Heart Disease Endorses Equal Opportunity
Bradley A. Radwaner, M.D., F.A.C.C.
If you ask a group of women in their 40s and 50s about their major health concerns for the next 10 or 20 years, most are likely to list breast cancer, osteoporosis and, if they smoke, lung cancer. While these are all legitimate concerns, many women fail to recognize the single biggest killer of American women – heart disease. Every year heart disease kills about a quarter of a million American women, compared to 40,500 for breast cancer and 41,600 for lung cancer. In recent decades, Americans have become more aware of the dangers of heart disease, and have made some important changes in lifestyle. Over the past decade, the death rate from heart disease has declined seven percent every year – for white males. In the same period, however, women and black males have experienced only a slight decline. If women want to achieve equal opportunity in this matter of life and death, it’s necessary to reexamine some long-held assumptions. One myth is central to all the others – that heart disease is a uniquely male problem. In fact, almost equal numbers of men and women die from atherosclerosis, or hardening of the arteries. The difference is that women tend to develop the disease about 10 years later than men. By age 70 women develop cardiovascular disease at a rate equal to that of men. Many women (and even the medical community) are lulled into a false sense of complacency because they feel they have a built-in protection against heart disease. Most pre-menopausal women do, in fact, have a relatively low risk of heart attack, possibly because of the protective effect of the female hormone estrogen. When a woman’s estrogen level drops after menopause, however, the risk rises sharply, catching most women unprepared. Even during the pre-menopausal years, m any women give up some of their natural protection by choosing to smoke. At least two-thirds of heart attacks in women can be attributed directly to smoking. Women who smoke 35 cigarettes a day or more have 10 times the risk of non-smokers. Long-term use of birth control pills also tends to increase a pre-menopausal woman’s risk of heart disease. A woman who takes birth control pills and smokes compounds this risk.
BIGGER THREAT TO WOMEN
Contrary to popular belief, heart disease is usually more severe and more life-threatening in women. A woman’s chances of surviving a heart attack are about 5 to 10 percent lower than a man’s. Women are twice as likely as men to die in the first few weeks after a heart attack and they also have a higher risk of death following open heart surgery or balloon dilation. The reasons for the increased risk are not fully understood, but some researchers believe that the smaller size of a woman’s arteries may make her more susceptible to clots. The authors of another study carried out at Cedars-Sinai Hospital in Los Angeles found that the women in their study were not only older than the men, but also sicker. They were referred much later in the course of the disease. Men were more likely to have heart surgery after a screening examination; women, after a life-threatening emergency. In the mistaken belief the heart disease is a male malady, women, and often their doctors, ignore the early symptoms until the disease has progressed to a dangerous level. Often the symptoms of a heart attack or angina are atypical in woman, not the usual crushing mid-chest pain, but rather nausea, shortness of breath or other less classic symptoms.
MANAGING THE RISKS
For a woman, the most important risk factor is age. But heart disease is not a normal part of aging. People who have strokes and heart attacks in their 60s and 70s are not dying of “old age”. Atherosclerosis is brought on by a combination of genetics and lifestyle. We can control our lifestyle. Age controls the way risk factors interact with each other. A 55-year-old man, for example, who combines three risk factors such as smoking, high blood pressure and high cholesterol doubles his risk of heart disease, but a woman the same age will find her risk tripled. Blood cholesterol should be under 200, but even more important than total cholesterol – is high density lipoprotein or HDL, the “good cholesterol”. A low level of HDL, under 40, is the second most important predictor of heart disease for a woman. Recent studies from Harvard indicate that an elevated C-reactive protein, a marker of inflammation, is an even more important predictor of heart attack and stroke risk than levels cholesterol in woman. It is important for women to get a blood cholesterol reading that breaks down the levels of HDL and LDL (low density protein) and gives the ratio of total cholesterol to HDL. Ideally your ratio should be less than 3.5; if it’s about 5.0, that’s a sign of danger. Smoking greatly increases the risk for heart attack in women of any age. But the damage can be undone. If you quit, within two to three years your risk will be about the same as someone who has never smoked. High blood pressure is a major health risk, even at mildly elevated levels. If you have readings higher than 140/90, your blood pressure is too high. When a woman combines high blood pressure with smoking, high cholesterol and use of birth control pills, she becomes a walking time bomb. Obesity and a sedentary lifestyle are two risk factors that often go hand in hand. Research shows that those at the greatest risk of heart disease are apple-shaped, with excess weight on the abdomen, rather than pear-shaped, with weight distributed on the hips and thighs. Whatever your shape, a diet that focuses on low-fat foods and a regular exercise program will promote a healthy heart as well as help with weight loss. After menopause or a hysterectomy, when the ovaries stop their production of estrogen, a woman’s risk of having a heart attack increases two-to-three-fold and by ten years after menopause, a woman and man’s risk is the same. Recognizing that heart disease is a major killer of women as well as men is the first step in fighting back. As a woman, you need to know what is unique about the disease as it affects women, and what you can do for prevention. Know y our pressure and work on lifestyle changes that will give you the heart to enjoy your post-menopausal years.