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Harvard Commentaries
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Harvard Commentaries
Reviewed by the Faculty of Harvard Medical School


Woman to Woman Woman to Woman
 

Our Mothers, Ourselves: Protecting Against Heart Disease


January 14, 2013

By Alice Y. Chang M.D.

Harvard Medical School

Do you know what the number one killer is for women? Most women are surprised to learn it is heart disease, not breast cancer. Unfortunately, even a majority of health care professionals answered this question incorrectly in a survey done by the American Heart Association.

At the Second International Conference on Women, Heart Disease and Stroke, I hoped to learn about new study information that more women were now being successfully treated for heart disease. What I learned is that women still have a higher risk of complications from procedures such as balloon angioplasty and coronary artery bypass surgery. So the current strategy for tackling this worldwide killer of women is prevention and elimination of risk factors.

In economically more advantaged countries, access to health care and preventive measures is available to most people. Yet when it comes to heart disease, women are not doing enough to keep themselves healthy. Heart disease in women is tricky because women have different symptoms than men, and the diagnostic tests tend to be less conclusive. In addition, women often put their family’s health in front of their own.

But in fact, it is in the interest of her family that a woman needs to pay just as much attention to her health, especially her heart. My new tactic is to find out if my female patients have adult daughters. If so, I try to recruit the daughters to work with me on risk-factor reduction for their mom. At the same time, the daughters get an education on heart disease prevention for themselves.

Know the Numbers

Ask your mother specifics about her heart risks and at the same time make sure you know your own.

Blood pressure — Ideal blood pressure is 120/80 or below. Lowering high blood pressure readings by even a few points decreases heart disease and stroke risk. A great place to start is with the DASH diet (short for "Dietary Approaches to Stop Hypertension"). The DASH diet calls for loading up on fruits and vegetables with some low-fat dairy foods. Avoid saturated fats and go light on the salt. Even if your blood pressure is normal, this is good advice for all of us.

Cholesterol — Knowing your total cholesterol is not enough. You and your mom need to know the results of a fasting lipid panel that also includes LDL (bad) cholesterol, HDL (good) cholesterol and triglycerides. For women, a low HDL number is a higher risk factor for heart disease than it is for men. Women should have an HDL number greater than 50. Exercise is the best way to raise your HDL. LDL also has gotten a lot of press lately with recent recommendations to go as low as possible. For someone with multiple risk factors for heart disease, LDL should be less than 100. For women, and men, diagnosed with coronary heart disease the goal should be an LDL of 70 or less.

Blood sugar — A fasting blood sugar should be less than 100. A fasting blood sugar higher than that but less than 126 on two or more occasions is called pre-diabetes. You want your mother to take action before she progresses to diabetes, defined as a fasting blood sugar greater than 126 or a random sugar sample greater than 200. There is a close correlation between heart disease and diabetes, especially in women. While there are medications available to potentially prevent women with pre-diabetes from developing diabetes, head-to-head studies show that weight loss and exercise are more powerful diabetes stoppers than drugs.

Body Mass Index (BMI) — Your BMI is a measure of whether you are overweight, Ideally, it should be below 25. Increased body fat, especially around the waist, decreases the ability of insulin to regulate blood sugars. The pancreas needs to work harder and put out more insulin as a person gains weight and exercises less. Eventually the pancreas can't produce enough insulin to keep up with rising blood sugars. The result is pre-diabetes, and if no action is taken, it can progress to type 2 diabetes.

Waist size — This may be a sensitive topic, but carrying your weight around your waist, the so-called “apple” appearance (the “pear” appearance is increased size around the hips), also carries a higher risk of heart disease. Waist size should ideally be below 35 inches.

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Target Key Health Behaviors

Don’t smoke, and if you smoke, quit. Advertising directed toward women closed the gender gap in tobacco use. This is the number-one behavior to target. Help your mom choose a quit date and support her in trying to quit. Have her ask her doctor about a stop-smoking program. Nicotine replacement and a smoking-cessation medication can help.

Exercise. While the goal is at least 30 minutes every day, as little as 30 minutes of walking three times a week can improve your heart health. You can even divide the 30 minutes into 10-minute blocks. Instead of meeting your mom for a meal, meet for a walk or exercise class. Suggest walks outside, walks at the mall, parking the car further away from the store, or at work by walking during breaks or lunch.

Eat a healthy diet. Make sure your mom gets plenty of vegetables and fruits in her daily diet — the goal is a total of nine servings per day. Not only is it good for the heart, a healthy diet helps to keep body weight in check, to lower blood pressure and may also help to lower her risk of cancer.

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Learn How to Recognize Symptoms of Heart Disease

Many women with heart disease never experience the classic mid-chest crushing pain that people associate with angina and heart attacks. Women often have pain on the sides of the chest or the back or the shoulders. Also be aware of these symptoms, especially when related to physical activity or emotional situations:

  • Left arm pain or discomfort
  • Pain going to the neck or jaw
  • Shortness of breath
  • Unexplained sweating
  • Upset stomach or nausea
  • Unexplained anxiety or fatigue

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The Bottom Line

Women are often advocates for the health of their partners and children. Now, we have to make sure we take care of each other in this battle against our number one killer, heart disease.

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Alice Y. Chang, M.D. is a former instructor in medicine at Harvard Medical School. She is currently associated with University of Texas Southwestern Medical Center. Her clinical interests and experience are in the fields of primary care, women's health, hospital-based medicine and patient education.

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