HEART/STROKE: Making the Right Choices
How to be smart about your heart and what you need to know—especially if you're a woman
BY:ROSEMARY BLACK
The facts alone are enough to send your blood pressure soaring: About 60 million Americans have some form of cardiovascular disease, the number-one killer of both men and women. Although many people—even doctors—still think of cardiovascular disease as a man's disease, it claims the lives of about 60,000 more women than men each year, says Michael Lauer, MD, professor of medicine at the Cleveland Clinic Lerner College at Case Western Reserve University in Cleveland, Ohio.
Indeed, though the death rate from heart disease has dropped significantly for men in the past 25 years, it has continued to rise for women, says cardiologist Nieca Goldberg, MD, chief of women's cardiac care at Lenox Hill Hospital in New York City and the author of Women Are Not Small Men (Ballantine Books). Part of the reason: Doctors underestimate women's risk, so they are less likely to get recommendations for preventive care or to be referred for cardiac testing, says Dr. Goldberg, a spokesperson for the American Heart Association (AHA). What's more, women who have heart attacks often fare worse than men, because their symptoms are less likely to be recognized, and they are treated less aggressively. Dr. Goldberg's—and the AHA's—goal is for a heart checkup to become routine for women and for women to receive the same cardiac care.
Heart disease may be the nation's leading cause of death, but it needn't be yours. "Most risk factors can be reduced, or even eliminated, by lifestyle changes and medications that keep blood pressure, cholesterol and diabetes under control," says Dr. Goldberg. In fact, "some experts believe that as much as 80 percent of heart disease could be prevented if risk factors such as poor diet, cigarette smoking and lack of exercise weren't in the picture," adds Dr. Lauer.
Know the Risks
Cardiovascular disease comes in many forms, but the most common is coronary heart disease, also known as coronary artery disease. It's characterized by a buildup of cholesterol and other deposits (plaque) inside blood vessels that can partially or totally block blood flow to the heart, depriving it of oxygen. Though heart disease can be stealthy, sometimes a heart attack is the first symptom. It usually develops over a lifetime and has well-established risk factors.
Some are impossible to avoid, such as your age or genes. Having a parent or sibling who developed heart disease before age 55 if you're a man, and before age 65, if you're a woman, increases your risk by 25 to 50 percent.
"And the older you get, the higher your risk, though men tend to develop heart disease 10 years earlier than women, at around age 50," says Dr. Lauer. "Most women are protected from heart disease by estrogen until menopause, when levels of the hormone plummet," explains Faye Lee, MD, a cardiologist at Good Samaritan Hospital in Los Angeles. After menopause, a woman's risk goes up sharply and it's soon the same as a man's.
Even if you have risk factors you can't change, you can still take steps to limit your risk of heart disease. "Lifestyle changes and medication can counter modifiable risk factors, such as high cholesterol, hypertension, overweight and inactivity, which all affect the development and severity of heart disease," says Dr. Lauer. In fact, recent studies suggest that snuffing out cigarettes and controlling three other major risk factors could literally save your life. Researchers found that roughly nine out of 10 people who died from a heart attack had at least one of four risk factors: high cholesterol, hypertension, diabetes and/or smoking.
About 25 to 30 percent of all deaths due to heart disease are directly related to smoking. A smoker is two to four times more likely to develop heart disease than a nonsmoker. Diabetes is another enormous risk factor for heart disease, since too much sugar in the blood damages blood vessels, and it's particularly hazardous for women. "Having diabetes quadruples a woman's risk," says Dr. Goldberg.
Heart-disease risk also rises as levels of total and artery-clogging LDL cholesterol increase and heart protective HDL cholesterol decreases. According to Dr. Goldberg, total cholesterol of 200 and above and "bad" LDL cholesterol above 130 in people without a history of heart disease (and 100 or above for people who do) indicate increased risk. So does "good" HDL cholesterol below 50 in women, and 40 in men.
Hypertension, the last of the "big four" risk factors, is dangerous, because it makes your heart work harder to pump blood and contributes to hardening of the arteries. "Your risk for heart disease starts to increase when your blood pressure goes higher than 130 over 70," says Dr. Goldberg.
Finally, lack of physical activity and being overweight are not only independent risk factors for heart disease, they increase your chances of developing hypertension, high cholesterol and diabetes.
Take Charge of Your Health
The best way to combat heart disease is to know your own risk factors, so you can address those that can prevent this life-threatening illness or minimize its damage. Make an appointment to have your doctor evaluate your risk for heart disease, Dr. Lauer advises. Everyone should have his or her blood pressure and cholesterol checked. If you're overweight or on medications that may raise blood sugar, you should also have a blood glucose test.
If you are experiencing symptoms of heart disease, such as chest pain or shortness of breath, you may be referred to a cardiologist for more advanced diagnostic tests. This may include stress echocardiography (which uses ultra-sound to monitor your heart as you walk on a treadmill to determine whether the muscles are getting enough blood) or angiography (where dye injected through a catheter threaded up to the arteries of your heart reveals the location and degree of a blockage on an X-ray).
What if you're diagnosed with heart disease? Because of medical advances, people with heart disease can lead fulfilling, active lives, says Dr. Lauer. Treatment typically involves cholesterol- or blood-pressure-lowering drugs, lifestyle changes and possibly procedures that open up blocked arteries. The newest drugs are powerful statins, "which have had a tremendous impact on the treatment of heart disease," says Dr. Goldberg. "Research shows that they can lower cholesterol, cut heart-attack risk in people with diabetes, even if their cholesterol levels are relatively low, and reduce the risk of a first or second heart attack." They're typically given to people with high cholesterol, diabetes or existing heart disease.
If you have hypertension or chest pain, your doctor may write a prescription for one of the beta-blockers, drugs that slow the heart down and lower blood pressure. "They also reduce the risk of death after a heart attack and decrease the risk of a second heart attack," says Dr. Goldberg.
A daily aspirin may also be part of your heart-attack prevention plan. Most heart attacks occur when narrowed arteries become plugged by a blood clot. Aspirin helps pre-vent blood from clotting, but it can also cause gastrointestinal bleeding, so your doctor should decide if it's right for you. "People with established heart disease or who are at high risk for heart disease should be treated with aspirin," says Dr. Lauer.
In addition, your doctor may recommend a procedure to repair or reopen blocked arteries. Angioplasty involves inflating a balloon to widen an artery and inserting a tiny mesh wire tube called a stent to hold it open. Bypass surgery, which may be necessary if blockages are severe, entails grafting a blood vessel from the leg or chest onto the blocked artery to bypass the blockage. It now can be done through relatively small incisions.
Heart-Healthy Living
"The most important thing that you can do to protect yourself from cardiovascular disease is to adopt a healthy lifestyle," says Robert Ostfeld, MD, assistant professor of medicine at Montefiore Medical Center in New York City. "It is never too late to start, and it is never too early to begin." Changing heart-damaging habits can also minimize the effects of heart disease.