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Health Female Adda
1 year ago
Prevent Cardiovascular Disease: Have a Healthy Heart
Fact: Cardiovascular disease kills more women over 25 than all cancers combined.

Fact: Young women who have heart attacks are twice as likely to die from them as men are.

Fact: You can protect yourself — and you should start right now.

Melissa Oliver was the last person you'd expect to have heart problems. The 35-year-old Indianapolis bank vice president and mother of a toddler was a slight 5'1", 118 pounds. She ran marathons and competed in triathlons. She was never sick and went to the doctor only for annual physicals. So when she felt a painful pressure in the middle of her chest one February afternoon in 2004, she chalked it up to indigestion. She popped some aspirin and a couple of Rolaids and proceeded to conduct a 20-minute conference call in her office. Only then did she call her doctor. He said she was having an anxiety attack and referred her for a cardiac stress test just to ease her mind. Problem solved, right?

Wrong. Before Oliver could even step onto the treadmill in her doctor's office 9 days later, pictures of her heart revealed something shocking: She'd had a heart attack. The tip of one of her arteries was partially blocked, the result of a congenital heart defect aggravated by high blood pressure — possibly dating back to her pregnancy, when she'd had the hypertensive disorder preeclampsia. But then her cardiologist gave her the really terrifying news: She could be headed for another attack, this one much worse than the first. "I couldn't believe it," Oliver says. "I thought I was going for my morning workout and then would be back at the office as usual. Instead, I ended up in the hospital that night and in surgery the next day with four stents in my artery."

As Oliver learned the hard way, you don't have to be old or male for cardiovascular disease to strike. In fact, it's the number one cause of death for American women over 25, killing more of us than all cancers combined. That's nearly 500,000 every year, and 57,000 more women than men. The American Heart Association estimates that almost a third of women have some form of heart disease. Still, most of them — cue that scary music again — don't even know it. And while research shows that women under 50 have fewer heart attacks than men their age, they're twice as likely to die from them. Why? It could be because women who suffer attacks are either sicker or seeking less aggressive treatment for their symptoms.

If all this has your heart beating a little faster, well, a little worry might not be such a bad thing — assuming it makes you start taking steps to prevent heart disease. And you can do just that, since many heart attacks in women are caused by factors like hypertension and high cholesterol that could have been treated or prevented altogether. "It's important to take care of your heart even before you have any symptoms," says Arthur Agatston, M.D., a Miami cardiologist and author of the new book The South Beach Heart Program. "Quite simply, the earlier you start, the easier it is to prevent heart disease."

Luckily, the latest research shows that the road to a healthy heart isn't so rough. Here, eight steps to make sure your beat goes on for a long, long time.

Step 1 So, how's your mom?

Researchers have long believed that having a close family member (mom, dad, sister, or brother) with cardiovascular disease was one of the clearest predictors of heart trouble in your own future. But according to a 2006 Swedish study, it's really Mom you need to worry about. Your risk increases by 17 percent if your father has heart disease, but it shoots up by a whopping 43 percent if your mother is afflicted. This may be more environment than genetics, since children typically spend more time with their mothers and tend to learn lifestyle habits from them. But even if you don't smoke and do exercise, it's possible that your risk could still be up as much as 82 percent if both of your parents had heart disease.

Which doesn't mean you're doomed, of course. But it does mean you shouldn't waste any time. If you have a family history, Dr. Agatston recommends in-depth tests that go beyond the normal blood workup every few years, starting in your mid*40s. First, talk to your doctor about having a CT scan of your heart, which can detect attack-causing plaque buildup in your arteries — even years in advance. Dr. Agatston calls these scans "mammograms for the heart." The first one establishes a baseline; subsequent images assess potential deterioration of the arteries. Although the scans aren't typically covered by insurance, that may change in the next few years. In the meantime, many hospitals and clinics accept payment plans. "The extra expense is worth it to prevent heart disease," Dr. Agatston says. "These are tests that really can make a difference in people's lives."

Dr. Agatston also suggests that all women request more detailed blood tests that measure not only the level of cholesterol but its type and size — factors that he says affect the heart in ways that scientists are only now beginning to understand. Talk to your doctor about a standard lipid profile. A blood test can also detect the presence of C-reactive protein in the bloodstream, which may contribute to plaque formation. More prevalent in people who are overweight, sedentary, hypertensive, or smokers, C-reactive protein's presence accurately predicts the likelihood of heart attacks in women with relatively low cholesterol, and researchers speculate that it could signal heart disease before symptoms develop. Ask your doctor to check your numbers next time you get blood work done.

Step 2 Sorry, you're gonna have to do a little math.

The connection between cholesterol — a waxy substance made in your liver and found in blood cells — and heart disease has been known for decades, but your total cholesterol number is only part of the equation. The real key is how much of it is low-density lipoprotein (LDL), the so-called "bad cholesterol," and how much is high-density lipoprotein (HDL), the "good" kind.

LDL cholesterol can build up in your arterial walls, causing plaque, which can rupture in the arteries and result in blood clots and possibly heart attacks. A recent study from the University of Texas Southwestern Medical Center indicates that keeping LDL levels low (the longer the better) can protect even people with other risk factors like smoking. Meanwhile, HDL plays the role of crime-fighting superhero to LDL's nasty villain, transporting the bad stuff through the blood to the liver, where it's metabolized and then eliminated. A Mayo Clinic newsletter article last August indicated that increasing HDL by even 1 milligram per deciliter (mg/dL) can reduce heart attack risk by 3 percent. "Basically, you want more of the good stuff, less of the bad stuff," says WH advisor Sharonne Hayes, M.D., director of the Mayo Clinic Women's Heart Clinic.

For most women, total cholesterol should be under 200, with LDL levels no higher than 100 and HDL no lower than 50. If your numbers are in line, doctors recommend retesting your blood every 5 years in your 20s and 30s.

Step 3 Don't be afraid to do drugs.

If blood tests show your cholesterol is high, a change in diet and exercise might help (see Step 5 for some suggestions). But in many cases, it's too late or your numbers are too high for these basic steps to help. That's when your doctor may give you a cholesterol-lowering medication, known as a statin, which keeps the liver from producing too much cholesterol. Some doctors have questioned the wisdom of prescribing these drugs, especially for patients who might lower their cholesterol through lifestyle changes. But recent studies show that statins can diminish LDL by as much as 40 percent, slightly raise the level of HDL, and reduce the risk of heart attacks by about 35 percent. This is why many experts say these medications are actually underprescribed. "Statins are incredible tools in lowering cholesterol and can keep many people from suffering heart attacks," Dr. Agatston says. "But there's no question: They're meant to work together with proper diet and exercise." Women taking statins may experience muscle fatigue as a side effect, though, and should get regular blood tests to check liver function.

Step 4 Ask yourself, "What kind of fruit am I?"

Carrying extra weight around isn't just a drag during swimsuit season. It can also be dangerous, especially if those excess pounds find their way to your belly and not, say, your hips. Recent studies indicate that abdominal fat is metabolically different from the other fat in your body: As you gain padding around your middle, the individual cells swell, and their size is linked to higher triglyceride levels and lower good cholesterol.

The best treatment for belly fat? Signing up for Weight Watchers isn't enough; you're going to have to pry yourself off the couch too. New research from Wake Forest University Baptist Medical Center shows that diet and exercise together reduce the size of abdominal fat cells, which doesn't happen if you lose weight through dieting alone. Working out regularly also has a ripple effect on the body: Not only do dangerous pounds come off, but your muscles become more efficient at using blood; your heart gets stronger; and your blood vessels become more limber, so blood flows more easily. "A lot of things don't make you feel better in the short term," Dr. Hayes says. "Exercise is the one thing that does."

And you don't have to run a marathon every week to get these benefits. Cardiologists recommend an average of 30 minutes of moderate aerobic exercise a day, which has been shown to increase life expectancy by 3 1/2 years. Whether walking, running, or swimming, you should aim to work your heart to about 50 to 70 percent of its maximum rate. Even this amount of exercise is powerful enough to combat other high-risk factors: A study out of the Cooper Institute in Dallas found that even moderately fit people had half the death rates of those who were sedentary.

While doctors used to think that weight training was bad for the heart because it increased blood pressure, research now shows it can actually lower blood pressure when transforming fat into muscle, which burns calories and keeps them from landing on your belly. This is why Nieca Goldberg, M.D., a New York City cardiologist and author of The Women's Healthy Heart Program, recommends strengthening exercises two or three times a week for all the major muscle groups — arms, legs, shoulders, chest, back, hips, and trunk. Dr. Agatston suggests a Pilates- or yoga-based regimen that zeroes in on the core muscles of your abdomen and lower back. Either way, consistency is key, as is starting young: Dr. Goldberg says regular strengthening can not only help prevent age-related loss of bone and muscle mass, but also help reduce body fat and improve endurance, both of which can decrease your risk of heart disease.

Step 5 Hey, are those your arteries closing up?

Exercise without diet gets you only halfway to where you need to be. But changing the way you eat doesn't mean starving yourself or signing up for a fad diet. "There's no single food that's going to kill you or save your life," Dr. Hayes says. "Proper diet is about a wide variety of healthy foods." That means, most importantly, avoiding trans and saturated fats: In a 2006 Australian study, researchers found that giving healthy subjects just one fatty meal affected blood flow and diminished HDL's protective qualities.

In its latest dietary recommendations, the American Heart Association suggests that no more than 7 percent of your daily calories come from saturated fats — butter, full-fat dairy like whole milk or cheese, and meat. Meanwhile, only 1 percent of your daily diet should consist of trans fats, which are found mostly in processed foods like cookies, crackers, and chips.

This is why Dr. Goldberg encourages sticking to a "Mediterranean" diet: a moderate amount of foods high in unsaturated fats like olive oil and fish; lean meat, such as beef filet, flank, or sirloin and pork tenderloin, and low-fat dairy; whole grains (think brown rice and barley); and at least five daily servings of colorful fruits and vegetables, which provide antioxidants that help keep blood vessels flexible. In particular, Dr. Goldberg and others tout the benefits of omega-3 fatty acids, found in salmon and other fish, because they may help lower blood pressure and the risk of abnormal heart rhythms. Dr. Agatston also recommends incorporating foods that lower bad cholesterol, like apples, which research suggests may help prevent plaque buildup; oolong tea, which has strong antioxidant properties that can make LDL particles bigger and less likely to enter the bloodstream; and legumes, such as beans, peas, and lentils, which decrease risk of cardiovascular disease. And he suggests foods such as almonds and walnuts and up to two glasses a day of red wine, which help reduce LDL cholesterol and protect the lining of the arteries.

Step 6 Stop kidding yourself that an occasional cigarette won't hurt.

Yes, you've heard the antismoking rant before. But there's a reason for it. Quitting smoking should top your list of things to do to avoid heart disease, Dr. Hayes says. And that's true even if the only time you light up is over mojitos with friends. Recent research shows that smoking between one and five cigarettes a day triples your chance of dying from a heart attack, and that it's even worse for women than for men. Smoking narrows arteries, raises blood pressure, thickens blood, and makes it more likely to clot — the classic recipe for a heart attack. This is especially true if you have other risk factors, like high blood pressure and high cholesterol, which together with smoking make you much more likely to get heart disease, according to Dr. Agatston. You take birth control and smoke? You've just put another bullet in the gun. That combo raises blood pressure and can lead to blood clots, further increasing your risk.

While studies have shown that women have a harder time breaking the habit than men, there is encouraging news: A fall 2006 study from the University of Chicago shows that the prescription drug naltrexone — when used in combination with behavioral therapy and nicotine patches — boosted smoking cessation rates among women by 50 percent (though it made no difference in men). Naltrexone also reduced weight gain in the first month after quitting. Talk to your doctor about the drug.

Step 7 Get prenatal care.

Around 135,000 women every year get gestational diabetes, high blood sugar that's likely a result of pregnancy hormones blocking adequate insulin production. Doctors used to think it came and went with pregnancy. But research now shows that gestational diabetes gives you a 50 percent chance of developing diabetes later in life, which in turn makes you three to seven times more prone to heart disease. That puts you in line with the 54 million other Americans who have prediabetes. Diabetes, especially type 2, is often attributed to obesity, though many cases result from genetics and/or environment. Cardiologists consider diabetics heart patients as well: Even if they've never had an attack, they tend to have high blood pressure and high cholesterol. "Having diabetes is equivalent to having heart disease," says Paula Johnson, M.D., chief of the division of women's health at Brigham and Women's Hospital in Boston. She treats diabetics and heart patients with the same regimen of aspirin and statins. "The best thing is to protect yourself with diet, weight control, and exercise so you never develop diabetes, even if you had it when pregnant."

Step 8 Understand how women differ from men.

Cindy DeMarco knew something was wrong when she awoke one morning in 2000 with nausea, dizziness, heaviness in her chest, and pain in her upper back. But the 30-year-old Virginia marathoner figured whatever it was would pass. She didn't realize that she was exhibiting classic signs of a heart attack — in women. While some do experience chest-clutching pain, many others have subtler symptoms (see Indigestion? Or a Heart Attack?). In fact, a recent survey of women recovering from heart attacks found that many had worsening symptoms for weeks leading up to an episode but mistook them for indigestion, fatigue, or muscle strain. Dr. Goldberg says two-thirds of women who die of heart attacks never even make it to the hospital — by the time they recognize what's happening, it's already too late.

Symptoms aren't the only way men and women differ when it comes to heart problems. Only in the last decade have scientists started to explore how heart disease manifests in each sex, and they still don't have a lot of answers. They do know that it's about more than the size of our hearts.

Research from the National Institutes of Health shows that doctors may have missed heart disease in some 3 million women who have diffuse plaque, where plaque spreads evenly through the arteries instead of building up to create major blockage. On angiograms (x-rays of the blood vessels) these arteries look clear. The NIH research also looked at women with microvascular disease, in which small vessels don't dilate properly during exertion. Their angiograms were often clear too. While they're not headed for immediate heart attack, women with diffuse plaque and microvascular disease do need to be treated with either lifestyle changes or medication or both. "Doctors should diagnose intuitively," Dr. Johnson says. "If a woman comes in with symptoms" — shortness of breath, positive cardiac stress test, high cholesterol — "we can assume she needs to be treated even if her angiogram is clear. We can't just send her home and do nothing."

As DeMarco learned, you may need to be your own strongest advocate where your heart's concerned. When she finally went to the emergency room several hours into her day, an internist told her she'd strained a muscle and tried to send her home with muscle relaxants. But DeMarco refused to leave until she'd had more tests. Good thing: An EKG showed that she'd had a heart attack, the result of a spasm in one of her arteries. "I learned that you have to be adamant about your treatment," she says. "I know my own body best and know when something's wrong. You have to insist they find out what it is."

The Best Foods for Your Heart (genConnect)
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