Women's Heart Health -- Nina Radford, MD - 8/27/03
By Nina Radford
Heart disease is the No. 1 health threat to women. Surprised? Many people are. But the good news is, heart disease can be prevented. We discussed women's heart health, including diet, warning signs, and the effects of menopause with Nina Radford, MD, from the Cooper Clinic.
The opinions expressed herein are the guest's alone and have not been reviewed by a WebMD physician. If you have questions about your health, you should consult your personal physician. This event is meant for informational purposes only.
Moderator: Welcome to WebMD Live, Dr. Radford. Why are so many people unaware of the role of heart disease in women's health?
Radford: A lot of women would be surprised to know that cardiovascular diseases are the number one killers of women and men. These diseases will claim the lives of half a million women each year. That's more lives than the next seven causes of death combined. Organizations like the American Heart Association and the National Institutes of Health have made getting this message out to women a top priority.
Moderator: What are the top five causes of heart disease in women?
Radford: I would say there are a number of risk factors for heart disease that are well known, but cigarette smoking is the leading reversible cause of heart disease in women. You might be surprised to learn that in the U.S. about 22% of women still smoke. It's estimated that by the year 2010, more women in this country will smoke than men because men are quitting at a faster rate than women.
The group that's taking up the habit the fastest is young women. We need to encourage our daughters and granddaughters to stop smoking.
Or better yet, never start.
Other important risk factors include:
Member question: Does emotional well-being play a part in cardiovascular disease?
Radford: Emotional well-being plays an important part in many aspects of women's health. A woman who is under stress is much less likely to follow a heart healthy diet or take the time to exercise. Stress can also:
Moderator: Let's assume that the first step to heart health is giving up smoking if you smoke. What would be the next step you would recommend?
Radford: The most important step that you can take to modify your risk for heart disease is to define your personal risk factors. This includes having your blood pressure checked. A normal blood pressure is 120 over 80. The most recent blood pressure guidelines report that even a blood pressure of 130 over 85 is called prehypertension and should be monitored.
Women ought to have fasting blood work done to check the levels of their bad cholesterol, LDL cholesterol, and good cholesterol, HDL cholesterol, and triglycerides. Normal levels of the bad cholesterol depend on your level of risk. Women with heart disease should have an LDL level less than 100. For other women, an LDL cholesterol between 100 and 130 is needed.
Fasting blood work can also reveal the presence of diabetes. Diabetes is a very strong risk factor in women. In general, women tend to have their heart attacks 10 or 15 years later than men, with the exception of the diabetic woman. The diabetic woman does not enjoy this gender protection.
With some very simple tests, a woman can generate a risk factor profile and she can then partner with her health care professional to get those risks under control.
Member question: My mother and I both became disabled with heart disease and diabetes at the age of 50, yet I cannot get my 29-year-old daughter to realize how limited her life might be if she doesn't make some radical changes.
Radford: There is a very strong genetic component to cardiovascular disease, risk factors, and heart disease. Thus, many of us have a crystal ball into our future by simply taking a look at our parents. Many young women find it difficult to imagine themselves disabled by high blood pressure or diabetes or heart disease. And yet if they see those things in their mothers they need to be very focused on maintaining their good health. It is much easier to maintain wellness than to regain it.
Just ask any woman trying to lose that dreaded baby weight. Once you put on 10 pounds it can be enormously difficult to lose it. It is much wiser to avoid high blood pressure by getting regular exercise, maintaining an ideal body weight, and following a diet with a variety of fruits and vegetables, whole grains, and lean protein sources, than to recover from the devastating consequences of a stroke or a heart attack.
Member question: I quit smoking over 25 yrs. ago. My blood pressure is very low. My cholesterol was over 300 but I've lowered it to 270 thru diet and exercise. I also lost 30 lbs and have kept it off for a year. What else can I do to keep heart disease at bay?
Radford: You have done a fantastic job! What you have accomplished is not easy, and clearly shows your dedication to reducing your risks for heart disease. I am a little concerned still that your cholesterol of 270 is too high. Unfortunately, even when we make all the right choices, in terms of our lifestyle and diets, we cannot outrun our genetics. You may have a genetic tendency towards high cholesterol, and even in the setting of good lifestyle choices you may need a cholesterol lowering medication. I encourage you to speak to your health care provider regarding this issue.
Member question: So many women take on the role of caregiver, but don't take care of themselves. Does this role hurt us in terms of heart health?
Radford: I think one of the biggest challenges for women today is juggling the many roles that we play in terms of being a parent, a daughter, an employee, an employer, being a volunteer in the community. So often women will put their own needs at the very bottom at their list of things to do today. So many women will feel selfish if they put their own need for 30 minutes of exercise above the need of their soccer playing children or demanding work environment.
What women need to realize is that they will not be doing anyone a favor if they find themselves in the coronary care unit. Women need to learn how to feel comfortable putting their health high on their priority list.
If a woman is too busy to find 30 minutes in her daily schedule four times a week for a walk around the block or a ride on a bicycle, then she is just too busy. She needs to take a good look at her priorities and reduce unreasonable expectations. Sometimes our mantra needs to be, "Completion is better than perfection."
Member question: Can you explain the role of menopause in heart disease? Why does menopause affect my heart? I thought HRT was supposed to help prevent heart disease, but now I'm told that it is bad for your heart. What can we do to help our hearts after menopause?
Radford: The issue of menopause hormone replacement therapy and heart disease is a complicated one. Because a woman has higher good cholesterol than a man and because her heart disease occurs later than men, (approximately 10 to 15 years after the menopause) it has long been assumed that our hormones protect our hearts. Recently the results of the Women's Health Initiative have been published, which show that hormone replacement therapy does not protect women from developing heart disease.
The important thing to remember about the Women's Health Initiative is that about half of the women enrolled in the study were over the age of 65 and the vast majority had never been on hormone replacement therapy. Thus, these women may already have had artherosclerosis or hardening of the arteries before they were given the hormone therapy. Nevertheless, hormone replacement therapy is indicated for the treatment of vasomotor symptoms, like hot flashes.
If a woman needs her risks for cardiovascular disease reduced, the use of hormone replacement therapy is not advised. Instead, we should concentrate on:
For the women who want to use hormone replacement therapy to treat hot flashes, the risks of heart disease are very, very low in an average menopausal woman. However, each woman's risks and benefits from taking hormone therapy will depend on her personal clinical profile and should be discussed with her health care professional.
Member question: What diet changes do you advise? I've eliminated all hydrogenated fats and eat mostly whole grains, vegetables, fruits, and very little meat.
Radford: The best diet for heart health includes a variety of fruits and vegetables. The DASH diet is the best diet for blood pressure reduction and it includes four to five servings of fruits and four to five servings of vegetables per day.
A diet that includes fish is important. Currently we recommend eating fish at least twice a week, but it's also important to try to avoid those fish that have high levels of mercury. The U.S. Food and Drug Administration has a list of mercury levels in fish and shellfish that's a great resource. You can find it at www.cfsan.fda.gov.
In terms of fat intake, the bad fats include the trans fats. Trans fats are unsaturated fats but they raise the bad cholesterol and lower the good cholesterol. Trans fats result from adding hydrogen to vegetable oils and it's most often used for commercial baked goods to increase the shelf life. Saturated fats can also raise cholesterol. Saturated fats can be found in whole milk, whole milk cheeses, butter, and meats.
The best fats are the unsaturated fats and monounsaturated fats, which can actually lower your cholesterol when used in place of saturated fats. Examples of polyunsaturated fats include safflower oil, corn oil, and sunflower seed oil. Monounsaturated fats include olive oil and avocados.
It's important to try to keep your protein sources as lean as possible with low-fat milk or cheese products, poultry, and fish.
Also, it's important not only to pay attention to what you're putting on your plate, but also how much. When you look at an average serving size on a package label, it's often much smaller than the size we serve ourselves at home or we're served in a restaurant. When you look at how much food you get in a "super-sized" serving, it should be enough to feed a family of four. We can get into a lot of trouble with plain excess calories even if we make the right choices with the kinds of food we eat.
Member question: What are the signs of a heart attack? Are they different for women than men?
Radford: Classically the symptoms of a heart attack are substernal chest pressure that radiates to the left arm and makes us sick to our stomach, sweaty, and short of breath. Most studies suggest that women do have some sort of chest pain symptom when they're having a heat attack. However, it may feel more like indigestion or muscle ache. Women are also more likely to have pain in the shoulders, back, or neck, or to have the major component be shortness of breath.
It is very important if women have symptoms that they think may be coming from their heart, to see their health-care professional. So often women tell me that they'd be embarrassed to go to an emergency room in case it wasn't their heart. This always strikes me as odd. How often would a woman ever be embarrassed if she had a normal mammogram?
No woman would ever say, "Gosh, I'm so embarrassed I didn't have cancer"? If you see your health professional and they determine the symptoms are not coming from your heart, fantastic!
However, if the symptoms are coming from the heart, it is very important to be proactive. About 63% of women who die suddenly of cardiovascular disease have no previous symptoms. Thus, if you're one of those lucky women to have symptoms, act on them.
Member question: Can taking a little aspirin everyday help prevent a heart attack? Or is that just for men?
Radford: The issue of aspirin use is also complex in women versus men. There was a large study published in Male Physicians that showed the use of aspirin, 325 milligrams every other day, reduced the risk of having a heart attack by 44%. However, the use of aspirin can be associated with an increased risk of stroke. Therefore, although these male doctors on aspirin had a reduced risk of heart attack, they did not have any different overall rate of death compared to the male physicians who did not take aspirin. The current recommendation is for men who have at least one risk factor for heart disease to take a baby aspirin, 81 milligrams daily.
You might be surprised to learn that there hasn't been a similar study of women that has been published. The good news is that there is currently a study underway in which 30,000 women ages 45 or older have been entered into a study to determine if low-dose aspirin use results in a similar reduction in heart attack risk for women. In the meantime, we're left making our best guess.
Our recommendations, again, based on findings in men, is that a woman who has one or more cardiovascular risk factors should consider the use of low-dose aspirin to reduce her risk of heart attack, as long as she doesn't have any other medical contraindications to aspirin use.
Member question: I have inoperable heart disease -- but had TMR four years ago, and EECP three years ago with questionable but possibly mild help. My angina is increasing. Other than transplant, any thoughts on other new treatments?
Radford: There are a number of treatments that are available for men and women who develop coronary heart disease. In general, they're pretty barbaric, in the sense that we put a stent in a blockage to squish it open; we perform coronary artery bypass grafting, or cabbage where we simply put bypass grafts around the area of the blockage, or we give the patient a new heart through transplantation.
None of these options are as good as having your own healthy heart. Thus, prevention is the name of the game. There are many patients who develop cardiovascular disease who, even after taking advantage of all that medical treatment can provide, have a dismal prognosis. I meet many patients who would gladly turn back the hands of time and trade french fries for carrots and couch time for the gym.
Specifically in the case of women, when they are often older when they have their heart disease, many therapies can be fraught with side effects. Again, emphasizing the beauty and wisdom of prevention.
Member question: I hope you can help me in trying to put some closure on my mom's sudden death last year. She had fibromyalgia and we had taken her to the ER several times in the last year, due to either heart palpitations and/or tightness. Each time she was given an EKG, and told it was something to do with the fibromyalgia, as there is something in the sternum that can be affected by that. Also my mom was a nurse and was fully aware of heart disease and signs and symptoms. As it were, she was complaining of heart palpitations (same as before, but NEVER said anything about there being any pain, only the palpitations. She and my dad had come by to pick me up so we could take her to the hospital,hen she let out a gasp and basically died.
Radford: That is a heartbreaking story, and I am so sorry you are dealing with that in your life. The diagnosis of heart disease in women can be difficult. The standard exercise treadmill test is not a one-size-fits-all for men and women. A better test for the diagnosis of heart disease in women would include an imaging modality like a nuclear stress test or an echocardiogram stress test.
I am a firm believer that if you have seen a health-care professional for symptoms that may be related to the heart and you do not feel satisfied with the explanation, if you have a gut feeling that the correct diagnosis has not been made, by all means obtain a second opinion. If you have a blood pressure of 150 over 90, and a cholesterol of 300, and your health-care provider has not helped you create a risk factor modification strategy, find a health care provider who will. Do not ever feel embarrassed that you will insult a doctor or hurt a doctor's feelings if you want a second opinion. It's not about them; it's about you. And you need to feel comfortable with your health-care conditions and their diagnoses.
Sometimes a woman may have chest pain symptoms and all of our diagnostic testing shows that it's not a function of blockages in the heart arteries. Thus, while we may not know the precise cause of the symptoms, we can at least reassure the woman that it's not caused by a problem which could kill her.
Moderator: We are out of time. Thanks to Nina Radford, MD, for sharing her expertise with us today. And thank you members for joining in the discussion. For more information about the Cooper Clinic, please visit their website at http://www.cooperaerobics.com/clinic. You can find out more about the American Heart Association's "Simple Solutions" program for women's heart health at their website: http://www.americanheart.org/simplesolutions.
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