Are you among the more than 40 percent of women who don’t realize that the Number 1 killer of women is heart disease? The fact is one woman in 25 to 30 dies of breast cancer while one in two dies of cardiovascular heart disease. A recent article in The Virginian-Pilot noted that there is a remarkable difference between men and women when it comes to heart disease.

“A woman’s heart is her major health threat,” the article stated. While the article pointed out clearly that heart disease is the leading killer of men, the time of greatest risk for men is about 10 years sooner than for women. Women have an abrupt change of their hormonal levels with loss of estrogen at about age 50, and this immediately increases their risk 2 to 3 times of having coronary artery disease and myocardial infarction.

Women’s symptoms are different from men’s, so it is important for you to know how heart disease affects you. Since heart disease occurs at a younger age in men, women may overlook a myocardial infarction or severe coronary artery disease in themselves because it doesn’t quite “fit the pattern.” A heart attack may have occurred without their knowledge just because the symptoms weren’t typical. Good information is a powerful tool in diagnosing and treating heart disease. The first step is awareness of the information, followed by diagnostic intervention, prevention appropriate to your current cardiac status, and finally treatment of heart disease based on your particular risks and severity of the disease.

You will note from your other readings about prevention of breast cancer in women that the similarities for the prevention of heart disease are striking. If you can keep your body healthy in terms of your immunity to cancer, you can do the same in terms of your prevention of heart disease. How is this possible when you sometimes feel that you don’t really have any control over the direction that your body takes? We tend to focus on one area of diagnosis and treatment, such as high cholesterol. However, body weight (BMI), the time you spend exercising, smoking, and elevated blood pressure affect the progression of this disease to a remarkable degree, and each one is important. As the Pilot article pointed out, there are problems with diagnosis because even if major heart arteries are not blocked, coronary microartery disease can be serious enough to cause a myocardial infarction.

In regards to prevention, a recent article in the July issue of Journal of the American Medical Association revealed that sudden cardiac death accounts for more than half of all cardiac deaths in women. The majority of these are the first manifestation of heart disease. This article was estimating the degree to which a healthy lifestyle may lower this risk. It stated that a low-risk lifestyle was defined as non-smoking, BMI less than 25, 30 minutes exercise a day, and good adherence to the Mediterranean Diet which emphasizes fruits, vegetables, nuts, beans, grains, and fish. The study involved 321 patients who were followed for 26 years.

The study found that even if you haven’t adhered to a low-risk lifestyle over the years, your risks can change as soon as you incorporate lower risk factors into your overall health pattern. The article concludes by noting that 81percent of these deaths could have been avoided had the women embraced a low-risk lifestyle.

While smoking is the leading preventable cause of cardiac death, hypertension comes in as a close second. Elevated cholesterol is overrated, but you can take a pill to at least improve the appearance of the numbers. Another risk factor is trans- or hydrogenated fat intake, which tends to have a specific negative effect on cardiac vessels. If you undergo an early menopause either surgically or naturally, hormone replacement therapy helps maintain your cardiac status. It is helpful also to look at the statistics regarding heart disease in postmenopausal women. Some of the death rate is due to increased aging or other diseases, which might affect the overall death rate.

In regards to cholesterol, an LDL of less than 100 is the best, and is only high if it is about 150 or over. HDL is best at 50 or over, and triglycerides are best at less than 150. Interestingly, a change in lifestyle focused on exercise and improved nutrition can change both of these without taking statins. Supplementation with niacin, a simple B vitamin obtainable at health food stores, can improve the LDL level, which statins cannot do.

Women have different heart symptoms than men. Angina in men is manifested by tightness of the chest or arm pain, while women have more vague chest or abdominal pains. Fatigue and sleep disturbances are a common precursor to myocardial infarction in women, but not so in men. Because of this difference, women often ignore their symptoms. One study noted that two-thirds of women who die of myocardial infarction had no “true” symptoms of heart attack.

Diagnostically speaking, an electrocardiogram in women is not as good for diagnosis as an echocardiogram. Elevated cholesterol over the age of 65 may not be associated with increased cardiac risk. Aspirin does not seem to be as effective in women for prevention of coronary disease as it is in men. Hormone replacement therapy benefits become negative as a woman ages, probably around the age of 60 and over. A coronary artery scan has predictive value in men and women, but is less specific for women in the under-60 age group. In over-60 women, the test is 90 percent accurate for predictability of heart disease. One interesting final note is that after CABG (coronary artery bypass graft), women tend not to take care of themselves as well as men. This may be because they don’t have a wife to prod them to take better care of themselves.

Overall, a heightened awareness of the factors causing heart disease, lifestyle changes which can put you in a lower risk category, and the availability of excellent diagnostic testing can change your incidence of heart disease and give you more good years to live. Remember, your heart is working hard for you every day, beating 60-80 times a minute 24 hours a day. The least you can do is take good care of it! I’ll see you at the gym. 

Dr. Carraway is the director of the Plastic & Cosmetic Surgery Center of EVMS. Call 757-557-0300 for more information.