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Cardiovascular Disease and Women
Heart disease is the concern of every woman today. You might think that breast cancer and osteoporosis are the two biggest diseases that affect women. However, women lose their lives to heart attack five times more often than breast cancer. About eight million women in the United States are living with heart disease and 440,000 women have heart attacks every year (9,000 of those women are under the age of 45). Because there is such a high likelihood you could get heart disease it is important for you to talk to your health care provider about your risks and concerns about heart disease. Women in general are less likely to get heart disease until menopause. It is believed that estrogen, a female hormone, provides protection to the heart until natural menopause when the estrogen level goes down. Women and men then, have the same risk of heart disease by the age of 60-65.
How your heart works:
Your heart is a four-chambered muscular organ that works as a pump. Normally your heart is the size of your fist. We hear the pump working as the heart beats. A normal heart beats about 60 to 80 times every minute. Your heart pumps blood out to the rest of your body. This is important because blood carries oxygen and all of the tissues and organs in the body must have oxygen to live. Blood leaving the heart travels through arteries and then returns to the heart from the tissues and organs through veins. Because the heart itself is a muscle, it too has arteries that supply it with blood and oxygen to help it function.
What can go wrong with your heart and cause Heart Disease?
The technical terms for heart disease are coronary heart disease (CHD) or coronary artery disease (CAD). Heart disease occurs when the arteries that feed the heart narrow and decrease the amount of blood and oxygen that reach the heart muscle. These arteries are narrowed or clogged by cholesterol and fat deposits called plaque. The narrowing of the arteries is called arteriosclerosis. The plaque that forms in the arteries is hard and brittle and cause a hardening of the arteries called atherosclerosis.
When the heart doesn’t get enough blood and oxygen you can feel chest pain, called angina. As a woman, you might have other symptoms like nausea, indigestion, unexplained fatigue, back or jaw pain. These symptoms usually occur during either emotional or physical stress. Don’t ignore these symptoms just because they aren’t the typical chest pain that most men experience. A heart attack occurs when one of the arteries in the heart becomes totally blocked and part of the heart muscle doesn’t get any blood at all. The complete blockage of an artery is usually from a blood clot on top of the cholesterol and fat deposit in the artery.
What can make your chance of having Heart Disease increase?
There are some things that can hurt your heart. These are called risk factors and include cholesterol, blood pressure, diet, exercise, smoking, diabetes and family history. The good news is that you can improve all but your family history. By improving your risk factors you will lower the chance of getting heart disease.Cholesterol:
Cholesterol is a waxy fat like substance that your body needs to function normally. Your body makes the cholesterol that it needs for cells in your body in the brain, nerves, muscles, skin and all of your organs. However, your body only needs a small amount of cholesterol to do these different jobs. When there is too much cholesterol in your blood it collects in the arteries forming plaque, including the arteries in your heart. This is what causes the narrowing in the arteries and leads to heart disease. High cholesterol is one of the risk factors for heart disease. It is possible to measure the levels of cholesterol in your blood. The goal or target numbers for your cholesterol may change depending on what other risk factors you have. More than fifty percent of women have high cholesterol. Ask your health care provider what your target numbers should be.
There are three types of cholesterol – LDL, HDL and Triglycerides.
LDL: Low Density Lipoprotein is the “bad” cholesterol. It is the cholesterol that clogs your arteries, preventing blood flow. Your LDL level is one of the main predictors of your risk of heart disease. The goal of treatment for high cholesterol is to lower your LDL. If you have no other risk factors the target level is below 160.
HDL: High Density Lipoprotein is the “good” cholesterol. It is the cholesterol that helps to get rid of the extra cholesterol in the blood. Your HDL cholesterol level should be above 45. Women need higher levels of HDL then men to protect their hearts.
Triglycerides are one of the forms in which your body stores fat. This is often elevated when total cholesterol is high, LDL is high and HDL is low. Women over 50 years old, with high triglycerides and no other risk factors are at a higher risk for heart disease than men. The target number for triglycerides is under 200.Blood Pressure:
There is a high incidence of high blood pressure in American women. Approximately 52% of women over age 45 have high blood pressure, which is called hypertension. Of those women, 70% of African American women and 60% of Caucasian women have high blood pressure. If you have hypertension your heart has to work harder and doesn’t pump as well as it should. Over time this will lead to an enlarged weak heart. In addition, high blood pressure can lead to hardening of the arteries in the heart called atherosclerosis. It can also negatively affect your brain causing stroke, and kidneys leading to kidney failure.
So what is blood pressure? You have probably had your blood pressure checked when you’ve gone to see your health care provider or you may have tried one of the automatic machines in a drug store at some point. What do those numbers mean? Blood pressure is a measurement of the pressure the blood puts on the arteries as it is pumped throughout the body. There are two numbers given in a blood pressure measurement. The top number is the systolic pressure that measures the force of the blood when the heart beats. The bottom number is the diastolic pressure or the force in between heartbeats when the heart relaxes. To write the blood pressure you write the systolic over the diastolic – 120/70 mmHg (millimeters of mercury) and you say it “120 over 70.”
Normal blood pressure is a systolic (top) number less than 140 mmHg and a diastolic (bottom) number less than 80 mmHg. Your heart likes your blood pressure to stay in this normal range. Your doctor will help you to monitor your blood pressure when you go in for an exam. You can also find somewhere in your community to get it checked like a senior citizens center, fire station, or community center. If you have your blood pressure checked and it is above normal you need to schedule a visit with your health care provider to talk about ways to lower it.
There are different causes of high blood pressure. Some of those causes are narrowing of arteries, increased blood volume or your heart beating faster or harder than it normally does. All of these causes will lead to increased pressure within the arteries in the body. Other medical problems can cause high blood pressure. We don’t always know what causes high blood pressure.
Each person’s blood pressure is unique just like each person’s heartbeat is unique. Because of that, we can’t say that there is one way to manage high blood pressure. Some people might require one medication once a day. Others might require three different medications. Still others might be able to lower their blood pressure by changing their diet and exercise patterns. Diet and exercise have been studied and proven to be effective in lowering blood pressure to some level. In other words, there will always be an improvement in your blood pressure if you improve your diet and exercise and lose weight if you are overweight.
Bad Eating Habits and Being Overweight:
There is so much media attention given to diet and weight that you may feel like you already know that you are supposed to “eat right” and “lose weight.” The important thing to remember is that when you eat a high fat, high cholesterol and low fiber diet, you are greatly increasing your risk of heart disease. In addition, you increase your likelihood of getting high blood pressure and diabetes. The encouraging news is that you have the power to control your diet and decrease your risk of getting these diseases.
When you are overweight, your heart is forced to work harder. About one third of all women are classified as being obese. Excess weight generally leads to raising your LDL “bad” cholesterol. When you lose weight you will lower triglycerides and raise HDL “good” cholesterol.
There are things you can do to change your diet and decrease your heart disease risk. You might want to ask your health care provider to recommend a dietitian or nutritionist to help you develop a diet plan. And you should always consult your health care provider before starting a new diet plan. Some of the recent diets that are popular in the media can actually be harmful to you.
Your diet should be low in saturated fat, total fat, and cholesterol. Saturated fats raise your LDL “bad” cholesterol the most and are found in red meats, poultry, and dairy products. Hydrogenated fats are just as bad and are found in baked goods, some cereals, non-dairy creamers and ice cream. One way to remember the “bad” fats is to think of them as being solid at room temperature, like shortening, lard, butter and stick margarine.
Our bodies do require some fat and we can get that in the “good” fats and small amounts of the “bad” fats, like lean red meat and poultry. The “good” fats include: Polyunsaturated, monosaturated fats and Omega 3 Fatty acids. These “good” fats are found in sunflower, safflower, corn, peanut, olive and canola oils. They are also found in soybeans, fish, flaxseed and nuts.
There have been several studies done that show a decrease in LDL “bad” cholesterol and decrease in heart disease risk when these “good” fats are substituted for “bad” fats in the diet. One study showed a 30% decrease in heart disease in women who ate two or more servings of fish every week. There haven’t been any studies that show taking fish oil supplements are as beneficial. In other words, to get the protective effect on your heart you need to eat fish, not take supplements.
You should increase your daily intake of fiber, fruits and vegetables. Once again, studies have shown that benefits for your heart come from good nutrition, not from taking vitamins and supplements. The major source of protein in your diet should come from nuts, soybeans, legumes, poultry and fish. Be careful about switching to “fat-free” and “low-fat” substitutes because they are often very high in calories. Start reading your food labels to become familiar with nutritional value and serving sizes. It will take time to change your shopping, cooking and eating habits, but know that the time and hard work will pay off.
Read the American Heart Associations Dietary Guidelines at: http://www.americanheart.org/presenter.jhtml?identifier=1330
Alcohol use related to heart disease has also been in the media a great deal. What we know is that minimal alcohol intake increases HDL “good” cholesterol but doesn’t affect the LDL “bad” cholesterol and it increases triglycerides. We also know that drinking too much alcohol can damage your liver and your heart muscle and lead to high blood pressure. Because of these bad effects of alcohol you shouldn’t think of drinking alcohol as a way to prevent heart disease. The National Heart Lung and Blood Institute recommends that you not drink more than four ounces of alcohol a week. If you drink more than this you should make an effort to cut back.
Learn more about Woman and Alcohol at: http://depts.washington.edu/uwcoe/healthtopics/alcohol/index.html
Lack of exercise is a major risk factor for heart disease. Regular exercise can lower your risk of heart disease by 50%. Sadly, about 60% of women are physically inactive. Remember your heart is a muscle and by exercising you are not only getting the muscles in your arms and legs in shape, you are getting your heart in shape too.
Routine exercise can lower LDL “bad” cholesterol, raise HDL “good” cholesterol, help regulate blood sugar, and lower blood pressure. Exercise will also increase the flexibility of arteries and will slow the hardening of arteries. Routine exercise doesn’t have to mean belonging to a gym. Brisk walking is actually one of the best forms of exercise and can be done most anywhere and not cost you a thing. You can benefit from exercising for 30 minutes a day, at least three times a week. You should always check with your health care provider before starting a new exercise program.
See the American Heart Association Exercise Guidelines at: http://www.americanheart.org/presenter.jhtml?identifier=2155
If you are a smoker then you have probably been told before that “smoking is bad for you.” But, do you know why? The nicotine in cigarettes increases your heart rate and blood pressure. This makes your heart work harder than normal. It will also constrict or tighten your arteries, which will limit the amount of oxygen that your tissues, organs and especially your heart will receive. If you smoke, you are more likely to have a heart attack 19 years earlier than if you didn’t smoke at all. Over half of the heart attacks in middle-aged women are caused by smoking.
It really is in your best interest and definitely in your heart’s best interest to quit smoking. The first thing you need to do is get motivated. Start by thinking about the positive things that will happen when you quit smoking such as overall better health, decreased risk of health problems and the money saved by not buying cigarettes. You may need help to do this and that is okay. There are prescription medications and stop smoking programs that can help you. Your health care provider is a great resource to help you quit smoking. Your friends and family can also be good support for you while you are trying to quit. There is no evidence that cutting down on smoking helps your heart. You need to quit smoking to reduce your chances of heart disease.
To learn more about how to quit smoking, read our section on smoking
Type 2 diabetes is a bigger risk factor for heart disease in women than it is for men. Also, women with diabetes are twice as likely to have heart attacks than women without diabetes. If you have diabetes you can greatly decrease your risk of heart disease by treating high blood pressure and high cholesterol and losing weight.
To learn more about diabetes go to: http://depts.washington.edu/uwcoe/healthtopics/diabetes.html
One thing you can’t change that influences your risk of heart disease is your family history. This can also be referred to as heredity or genetic pre-disposition. It appears as though heart disease does “run in the family.” Your chance of getting heart disease increases when a parent or brother or sister has had a heart attack before the age of 50. While you cannot control what has happened to your family members, it is important to know your family history and to share it with your health care provider.
Risk Factor Modification:
Do you want to know your individual risks for heart disease? Go to the American Heart Association’s Web page and use the risk calculator. http://www.americanheart.org/presenter.jhtml?identifier=3003499
If you have any risks you would like more information on how to improve and modify, check out these Web sites:
For information on how to “Shape Up,” go to: http://www.shapeup.org/
Or learn about a new exercise program called “Choose to Move” developed for women like you at: http://www.choosetomove.org/about.html
To learn about diet and nutrition from the American Dietetic Association go to: http://www.eatright.org/
For heart healthy recipes go to: http://www.4woman.gov/hhs/recipes.cfm?Session_ID=200301280111236183
Christina Coops, RN, BSN
ARNP Student - University of Washington
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