Health Leader - The Woman's Heart

STORY BY

Imelda Gott

Part Two

Recently, I awoke short of breath. Lying on my side, I felt as if a hand was gripping my heart. When I turned on my stomach, I felt as though a weight was on my back. After trying several sleeping positions, I finally got out of bed.

Over breakfast my husband said, “You don’t look too good. You look gray.” (Thank you very much. At my age, gray is a four letter word.) I admitted that I felt like I couldn’t get enough air in my lungs. We decided to head for the emergency room.

After receiving oxygen, I felt fine. The blood tests didn’t show any problems, but given the symptoms that brought me in, plus my mid-50s age, the physician suggested I be admitted for observation: It could be a heart problem, he said.

I was lucky. My symptoms and risk for heart attack were taken seriously. Over the last few years, women’s heart disease symptoms finally have gained respect from the medical profession. Still, many women don’t consider themselves candidates for cardiovascular problems, so they let unfamiliar aches or symptoms slide until the damage can’t be undone.

We’re now getting the message: Heart disease is the No. 1 killer of women—ahead of breast cancer, lung cancer, and every other disease we consider a threat to our lives.

Risk factors

I have had a cholesterol problem since I was in my late 30s and with medication my HDL (good) and LDL (bad) cholesterol levels are within the new American Heart Association guidelines.

My brother had a heart attack in his mid-50s. A close relative, a sibling or parent who has had a heart attack before age 55, is a risk factor. But high cholesterol and family history are only two indicators.

Simply being fifty-something is another red flag that has come to the attention of healthcare professionals relatively recently: For women, the risk for a heart attack starts between 40 to 60 years old, although heart disease itself can occur slowly and start as early as the teenage years.

While you can’t do anything about your family history or age, modifying your behavior can lower your probability for heart disease.

Brand new, stricter guidelines for women

For women, the new AHA guidelines are more aggressive than ever. And the one clear message in this ramp-up of recommendations is the damage begins early, not the day your menstrual cycle stops. Risk reduction can begin early, too.

All women over 65 should talk to their doctors about daily aspirin therapy to reduce heart attack risk and women over 50 to reduce stroke risk. According to the new AHA guidelines, high-risk women should take (if possible) the upper dose of aspirin (325 mg) rather than 162 mg (equivalent of two baby aspirin.)

Aspirin may not be indicated however for women who have bleeding disorders, are prone to ulcers or have uncontrolled hypertension. (Other contraindications exist, too, such as the concurrent use of certain drugs or supplements.)
Exercise 30 minutes or more a day for heart and vascular health. To maintain or lose weight though, 60-90 minutes a day or more is recommended.
Supplements are controversial, but research seems to point to uselessness when it comes to cardiovascular prevention. Below are some guidelines for what does and doesn’t seem to help heart health:
- Omega-3 fatty acids (derived from fish oils.) are recommended. Current suggested doeses: 850-1000 mg of EPA and DHA (two of the three fish oils. The third, alpha-linolenic is less potent than the other two, though they are packaged together in supplement form.)
- Two to four grams of these fish oils are recommended for women with high triglycerides.
- Other antioxidants, as they relate to cardiovascular health seem to be ineffective. These include beta carotene, vitamin E and C.
- Folic acid, which used to be recommended for prevention of heart disease has not been found useful, contrary to prior recommendations.
Bad (LDL) cholesterol should be lowered to 70 in high-risk women. A number below 100 is generally viewed as acceptable when other risk factors are not present.
Alcohol consumption should not exceed one drink per day. One drink means
- A 12-ounce beer
- Four ounces of wine
- 1.5 ounces of 80-proof spirits
- One ounce of 100-proof spirits

Herbs, HRT and Other Drugs

“We don’t know exactly why women who are menopausal or perimenopausal are at higher risk. We originally thought that it might be related to the drop in estrogen,” says cardiologist Poyee “Pansy” Tung, assistant professor of internal medicine in the Division of Cardiology at The University of Texas Medical School at Houston. Tung recently spoke to a group of more than 100 women about their risks of heart attack at a UT-sponsored public seminar.

To relieve menopause-associated symptoms, hormone replacement therapy is sometimes prescribed. “But we learned that HRT is not beneficial in preventing heart disease and may actually increase your chances of an MI (myocardial infarction or heart attack) or stroke,” she adds.

Not only should women avoid hormone replacement except under a physician’s supervision, women should also steer clear of some herbs. Ma huang, promoted as a supplement to improve one’s energy level, can exacerbate a woman’s problems with heart disease. “It’s advertised to help women regain vitality, but it contains ephedrine that speeds up the heart rate creating an increased demand on the heart, and blood vessel constriction that can result in hypertension.” Tung adds that in Japan, where soy is a diet mainstay, the incidence of menopause-associated symptoms including hot flashes is lower.

Migraine headache medications like Imitrex® and caffeine in large doses can cause blood vessel constriction which can raise blood pressure, a problem for those with even borderline hypertension (140/90).

Tung says that for most people the caffeine in a couple of cups of coffee a day is not a problem. She advises that before having “energy” drinks such as Red Bull, Rock Star or Monster, we consumers should read the nutritional information. “The caffeine is not too bad, about what you’d find in two cups of coffee. But with 27 grams of sugar, I’d be more concerned about gaining weight.”

Not like a man

The symptoms of a heart attack in women are not as precise as those for men.

Indigestion
For some women, indigestion is a major symptom. Yet, even simple indigestion can range in location and severity. Anatomically, the esophagus sits almost on top of the heart. The difference between chest pain from angina or heart attack and esophageal pain from heartburn, dyspepsia or indigestion can be hard to distinguish, even for healthcare professionals.

Sweating
With the indigestion-like symptoms, women experiencing a heart attack may break out in a sweat. (Men may get sweaty also but it isn’t reported as frequently.)

Fatigue
In some cases, women report vague lightheadedness or fatigue not associated with pain or classic heart attack symptoms.

Shortness of breath
Sometimes they experience shortness of breath. In men, shortness of breath is usually accompanied by pain in the chest, arms or neck. Women may not have accompanying pain or may have it in seemingly odd places, such as the back.

Age
On average, women start having serious cardiac events 10 years later than men, about the time women are in or entering menopause.

Unlucky a Second Time
Women who have a second heart attack are more likely to die from it than men who experience a second heart attack. In addition, women are more likely to have disabling heart failure or stroke after a heart attack.

The X Factor—35 inches

If you’re a woman and your waist measures more than 35 inches (40 inches for men), you may be at added risk for a heart attack. The 35-inch waist is one indicator of a condition called syndrome X, metabolic syndrome or insulin resistance syndrome. The AHA estimates that as much as 25 percent of the US population has this condition. Belly fat or “apple” shapes also stress the heart more.

“These people are at higher risk of cardiovascular events—both heart attacks and strokes, as well as developing diabetes,” says Tung.

Besides abdominal obesity, other factors associated with this syndrome are high blood pressure, insulin resistance and a higher level of triglycerides in blood tests. The causes are obesity, inactivity and genetic factors. The treatments are weight reduction and physical activity.

Take Action

“Women are under treated,” Tung says. “They are less likely to be given stress tests or angiograms.”

If you think you may have a cardiovascular problem, tell your primary care physician. Talk to your doctor if you have any of the risk factors for heart disease. If you are having symptoms of a heart attack, call 911. Take a regular (325mg dose) aspirin. If you go to an emergency room by car, have someone drive you.

When I went to the emergency room, I was given blood tests to determine whether I had had a heart attack, and my cholesterol and triglyceride levels were tested. When I was admitted to the hospital for observation, I was given a heart monitor to wear for 24 hours, and a nuclear stress test.

Luckily, my tests didn’t show heart disease or evidence of a heart attack. Yet, had there been a problem, I would have followed the recommended advice to treat it immediately, instead of relying on outdated beliefs that reasonably young women just don’t have serious heart disease. Since I have a lifetime one-in-three chance of heart disease, I’m memorizing the new guidelines—and acting on them.

“Talk to your doctor about what you can do to reduce your risk of heart disease. It’s as important as having a mammogram,” Tung urges.

And if you’re a woman with nagging concerns about your symptoms, don’t be embarrassed. Check them out. You’ll be alive—and well—to educate the next generation of women.