HEART DISEASE
See also...
Q. Do women really need to worry about heart disease?
A. Since heart disease is the number one killer of
American women, heart disease is a woman's concern--every woman's concern. One in ten
American women 45 to 64 years of age has some form of heart disease, and this increases to
one in five women over 65. Coronary heart disease is a disease of the blood vessels of the
heart that causes heart attacks.
Q. Is heart disease really the number one killer for
post-reproductive age women?
A. Cardiovascular disease is the leading cause of
death for both men and women in the United States. Cardiovascular diseases claim more
female lives every year than the next 16 causes of death combined, and almost twice as
many as all forms of cancer. More than 250,000 women each year die of coronary heart
disease, compared to 46,000 deaths from breast cancer. Cardiovascular disease does
increase as we age, particularly after the menopause. Premenopausal women are also at risk
for cardiovascular disease if they have cardiac risk factors such as smoking,
hypertension, diabetes, elevated cholesterol and family history of premature
cardiovascular disease.
Q. How do I know if I have heart disease? Are there medical
tests to alert me?
A. Cardiovascular disease can be silent but usually
has symptoms. Lack of blood flow to the heart muscle can cause symptoms of chest
discomfort, shortness of breath, fatigue and sometimes palpitations and dizziness. Talking
to your doctor about your symptoms, along with good routine follow-up care are necessary
first steps to determine if any further evaluation is necessary. Many cardiac risk factors
can be controlled, modified or eliminated, including hypertension, diabetes, elevated
cholesterol, smoking and obesity/physical inactivity.
Q. I had my lipid levels checked but I do not understand the
results. What do they mean?
A. A person's particular blood lipid analysis is
determined to some degree by one's diet and genetic factors. A routine fasting blood lipid
analysis provides a measure of a total cholesterol, HDL-cholesterol (good cholesterol),
LDL-cholesterol (bad cholesterol), and triglycerides. Increases in all but the good
HDL-cholesterol have been shown to increase the risk of heart disease. In fact, a low
HDL-cholesterol level is also a cardiac risk factor. The results of the blood lipid
analysis will determine if it is necessary to take a cholesterol lowering medication and
follow a low fat, low cholesterol diet. Practice guidelines to manage cholesterol levels
are set by the National Cholesterol Education Panel (NIH). You should discuss the results
of your blood tests with your doctor to determine what it means for your health and risk
of heart disease.
Q. I read that women show different signs than men do prior
to a heart attack. What can I do to make sure the emergency room treats me correctly?
A. Nearly 90% of women with a heart attack will
have chest pain the same as men. Historically, however, chest pain has not been perceived
to be of great prognostic value in women, or a great clue that heart disease is really
present. Chest pain can have different origins and women can experience uncharacteristic
features of cardiac chest discomfort. The likelihood of chest pain coming from the heart
depends to a great extent on the person's particular cardiac risk profile. For example, a
premenopausal women who smokes is as likely to have cardiac chest pain as a postmenopausal
woman with hypertension. All chest discomfort in women must be taken seriously and
evaluated for its source, whether cardiac or otherwise. One should not wait to seek
medical attention if there are symptoms of chest discomfort with or without physical
exertion. Some studies have shown that women who tell their doctors about chest pain are
not treated as agressively as are men. Women who are not satisfied with a physicians
evaluation of their chest discomfort should be persistent and seek another opinion.
Q. How much difference can diet and exercise REALLY have on
the health of my heart and cardiovascular system?
A. Following a low fat, low cholesterol diet and
exercise are excellent health habits for all to follow. This helps lower one's blood lipid
analysis, blood pressure and blood sugar. These are all factors that contribute to the
development of atherosclerosis (hardening and blockage of the blood vessels). Studies have
shown that increasing levels of leisure-time physical activity are associated with
decreased risks of coronary heart disease. Physically active women have an approximate
60-75% lower risk of heart disease than sedentary women. Physical activity includes such
activities as daily walking, climbing stairs, gardening etc. Unfortunately, over 50% of
all women in the U.S. are physically inactive.
Q. I have a friend who is 38 years old. She has irregular
heart beats or PVCs. Her doctor said that a woman's system changes as she enters menopause
and can result in PVCs. Are they dangerous? Can you explain PVCs and menopause?
A. A 38 year old woman who experiences irregular
heart beats or "PVCs" (premature ventricular contractions) may have extra beats
which are relatively harmless or it may be a sign of some form of heart disease. If a
woman has palpitations (the sensation of fast and/or irregular heart beat) or other
symptoms such as dizziness or shortness of breath, she should inform her doctor. Your
doctor can take a careful history and perform a physical exam. In some cases, further
testing of your heart may be necessary to determine the specific heart rhythm that may be
causing the sensation of palpitations. In some individuals, caffeinated products, alcohol
and stress can provoke extra beats. Menopause alone does not predispose a woman to
palpitations unless she has other medical conditions/or cardiac risk factors that could
lead to heart disease. However, menopause creates an estrogen deficient state that poses a
risk to the cardiovascular system. This is because estrogens have a number of properties
that protect the blood vessels and lowers LDL-cholesterol levels, while raising the
HDL-cholesterol.
Q. What factors increase my chances for heart disease?
A. The three biggest risk factors for cardiovascular
disease that you can do something about are cigarette smoking, high blood pressure, and high blood cholesterol. Other risk factors, such as overweight
and diabetes, also are conditions you have some control over. Even just one risk factor
will raise your chances of having heart-related problems. But the more risk factors you
have, the more likely you are to develop cardiovascular diseases--and the more concerned
you should be about protecting your heart health. Various studies show that
physical inactivity is a risk factor for heart disease. Heart disease is almost twice as
likely to develop in inactive people as in those more active. Excess body weight in
women is linked with coronary heart disease, stroke, congestive
heart failure, and death from heart-related causes. The more overweight you are, the
higher your risk for heart disease. Diabetes, or high blood
sugar, is a serious disorder that raises the risk of coronary heart disease. The risk of
death from heart disease is about three times higher in women with diabetes.
Diabetic women also are more apt to have high blood
pressure and high blood cholesterol. The risk of heart attack or stroke is higher
for women who both smoke and use high-dose birth control pills (oral contraceptives).
Q. How can I reduce my risk for heart disease?
A. Regular physical activity can help you reduce
your risk of coronary heart disease. Being active helps women take off extra pounds, helps
to control blood pressure, lessens a diabetic's need for insulin, and boosts the level of
"good" HDL-cholesterol. Some studies also show that being inactive increases the
risk of heart attack. In general, the National Heart, Lung and Blood Institute recommends
the following Heart Healthy Action Plan:
- Quit smoking
- Cut back on foods high in fat, saturated fat, and
cholesterol
- Check blood pressure and cholesterol levels
- Get more exercise
- Lose weight if you are overweight
Q. How
does high blood cholesterol affect your risk for heart disease?
A. Cholesterol is a fatty substance
produced by the liver to help meet the body’s need for hormones and bile acids. It
also enters the body when high-fat foods are consumed and when the body’s cholesterol
level is higher than necessary for normal cell functioning. The resulting high blood
cholesterol is a condition that greatly increases your chances of developing coronary
heart disease. That is because extra cholesterol in the blood settles on the inner walls
of the arteries, narrowing them, allowing less blood to pass through them to the heart.
The higher your total blood cholesterol level, the greater your heart disease risk.
For all adults, a desirable total blood cholesterol
level is less than 200 mg/dL. A level of 240 or above is considered high blood
cholesterol. But even levels in the "borderline-high category (200-239) boost the
risk of heart disease.
For a woman, the level of high density
lipoprotein (or HDL, the so-called "good" cholesterol) also affects heart
disease risk. If your HDL is less than 35, your risk of heart disease increases.
Q. What are the main tests for coronary
heart disease?
A. Diagnostic tests are usually
needed to confirm the presence and assess the severity of coronary heart disease. Often,
more than one test is needed because different tests supply different information. Also,
patients vary in their symptoms and may need more than one test to find out the
heart’s condition. The primary tests used to diagnose heart disease are described
below. Many are not invasive procedures -- they are done outside the body -- and are
painless.
These tests include:
- Electrocardiogram (ECG or EKG) makes a graphic record
of the heart’s electrical activity as it beats. This can show abnormal heartbeats,
muscle damage, blood flow problems, and heart enlargement.
- Stress test (or treadmill test or exercise ECG)
records the ECG during exercise, usually on a treadmill or exercise bicycle. Some heart
problems show up only when more effort is asked of the heart, as happens during increased
activity. So the exercise ECG may be done even if the resting ECG is normal.
Other exercise tests may be done with an ECG or a
nuclear scan to assess heart muscle concentration or blood flow in the heart. Older women
may not be able to exercise due to arthritis, osteoporosis or another condition. For them,
a stress test can be done without exercise by using a medication that increases blood
flow.
Different standards exist for reading the EKG in
women as compared to men. Make sure your doctor knows them.
Q. What is the connection between hormone replacement
therapy (HRT) and heart disease?
A. Hormone replacement therapy--a term for
prescription hormone pills that are taken daily--can be used to relieve these symptoms.
Some women are prescribed pills that contain only estrogen. A woman with a uterus may take
estrogen combined with a second hormone called progestin.
Estrogen pills have several important benefits. They can
help you feel more comfortable as your body adjusts to lower estrogen levels by decreasing
hot flashes, night sweats, or vaginal dryness. They also help to prevent osteoporosis, a
thinning of the bones that makes them more likely to break. Many studies also have found
that estrogen pills help protect women from developing coronary heart disease, but more
research is needed before we will know this for sure.
Estrogen therapy also has risks. It may increase the
chances of developing gallbladder disease, and it may worsen migraine headaches. It may
also increase the risk of breast cancer. But by far, the biggest risk of taking estrogen
pills is cancer of the uterus, but this risk is greatly decreased by taking progestin,
another hormone. Finally, we don't yet know whether this combination will boost the risk
of breast cancer. Studies are now under way to find answers to these important questions.
There are also some studies which show that estrogen may decrease the chance of developing
or decrease the severity of Alzheimer’s disease.
In the meantime, a woman and her doctor must decide whether
the benefits of hormone therapy are worth the risks. If you are considering this
treatment, you will need to consider your overall health and your personal and family
history of heart disease, uterine and breast cancer, and osteoporosis.
If you are now on hormone therapy, check with your doctor
to be sure you are taking the lowest possible effective dose. At least every 6 months, you
and your doctor should discuss whether you need to continue treatment. Be alert for signs
of trouble--abnormal bleeding, breast lumps, shortness of breath, dizziness, severe
headaches, pain in your calves or chest--and report them immediately. See your doctor at
least once a year for a physical examination.
For More Information.....
You can find out more about heart disease by contacting the
following organizations:
National
Heart, Lung, and Blood Institute (NHLBI)
Consumer Information Center (CIC)
Food and Drug Administration (FDA)
Food and Nutrition Information Center
Human Nutrition Information Service (HNIS)
National Cancer Institute (NCI), 800-4-CANCER
National Clearinghouse for Alcohol and Drug Abuse
Information (NCADI)
National Diabetes Information
Clearinghouse (NDIC)
Office of Disease Prevention and Health Promotion
Office on Smoking and Health (OSH),
Center for Chronic Disease Prevention and Health Promotion
Voluntary Health Agencies
American Cancer Society (ACS)
American Dietetic Association (ADA)
American Diabetes Association
American Heart Association (AHA)
American Lung Association (ALA)
This information was excerpted from the National Heart,
Lung, and Blood Institute’s pamphlet, "Women
and Heart Disease" and the NHLBI’s The Healthy Heart Handbook for Women
and the US Public Health Service’s Office on Women’s Health "Heart Disease
and Stroke in Women: the facts."
Contributing to this FAQ on heart disease: The University of
Maryland Medical Center, a National Center of Excellence in Women's Health sponsored by
the Public Health Service's Office on Women's Health.
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