Women’s Heart Health!
As a cardiologist practicing in Los Angeles, I see a lot of heart disease in women and men. In fact, heart disease is the leading cause of death in women over 50. Cardiovascular disease including coronary artery disease and stroke are twice as likely to cause death than all forms of cancer on a yearly basis. I largely treat patients who have symptoms of or have experienced a heart attack or angina. These patients are usually under medical care and on medications to treat their risk factors. For the purposes of this article, I would like to concentrate on healthy living before an event takes place with the hopes of preventing future events.
What are the risk factors for coronary artery disease? Simply put, family history, smoking (current or prior), age, sex (men affected on average 10 years earlier), diabetes, high cholesterol, sedentary lifestyle, obesity (BMI over 30). Age and sex are not modifiable risk factors. The others are modifiable to variable degrees.
Diabetes, the state of not having enough insulin (type I diabetes) or the state of insulin resistance (type II diabetes), is highly correlated with cardiovascular events both heart attacks and strokes along with peripheral vascular disease (obstruction in leg arteries). Essential to both conditions is control of blood sugar levels in the bloodstream through medications, but equally important through diet and exercise.
Smoking, of anything, in any form is bad for your health. With relation to coronary artery disease, smoking accelerates the development of atherosclerotic plaques, makes one prone to forming blood clots (the proximate cause of heart attack), destabilizes plaques making them more likely to rupture (causing clots and heart attacks). When you stop smoking, the pro-inflammatory effects on the coronary artery wall improve, the damage done does not. People who quit smoking drop their chances of repeat heart attack.
Cholesterol is a necessary component of normal body function. However, elevated LDL cholesterol is highly associated with vascular disease and correlates with higher event rates. The initial treatment for high cholesterol is a healthy diet, exercise and smoking cessation along with normal body weight. HDL is a “good” form of cholesterol which is abnormal when below 40. To raise this, exercise is the most direct method.
Sedentary lifestyle is self-explanatory, regular exercise is a lynchpin of all therapy for cardiovascular health.
Hypertension is defined most recently as systolic blood pressure over 120, or diastolic blood pressure over 85. Again, exercise and diet (particularly low sodium) is the initial treatment.
So what do we want to do to prevent all of the above from developing? Will it cost a lot of money or time? How do I know if I am obese? Or hypertensive?
First, a physical exam with a qualified physician or nurse practitioner will give you the basic information. You should leave the appointment with basic screening blood tests including a lipid panel, a blood pressure assessment, a BMI (body mass index calculated with height and weight).
The recommendation for a heart-healthy diet focuses on whole foods and lean protein. The most widely recommended diet is the Mediterranean diet which is high in fruits, vegetables, nuts, seeds, whole grains, fish and chicken or the DASH diet which is whole grains, fruits and vegetables and sodium limitations, chicken, and fish. Alcohol in moderation which is defined as one drink per day for women or less.
Exercise: in a sentence, 150 minutes of moderate exercise per week broken up as you like. 30 minutes a day for 5 days, 50 minutes for 3 days etc. You should get the heart rate up to 50-70% of maximum predicted heart rate.
Maximum predicted heart rate is 220-age for example 220 – 50 would be 170
50% of that is 85 and 70% would be 119 so your moderate exercise should generate a heart rate between 85-119 beats per minute.
Examples of moderate exercise are brisk walking, bicycle, lawn mowing. Other options include elliptical trainers, stationary bicycle, aerobic classes, water aerobics, chair aerobics.
If one has very poor physical stamina, then short 5-10 minute bouts of something that is tolerable like slow walking done daily until the stamina builds. Start somewhere and work on progressing. Do not exercise with pain, extreme shortness of breath, chest pain or dizziness.
Other issues:
Hormone replacement: the assumption that estrogen is protective in cardiovascular health for women is longstanding as the reason that women develop vascular disease an average of 10 years later than their male counterparts. Many studies have looked at the relationship of hormone replacement and the current recommendations are if you are postmenopausal and haven’t been on hormone replacement then there may be an increased risk of heart attack and blood clots. If you are perimenopausal and begin replacement hormones, there seems to be no increase in vascular events, but there is no evidence of reduced events either.
Drug therapy for high cholesterol: recommended in certain cases of LDL over 190, prior event, diabetics, and a risk score of over 7.5% found using a risk calculator available online called ASCVD risk calculator.
Stress reduction
We cannot always remove ourselves from stressful situations but we can learn to manage our stress levels and begin to alter the physical and emotional response to stress. Useful techniques are
- mindful breathing/ mindful meditation (there’s an app for that!)
- yoga
- time with your girlfriends, socializing, relaxing
Warning signs that should prompt evaluation by a physician:
- Chest pain or pressure when exerting yourself, better with rest
- Extreme shortness of breath at rest or with mild exertion.
- Dizzy spells or passing out
To summarize:
- Healthy diet and regular exercise are key to maintaining cardiovascular health.
- Don’t pollute your body with tobacco products or excessive alcohol.
- Get a physical with laboratory measurements yearly.
- Maintain a healthy weight
Recommendations for reading:
- American Heart Association web page.
- Womenshealth.gov web site