Initially, Claire Cornfield, a 56-year-old graphic designer from Lansing, Mich., couldn’t believe the diagnosis. “I’d always thought of heart disease as a problem for middle-aged men who smoked too much. I was astonished when my doctor told me if I didn’t lose weight and start to exercise I would have a heart attack within a year.”
Cornfield’s condition is not that unusual. Women have just as many cardiovascular risks and problems as men, says Nanette K. Wenger, MD, professor of cardiology at Emory School of Medicine in Atlanta. “Coronary disease is the leading cause of death and disability for women.” In fact, after age 50, more than half of all deaths in women are due to heart-related conditions.
Hormones and Your HeartSo how does your menopause status affect the health of your heart? Many experts believe premenopausal women have a lower incidence of cardiac pro-blems because they have higher levels of estrogen, which raise levels of “good” HDL-cholesterol. This form of cholesterol is like the garbage truck of coronary arteries, carting “bad” LDL-cholesterol off to the liver for processing and excretion, helping keep arteries clear. Also, observational studies find that women who take estrogen after menopause have a lower incidence of heart disease than those who don’t, says Howard Hodis, MD, professor of medicine and preventive medicine at the University of Southern California in Los Angeles.
But another story emerged when researchers conducted a large, controlled clinical trial comparing older postmeno-pausal women who took hormone
therapy to those who didn’t. This study, called the Women’s Health Initiative (WHI), found a slightly increased risk of heart disease among women taking one type of oral hormone therapy (Prempro®). The findings resulted in the U.S. Food and Drug Administration (FDA) and most scientific organizations, including The North American Menopause Society (NAMS), recommending that hormone therapy not be used solely to prevent heart disease in postmenopausal women.
This recommendation, however, is uncertain for women who reach menopause before age 40. The evidence is clear that these women have a much higher risk of heart disease than women who reach menopause at the typical age of 51, says Hodis. One study he was involved with found that women who experienced early menopause had more plaque clogging their arteries and restricting blood flow than similarly aged women who reached menopause at the usual time.
Why are these women more at risk? Probably the lack of estrogen over such a long time, says Hodis. Nonetheless, hormone therapy is not FDA-approved for lowering the risk of cardiovascular disease—including for women experiencing early menopause.
Taking ControlSmall consistent steps make strides toward taking control of risk factors, no matter how great the risks or the warning signs.
After adapting her diet and taking swimming lessons at the local gym, Cornfield was surprised at the difference in her health. “At first I was shocked into action, but once I started to notice who good I felt after exercise, it was easy to continue. I’ve got much more energy now, and my sleep has improved also.”
For more information, visit the following Web sites: www.aha.org and www.womenheart.org.
Treatment OptionsWhen treatment is needed, always focus first on the treatment that has no risks—lifestyle changes. Nonprescription and prescription therapies are also available when lifestyle changes alone are not enough.
Lifestyle ChangesPlenty of exercise. The best way to a healthy heart is through exercise. Thirty minutes a day is all you need to make a difference. Take part in an enjoyable physical activity at least every other day, such as swimming, walking or weight-bearing exercise. Or build thoughtful exercise into your day by walking to the store or work or taking the stairs every time rather than the escalator
or elevator.
Heart healthy diet. The American Heart Association (AHA) suggests a diet high in fresh fruit and vegetables, whole grains and high-fiber foods. Aim to eat two portions of oily fish a week, and limit your salt intake to 1 teaspoon a day (2.3 grams sodium). Reducing saturated and trans fat intake will also improve the health of your arteries.
Nonprescription TherapiesNonprescription therapies are also used by many women to lower their heart disease risk.
Soy. The 2006 AHA Advisory Panel noted that many soy products benefit cardiovascular health due to their high levels of polyunsaturated fats, fiber, vitamins and minerals and their low levels of saturated fat.
Aspirin. AHA guidelines recommend that women with a high risk of heart disease take a daily low-dose aspirin (75 to 325 mg). Talk to your healthcare provider for advice.
The evidence is unclear regarding vitamin supplements. Vitamins E, B and C were thought to have a beneficial effect in preventing heart disease, but studies are inconclusive. However, a daily multivitamin-mineral supplement provides good insurance for women who may not get all the proper nutrients in their diets.
Drug TherapiesThere are many effective FDA-approved therapies to treat specific conditions and help prevent heart disease. For example, diuretics are highly effective in controlling high blood pressure; statins are the preferred therapy for normalizing cholesterol.
Estrogen should not be used solely for preventing heart disease, as studies have shown that some types of hormone therapy may increase the risk of heart disease, blood clots and stroke in postmenopausal women.
Risk Factors for Heart Disease
Studies have identified a number of consistent risk factors that increase a woman’s threat of heart disease or stroke.
High levels of blood fats High levels of “bad” LDL-cholesterol, low levels of “good” HDL-cholesterol or high levels of another blood fat (triglycerides) are important markers when it comes to heart disease. Triglycerides and LDL-cholesterol tend to stick to blood vessels, narrowing the space through which blood can flow and increasing the risk that a piece of plaque (the gunk accumulating on blood vessel walls) could break off and clog a vessel downstream. Clogged vessels in the heart result in a heart attack; in the brain, a stroke.
Being overweight The pounds are harder to shift at midlife, but maintaining your ideal weight can reduce your risk of heart disease by 35 percent to 55 percent. If you have a waist circumference of 35 inches or more, you have an increased risk of high blood pressure, diabetes, high cholesterol and elevated triglycerides as well.
Age After 45, women are more likely to develop diabetes, high cholesterol levels and high blood pressure, all of which increase their risk. While there is a genetic component to these factors, there are also many lifestyle components. By the time you reach 55, however, your age is the most significant cardiac risk.
Having an unhealthy diet Aim to reduce saturated fat and cholesterol from your diet. One study from Stanford University found that a low-fat diet containing lots of vegetables, fruits, beans and whole grains lowered total and LDL-cholesterol levels more than one that didn’t.
Having diabetes People with diabetes are more likely to die of a heart attack or stroke than of the disease itself. Plus, women with diabetes tend to have higher rates of heart disease and death from heart disease than men with diabetes.
High blood pressure. Ideally, your blood pressure should be 120/80 mm Hg or less. Your doctor should check it at every visit, at least once a year.
Smoking Women who quit smoking—no matter how much they smoked or how long ago—drastically lower their risk of coronary heart disease. Studies find that women who smoke are two to six times more likely to have a heart attack than nonsmokers.
Stress A stressful lifestyle increases the risk of heart disease. Try to incorporate exercise, meditation and relaxation techniques into your life. They can significantly
reduce stress.
Family history of cardiac disease Your risk of heart disease is higher than the average person’s if anyone in your immediate family had early onset cardiovascular disease (before age 55 for men; before age 65 for women). You also have a higher risk if you’re African American, Mexican American, Native American, Native Hawaiian or belong to some Asian American groups, all of whom tend to have high blood pressure rates.
MEMOWhile a man’s risk for heart disease increases after age 45, a woman’s increases after menopause, irrespective of her age |
