Q: Heart disease runs in my family. As a 51-year-old woman, what can I do to protect my heart and prevent cardiovascular disease?
—Judy K., Lansing, MI
Whether you have a genetic predisposition or not, heart disease is a very serious issue for women. According to the December 2011 Harvard Women’s Health Watch, nearly 43 million women in the US have some form of cardiovascular disease (CVD). Heart disease is the leading cause of death among women, killing nearly 422,000 each year—six times more than breast cancer.
When the National Heart, Lung, and Blood Institute initiated the "Red Dress" campaign in 1997, only 30 perceft of surveyed women considered heart disease a leading cause of death for women. That awareness rose to 55 percent by 2005. Even so, awareness remained low for racial and ethnic minorities, and most women don’t believe that they are personally at risk. Nor do doctors recognize women’s risk adequately: As the second Red Dress report was being released in 2005, a physician awareness survey found that fewer that 20 percent of doctors knew that more women than men die each year from cardiovascular disease.
Gender Differences and Why They Matter
Women’s Hearts—like their livers and kidneys—tend to be smaller than men’s, even if their total body weight is the same. Daily aspirin doesn't seem to prevent a first heart attack in healthy women, as it may in men. (For more information, see www.hearthealthywomen.org.)
Women are also more likely to die from a first heart attack than men. And the impact of alcohol consumption is worse for women: Men have a higher water-to-fat ratio, which helps dilute the effects of alcohol. Further, women are more likely than men to binge drink, which is the most dangerous way to consume this pickling poison.
Women tend to develop heart disease 10—15 years later than men, probably because of the protective effect of estrogen. Giving estrogen to postmenopausal women, however, doesn’t seem to improve cardiovascular disease risk, except in cases of arrhythmias. Smoking lowers estrogen levels, which is why women smokers don’t have that 10—15 year delay compared to men in developing cardiovascular disease.
Men’s Cardiovascular disease is much more likely to be due to atherosclerotic plaque, which narrows arteries and raises blood pressure. Women are more prone to peripheral (rather than central) artery disease, and women’s "heart attacks" are often due to muscle spasms, possibly due to loss of magnesium over years of menstrual bleeding.
It shouldn't come as a surprise that women's hearts work slightly differently than men's. You may have heard that a good way to figure out your target heart rate in a workout is 80 percent of 220 minus your age. So, for a 60 year old man, that means 128 is a good target heart rate during intense exercise. It's a little less for a woman, however, and you can do the somewhat complicated math or just know that it's a little lower—around 115.
Because women are less likely to develop atherosclerosis, the cholesterol issue is less pertinent for them, and the number 200 is not a magical guarantee for heart health. More than half of women who experience a first heart attack have "normal" cholesterol levels. Younger women with high cholesterol may be more at risk for CVD, but after age 65, low cholesterol confers increased mortality risk for all diseases, including heart diseases.
Women also have other risk factors that differ from men, and heart disease doesn’t present identically for them. The following symptoms do not necessary predict an impending heart attack, but they can be an indication that something is wrong. So get your heart checked out by a holistically oriented MD or ND if you experience an uptick in the following:
The good news is that the risk factors are almost all improved by healthy lifestyle choices. Smoking, poor diet, physical inactivity, excess cholesterol consumption, obesity, high blood pressure, and diabetes are the major risk factors.
Although progress may be slow, all of us can eat more veggies; quit the junk food and cigarettes; drink less coffee and booze; walk, swim, do yoga, or lift weights six days a week; and stop eating sugar. Simply losing 10 percent of your body weight can drop your blood pressure enough to make the pump last an extra 5—10 years. So make a commitment to treat yourself right each morning when you wake up, and you can go a long way toward mitigating your risk for a heart attack.