For Women: Take This Risk to Heart

Cardiovascular disease is women's top killer. Fifty-seven percent of U.S. women are aware of heart disease as the leading cause of death in females, an increase from previous years, according to the American Heart Association (AHA). However, awareness among African-Americans and Hispanic women was lower than among Caucasian women and has not changed significantly over time.

Women also don't know their own risk or are in the dark about the sometimes subtle signals of a heart attack.

Why the disconnect? In general, heart disease has been perceived as an older person's disease that need not concern women until menopause, says Nanette Wenger, M.D., a cardiologist in Atlanta. For years, women also thought hormone therapy (HT) would protect them from heart trouble. "But heart attacks can and do occur at any age, and we now know that HT may actually prompt heart disease," Dr. Wenger says.

The most common form of heart disease is coronary artery disease, which affects the blood vessels of the heart. Heart disease also includes atherosclerosis, or the thickening and hardening of the arteries, as well as stroke and heart failure. The groundwork for coronary heart disease can start in your 20s.

"The take-away message is that coronary heart disease should be a concern of all adult women, and knowledge about your risk could save your life," says Dr. Wenger. She helped write aggressive AHA guidelines to help reduce women's risks for heart disease.

Risk factors

Risk factors for heart disease can be divided into those that suggest a major risk and those that lead to an increased risk. Major risk factors are high blood pressure, high blood cholesterol, diabetes, obesity or being overweight, smoking, physical inactivity, heredity, and age. Factors that could lead to an increased risk include stress and excessive alcohol consumption—for women, that means more than one drink a day.

Starting at age 20, Dr. Wenger says, women should know their blood pressure and cholesterol levels. One red flag is a high level of LDL ("bad") cholesterol, which clogs arteries, and a low level of HDL ("good") cholesterol, which clears arteries.

Knowing your risk factors is vital. The more risk factors you have and the worse they are—the higher your blood pressure, for instance—the greater your risk for heart disease.

Once you know your risk factors, you can learn whether you're at high, intermediate or low risk for heart disease. Then you can set goals and work with your doctor to reach them, Dr. Wenger says.

Lifestyle changes

The AHA guidelines call for cholesterol-lowering drugs or aspirin in some cases and lifestyle changes at all levels of risk. The National Institutes of Health says these steps could help lower your risk by a whopping 82 percent:

  • Lose weight. You'll cut your blood pressure, cholesterol and diabetes risk, hitting three key risk factors at once. For apple-shaped women, losing spare-tire fat is vital. Belly fat has been linked to higher levels of triglycerides, a blood fat that raises your risk for heart disease. "If your waist is more than 35 inches, you're more likely to develop heart disease even if you don't have other risk factors," says Nieca Goldberg, M.D., a New York cardiologist who focuses on women. Weight loss involves the same equation: Cut calories and become more active, she adds.

  • Trim saturated fat and salt from your menu. When you can, trade butter for heart-healthy canola or olive oil. Swap red meat for seafood, a good source of omega 3 fats shown to help reduce triglycerides, clotting, and blood pressure.

  • Get a move on. Exercising 20 to 30 minutes several days a week can cut your blood pressure and protect your heart, studies show. In a month, says Dr. Goldberg, you may see your systolic blood pressure (the upper number) drop eight to 10 points. In six months, your HDL may rise 10 percent, she adds.

  • Quit smoking. Smoking is women's most common risk factor and triples your heart attack risk. It may take a few tries to quit. You'll need to address your addiction physically, with a patch or gum, for instance. You'll also need to modify your behavior, by munching a carrot when cravings strike, for example.

  • De-stress daily. Visit a friend. Light candles and listen to mood music. Take a yoga class. Putting yourself on your "to do" list and finding ways to defuse stress will help slow your breathing and heart rate as you lower your blood pressure. That's "just as important as proper diet and exercise," Dr. Goldberg says.

Heed these symptoms

If you have to sit down after you clear the dishes, a heart attack could lie on your horizon, says Dr. Goldberg.

Unshakable fatigue—tiredness that hampers activities—and sleeplessness appear to be early warning signs of a woman's heart attack, according to a 2003 report in the AHA journal Circulation. Other symptoms:

  • Shortness of breath

  • Nausea

  • Uncomfortable chest pressure (instead of sharp chest pain)

  • Pain that spreads to the shoulders, neck, or arms

If you have these symptoms, especially if they last more than five minutes, call 911.

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