Doctor-Recommended Tips for a Healthy Heart

Many of us still don’t know enough about heart disease, the No. 1 killer of women. So we asked renowned cardiologist Nieca Goldberg, M.D., what women need to know to protect themselves. Plus, are you on the road to a heart attack? Find out with our quiz…

Here’s a scary fact: Heart disease kills more women in the U.S. than all forms of cancer.

But it’s a health danger that women can prepare for: Knowing its symptoms, risks and preventive steps could save many lives, says cardiologist Nieca Goldberg, M.D., medical director of New York University’s Langone Medical Center Women’s Heart Center.

She should know: Goldberg is a pioneer in cardiac care for women, as well as a national spokeswoman for the American Heart Association (she's also on its board of directors.) She has also written two books on women’s health, Dr. Nieca Goldberg's Complete Guide to Women's Health and Women Are Not Small Men: Life-Saving Strategies for Preventing and Healing Heart Disease in Women (both Ballantine Books).

In this exclusive Lifescript interview, Goldberg offers life-saving advice for women concerned with heart disease.

What’s the biggest problem for women and heart disease?
Many women are ignoring the risk factors. They may learn they have high cholesterol, but then they don’t do anything about it.

And many perceive prescribed medications as dangerous. Instead, they turn to untested supplements that have no government oversight regarding safety.

Are women aware that heart disease is a big killer?
Many think that heart disease happens to men or older women. They think that it’s not something that could happen to them. Women still need to overcome that denial.

Still, statistics from the American Heart Association show that women are becoming more aware. Seven years ago, only 13% of U.S. women knew that heart disease and stroke were the leading killers of women. Today, more than 50% know.
Unfortunately, only 20% acknowledge that they could be among those affected by heart disease.

How does the denial and lack of knowledge hurt?
Women often don’t recognize the symptoms of heart problems. When I talk to women who’ve had a heart attack, they recall they had subtle symptoms the week before. For instance, maybe they had to sit down while doing housework because of pressure in their chest.

Studies have shown, too, that when 911 is called, it takes longer for women to get to the ER than men; 911 workers spend more time with them. Women often say, “I didn’t want to go in the ER and wait.” It’s as if they want to convince someone that the symptoms aren’t related to their heart. They’ll blame them on acid reflux or heartburn, which is frequently confused with heart disease.

Find out the differences here.

What symptoms should women look for?
They should always be on high alert for chest or abdomen pressure, exhaustion with little exertion and shortness of breath, especially if you have no history of acid reflux.

During a heart attack, women are also more likely to have unusual fatigue, nausea, dizziness and back pain.

But symptoms of heart disease can appear without a heart attack. Women can have shortness of breath and chest tightness if they have narrowed arteries, high blood pressure that isn’t controlled or microvascular angina, which occurs when the flexibility of small blood vessels supplying the heart becomes impaired.

Do women have the same risk factors as men?
Yes, most of the risks are the same, but the magnitude of the risk is different. Diabetes, low HDL cholesterol (the “good” kind) and excess belly fat are more of a problem in women.
Diabetes can increase a woman’s risk fivefold. Why diabetes is worse for women is unclear, but it may be because they have smaller, more vulnerable blood vessels. Too much glucose in the blood – the result of uncontrolled diabetes – damages blood vessels.

Women tend to have higher HDL cholesterol levels throughout life than men. They need higher levels of HDL to get the same protective benefits. Ideally, women should have a level greater than 50; men, only greater than 40.

Lastly, belly fat is associated with carbohydrate intolerance (the body’s inability to process carbohydrates completely), increased inflammation and blood clotting, and high blood pressure. These are all risks for heart disease.

What about stress?
Marital distress plays a bigger role in heart health for women. Research has shown that women who live with marital stress over time have high blood pressure when they’re home, but not when they’re at work – even if their jobs are stressful.

However, jobs can be a tremendous source of stress for men and women, especially if you have little control over your work situation.

Is heart disease diagnosed differently in women?
For years, doctors used the standard exercise ECG (electrocardiogram), or stress test, in men and women. Patients were hooked up to machines and asked to run on a treadmill while we watched their blood pressure, heart rate and heart.

But the tests often produced false positives for women; the ECG was abnormal, even though the women didn’t have heart disease. Doctors don’t know why.

Using imaging studies with stress tests is more helpful. Getting an image of the heart before exercise and another afterward produces more accurate results. The images show how your heart is affected by exercise, which tells us whether you have heart disease.
A bigger problem in diagnosis is the ineffectiveness of angiograms [an X-ray of blood vessels]; the small blood vessels that narrow in women can’t be seen on them. Even in women who’ve had heart disease or heart attacks, you won’t see the distinct narrowing of the arteries that you see in men. So you can’t rely on angiograms with women.

If women have symptoms of heart disease and a positive stress test, then the doctor should treat her symptoms.

Is treatment different for women too?
For starters, women don’t always get the same benefits from aspirin that men do. Studies show that taking an aspirin can reduce the recurrence of a heart attack in men and women. But it doesn’t reduce your risk for a first heart attack if you’re a healthy woman between the ages of 45 and 65. The exact reason is unknown.

Still, you should talk to your doctor about taking aspirin if you have risk factors such as high blood pressure, high cholesterol and a family history of heart disease. You may get some benefit from aspirin.

Also, certain medications have different side effects in women than in men. For instance, ACE- inhibitors [drugs that open arteries] taken in high doses for hypertension, high blood pressure or heart failure seem more likely to cause coughing in women.

Beta blockers, also used for high blood pressure, are associated with more depression in women, although men may be underreporting depressive symptoms.

Coronary bypass surgery seems to put older women at greater risk for a stroke. But that may be because women are often sicker than men by the time they have surgery.

Why are they sicker?
Most likely a combination of factors: Because women may delay getting the medical care they need, they’re usually older than men by the time they have surgery. They’re also more likely to have untreated risk factors, such as high blood pressure and diabetes.

The good news is that the use of stents and angioplasty have significantly improved in recent years, thanks to smaller catheters – thin flexible tubes – that are inserted into the arteries with balloon-shaped tips to press open the narrowed arteries.
Any other gender differences?
In women, especially those under age 50, heart disease is sneakier. Younger women tend to have plaque distributed more evenly through their bodies and in tiny blood vessels that you can’t see on angiograms.

They’re less likely to have the more visible, lumpy plaque in larger arteries that you see in men and older women.

What does this mean for women’s heart disease survival rate?
More women die of their first heart attack than men. And of women ages 40 and above, 23% will die of their first heart attack within the year, compared to 18% of men.

Women are more likely to have untreated or under-treated heart failure, high blood pressure and diabetes – all conditions that put them at risk for heart attacks.

What else do we now know that we didn’t, say, five years ago?
There wasn’t as much information about microvascular disease – we weren’t talking about it. Then the WISE (Women’s Ischemia Syndrome Evaluation) study by the National Institutes of Health came out in 2006, giving us a lot of information about young women who have heart attacks.

It showed us that even though their arteries look clear on an angiogram, women can still have heart disease. In women, the plaque is occurring in small arteries of the heart.

What can women do to keep their hearts healthy?
Start by strapping on a pedometer and trying to walk 10,000 steps a day. They should also have their blood sugar, cholesterol and blood pressure checked, so they know if they’re at risk for heart disease.

Eat more whole grains, fruits and vegetables, especially the red, yellow and green ones, which are loaded with antioxidants. Eat less saturated fat. Get your vitamins from food, not supplements.

Eat fiber to help lower your cholesterol and get omega-3 fatty acids by eating fatty fish, such as salmon, tuna or mackerel at least twice a week. Or, if necessary, take a supplement.
Build aerobic exercise into your day by walking, dancing, doing Wii Fit or going to the gym. Exert yourself enough to feel short of breath but still able to speak.

Make time to chill out every day. Do yoga or tai chi. Don’t take the BlackBerry to bed. And do whatever you can to quit smoking if you’re still lighting up.

You can significantly reduce your risk… even if you have a family history of heart disease.

Check out our Heart Disease Health Center.

Learn how heart disease develops. Watch this video.

Are You on the Road to a Heart Attack?
Every 20 seconds, a heart attack occurs somewhere in the U.S. Coronary heart disease, the leading cause of death in this country, contributes to the 1.5 million heart attacks that occur each year. Will you become a part of this statistic?