Heart disease and women
Mention the term "heart attack" and most people imagine a pudgy, middle-aged man drenched in sweat and clutching his chest. Few people seem to consider heart disease as a woman's disease.
But according to the American Heart Association, cardiovascular disease is the leading killer of women over age 25. It kills nearly twice as many women in the United States than all types of cancer, including breast cancer.
Men have a greater risk for coronary artery disease and heart attacks earlier in life than women. Women's risk for heart disease increases after menopause.
EARLY HEART SIGNS
Women may have warning signs that they ignore for weeks, months, and even years before having a heart attack. Some doctors still do not recognize the warning signs reported by female patients.
Men most often have the "classic" heart attack signs: tightness in the chest, arm pain, and shortness of breath.
Women's symptoms can resemble those of men. However, a woman may also complain of nausea, fatigue, indigestion, anxiety, and dizziness.
ACT IN TIME
Recognizing and treating a heart attack right away improves your chance for survival. The typical American -- male or female -- waits 2 hours before calling for help.
Studies have shown that quickly treating people with early signs of a heart attack can either prevent the heart attack or decrease the amount of damage to the heart muscle.
Know the warning signs and always call 911 within 5 minutes of when symptoms begin. By acting quickly, you are less likely to go into cardiac arrest (where the heart stops beating).
MANAGE YOUR RISK FACTORS
A risk factor is something that increases your chance of getting a disease or having a certain health condition. You can change some risk factors for heart disease. Other risk factors you cannot change.
Women are advised to take charge of their health by working with their doctor to address risk factors, and keep tabs on cholesterol levels, blood pressure, and lifestyle.
Keeping your blood cholesterol levels in the right range can help prevent heart disease and stroke.
- Your LDL cholesterol is called "bad" cholesterol. Lower numbers are better. If you are at risk for heart disease, keep your LDL cholesterol level below 130 mg/dL.
- Your HDL cholesterol is called "good" cholesterol. You want your HDL cholesterol to be high. For women, it should be above 50 mg/dL.
Keep your blood pressure under 120/80 mmHg. Use blood pressure drugs when your blood pressure is higher than 140/90 mmHg. (Persons with diabetes or kidney disease may need to start taking medication at lower blood pressure levels.)
Estrogen is no longer used to prevent heart disease in women of any age. Estrogen may increase the risk of heart disease in older women. However, it may still be used in some women to treat hot flashes or other medical problems.
- Its use is probably safest in women under 60 years of age.
- Estrogen should be used for the shortest possible period of time.
- Only women who have a low risk for stroke, heart disease, blood clots, or breast cancer should take estrogen.
In general, daily low-dose aspirin (or a drug called clopidogrel) may be used to prevent heart disease in women between ages 55 and 79 who have never had a heart attack or stroke. For women age 80 and older, it is not clear whether the heart benefits of aspirin outweigh the bleeding risks. Ask your doctor before taking aspirin.
LIVE A HEALTHY LIFESTYLE
Some of the risks for heart disease that you CAN change are:
- Do not smoke or use tobacco.
- Get plenty of exercise. Women who need to lose or keep off weight should get at least 60 - 90 minutes of moderate-intensity exercise on most days. To maintain your weight, get at least 30 minutes of exercise a day, preferably at least 5 days a week.
- Maintain a healthy weight. Women should strive for a body mass index (BMI) between 18.5 and 24.9 and a waist smaller than 35 inches.
- Get checked and treated for depression, if necessary.
- Women at high risk for heart disease should take omega-3 fatty acid supplements.
If you drink alcohol, limit yourself to no more than one drink per day.
Good nutrition is important to your heart health, and it will help control some of your heart disease risk factors.
- Choose a diet that is rich in fruits, vegetables, and whole grains.
- Choose lean proteins, such as chicken, fish, beans, and legumes.
- Eat low-fat dairy products, such as 1% milk and low-fat yogurt.
- Avoid sodium (salt) and fats found in fried foods, processed foods, and baked goods.
- Eat fewer animal products that contain cheese, cream, or eggs.
- Read labels, and stay away from "saturated fat" and anything that contains "partially-hydrogenated" or "hydrogenated" fats. These products are usually loaded with unhealthy fats.
For more information about the treatment of heart disease, see:
Mosca L, Benjamin EJ, Berra K, Bezanson JL, Dolor RJ, Lloyd-Jones DM, et al. Effectiveness-based guidelines for the prevention of cardiovascular disease in women--2011 update: A guideline from the American Heart Association. Circulation. 2011;123(11):1243-1262.
North American Menopause Society. Estrogen and progestogen use in postmenopausal women: 2010 position statement of The North American Menopause Society. Menopause. 2010;17:242-255.
Michael A. Chen, MD, PhD, Assistant Professor of Medicine, Division of Cardiology, Harborview Medical Center, University of Washington Medical School, Seattle, Washington. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.
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