Every Woman’s Greatest Health Risk
Heart Disease is Different for You
By Eugene J. Ichinose, MD, FACC
Do you realize that more women die of cardiovascular disease than from stroke, lung cancer, chronic lung disease and breast cancer combined?
Regardless of race or ethnicity, cardiovascular disease is the leading cause of death among women, both in Oklahoma and nationwide. It accounts for nearly 500,000 deaths in the U.S. each year. Despite these sobering statistics, 45percent of women fail to identify cardiovascular disease as their greatest health risk. (Reference 1)
HOW DO YOU DETERMINE YOUR RISK FOR CARDIOVASCULAR DISEASE?
Medical history, lifestyle behavior and family history are indicators of early disease. Other conditions influence a woman’s risk for heart disease and determine if a woman needs further screening tests to detect heart disease.
In the “high risk” group, there is a 19 percent chance that within 10 years a woman will experience a heart attack, stroke or die from heart disease.
In the “at risk” group, there is a 5.5 percent chance that within 10 years a woman will experience a heart attack, stroke or die from heart disease.
In the “optimal risk” group, there is a 2.2 percent chance that within 10 years a woman will experience a heart attack, stroke or die from heart disease.
In the ”unclassified” group, there is 2.6 percent chance that within 10 years a woman will experience a heart attack, stroke or die from heart disease. Women in the unclassified group are without risk factors for heart disease. Because they do not maintain a healthy lifestyle, they are excluded from the optimal risk group. (Reference 2)
Obesity is defined as a condition of having a body mass index of greater than 30.
Evidence of atherosclerosis (coronary heart disease) can be determined by obtaining a screening test called a carotid ultrasound or coronary calcium score, which is available through the Oklahoma Heart screening program (918-592-0999).
The 10-year predicted cardiovascular disease (CVD) risk can be calculated using the Framingham Risk Score which you can find at //hp2010.nhlbihin.net/ATPiii/calculator.asp?usertype=profand.
Pregnancy is a natural cardiovascular and metabolic stress test that may estimate a woman’s lifetime risk for heart disease. Histories of preeclampsia will double the risk for subsequent ischemic heart disease, stroke and venous thromboembolic event over the five to 15 years after pregnancy. This may be an indication to carefully monitor and control risk factors during those years after pregnancy. (Reference 2)
All women should stop smoking and avoid second hand smoke. All women should also plan regular physical activity such as 30 minutes of brisk walking. For women who need to lose weight or sustain weight loss, a minimum of 60-90 minutes of moderately intense physical activity is recommended.
High blood pressure is a systolic blood pressure of greater than 140mmHg or diastolic blood pressure greater than 80mmHg. High blood pressure becomes more common in women over 65 years. The prevalence of hypertension in blacks in the United States is among the highest worldwide. It is especially high in black women at 44 percent. (Reference 2) Unfortunately, women tend to be under treated. Although, men continue to improve their rates of treatment and control, in the NHANE survey of 1999-2000, the treatment and control of hypertension in women has not changed.
Women should strive for a blood pressure of less than 120/80mmHg through lifestyle approaches such as weight control, increased physical activity, sodium restriction and increased consumption of fresh fruits, vegetables and low fat dairy products.
There is a frightening trend of increased body weight. Nearly two of every three U.S. women over 20 years old are now overweight or obese. This is a major contributor to the epidemic of type 2 diabetes mellitus now seen in more than 12 million women in the U.S. Type 2 diabetes mellitus greatly increases overall risk for heart attack and stroke.
Both lifestyle and medications should be used as indicated in women with diabetes to achieve a hemoglobin A one c (HbA1c) of less than seven percent if this can be accomplished without significant hypoglycemia.
During perimenopause, cholesterol and triglycerides become erratic, increasing by approximately 10 percent. HDL gradually declines after menopause. In the U.S., saturated fats come mainly from meat, seafood, poultry with skin, and whole-milk dairy products (cheese, milk, and ice cream). A few plant foods are also high in saturated fats, including coconut and coconut oil and palm oil. (Reference 4) The intake of saturated fat should be less than seven percent of total calories and cholesterol intake should be less than 200mg per day.
The use of hormone therapy and selective estrogen-receptor modulators should not be used for primary of secondary prevention of coronary heart disease. The use of vitamin supplements such as vitamin E, C, beta-carotene, folic acid with or without B6 and B12 have not been found helpful in preventing or treating coronary heart disease.
Women more frequently experience non-classic symptoms on presentation of a heart attack. Shortness of breath, nausea & vomiting, fatigue, sweating and arm or shoulder pain without chest pain occur more frequently in women than in men.
Based on a 2009 survey from the Center for Disease Control, Oklahoma remains in the top five states for the highest rate of heart attacks. 25 percent of the population of Oklahoma actively smokes, which is the third highest smoking rate. Oklahoma also placed third as the most sedentary state with 31 percent of the population not participating in any physical activity in the past 30 days. Tragically, Oklahoma had the greatest percent of people, 85 percent, consuming less than five servings of fruits and vegetables per day.
By following the above recommendations, you can begin to prevent heart disease from jeopardizing your health and longevity. Screening today could save your life tomorrow. Take time to take care of yourself.
REFERENCES
1. Mosca L. Mochari H, Christian A, et al:National study of women’s awareness, preventive action, and barriers to cardiovascular health. Circulation 113:525, 2006.
2. Mosca, L et al: Effectiveness-Based Guideline for the Prevention of Cardiovascular Disease in Women 2011 Update. JACC 2011:57;1404-1423
3. Braunwald’s Heart Disease: A textbook of cardiovascular medicine, Eighth Edition, 2008 Chapter 76 Kristin Newby, Pamela Douglas.
4. //www.hsph.harvard.edu/nutritionsource/what-should-you-eat/fats-full-story/index.html