Dr. Mimi Guarneri, MD, FACC, ABIHM, is board certified in cardiovascular disease, internal medicine, nuclear medicine, and holistic medicine. Dr. Guarneri is president of the American Board of Integrative Holistic Medicine and serves as Senior Advisor to the Atlantic Health System for the Center for Well Being and Integrative Medicine. Dr. Guarneri is founder and director of Guarneri Integrative Health, Inc. and Taylor Academy for Integrative Medicine Education and Research located at Pacific Pearl La Jolla in La Jolla, CA.
Dr. Erica Oberg, ND, MPH, received a BA in anthropology from the University of Colorado, her doctorate of naturopathic medicine (ND) from Bastyr University, and a masters of public health (MPH) in health services research from the University of Washington. She completed her residency at the Bastyr Center for Natural Health in ambulatory primary care and fellowship training at the Health Promotion Research Center at the University of Washington.
Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
In 2004, for the first time, female-specific guidelines were developed by the American Heart Association (AHA) in recognition of the gender differences in both the mechanisms and presentation of cardiovascular disease. In 2011, the guidelines were updated and, also for the first time, the AHA discussed the characteristics of "ideal cardiovascular health." Ideal cardiovascular health includes:
The classical heart healthy diet is low fat (<10% saturated fat and <300 mg cholesterol); however, low-fat diets tend to raise triglycerides (TG) and decrease HDL (known risk factors for women). New National Cholesterol Education Panel (NCEP) guidelines recognize that the type of fat matters as much, if not more, than the quantity. It is important to differentiate the good quality fats and eat sufficient quantities while limiting saturated fat, trans fats, and animal fat in general. Heart healthy fats should be consumed to make up 20% to 25% of the diet. Good fats are mono- and poly-unsaturated fats such as olive oil and plant fats (avocado, nuts, seeds, and coconut oil). Unhealthy fats come from animal sources (especially red meat) and processed foods (such as cookies and pastries, especially ones packaged for long shelf life). Several dietary patterns are consistent with this information and are known to protect against and help reverse cardiovascular disease. These include the Dietary Approaches to Step Hypertension (DASH) diet, the Mediterranean diet, and the Ornish vegetarian diet.
The DASH diet is characterized by being low in saturated fat, cholesterol, and total fat. It is focused on fruits, vegetables, and fat-free or low-fat dairy products. It is rich in whole grains, fish, poultry, beans, seeds, and nuts, and contains fewer sweets, added sugars, sugary beverages, and red meats than the typical American diet. The DASH diet has been studied extensively by researchers, and it consistently helps people lower blood pressure, lose weight, and improve cholesterol levels.
Another well-studied protective pattern is the Mediterranean diet. Adherence to the Mediterranean dietary pattern has been associated with lower all-cause mortality, less cardiovascular disease, as well as lower rates of dementia, diabetes, and cancer. Additionally, following a Mediterranean diet leads to improvement in overall health. A Mediterranean dietary pattern consists of high amounts of fresh fruits and vegetables, healthy fats such as olive oil and low-fat yogurt, plant and marine-based proteins, and moderate wine. Meats and sweets are only rarely consumed. Recently, the large PREDIMED trial compared a low-fat diet to two versions of a Mediterranean diet, enhanced with either olive oil or extra nuts. While all the diets reduced blood pressure, the Mediterranean diets reduced rates of myocardial infarction, stroke, and the number of deaths from cardiovascular causes over a period of about 5 years. The Mediterranean diet also reduced blood sugar and inflammation, as measured by high-sensitivity C-reactive protein (hs-CRP).
The Ornish vegetarian diet has also been well-studied and has been shown to not only treat but also reverse heart disease. The Ornish diet is very low in fat and includes more carbohydrate than the Mediterranean or DASH diet; however, the carbohydrates are from whole grains such as oatmeal, quinoa, and brown rice and legumes such as beans and lentils. The research on the Ornish diet emphasizes that the diet is not the only answer; to reverse heart disease, people must make overall lifestyle changes including being physically active, addressing their emotional heart with group support, and practicing meditation or yoga.
What the DASH, Mediterranean, and Ornish diets have in common is that they are all based on unrefined fresh foods, primarily from plants. Importantly for women with cardiovascular disease, the DASH and Mediterranean dietary patterns are low in refined carbohydrates, which means they will help lower triglycerides and increase HDL -- two major contributors to cardiovascular disease for women.
Signs include hypertension, angina, edema (fluid accumulation in tissues), palpitations, and vague symptoms that are often confused with indigestion or musculoskeletal pain. Overall symptoms get worse with exertion and improve with rest. Women are more likely than men to experience unstable angina (chest pain or sensations that occur irregularly and unpredictably).
Some women experience classic angina symptoms such as chest pain or pressure but more commonly, women experience: