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


Strategies To Prevent Heart Disease In Women


September 27, 2013

Women's Health
9103
Women And Heart Disease
Strategies To Prevent Heart Disease In Women
Strategies To Prevent Heart Disease In Women
htmHTWstrats
Your actions today can help to prevent, delay, or minimize the effect of heart disease. The key strategy is controlling risk factors.
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InteliHealth
2009-09-02
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InteliHealth Medical Content
2011-09-02

Reviewed by the Faculty of Harvard Medical School

Strategies To Prevent Heart Disease In Women

Your actions today can help to prevent, delay or minimize the effect of heart disease. The key strategy is controlling risk factors.

True, you cannot control every risk factor. For example, family history of heart attack is a risk factor for heart disease. In other words, heart disease tends to run in families. However, for some families this is partly due to behavior not just due to genetics. Family members tend to eat the same foods, and whether a person chooses to be physically active or to smoke can depend on the home environment and the example of other family members.

Age and gender also influence your risk of heart disease. The good news for women is that they develop heart disease later in life than do men. The risk for a heart attack increases steeply after the age of menopause. Experts used to think that the change in estrogen levels after menopause might be the reason for this steep increase in heart disease risk. This is no longer thought to be true, since we know estrogen replacement after menopause doesn't help a woman's heart risk.

Major Risk Factors

Here is a review of key risk factors for heart disease.

Cholesterol Levels

Cholesterol and triglycerides are types of lipids. Like other lipids, they are soft, fatlike substances that serve as a source of fuel. Too much cholesterol can buildup inside your arteries, forming a deposit that is called a "plaque." A plaque in your artery can interfere with smooth blood flow and encourage blood clots to form. This is how a plaque — also called atherosclerosis — can lead to a heart attack.

To circulate through your blood, cholesterol and triglycerides combine with proteins to form lipoproteins.

There are four types of lipoproteins, differing in the ratio of protein to triglyceride and cholesterol. The two most important types are low-density lipoprotein (LDL) and high-density lipoprotein (HDL).

LDL cholesterol, the so-called "bad" cholesterol, is transported to sites throughout the body. LDL cholesterol does serve useful purposes. It can be used by your body to repair cell membranes or to make hormones. LDL cholesterol, however, can accumulate in the walls of your arteries as plaque, so too much of it is a bad thing.

HDL cholesterol, the so-called "good" cholesterol, transports excess cholesterol (including cholesterol from artery plaques) to the liver. In this way, HDL does you a good service. In the liver, excess cholesterol can be altered and removed from the body.

Every woman should know her total cholesterol, LDL cholesterol, HDL cholesterol and triglyceride levels. All four values help create your lipid profile, and this profile helps define your heart disease risk.

Women tend to have higher HDL levels than men, but after menopause this difference becomes less marked. The HDL level can begin to often drift down and the LDL level can go up. Diet, exercise and one drink of alcohol per day (for women who already drink) all help to keep a healthy balance of HDL and LDL cholesterol. Cholesterol-lowering medications, especially drugs called statins, continue to provide great results for women with heart disease and women with an increased risk of heart disease.

Blood Pressure

Normal blood pressure level is defined as less than 120 millimeters of mercury (mm Hg) for systolic blood pressure (the top number in the blood pressure ratio) and less than 80 mm Hg for diastolic blood pressure (the bottom number in the blood pressure ratio). Mildly elevated blood pressure (120 to 139 mm Hg for systolic pressure, or 80 to 89 mm Hg for diastolic pressure) is called "prehypertension." People with prehypertension usually develop hypertension as they grow older. The higher the blood pressure, the more likely it is to take a toll on the heart and on the brain. High blood pressure is strongly associated with stroke, as well as with heart failure and kidney failure.

How frequently should you get your blood pressure checked? The answer depends on whether or not your levels are high. If your blood pressure is normal, get it checked at least once every two years. If it is high-normal, get it checked once a year. If it's extremely high, you should get immediate care. Because blood pressure varies, it's important to get multiple measurements to know if a high level is sustained over time.

Diabetes

Another risk factor for heart disease is diabetes, a chronic disease of insulin deficiency or resistance. Diabetes is a contributing factor in a significant percentage of heart attacks and strokes. Type 2 diabetes, the most prevalent type, is commonly associated with obesity and can in many cases be prevented by maintaining ideal body weight through exercise and balanced nutrition. If you have a first-degree relative with type 2 diabetes, your risk of developing the disorder is especially high.

Tips For Controlling Risk

Lifestyle modification is helpful for controlling high blood pressure, moderating lipid levels and managing or preventing diabetes.

Here are guidelines for lowering your risk of heart disease.

Stop Smoking

Don't start smoking. If you smoke, do everything you can to stop. It is the single most important thing you can do for yourself. And not just because of its effect on your heart and your blood vessels. The effect of smoking on your lungs aggravates almost every other medical condition.

Get Active

Routine physical activity is highly recommended and helpful in controlling obesity. Try to perform at least 30 minutes of moderate physical activity every day. If you need to lose weight, aim for 45 minutes or more of daily dedicated exercise time. Fast walking is one of the best things you can do. You may enjoy it more if you walk with a companion or listen to music on a portable stereo.

Keep in mind that if you can lose even a small amount of weight, five pounds for example, it may have a positive effect on lipid levels and blood pressure.

Limit Alcohol Consumption

Limit daily alcohol intake to three ounces or fewer. People who drink large amounts of alcohol (defined as six to eight ounces a day) tend to have higher blood pressure. Alcohol may also aggravate triglyceride levels, as well as make it harder to control diabetes.

Watch What You Eat

Here are common guidelines for eating healthy.

  • Eat five servings of fruits and vegetables daily.
  • Maintain adequate dietary potassium, calcium and magnesium intake.
  • Reduce saturated fats and cholesterol.

You should also be aware of your salt sensitivity. Women who are salt sensitive retain salt and water as part of the cycle of estrogen. Before your menstrual period, you may notice that your shoes don't fit quite so well, your rings get tight and you feel bloated. Salt and water retention may be associated with high blood pressure.

Women with high blood pressure should reduce salt intake to less than six grams a day.


Questions From Women About Heart Disease


Here are questions from women about heart disease. Click on the question to find the answer.

I come from a family with a history of heart disease, but otherwise I don't have any special risks. How significant is my family history?

A: Your family history is still a factor. We are learning more about the genetics of all conditions, heart disease in particular. It is possible that an inherited gene might make your blood clot more easily, might push up your cholesterol levels or might cause you to develop high blood pressure. So stay vigilant about your heart health, because you are likely to add other risk factors over time.

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I am an elderly woman and have already undergone bypass surgery. Do I need to be concerned about my cholesterol level?

A: It's very important for you to keep your cholesterol level down. The fact that you've had bypass surgery means that you have coronary artery disease (atherosclerosis). Like anyone with atherosclerosis, you are at high risk of future heart problems. Because it has been shown to lower heart attack rates, cholesterol treatment is recommended for someone with atherosclerosis, even if your cholesterol is normal or very close to normal! Close attention to your blood pressure, weight and diet are also very important.

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When should I undergo a treadmill stress test?

A: Exercise tests (also called "stress tests") may help to confirm a diagnosis of coronary artery disease when this is suspected to be the cause of chest pain. These tests are less exact as a diagnostic tool in women than they are in men. Their results can't always be trusted. More often than doctors would like, women who don't have true artery disease can have false positive treadmill test results. The test can also go wrong by giving a false negative result for some women who do have coronary artery disease. Doctors have to be very careful to use the test results as a suggestive extra piece of information, not as a final word. In general, women without symptoms don't benefit from having treadmill tests, because the test result doesn't mean much when it's the only thing that points to heart disease.

For women with symptoms that may indicate coronary artery disease, an electrocardiogram (ECG) will be performed as a first test, while you're resting. Your doctor will look at the ECG result and review your risks for heart disease, your age, family history, smoking status, blood pressure and cholesterol levels and whether or not you have diabetes. After this, a stress test might be ordered. For women, doctors often order a different kind of test. One such test is called a "stress echocardiogram." This test uses either exercise or a drug to cause the heart to beat more quickly and vigorously. Then it uses an ultrasound to examine the heart muscle motion.

Women older than age 40 who wish to begin vigorous exercise should check with their doctor before starting. Those with a high risk for heart disease may benefit from some form of stress testing before starting a high-intensity exercise program.

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My doctor tells me I have high levels of HDL. Will that protect me against heart disease?

A: A high HDL level indicates a lower risk of heart disease. Whether the HDL cholesterol itself is providing the protection is not clear. But evidence suggests that the higher the number, the less the risk. Greater than 60 mg/dL is a very good level of HDL. The protection of a high HDL is not perfect. If you have several risk factors, then even a very high HDL level might not spare you from heart disease.

A woman's HDL level tends to drop with menopause. Physical activity can help you keep your level of HDL as high as possible.

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I have high cholesterol but I don't have symptoms of heart disease. Should I seek treatment?

A: It depends on your age, other risk factors and your cholesterol level. Women who have very high LDL cholesterol levels and/or low HDL cholesterol levels may benefit from drug therapy. Woman who have had a heart attack or coronary artery disease, should be treated. Usually, treatment requires medication. The most common medicines used are in a family of drugs called "statins". Your doctor can say if treatment is recommended for you.

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