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Doctor Says Heart Disease in Women is 80 Percent Preventable

Posted on: Friday, 17 February 2006, 06:00 CST

Perhaps you've heard or seen one of several national campaigns aimed at educating ladies about heart disease _ something the American Heart Association says affects 38 million American women and killed 483,800 of them in 2003.

Women may have unique warning signs and risk factors, and their heart problems may not be detected by catheterization tests that thread dye into the arteries to light up blockages.

In addition, a landmark study released this month says that a low-fat diet alone may not provide women enough protection against heart disease.

So how can you help yourself and your doctors?

Here's a guide we developed from the latest medical literature, several new books and Dr. Pamela Marcovitz, a leading women's cardiology specialist who directs the Ministrelli Women's Heart Center at Beaumont Hospital in Royal Oak, Mich.

There's so much women can do, she says: "Eighty percent of heart disease is preventable."

Some of the information here may sound familiar _ but there are new indicators of heart problems you may not know as much about.

FAMILY HISTORY

The problem: Of all the risk factors, your family history may be most important. "Heart attacks run in families," says Marcovitz.

The greatest predictor: a sibling who has had a heart attack, she says. A heart attack in a sibling raises a person's risk three to four times; one in a mother or father, 1.5 times.

Of greatest concern is if a father or brother had heart disease before age 55, or a mother or sister before age 65.

The solution: The best way to reduce risk is through lifestyle changes, particularly exercise and a low-fat diet.

If you can't reduce your numbers that way, you may need medicines to lower your blood pressure and cholesterol.

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YOUR WEIGHT

The problem: The more overweight you are, the greater your risk, particularly if your excess weight is in your middle.

Extra weight causes the heart to work harder, raises blood pressure, increases your bad cholesterol and triglycerides and decreases your good cholesterol.

Measure your waist, just above the belly button, and your hips where they are the widest. Divide the waist measurement by the hip number. A good result is anything less than 0.8.

The solution: Exercise at least 30 minutes daily. Cut food portions. Drink at least eight glasses of water daily. Avoid prepared foods, sweets and carbohydrates.

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HIGH BLOOD PRESSURE

The problem: High blood pressure, or hypertension, occurs when arteries are narrowed. The heart has to work harder to push blood through the system, causing inflammation of arteries and enlargement of the heart muscle, putting you at risk of heartbeat irregularities. High pressure can raise your risk of heart disease by 25 percent.

Your blood pressure is measured with a cuff around your arm. The top (systolic) number is measured when the heart beats. The lower (diastolic) number estimates the pressure when the heart rests.

120 or lower systolic over 80 or lower diastolic is best.

120-139 over 80-89 is pre-hypertension.

140-159 over 90-99 is Stage 1 hypertension.

160 or higher over 100 or higher is Stage 2 hypertension.

The solution: Lose weight. For every 2.2 pounds you lose, you lower your blood pressure a point. Eat less salt. Limit coffee and alcohol. Exercise. Eat foods rich in antioxidants, such as fruits, vegetables and nuts. Consume more potassium, which is found in foods like tomato paste, 1,238 milligrams per half-cup; yogurt, 531 per 8 ounces; and bananas, 422 per banana.

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HIGH CHOLESTEROL

The problem: Cholesterol is fat that builds up in your arteries and can cause a heart attack. The most basic measurement, derived through a blood test, is called total cholesterol. It's best to have that at 180 or below.

There are three other basic cholesterol numbers you need to watch:

LDL is the so-called bad cholesterol, low-density lipoprotein.

HDL is so-called good cholesterol, or high-density lipoprotein.

HDL-to-Total Cholesterol Ratio. Divide your total cholesterol by your HDL. Under 3.5 is best.

Total cholesterol

Below 180 is best.

200-239 is borderline.

240 and higher is high.

LDL

Below 70 is best, particularly if you have diabetes or heart disease.

Below 100 is good.

100-130 may be acceptable if you have few other risks.

130-159 is borderline high; your doctor may suggest drugs at this level.

160-189 is high.

190 and higher is very high.

HDL

55 or higher is best.

40-54 is borderline.

Below 40 is bad.

The solution: Stop smoking. Lose weight. Cut down on foods high in saturated fat, such as red meat and whole-milk dairy products and trans fats (those with hydrogenated oils). Increase heart-healthy foods like fruits and vegetables, fiber products like oat bran and beans, bioflavonoids like strawberries and eggplant, and antioxidants rich in vitamins C, E and beta-carotene. Also: omega-3 fatty supplements and 5 ounces a day of alcohol _ that's one small glass of wine.

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HIGH TRIGLYCERIDES

The problem: Calories not immediately used by the body are converted into this type of fat. Women who have high triglyceride numbers and who are overweight and who have high blood pressure or diabetes are at higher risk of heart disease.

Below 150 is good.

150-199 is borderline high.

200-499 is high.

500 and higher is very high.

The solution: Losing 5 pounds will lower triglycerides by 30%. Drink less alcohol. Eat more fiber and complex carbohydrates. Increase consumption of healthy oils, such as olive and canola. Reduce refined carbohydrates used in processed foods

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HOMOCYSTEINE AND C-REACTIVE PROTEIN (CRP)

These are two newer markers of inflammation.

The problem: Measured through a blood test that you should specifically ask for, high homocysteine levels triple the risk of a heart attack. Homocysteine levels also can be elevated because of organ transplants, low thyroid hormone levels, stress and a deficiency of B vitamins. Higher levels may predict risk, but "we don't know if lowering it lowers your risk," Marcovitz says.

CRP now is considered a better independent risk factor for heart problems, she says, because inflammation plays a role in heart attacks and progression of heart disease. High CRP levels quadruple a person's risk.

Homocysteine level

5 or less is good.

5-10 is normal.

10-30 is moderate.

31-100 is high.

100 or higher is severe.

CRP

Less than 3 is good.

Less than 2 is better.

3 or higher: You are at risk of a heart attack.

A study published in August in the Journal of the American College of Cardiology says women naturally have higher CRP levels than men, especially as they age, leading doctors to question whether high levels in women predict future heart problems.

The solution: Exercise. Take one baby aspirin daily. Lose weight. Eat smaller portions. Consume foods with omega-3 fatty acids, such as seafood, nuts and flaxseed; omega-6 fatty acids, such as olive and canola oils; omega-9 fatty acids, such as corn and safflower oil. Also look for foods or supplements rich in vitamin B, folic acid, B6 and B12. These include green leafy vegetables, oranges, potato skins, bananas and fortified cereals for folic acid.

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ELEVATED FIBRINOGEN

The problem: Elevated amounts of this blood-clotting protein that increases with inflammation cause clotting that contributes to stroke and heart attack.

The solution: Lose weight. Stop smoking.

Metabolic syndrome

What it is: A cluster of symptoms that makes you twice as likely to have a heart attack and three times as likely to have diabetes. The signs: abdominal obesity, high triglyceride levels, low HDL, high blood sugar and high blood pressure. The syndrome can be overlooked when a person has acceptable total cholesterol levels.

You have the syndrome if you have any three or more of these measurements:

HDL under 40 for men and 50 for women.

Triglycerides over 150.

Blood pressure more than 130/85.

Fasting glucose of 100 or more.

Strategies: Lose weight. Increase exercise. Reduce salt. Add more fiber to your diet. Avoid low-fat, high carbohydrate diets.

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OTHER RISK FACTORS

Stress; smoking; oral contraceptive use after age 35, especially if you are a smoker; steroid drugs; polycystic ovary syndrome, an endocrine disorder; and under-active thyroid disease.

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WARNING SIGNS

Heart attack: Chest pain is the most common warning. But women may also report left arm pain, jaw pain, throat tightness, pain in the upper or middle back, flu-like symptoms and nausea. "Certainly anything that comes on suddenly and is unusual for you is important," says Dr. Pamela Marcovitz, a leading women's cardiology specialist who directs the Ministrelli Women's Heart Center at Beaumont Hospital in Royal Oak, Mich.

"So is sweating accompanying any other symptom," she says.

Stroke warning signs: Any sudden changes, such as numbness in the face, arm or leg; confusion or difficulties speaking, comprehending or walking; dizziness, balance or coordination problems; headache or vision problems.

When any of these symptoms occurs, call 911 or go to the nearest emergency room.

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WEB

www.womenshealth.gov/

www.hearthealthywomen.org

BOOKS

"The Women's Healthy Heart Program" by Dr. Nieca Goldberg (Ballentine Books, $15.95)

"Road to a Healthy Heart" by Joseph Piscatella (Workman, $14.95)

"A Woman's Guide to Saving Her Own Life" by Mellanie True Hills (Hills, $39.95)

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(c) 2006, Detroit Free Press.

Visit the Freep, the World Wide Web site of the Detroit Free Press, at http://www.freep.com.

Distributed by Knight Ridder/Tribune Information Services.

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Source: Detroit Free Press

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