Heart Disease: What Can You Do?

What else can women do to prevent heart disease? The Network gets this question often in the aftermath of the Women's Health Initiative, which found conclusively that hormone replacement therapy is not effective in reducing a woman's risk of developing heart disease. We've written this article to share what is currently known about heart disease, and to encourage women to take sensible steps to reduce their own risk of developing the disease.

Number-One Killer: But When?

We're often told that heart disease is the number-one killer of American women, and that's correct. But it's important to take a more detailed look at who suffers from heart disease, and at what age. Heart disease doesn't become the leading killer of American women until age 75.1 From then on, it's the most likely cause of death for women of all backgrounds. But there are interesting differences in who suffers from heart disease at an earlier—and presumably preventable—age. Heart disease becomes the number-one killer of African-American women a full 10 years before all other women in the U.S. The rate at which African-American women die of heart disease during those years is more than double that in Asian, Latina, Hispanic and white women. ¹

Does Menopause Cause Heart Disease?

In one word: no. Menopause seems to be associated with increasing cholesterol levels in some women, but so is aging. It may be that younger women's higher levels of estrogen explain why they are less likely to develop heart disease in middle age than men. On the other hand, testosterone is linked to heart disease in men. And men are always more likely to die from heart disease than are women, even after menopause and continuing into extreme old age. At ages 85 and up, men still have higher death rates from heart disease than women.¹

Do You Really Need to Worry? Yet?

If menopause doesn't cause heart disease, and it isn't the most common killer of women until age 75, do we really need to worry much about it before then? There are lots of other conditions that are more common with age, such as arthritis and poor eyesight. Couldn't we just wait and deal with all these things if and when they happen?

Here's that same word again: no. It doesn't make sense to wait until you are 75 to worry about heart disease. If you don't think about heart disease in advance, you may never get the chance to do anything to reduce your risk of dying from it. Heart attack (also called myocardial infarction or MI) is often the first and only experience a woman has with heart disease before she is listed in the obituary notices. Women are more likely than men to die immediately or during the year after their first heart attack. And those deaths don't always come at an acceptably old age, either. Twenty percent of all women who die between ages 55 and 64 succumb to heart disease. Finally, heart disease can cause disability as well as death. Women with heart disease are also at higher risk for certain kinds of strokes, which can leave a person incapacitated in several ways. Heart disease itself can cause pain, shortness of breath and loss of stamina. All of these symptoms can interfere with a wide range of everyday activities, worsening the quality of life for older women.

What Can You Do and When Should You Do It?

Everyone can reduce their risk of heart disease. The Network encourages all women, including young women just starting to establish their own patterns of exercise and eating, to become familiar with these risk-reduction strategies and to begin to incorporate them into their lives. It's never too early, and it's also never too late.

There are many ways women can reduce their risk of heart disease. The most important risk factors for heart disease besides aging and family history are smoking, diabetes, high blood pressure, high cholesterol levels, abdominal obesity and physical inactivity. Good studies have shown that changing health habits can reduce or eliminate each of these risk factors, resulting in a much lower rate of heart disease.

• Smoking: If you smoke, make plans to stop. Treatments using person-to-person contact are especially effective and should include social support and problem-solving skills. The Surgeon General's June 2000 guidelines, Treating Tobacco Use and Dependence, present a thorough overview of all studies. Chapter 7 reviews what is known about helping women quit. The guidelines are available online at www.surgeongeneral.gov/tobaccosmokesum.htm.
• Diabetes: People with diabetes are two to four times more likely to have a stroke or heart attack than are people without diabetes. Good treatment, once diabetes is diagnosed, can reduce this increased risk and other complications of diabetes. Even better news, though, is that adult onset diabetes can be prevented. People whose blood glucose levels are higher than normal but not yet diabetic are very likely to develop the disease within the next few years, unless they take steps to reduce their risk. A large study recently found that physical activity and healthful eating habits are more effective than medication for preventing diabetes. Thirty minutes of activity, five days a week, and a seven-percent weight loss were enough to lower the risk of developing diabetes by more than 50 percent.²
• High Blood Pressure: Changing eating habits to increase fruits, vegetables and whole grains and to decrease fat, meat and sweets can lower blood pressure and reduce the risk of heart attack and stroke. In a controlled study, this diet (called Dietary Approaches to Stop Hypertension, or DASH) lowered blood pressure just as well as taking medication did. The DASH diet seems especially effective in African Americans. (Sixty percent of the participants were African American, and 50 percent were women.) Free copies of a booklet on the DASH diet with sample recipes and helpful tips on making changes to your eating habits are available from the National Heart, Lung and Blood Institute: www.nhlbi.nih.gov/health/public/heart/hbp/dash/index.htm or 301-592-8573.
• High Cholesterol: If you are at high risk for heart disease because your cholesterol levels are high, eating a moderately low-fat diet and keeping your intake of dietary cholesterol low can bring down your cholesterol levels. One diet that has been studied and found to be effective is the Therapeutic Lifestyle Changes (TLC) diet. You can get information about it by going to www.nhlbi.nih.gov/cgi~bin/chd/step2intro. cgi.
• Physical Inactivity: Some studies have shown this to be a stronger predictor of heart disease than obesity. Although more exercise is better, women can reduce their risk of heart disease with 30 minutes a day of moderate exercise. ³
• Abdominal Obesity: Fat around the waist and center of the body seems to be more of a threat to future good health than fat in the hips.⁴ Women whose waists are less than three-fourths the size of their hips are at lower risk. For instance, if your hips measure 40 inches, your waist should measure 30 inches or smaller. Luckily, most women who are able to lose weight do so in the waist and abdomen. And weight loss doesn't need to be very large to make a difference. Losing 10 percent of total weight (for example, 16 pounds for a 160-pound woman) has been shown to reduce risk of heart disease. Many people can accomplish a 10 percent weight loss through increased activity and lower calorie intake.

In the meantime, for people who cannot incorporate risk-reduction strategies into their lives, or who haven't gotten adequate results in the past, low-dose aspirin and cholesterol-lowering drugs have been shown to reduce the risk of heart disease. Women can also lessen their risk by treating risk factors including diabetes and high blood pressure.

To take a short quiz that can help to assess your risk for heart disease, click here. 

Cindy Pearson is the Network s executive director.

REFERENCES

1. Anderson RN. "Deaths: Leading Causes for 2000." National Vital Statistics Reports: 50( 16). Hyattsville, MD: National Center for Health Statistics, 2002. ~ New England Journal of Medicine 2002; 346; 393.

2. U.S. Department of Health and Human Services. "Physical Activity and Health: A Report of the Surgeon General." Atlanta: Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, 1996.

3. Folsom AR et al. "Associations of General and Abdominal Obesity with Multiple Health Outcomes in Older Women: the Iowa Women's Health Study." Archives of Internal Medicine 2000; 160(14): 2117-2128.