Heart disease is a serious concern for men and women alike.
But recent studies reveal that cardiovascular disease affects women's bodies
differently. After decades of being overlooked in heart health research, women
are finally getting some attention -- and rewriting the rules on cardiovascular
health. See how heart disease develops in women, discover how heart attack
symptoms can vary between sexes and learn how accurate diagnostic tests really
are.
Women's
bodies react differently to heart disease.
Not long ago, health experts thought heart disease was
something only men had to worry about. Case in point: When the American Heart
Association held its first public conference for women in 1964, the name of the
event was Hearts to Husbands. The sole objective? To teach wives how to keep
their spouses healthy—with no mention of how heart disease might be affecting
them.
We've come a long way. Now, there's no mistaking that heart disease is an
equal-opportunity killer. In fact, it kills 1 out of every 2.6 American women,
making it the No. 1 cause of death for both sexes nationwide.
Yet even as public awareness of female heart disease grows, researchers still
are parsing out the particulars. Women historically have been underrepresented
in heart studies, partly due to concerns that female hormone fluctuations would
distort the results. But therein lies the rub: Women are not just smaller
versions of men.
A wave of newer studies reveals that women's unique chemical makeup combined
with anatomical differences (such as smaller arteries and veins) affect how
heart disease develops in us, how accurate diagnostic tests are, and how well
we respond to certain medications.
Women's arteries can look clear -- even
when they're not.
Persistent chest pain, shortness of breath, unexplained
fatigue. Fully 83 percent of men with these symptoms have deposits of plaque in
their major arteries, a condition called arteriosclerosis that's easily picked
up by an angiogram.
But in 50 percent of women who report such symptoms, their major arteries
appear healthy, according to a landmark 2006 study. That's because women tend
to develop deposits of plaque diffusely in the smaller arteries near the heart,
an equally dangerous condition known as microvascular disease, which is
treatable with medication.
If you're experiencing heart symptoms but your angiogram comes back normal, ask
your doctor about having an exercise stress test or an MRI, both of which are
better at detecting this problem.
Women have been pushing themselves too
hard in workouts.
To ensure a workout provides sufficient aerobic exercise,
health experts have long told us to exert ourselves until the heart hits 65-85
percent of its maximum rate (measured in beats per minute). But it turns out
the classic formula for calculating peak heart rate -- 220 minus a person's age
-- applies only to men, who have a higher maximum than women do, according to a
recent study in the journal Circulation.
The updated peak heart rate formula for women: 206 minus 88 percent of
your age. For a 40-year-old woman, that's about 171 beats per minute (206 -
[.88 x 40]), meaning the target rate during exercise
is 111-145 beats per minute.
This new formula also might prevent false positives on cardiac stress tests,
which are designed to pick up on problems by monitoring (among other variables)
how closely the heart comes to hitting its max.
Statins warrant a second look.
Roughly 13.5 percent of American women between the ages of
45 and 64 take statins, drugs aimed at preventing harmful LDL cholesterol from
building up in arteries.
But when researchers broke out the stats by sex in a large study in 2009, they
discovered the drugs significantly lower the risk of heart attack or death only
for women who already have heart disease. (Healthy men, on the other hand, do
see a preventive benefit.) And the concerns don't stop there.
Statins can cause side effects in women such as:
-- Muscle pain
-- GI distress
-- Memory problems
Women also have a greater risk of developing type 2 diabetes while on the
drugs than men do. For many women who do not already have heart disease, the
adverse effects of statins outweigh the benefits they're likely to derive.
What to do if you've been taking a statin for high cholesterol and are
experiencing side effects: Ask your doctor if you need to continue. For some
women the answer will be yes (say, because of existing heart disease); if
that's the case, ask about switching to a water-soluble type, which might be
less risky.
Emotions take a greater toll.
Chronic stress doubles the risk of heart disease by
elevating resting heart rate and ratcheting up blood pressure.
And women have special reason to be concerned. Research conducted at the
University of Cincinnati suggests that women experience greater levels of acute
and chronic stress than men do, and stress-related mental illnesses, including
depression, occur at least twice as often among women as men.
Getting control over stress isn't just about your day-to-day happiness; it's
critical to your health.
It's wise to rethink an aspirin
regimen.
Many women started popping aspirin regularly when their
doctors informed them it could help prevent a heart attack, but this
recommendation was based on studies of men.
Newer findings from Harvard University show that aspirin does not prevent a
first heart attack or death in healthy women under 65. Because habitual
aspirin use can cause stomach ulcers, if you're taking aspirin preventively,
talk with your doctor about whether you should stop. Bear in mind that some
younger women -- such as those with risk factors for heart disease or stroke --
can benefit from a low-dose aspirin regimen.
If you suspect you're having a heart attack: The American Heart
Association advises chewing and swallowing one 325 mg aspirin tablet while
you're waiting for help to arrive. This can prevent blood from clotting in
compromised arteries.
Drinking is more dangerous for women.
Granted, for men and women alike, one alcoholic drink a day
can benefit the heart -- in fact, it can lower a woman's heart disease risk by
17 percent. But beyond that, alcohol seems to affect men and women very
differently.
Several years ago, Japanese researchers found that women who drank 2 - 4 drinks
per day were 45 percent more likely to die of heart disease than female
nondrinkers. On the other hand, men who drank that much were 19 percent less
likely than male nondrinkers to die from heart disease. The study didn't look
at the reasons for these surprising differences, but it's probably best to imbibe
moderately while scientists search for answers.
His-and-hers heart attack symptoms.
In the movies, heart attacks follow a familiar pattern: The
actor freezes, clutches his chest, and promptly keels over on the golf course.
But for up to 33 percent of female heart attack sufferers, this Hollywood
version of events never happens.
Instead, they experience nausea, extreme weakness, lethargy, skin clamminess,
upper back pain, and shortness of breath. These subtler symptoms frequently are
overlooked by patients and doctors alike, putting lives at risk.
Steven List's Heart Attack Experience
Who: Steven List, male, 57, Austin
Key heart attack symptoms: tingling in left arm, stabbing sensation in
chest
His story: "My heart attack happened during my regular after-work
karate class. About an hour into my session, I started feeling funny.
Just...uncomfortable. This wasn't like me. I worked out at least three times a
week. I didn't drink, and I hadn't smoked in 13 years. At my checkup eight
weeks earlier, my doctor had given me a clean bill of health."
"I sensed that something was up. I got an odd sensation in my lower
chest--it felt almost like a spasm of my diaphragm muscle. I definitely hadn't
experienced anything like that before. Feeling that I shouldn't continue
exerting myself, I left the karate floor and went into the changing room to
relax. I tried sitting. I tried walking back and forth. I splashed some cool
water on my face."
"But my chest discomfort only intensified, and within a few minutes it had
sharpened into some of the worst pain I'd ever felt--like someone pushing a
spear into my chest. By then I was lying on the floor, and my left arm had
started tingling. That's when I became certain I was having a heart attack.
Scared for my life, I waved down a fellow student and asked him to call
911."
"At the hospital, a team wheeled me straight into the E.R., ran an EKG,
and administered several medications. Then the cardiologist came in and said we
should proceed immediately to an angiogram to check things out, and then maybe
angioplasty or bypass surgery, depending on what he found. In the end, they
inserted a stent, which is basically a little support tube that was snaked into
my artery to hold it open. It was truly amazing. The entire heart attack
experience took just 4 1/2 hours from start to finish, and I came away with no
heart muscle damage, no major surgery, and a new lease on life."
Sue Andrew's Heart Attack Experience
Who: Sue Andrews, 53, Cleveland
Key heart attack symptoms: dizziness, intermittent achiness and weakness
Her story: "It happened three years ago, around 9:30 on a normal
Monday morning. I had just begun giving a presentation to my colleagues when I
noticed I was becoming very dizzy and clammy--almost like you'd feel if you
were having an anxiety attack. I also felt pressure in my chest, which then
subsided and morphed into a pain across my shoulder blades. That's weird, I
thought. I'm not nervous or anxious, so I guess I'm just coming down with
something. I went ahead with my presentation, trying to hurry it a bit because
I wanted to get it over with. At one point I had to pull up a chair and sit
down to alleviate the dizziness. Apparently I hid my distress well because a
number of my coworkers later told me they never suspected anything was wrong.
"I finally wrapped up the meeting about 40 minutes later. Still feeling
strange, I went to the office kitchen, got myself a glass of water and made my way back to my desk.
When the feeling didn't pass, I called my husband and said, 'I think I must be
getting some kind of flu. I'm going to head home and go to bed.' He offered to
pick me up instead."
"Fortunately, my husband insisted I see a doctor. So we went to a local
walk-in clinic, where the physician on duty listened to my symptoms and
performed an EKG. The results were 'slightly off,' he said, so he instructed me
to go to the emergency room for some blood tests. No one mentioned anything to
me about the possibility of a heart attack.
"I got to the E.R. around 12:30. After repeating my symptoms at the
checkin desk, I was informed I'd have to wait my turn. So I tried to make
myself comfortable in the waiting room as I watched people come and go. When a
man came in with chest pains, they rushed him in ahead of everybody. I looked
at him, thinking, I wonder if he's having a heart attack--never believing that
I might be, too. Fully three hours after I arrived, they called me in. I
repeated everything to the nurse. A team took blood samples and started doing
lots of tests. Finally a doctor came in and announced, 'We're going to admit
you. You've had a heart attack.' I don't know which is more incredible--that it
took so long for me to get a diagnosis, or that I survived the wait."
Get a healthier heart, one day at a
time.
Good news: Because women tend to develop heart disease later
in life than men do, preventive measures have more time to work their magic.
These include exercising regularly, eating a diet that's rich in whole foods,
maintaining a healthy weight, and not smoking. To help meet these important
goals, start with a few simple moves.
7 a.m. Sprinkle slivered almonds on your cereal. Research shows that these nuts
can lower the risk of heart disease by reducing levels of harmful LDL
cholesterol. In addition, antioxidants and vitamin E found in almond skins
might prevent plaque from forming on artery walls. Bonus points if your cereal
is made with whole grains, which help keep blood pressure in check.
8 a.m. Time your toothbrushing session. Recent studies show a strong
association between gum disease and heart disease, possibly because unhealthy
gums cause systemic inflammation. So don't rush your morning brush. The
American Dental Association says you need at least two minutes to clean teeth
and gums thoroughly. Use your wristwatch to time yourself or pick a brush with
a built-in timer light.
9 a.m. Distance yourself from your destination. People who take at least 5,000
steps during the day (about 30 minutes of walking total) are 40 percent less
likely than sedentary people to develop metabolic syndrome, a precursor to
heart disease. So wherever you're headed, try parking down the block or in a
far corner of the lot. A few mini-walks can help you hit the target.
10 a.m. Stand up and stretch. Midmorning is one of most productive times of
day, when concentration and focus are at their peak. But don't get too attached
to your chair: Prolonged periods of sitting are associated with higher levels
of cholesterol -- and an increased risk of heart-related death. Aim to unseat
yourself for a few minutes every hour.
12:30 p.m. Keep the junk out of lunch. You already know to eat something made
with fresh, whole ingredients -- such as a crunchy green salad topped with
grilled chicken and low-fat dressing. Just watch out for the "halo
effect." This is the sneaky tendency to overindulge in junk food like
chips and soda after eating a virtuous entree. Remember: Heart health doesn't
end at the main dish.
2:30 p.m. Nibble a high-fiber, high-protein snack. Great choices include hummus
with whole wheat crackers and apple slices with a smear of natural peanut
butter. In addition to delivering heart-healthy nutrients, snacks with this
nutritional profile sate your appetite better than processed foods like cookies. This makes you less
likely to overeat at dinner.
4 p.m. Take a sanity break. Stress often strikes in late afternoon as
productive daylight hours dwindle. Don't get frazzled. Take a 10-minute
breather and do something relaxing, such as listening to music or e-mailing a
friend. Decompressing in stressful situations brings down your blood pressure
and helps you feel more in control.
6 p.m. Drink (in moderation). The American Heart Association recommends that
women consume no more than one alcoholic drink per day. At dinner or happy
hour, get more bang from your beverage by choosing red wine. It contains
antioxidants and compounds such as resveratrol that are associated with lower
heart disease mortality.
9 p.m. Power down your gadgets. Surfing the Web, texting on your cell, and
watching TV can interfere with sleep by stimulating the brain, so stop
screen-based activities about an hour before bedtime. Your heart will thank you.
Women who get at least 6 hours of sleep every night have less plaque buildup in
their blood vessels than women who sleep less.
10 p.m. Hug your family goodnight. A loving touch--whether it's from a massage,
a snuggle session, or a good bear hug--spurs the release of oxytocin, a
chemical that can bring down blood pressure by enhancing the flexibility of
blood vessels.
