25 May Heart Disease: Not Just a Man Thing

What Every Woman Needs to Know About Heart Health

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The telltale signs were there, chest pain that radiated through her arm, exhaustion, nausea, but like many women who experience these symptoms, Tasya Lacy never suspected that she was having a heart attack. “I’m a Hula-Hoop fitness instructor. I thought the pain was caused by a pulled muscle and the tiredness was from the stress of running a business and planning my upcoming wedding,” she explains.

Fortunately, Lacy’s fiancé insisted that she go to the hospital. There, doctors found that 99 percent of her main coronary artery-one of the arteries that carry blood to the heart-was blocked due to coronary heart disease (CHD). Also called coronary artery disease, CHD is the most common type of heart disease in women and men. It occurs when deposits (plaques) consisting of fat, cholesterol, and other substances build up within the coronary artery walls, causing the arteries to narrow-a process called atherosclerosis. If the plaque bursts, a blood clot can form and severely restrict or completely obstruct the flow of oxygen-carrying blood to the heart, causing a heart attack.

Fortunately, Lacy, who is Black and was 50 years old at the time of her heart attack, got help. But many women aren’t as lucky; one in five dies from some form of heart disease, according to the Centers for Disease Control and Prevention (CDC). Yet many women are unaware of this danger. Just over 50 percent of women overall and about 36 percent of Black women know that heart disease is their number one killer.

Are you at risk?
The following are risk factors you can’t change.
Age. A woman’s risk of heart disease increases significantly after age 55, when production of estrogen, which has a protective effect on the heart, begins to decline. But premenopausal women can have CHD, too.

Family or personal history. If your father or brother was diagnosed with heart disease before age 55 or your mother or sister was under age 65, you are at increased risk. A personal history of stroke, peripheral arterial disease, or kidney disease also boosts your risk.
“Gender-specific risk factors to be aware of include having had a preterm delivery, preeclampsia (high blood pressure during pregnancy), or gestational diabetes,” says Carolyn Wu, MD, MS, a cardiologist with Johns Hopkins Community Physicians Heart Care in Bethesda and Chevy Chase, Maryland. She adds that people with autoimmune diseases, particularly rheumatoid arthritis or lupus, also face an increased risk of CHD, as do women and men who have undergone certain types of chemotherapy or radiation to the chest for cancer.

Six ways to reduce your risk
To reduce CHD risk, experts offer these recommendations.

1 Lower cholesterol levels. High LDL, or “bad,” cholesterol is the primary culprit, but low HDL and high triglycerides are harmful, too. Following a heart-healthy eating plan (see “Diet for a Healthy Heart”), being physically active, maintaining a healthy weight, and, if needed, taking cholesterol-lowering medication can help.

2 Stop smoking. Smoking can lower HDL, or “good,” cholesterol. Fortunately, the risk of developing CHD drops sharply one to two years after quitting. If you have CHD, quitting lowers the risk of having a heart attack and dying from heart disease.

3 Reduce high blood pressure. Hypertension, or high blood pressure (above 120/80 for women age 20 and older), is a major risk factor for heart disease. Following a healthy eating plan and getting regular physical activity can help. Some people may also need medication.

4 Keep blood glucose levels under control. Diet, physical activity, and weight loss can help lower elevated blood glucose levels and help prevent or delay the development of type 2 diabetes. Medication may also be needed.

5 Maintain a healthy weight. Keep your BMI under 25. Excess weight raises your blood pressure and LDL and triglyceride levels, lowers your HDL level, and increases your risk for diabetes.

6 Get moving. For heart benefits, aim for at least 150 minutes of moderate-intensity exercise each week.

The impact of race
Black women are more likely than other females to have hypertension, elevated cholesterol levels, and type 2 diabetes, and they are more likely to be overweight or obese. Consequently, the risk of heart disease-and dying from it-is especially pronounced for Black women. The picture is not much better for Latinas and other women of color; heart disease is either tied with cancer or second to it as a leading cause of death in these groups.

Fortunately, all women of color can decrease their risk for heart disease by following the lifestyle measures described above. “Many people don’t know that these simple lifestyle measures can reduce the risk of heart disease by up to 80 percent,” says Jacqueline Eubany, MD, FACC, FHRS, a cardiologist in private practice in Orange, California.

One measure is losing weight. Yet studies have shown that Black women are more accepting of their bodies, even when they are overweight or obese. Such “body positivity” has begun to be embraced by women of other races as well. But Dr. Eubany cautions that obesity remains a major risk factor for CHD. “You don’t have to be skinny, but you can’t eat whatever you want and still have good numbers when it comes to cholesterol, blood sugar, and blood pressure,” she warns. “Even if a woman’s numbers are normal when she’s young, they aren’t sustainable in the long run.”

Know the signs
If you experience one or more symptoms below, call 9-1-1 right away.

• Chest pain, pressure, squeezing, or fullness that lasts more than a few minutes or goes away and comes back. Chest pain or discomfort is the most common symptom in women and men.
• Pain or discomfort in one or both arms, the back, neck, jaw, or abdomen.
• Shortness of breath with or without chest discomfort.
• Nausea, fatigue, lightheadedness, or a cold sweat.

Dr. Wu points out that some women with heart attack symptoms may not have traditional risk factors for CHD. “It’s important for doctors to keep other possibilities, such as spontaneous coronary artery dissection, in mind and to perform the appropriate diagnostic tests to evaluate for those conditions.”

Bottom line
“CHD doesn’t usually cause symptoms until something catastrophic happens,” says Dr. Eubany. That’s why regular visits to the doctor are essential to monitor blood pressure, cholesterol, and glucose levels.
Lacy offers this advice: “Don’t ignore your symptoms. Your body is giving you a warning sign that something is wrong.” DW

By Beverly Lucas

Beverly Lucas is a freelance writer and editor based in Teaneck, New Jersey.