perception based on experience and obviously it would be very hard to prove by any scientific  nevertheless such perceptions can influence a doctor s recommendation for or against diagnostic tests like coronary Arterio Grams and treatments like surgery. Also even when a doctor suspects heart disease women May be less willing than men to accept aggressive testing and treatment. Quot when you have a Man and a woman with angina and both in their 50s, a physician often gets the impression that the woman is less Apt to accept procedures and is much More prone to say a give me some medication Quot Fuster said. Heart disease is often difficult to diagnose in women and thus to treat because the Standard exercise and other tests that Are reliable for men often give false results in women. For unknown reasons Treadmill tests can be unreliable among women who seem to have a different physiologic have been promoted. Did desert shield storm cause both the air Force and some non selectee to be cheated tech. Sgt. Wilma j. Lewis Torreon a Spain a capt. Katherine a. Day Deputy chief personnel management division Safe Headquarters replies thanks for the Opportunity to answer your question concerning the weighted airmen promotion system and the effect desert shield storm had on recent promotion quotas. Many airmen who were eligible for promotion consideration to the grades of staff technical and master sergeant could not be promotion tested due to deployment. Upon return to their permanently assigned Home bases returnees were Given up to 75 Days to attend to personal affairs and to provide them a sufficient amount of study time. Those eligible who tested late and could not be considered at the time initial selections were made will receive supplemental promotion consideration. When promotion quotas for each air Force specially code Aasc Are determined individuals who have not tuesday september 10, 1991 response to exercise than do men. Breast tissue can interfere with tests that produce images of the heart limiting their usefulness said or. Robert Bonow of the National heart lung and blood Institute. Many cardiac surgeons have reported that women fare less Well than men after bypass surgery. They attribute the discrepancy to the smaller arteries in women and the advanced age at which they have such operations. As researchers focus More on heart disease in women they Are questioning whether the poorer surgical results reflect a tendency for More women to have bypass operations on an emergency or urgent basis rather than selectively. At any age and in either sex emergency surgery is riskier. Another unknown is the degree to which unrecognized and untreated angina harms women s hearts. Quot the plea is for More data Quot from studies to determine whether performing bypass surgery selectively at an earlier stage of the disease will improve results in women one doctor said. Until the results of those studies Are in hand Many doctors will advise women with heart disease to rely on medical therapy for a longer period instead of having surgery. Doing so however increases the Chance of emergency surgery. The Issue of research on women and heart disease is embarrassing to the scientific Community because it has failed to obtain crucial data about an important Public health problem while it has devoted great Effort to exploring More esoteric issues in heart disease. A women s life expectancy is now 79 years a third of it after menopause when heart disease hits hardest. Yet most research studies exclude volunteers older than 60, said or. Peter f. Cohn a cardiologist at state University of new York at Stony Brook . So to do the needed studies researchers will need to revise their thinking about the customary age limits. And there Are Many other important questions in Many areas that have yet to be answered. Many concern the role that various female and male hormones play in causing heart disease. Doctors have been discouraged from pursuing this line of research in part because they once prescribed Oestrogens for men with heart disease with disastrous results. Nevertheless because the hormonal systems of men and women Are so different it would not be surprising if they had different effects on heart disease. Quot the question is How can you pinpoint what exactly makes the difference Quot said Fuster. He added Quot when one looks at All the factors that play a role in coronary artery disease one becomes humbled by the fact that it is so  tested for promotion Are counted As part of the eligible population. This ensures no Aasc is shortchanged on quotas just because it May have More untested eligible than another Aasc. As tests Are received scored and tabulated by the air Force manpower and personnel Center late testers received their supplemental consideration. In order to be selected for promotion they must tie or beat the cutoff score that was established for their Aasc. Separate promotion quotas Are not reserved for late testers. Thus everyone receives fair and equitable Opportunity for the available stripes regardless of when tested. To write us a readers action line is the readers a court of last resort striving to answer some of the questions about life overseas in a military environment or questions about policies and guidelines when other avenues for answers Are not readily available. If you have a question and Don t know where to turn for the answer. Write to readers action line co the stars and stripes Apo 09211 4211. 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