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Being female in this world carries with it particular health risks -- breast cancer and a higher risk of rheumatic diseases, for example. But it also provides protection: there is a lower risk of heart disease before menopause. What is not well known, though, is that after menopause women's heart disease risk eventually increases to that of men of the same age.

Now new research has shown that women's risk of "sudden cardiac death" is significant also, and that we can predict who is susceptible to it. Sudden cardiac death (SCD) is caused by electrical instability of the heart. Basically the wiring system of the heart suddenly goes haywire and the heart beats ineffectively, causing an immediate drop in blood pressure, and, frequently, death. SCD can be triggered by a heart attack, or can strike out of the blue.

SCD is the reason the nation is currently preoccupied with putting defibrillators in airports, schools, and malls. When someone drops unconscious from SCD, a small electrical shock delivered within a few minutes can bring them back to life. The new study, recently published in the journal Circulation, tracked for 22 years 120,000 women who participated in the Nurses' Health Study. There were 244 cases of SCD during that time. The number is lower than what might be expected in a group of men, but obviously is still significant.

Most of the SCD deaths occurred in women who had never had heart disease. But the most important finding was that most of the women who died of SCD had higher cardiac risk than average. In particular, they tended to have diabetes or high blood pressure, or were smokers. Obesity and family history of heart disease were other risk factors, though not as strongly associated with SCD.

It's another reason prevention is so important. Prevention doesn't make sexy TV shows; it doesn't get people's attention like a near-death experience does. All the people who are alive because of prevention will never know why they're still alive.

It's hard to listen to your doctor, and even harder to take some stupid pill every day, when all you have to think about is a statistic. Most people are a little paranoid about doctors anyway, and they balk at accepting treatment for something they can't see or feel, like hypertension. You live longer if you do things like control your diabetes or your hypertension. And you live better, too.

Apart from the above potential preventive items against SCD, research has shown recently that essential fatty acids, such as found in fish oil, can help.

To consider the importance of fats in your diet, think of the body as a bottle of vinegar and oil salad dressing. The oil parts and the watery parts don't mix very well, and there's a whole world of activity going on inside each part. Every cell membrane is made up of fats; every nerve's function requires the appropriate fats. Without oils in the skin, you would evaporate within a few hours.

That's the story of the human body: how water and oil have learned to get along. Just like we have essential amino acids that we need to eat every day so that we get enough protein, we also have essential fatty acids that we need to have a healthy fatty part of our body. The amount of these essential fatty acids in the typical American diet isn't enough, and that impacts our hearts. One of the best ways to get essential fatty acids is through fish oil. Apart from decreasing the risk of sudden cardiac death, fish oil can decrease triglycerides and decrease the risk of forming the blood clots that cause heart attacks.

In patients who have had an episode of SCD, or who have had a heart attack and are at high risk, the best therapy is probably an implantable defibrillator. This is a pacemaker-like device that sits under the skin and monitors the heart continuously. If the heart goes into a dangerous rhythm, the device quickly charges itself and delivers a shock to the heart. The shock hurts, but it can be life saving.

Dr. Mike Merrill is an internist practicing in Buffalo. His column appears every other week on this page.

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