How many women develop heart disease in the US?

Today eight million women are living with heart disease. One of every 2.5 women will die of heart disease or stroke compared to one in 30 who will die of breast cancer.

• 10% of those are under 45 years old, another 25% are under 65, this is not just an "old" lady's disease. A heart attack occurs when the blood supply to the heart muscle is stopped. A cholesterol filled plaque, a clot or a severe narrowing of the blood vessel may stop the blood supply. When the blood supply is stopped the heart muscle down stream is damaged and dies
• Half a million women have heart attacks each year, 100,000 are under 65 and 10,000 are under 45
• Our risk does equal that of men after menopause but there are many women who suffer from heart disease at younger ages
• 267,000 women die from heart attacks each year. This is six times the number of women who die from breast cancer
• 4 million women have chest pain from the heart, commonly called "angina". Only 10% of those are hospitalized
• 1 in 3 women die in the first year following a heart attack, compared to 1 in 4 for men
• Twice as many women have another heart attack within six years
• Twice as many women are disabled from their heart disease within six years as men
• Women have twice the risk of death following bypass surgey
• Women are less likely to receive the best drug therapy following a heart attack
• More women die of heart disease each year, but women receive only 33% of the stents, angioplasty, only 28% of the implantable defibrillators and 36% of open heart surgery. And only 25% of heart research subjects are women
• The key is to fight this disease before it claims part of your heart

Do some ethnic groups have a higher risk?

Yes, some do. The African American woman has the greatest comparative risk. The incidence of heart and blood vessel disease is as much as 72% higher in African American women as white women. This is due to genetics and the higher incidence of hypertension or high blood pressure. African American women are twice as likely as whites to have a heart attack between the ages of 55 and 65. Hispanic women have a much greater risk of diabetes, and diabetes is now a heart disease equivalent, meaning if you have diabetes it is considered the same risk as already having heart and blood vessel disease. The incidence of heart attack is twice as high in women with diabetes. This is frightening information but there is good news also.

What are other risk factors associated with heart disease?

We have talked about some of the unmodifiable risk such as gender, age and race. We have not talked about family history but a heart attack in a female relative (mother or sister) under 65 and a male relative (father or brother) under 55 are significant risk factors. The modifiable risks or those things we can change are many.

What about modifiable risk factors?

These modifications apply to both women and men.

• Smoking - there is no compromise here, you have to quit, there are no OK cigarettes. Avoid second hand smoke.
• Get 20-30 minutes of sustained exercise daily. Just like a prescription, DAILY. It can be walking, biking, swimming, running...any exercise that increases and sustains your heart rate at a training level. If you have not been exercising please see your health care provider first. Have an annnual physical.
• Diabetes - know your family history of diabetes and your own fasting sugar levels. Even if you don't eat "sweets" the body changes what we eat to sugar, called glucose, to fuel the cells of the body. If you do not use glucose properly because of "insulin resistance" or a lack of insulin you may have diabetes. If you do, diabetes is treatable and controllable, but it takes time and attention. You and your healthcare provider must work as a team.
• Weight - maintain your ideal body weight and be sure your abdominal circumference is below 35 inches. Diet and exercise are the key here.
• Cholesterol levels - have your fasting cholesterol levels checked including the HDL (good) and the LDL (bad) levels. The HDL should be greater than 60 by the national standard or the NCEP or ATP III guidelines. Lab guidelines tell us 45 for men and 50 for women. Your LDL should be less than 100 ideally if you have two of any of the risk factors listed above. Diet should be low in saturated (animal fats). Decreasing charbohydrates and refined sugars in the diet will help to decrease the LDL levels. Exercise will decrease the LDL or bad cholesterol and increase the HDL or good cholesterol.
• Blood Pressure - have this checked at least twice a year. The new standards from AHA say if your blood pressure is less than 120/80-great! If pressure is greater than 120/80, you should decrease weight, decrease salt intake in your diet, and exercise, after seeing your health care provider. If pressure is greater than 140/90 - you need medical treatment. If you have diabetes your resting blood pressure should be less than 120/80.
• OF The GREATEST IMPORTANCE: See your health care provider. Report changes in the way you feel with special attention to fatigue (decreased tolerance for physical activity), irregular heartbeats, chest pressure, feeling of not being able to take a deep breath. Do NOT disregard symptoms.

What about non-modifiable risk factors?

One of these is age. As women get older our risk for heart disease increases. Post-menopause our risk rapidly catches up to men. As we discussed earlier we have a 10% chance of developing heart disease after 45 years of age and 25% after the age of 65. Secondly, our family history is very important. We inherit our cholesterol profile, (although it is somewhat modifiable), and our tendancy for heart disease is influenced by the inherited factors predisposing us to diabetes and high blood pressure. If we look at our parents and siblings we can see ourselves. Many of the other risk factors we cannot blame on anyone but ourselves - weight, eating habits, smoking and exercise pattern.

What about C-reactive protein and homocysteine levels?

The C-reactive protein is a "marker" for inflammation. T his is a blood test that measures a protein produced by the liver in response to inflammation somewhere in the body. It is not a specific test for the heart. It has been used to monitor therapy for inflammatory diseases in the past, like rheumatoid arthritis, lupus and vasculitis. Recently it is being promoted as a test for inflammation in the blood vessels. These levels are known to be elevated in heart attack victims and some suggest it may be a marker for an upcoming heart attack. Again the test is not specific for the heart or blood vessels yet, there are other tests being developed that will help us to better distinguish between infammation in the cholesterol plaque of the arteries. and that will be a more helpful test. Elevation of this level (above 0.6 mg/dl) is considered by many to be another risk factor for heart disease.

Homocysteine is a normal by-product of the breakdown of an amino acid, methionine, a protein in our diets. For people with abnormally high levels there is an increased chance of blood clot formation and blood vessel wall irritation and breakdown. This predisposes the vessel to collection of cholesterol in the wall. This can be treated successfully in about half the persons with elevated levels by using high dose B-vitamins, B-6, folic acid and B-12, availabe by prescription in tablet form. This level and response is measured with a blood test.

Where can I get more information?

You can call the American Heart Association Go Red for Women program at 1.800.AHAUSA1 or visit their website.
You can also call the National Coalition for Women with Heart Disease at 202.728.7199 or visit their website.