An alarming study recently conducted by the Centers for Disease Control and Prevention suggests that death rates from heart disease may actually be increasing in women ages 35 to 44. Have the years of education about lifestyle and diet made a difference? Is there still confusion about women’s heart-attack
symptoms, which tend to be more subtle than men’s? The answers are still not clear, but the big message for those of us in the medical community is that heart disease is not going away, despite encouraging survival rate trends in the older population. Good habits start early, and as a society we need to be smarter about our food and exercise decisions long before middle age when this begins to become more of a focus. There is evidence that atherosclerotic changes that lead to coronary heart disease begin even in children. This means the body’s process of laying down sticky plaque, leading to narrowed arteries and compromised blood flow, likely begins at a young age. If you are a parent or grandparent of younger children, keep this issue in mind as you make grocery and take-out food decisions. “Heart healthy” lifestyles are important for children and young adults, whether or not weight is an issue.
For women, heart health has some added complexities. The risk of heart disease in women rises as they grow older, and many people are surprised to learn it is the leading cause of death for women over the age of 40. Menopause is a contributing factor for heart disease because the loss of natural estrogen
seems to influence heart health. The walls of blood vessels undergo changes as women grow older, making plaque more likely to settle on vessel walls and increasing the risk of forming blood clots. A substance in the blood that encourages clotting, called fibrinogen, rises as we age, which makes it more likely for unhealthy blood clots to form, narrowing the arteries and slowing blood flow to the heart. In addition, cholesterol levels change as women (and men) grow older. This means the level of fats in the blood rise as the bad cholesterol (LDL) increases and the good cholesterol (HDL) decreases.
More women than men die from heart attacks, and many researchers believe this is because the symptoms of a heart attack may be more subtle in women than in men. Certainly many female heart-attack victims have dramatic heavy chest pressure and arm pain that indicate trouble, but there are also a sizable number of women who experience vaguer symptoms, such as nausea; neck, jaw or back discomfort; shortness of breath; sweating or lightheadedness. Most heart attacks start slowly, with mild pain or other subtle signs, and sometimes symptoms go away and then return. Many people aren’t certain what is wrong and wait far too long to get help. Even if you are not sure, it is very important to be proactive and call 911 because if you are indeed experiencing a heart attack, waiting compromises heart muscle. There are new medications and treatments that can be extremely effective, but you must seek care as soon as possible for the best results. How do you take good care of your heart? For women, hormone therapy clouds the issue somewhat, because the latest data seem to suggest that rather than helping protect against heart disease, hormone replacement therapy (HRT) may actually be harmful. Women should discuss the pros and cons of short-term
HRT with their gynecologist and cardiologist if they have one; they can offer guidance and recommendations. Women and men differ biologically, but for both, heart-healthy behavior habits are incredibly impor- tant. Stop smoking, maintain your ideal body weight, exercise for 30 to 40 minutes three to five times a week, and eat a lowfat diet filled with fresh vegetables and fruit. If you follow this advice, and still have high blood pressure and/or high cholesterol, then comply with your physician’s recommendation to control and treat these conditions with medication. There’s no quick fix to heart disease, but it can be managed and, in many cases, prevented. Dedication to lifestyle changes like diet, medication use and exercise, coupled with an excellent physician-patient relationship, are the pillars for building a vibrant life of health and wellness.
