Preventing Heart Disease in Women
WebMD Live Events Transcript
Heart disease is a leading killer of women, but there are things you can do to protect your heart. Just in time for National Woman's Heart Day, Lori Mosca, MD, chief medical advisor for the Sister to Sister: Everyone Has a Heart Foundation, told us on Feb.17 what you can do now to prevent heart disease.
The opinions expressed herein are the guests' 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.
Welcome to WebMD Live, Dr. Mosca. Cardiovascular disease is a leading cause of death for women in the U.S. But there seems to still linger the perception that heart disease is a man's disease. What can we do to raise awareness among our sisters to the dangers of heart disease in women?
It's important that every woman know that heart disease is her leading killer and each year more women die of cardiovascular disease than men. Programs like this educate women about their true risk and what they can do to lower it can go a long way in helping to reduce this.
It's particularly important that all women know their specific risk factors for heart disease, because general awareness is not enough. Women need to know what their blood pressure level is, what their cholesterol numbers are, both the good and the bad, and they need to know what they should be. For example:
- The optimal blood pressure for women should be less than 120 over 80
- The optimal LDL or bad cholesterol should be less than 100
- The optimal HDL or good cholesterol should be greater than 50
- The triglycerides should be less than 150
In addition, they should know their blood sugar should be less than 100; and
their waist circumference should be less than 35. One more thing, the body mass
index, which is a ratio of the weight over the height squared, should be between
18.5 and 24.9.
Many women do not know their specific numbers, but they can find them out tomorrow (February 18, 2005) on National Women's Heart Day at one of 12 major cities across the United States, sponsored by the Sister to Sister Everyone Has a Heart Foundation. The best news is that the screening is completely free and you get your results on the spot. You can also get education from health care providers and experts across the country.
If a woman is unable to attend the free health fair, then she should be sure the next time she goes to her doctor that she learns her numbers: what they should be and how best to get there.
Check www.sistertosister.org for a listing of cities.
How do I know, as a layman, that when I see my doctor for my annual check up that he/she will order ALL the lab tests I need? This would be not just for my heart but also for my whole body, correct?
The best thing to do is to ask your doctor directly what he or she recommends for your annual preventive health evaluation. If you are not sure what specific questions to ask or what might be included in such an exam, you can visit the New York Presbyterian Hospital Preventive Cardiology web site at www.hearthealthtimes.com and download recommendations for a preventive screening exam. Take this form to your doctor and ask what your numbers are and if you need to be screened for any of the conditions on the list. Don't be shy about asking your doctor about preventive health care. Most doctors enjoy discussing health as much as they do treating disease. They appreciate it when a patient wants to take better care of him/herself. Remember, you have an important partnership with your doctor.
If a woman experiences heart palpitations but no chest pain, should she be concerned?
Sometimes palpitations are benign and sometimes may need further evaluation. If you are experiencing palpitations, it's important to avoid caffeine, alcohol, and cigarettes and make a follow-up appointment with your doctor if they do not subside. If you experience palpitations when you are exerting yourself, it is especially important to seek medical evaluation. This could be an indication of a problem with your heart rhythm or sometimes it can be an indication of coronary artery disease. However, most times palpitations are benign and nothing to worry about and can be controlled with simple lifestyle techniques. But you should never assume this and make sure that you've talked to your doctor.
Is it correct that your target heart range (THR) is 220 minus your age?
The target heart range can be calculated by knowing what your maximum heart rate should be. The maximum heart rate is estimated for most healthy adults by subtracting the age from 220. This gives the estimated maximum heart rate. Then, to determine your target heart rate while exercising, you can multiply this number by 0.6 to 0.8 in most cases. However, when I have a patient with heart disease I might lower the target heart range or if I have a healthy adult wanting to increase their fitness level, then I might increase the target heart range.
Your doctor can give you the best advice about what your specific target heart range should be. Be sure to discuss with your doctor if you need a cardiac evaluation prior to beginning an exercise program.
What is the consequence for exercising above your THR?
If you are healthy, there is generally not a problem to exercise above your target heart range. This will lead to improved fitness levels. However, if your heart is compromised because you have blockages in the coronary arteries, and you exercise above a safe target heart rate range, then you could suffer cardiac damage.
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Are there any vitamins that can be taken that have shown good effects on the heart?
That is a very important question and I'm glad you asked. The American Heart Association established evidence-based prevention guidelines for women regarding cardiovascular disease in February 2004. I had the good fortune of chairing that expert panel. We reviewed the world's literature and concluded that vitamin supplements are not recommended to prevent heart disease. In fact, we recommended that antioxidant vitamin supplements not be used and could possibly have harmful cardiovascular side effects. Women who are of childbearing age should take folic acid supplements. Otherwise, there are no strong indications to take regular vitamin supplements, except for calcium in postmenopausal women.
We are still conducting research to determine the safety and possible benefits of several vitamins and other supplements. Until this research is complete, the best advice is to eat a diet that is rich in fruits and vegetables, high in fiber and low in saturated fat and trans fat. While there is no clinical trial data regarding a standard multivitamin, most doctors believe that there is -- that this is okay for most adults.
Keep in mind that the best way to prevent heart disease is through good
lifestyle and not necessarily through supplementation.
I have been taking Co-Q enzymes for about 15 years now. Should I stop?
I have many patients that come to me taking similar enzymes and herbal supplements. I always recommend that the patient discontinue such therapy, because there is no proven benefit and there is always the possibility for side effects, especially because these over-the-counter preparations are not FDA regulated. We have so many proven options and prescription drugs that have been shown to protect the heart, yet are underutilized. So it behooves all of us to consider those rather than unproven therapies.
What about the 81mg aspirin a day? My doctor has me on that.
Aspirin therapy is strongly recommended for all high-risk patients. High risk means that you have established cardiovascular disease or you have a greater than 20% likelihood of having a heart attack or dying of heart disease in the next 10 years (your doctor can calculate this for you.) The dose that is recommended for high risk patients is 81 mg to 162 mg. The lowest dose should be used when possible to prevent side effects, such as gastrointestinal bleeding.
For intermediate risk patients, many doctors do recommend aspirin therapy. However, the benefits of the therapy should be weighed against the possible side effects. Again, the lowest effective dose should be considered.
For low-risk patients, the potential benefits of aspirin therapy may not outweigh the potential risks. Therefore, the American Heart Association's evidence-based guidelines for the prevention of cardiovascular disease in women stated that low-risk women should not take aspirin therapy on a routine basis to prevent heart disease until more research is complete.
I'm a 44-year-old wife and mother (1 child, 8 years old) with a full-time job, and an ex-smoker (but does it socially every once in a while). My diet is not the best, but better than it used to be. I have little or no time at all to pencil in exercise with my busy schedule and heart disease runs in my family. My mother had her first heart attack at the age of 60 and also died of heart disease. I know I'm at a higher risk than most, but how can I better myself to reduce these risks?
It's important that you recognize that you have both genetic risk and lifestyle risk factors. It is critical, to prevent history from repeating itself, that you take time out for yourself. I understand how hard it is for busy women that are taking care of children and many others to find time to put themselves at the top of their to-do list. However, if you don't, you eventually will not be able to do anything else on the list because you might not live to your full potential.
It's hard to think about and take action to prevent something that seems far off in the future. But I can tell you that if you act now, you will not only save a lot of problems later and live to enjoy your grandchildren, but you will also feel better every day. And it's important that we not only think about our life span, but our health span. We want to aim for quality of life, not just quantity. Exercise and eating well and avoiding smoke will give us both.
Good luck to you, and importantly, remember that you are a critical role model for the rest of your family and loved ones. So when you take time for yourself, you are also helping others.
How often does Sister to Sister have these events?
The Sister to Sister Everyone Has a Heart Foundation has been conducting free screenings since 2001, and the number of cities is rapidly increasing. We have found that over one-third of women screened at the health fairs are at risk for heart disease. Many of the women who have attended the events have made substantial lifestyle changes and probably saved their own life. And it is a wonderful ripple effect because as women get educated at our events, they're able to spread their wealth of knowledge to help their sisters.
We are out of time. Our thanks to Lori Mosca, MD, PhD, for joining us today. And thanks to you, members, for your great questions. I'm sorry we couldn't get to all of them. For more information about National Woman's Heart Day and the Sister to Sister: Everyone Has a Heart Foundation, Inc, please visit their web site at www.sistertosister.org.
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