Exercise, Diet, Vigilance Key to Heart Health

By  Wendy Harris

Post-Crescent staff writer

If you tend to worry more about breast cancer and relegate concerns about heart disease to the men in your life, you wouldn't be the first woman to do so.

But here's a reality check.

"Cardiovascular disease is the leading cause of death for women and it's responsible for more deaths than all other major causes combined," says Dr. Kenneth Geller, cardiologist   with Affinity Heart and Lung Center in Appleton.

All told, cardiovascular disease kills nearly a half-million American women each year. Coronary artery disease — when plaque-clogged arteries starve the heart of blood and oxygen, meanwhile, is the number one, single killer of women over   age 25.

And since 1984, heart attack, stroke and other cardiovascular diseases have killed more women than men. Yet most of the research on heart disease, and the treatment options that have resulted, have been based on men.

Times are changing, however.

Dr. Nieca Goldberg, nationally known cardiologist and author of "The Women's Healthy   Heart Program," says that the long-standing gender gap that has regarded heart disease as a men's health issue is beginning to close.

But there is still plenty of work to do.

"In the past several years, there has been an improvement in women's awareness that   they are at risk for heart disease through national campaigns," said Goldberg, who is also a spokeswoman for the American Heart Association's Go Red For Women campaign.

Go Red For Women is dedicated to raising women's consciousness about their risks for heart disease and empowering them with information to pursue healthier lifestyles. Yet four years into the campaign, only 13 percent of women view heart disease   as a health threat, the AHA found.

"There is still a big disconnect," Goldberg said. "Women are still not personalizing it enough. And in order to do things to reduce your risks of heart disease, you really need to believe you are at risk."

"Women are not small men"

With the growing awareness in healthcare that women's hearts aren't just miniature versions of men's, some compelling differences have emerged, Goldberg said.

Until age 55, men are much more likely to develop symptoms of heart disease. But after   menopause, women's risks go up significantly, she said.

And once the disease emerges in women, their outcomes tend to be worse than men's.

"When women have heart attacks, they are more likely to die from them," Goldberg said.   "Women tend to come in sicker to the hospital."

The reasons are several. Women's symptoms — often different from men's — are frequently   dismissed by both women and their doctors, Goldberg said, so there is a delay in treatment.

Also, risk factors like high blood pressure, high cholesterol, diabetes and smoking tend to hit women harder, she added.

Recent research also has made a revealing discovery: Women with heart disease are more   likely to have clear coronary arteries during an angiogram, long considered the gold standard for spotting artery blockages.

Last year, the federal Women's Ischemia Syndrome Evaluation, know as the WISE study,   found that cholesterol plaque can spread evenly through the artery walls of women, making it undetectable by the angiogram.

In women with this condition, called "coronary microvascular syndrome," plaque also builds up in the very small arteries of the heart, causing narrowing, reduced oxygen flow and pain that can be similar to that of people with blocked arteries,   the researchers concluded.

"Women's symptoms shouldn't be readily dismissed even if they have normal angiograms,"   Goldberg said.

Women's warning signs

Beyond the stereotypical chest pain, women are more likely than men to experience other   symptoms of heart attack, including sudden fatigue, shortness of breath, nausea and vomiting, and back or jaw pain.

Early signs of coronary artery disease can be even more difficult to identify.

"More commonly, women complain of fatigue and overwhelming tiredness, said Dr. Silja   Majahalme, a cardiologist with the Appleton Heart Institute. "Unfortunately, women don't characterize it as being related to their heart. They will downplay it and think, 'I'm just tired.'"

And so can doctors.

"Unfortunately, there is still ignorance in the health care community," Majahalme said.

Goldberg agrees.

"We find that a lot of times when women go to doctors, they aren't being heard,"   Goldberg said. "They often say their symptoms are being ignored."

Majahalme and Goldberg encourage women to visit their doctor and be assertive if they have concerns, especially if they have known risk factors.

And if you feel your doctor is dismissing your symptoms, ask for an explanation, Goldberg added.

"It's very important to say to the doctor, 'If it's not my heart, than tell me what it is?'" she said.

Know your numbers

The best way to assess your risk is to know your numbers, Affinity's Geller said.

"Over the age of 30, women should know their cholesterol and their triglycerides and   whether there is a family history of heart disease," he said.

"A lower HDL – the good cholesterol, is more predictive of coronary artery disease in women than men," Geller noted.

High triglycerides also pose a greater risk to women than men, he noted. The same holds true for smoking.

"The nice thing about quitting smoking is that after about three to five years, your risk returns to that of the general population," Geller said.

Cardiovascular disease is more common among those whose parents had premature disease. Having a sibling with heart disease, meanwhile, increases your risk by about 45 percent.

Compared to men, women's bodies may be more vulnerable to risk factors because their   vessels are smaller, Majahalme said.

"Women's vessels are smaller and changes can happen easier," she said. "Women's vessels are more sensitive to these toxins."

While research may still have some catching up to do, the best medicine for women's heart health remains preventative: a healthy lifestyle.

"Diet and exercise, those are the key things," Majahalme said. "Old-fashioned, boring   things like regular exercise and a heart-healthy diet are the best things a   woman can do for her health."