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The Silent Killer Women and heart disease Quick: What is the No. 1 killer of American women? If you answered breast cancer, you are wrong. While 40,000 women die from breast cancer each year, more than twelve times that number (500,000) are killed every year by cardiovascular disease. Furthermore, while one in eight women will contract breast cancer during their lifetimes, more than double that number (one in three) will experience cardiovascular disease at some point in their lives. So what is the nature of this prevalent disease, often dubbed the "silent killer," and what can be done to prevent this growing problem among American women? Cardiovascular disease refers to diseases of the heart and blood vessel system (arteries, capillaries, and veins) within any part of a person’s body, such as the brain, legs, or lungs. "Cardio" refers to the heart and "vascular" refers to the blood vessel system. Although they are often equated, it is important to distinguish between heart and cardiovascular disease because they involve different parts of the body. Heart disease refers only to diseases of the heart and the blood vessel system within the heart, while cardiovascular disease includes disease of the heart as well as disease of all other parts of the blood vessel system in the body. The heart is a strong, muscular pump slightly larger than your fist that pumps blood continuously through the circulatory system, the network of elastic tubes that allows blood to flow throughout your body. The circulatory system includes two major organs, the heart and lungs, and blood vessels (arteries, capillaries, and veins). Arteries and capillaries carry oxygen- and nutrient-rich blood from the heart and lungs to all parts of the body. Veins carry oxygen- and nutrient-depleted blood back to the heart and lungs. Heart and blood vessel problems do not happen quickly. Over time, arteries bringing blood to the heart and brain can become blocked from a buildup of cells, fat, and cholesterol (plaque). Heart attacks are caused by a reduced blood flow to the heart because of blockages in the arteries. When this lack of blood flow occurs in the brain, from a blood clot or from bleeding in the brain caused by a broken blood vessel, it is called a stroke. Do women really need to worry about heart and cardiovascular disease? The answer is a resounding "yes." Almost twice as many women die from cardiovascular diseases than from all forms of cancer combined. Also, contrary to popular conception, heart disease is as much a woman’s as a man’s problem. Heart disease is the No. 1 killer of both men and women in America, and stroke is the third leading cause of death for American women (behind cancer at No. 2). Men have heart attacks and strokes more often than women, but the death rate from cardiovascular disease for women is higher. Heart disease affects women of all racial and ethnic groups, as well as women with other illnesses, such as diabetes. Black women are more likely to die of heart disease than white women. Increasing age is also a factor in heart disease, and with people aged sixty-five and over the fastest growing age group in the United States, heart disease is becoming a growing problem for women. As women age, particularly after menopause, they become more at risk for cardiovascular disease. Lower levels of estrogen during and after menopause are thought to increase a woman’s risk for cardiovascular disease. Early menopause, natural or surgical, can double a woman’s risk for developing coronary heart disease, one common type of cardiovascular disease. Younger women are also at risk for cardiovascular disease if they have high blood pressure, diabetes, high cholesterol levels, or a family history of cardiovascular disease at young ages, or if they smoke. Women with congenital heart disease (in which they are born with a heart defect) have a higher risk of having a baby with a heart defect. What are the different types of heart and cardiovascular disease? There are many forms of heart and cardiovascular disease, and following are descriptions of the most common of these diseases: l Atherosclerosis: Atherosclerosis is a type of arteriosclerosis (or thickening and hardening of the arteries). As people age, some hardening of the arteries may occur naturally. When a person has atherosclerosis, the inner walls of the arteries become narrower due to a plaque buildup. Plaque results from deposits of fat, cholesterol, and other substances. Blood clots form, blocking blood flow, which can lead to heart attacks and strokes. High blood cholesterol, smoking, high blood pressure, diabetes, obesity, and physical inactivity all put you at greater risk for atherosclerosis. l Coronary heart disease (or coronary artery disease): Coronary heart disease, the most common form of heart disease, affects the blood vessels (or coronary arteries) of the heart. It causes angina (chest pain) and heart attacks. Women over the age of forty are more at risk for this disease because heart-related problems tend to increase with age. The good news is that you can do something to prevent this disease. l Angina: Angina is a pain or discomfort in the chest that happens when some part of the heart does not receive enough blood. It feels like a pressing or squeezing pain, often in the chest under the breastbone, but sometimes in the shoulders, arms, neck, jaw, or back. The most common trigger for angina is physical exertion. Other triggers can be emotional stress, extreme cold or heat, alcohol, and smoking. Unlike heart attacks, in which the blood flow to a part of the heart is suddenly and permanently cut off, angina seldom causes permanent damage to the heart. l Stroke: Lack of blood flow to the brain from a blood clot, or from bleeding in the brain due to a broken blood vessel, cause strokes. Without a good blood supply, brain cells cannot get enough oxygen and begin to die. You can also have what are sometimes called "mini-strokes," or transient ischemic attacks (TIAs), in which no damage is done to the brain. But even though TIAs do no damage, they are serious and can put you at higher risk of having a full stroke. l High blood pressure (or hypertension): There are ways to measure blood pressure and medications to lower blood pressure. A blood pressure reading measures the force of blood pumped from the heart against the walls of your blood vessels. It is recorded as two numbers: a top number of systolic pressure, or the pressure of blood in the vessels as the heart beats; and a bottom number of diastolic pressure, or the pressure of the blood between heartbeats (when the heart rests). Although the average blood pressure reading for adults is 120/80, a slightly higher or lower reading (for either number) may not be a problem. High blood pressure is diagnosed when the reading consistently exceeds 140/90. Hypertension is often called a "silent" killer because it usually has no signs or symptoms. High blood pressure can cause heart failure in women and can also lead to stroke, kidney failure, and other health problems. More than half of all women over age fifty-five suffer from this serious condition. It is both more common and more severe in black women. Talk to your health care provider and get your blood pressure monitored regularly. l Heart failure: Heart failure means that the heart is not able to pump blood through the body as well as it should. It does NOT mean that the heart literally stops. Heart failure develops slowly over time and can have a large impact on a person’s life and ability to perform daily activities of living, such as dressing, bathing, and getting around. Congestive heart failure is a term often used to describe heart failure, but congestion, or the buildup of fluid, is only one symptom of heart failure and does not occur in all people who have heart failure. There are two main categories of heart failure, systolic and diastolic, and within each category, symptoms can differ from person to person. Systolic heart failure occurs when the heart’s ability to pump blood decreases. The heart cannot push enough blood into the circulatory system, causing blood coming into the heart from the lungs to back up and leak fluid into the lungs (called pulmonary congestion). Diastolic heart failure occurs when the heart has trouble relaxing or resting. The heart muscle becomes stiff and cannot fill with blood, causing fluid to buildup (most often in the feet, ankles, and legs) and lung congestion. Talk with your health care provider right away if you have any of the signs of heart failure. There are drugs to treat heart failure. Having a healthy diet and getting regular exercise can lower your risk for the disease. What increases my chances for getting heart and cardiovascular disease? Some factors increasing your risk for heart and cardiovascular disease are beyond your control, such as getting older, family health history, and race, but other factors are controllable. These controllable risk factors include: * Smoking and exposure to secondhand smoke. * High blood pressure - found in over half of women over age forty-five. * High blood cholesterol - Elevated lipid, cholesterol and triglyceride levels are all risk factors. Although doctors have traditionally focused on lowering LDL cholesterol (low-density lipoproteins, or bad cholesterol), research now indicates that having high HDL (high-density lipoproteins, or good cholesterol) might be even more important. LDL (bad) cholesterol level Less than 100 mg/dL-optimal 100-129 mg/dL-near optimal/above optimal 130-159 mg/dL-borderline high 160-189 mg/dL-high 190 mg/dL and above-very high HDL (good) cholesterol - A level of 60 mg/dL or more is good and helps to lower your risk for heart disease. Remember that HDL (good) cholesterol protects against heart disease, so higher numbers of HDL are better. A level lower than 40 mg/dL is low and increases your risk for developing CVD. * Physical inactivity- People who are not active are twice as likely to develop heart disease compared to those who are more active. * Excess body weight. * Diabetes (or high blood sugar)- Diabetes, high blood pressure, high cholesterol, and obesity often go hand-in-hand, raising a person’s risk for heart disease. Diabetes has been found to double the risk of a second heart attack in women but not in men. * Birth control pills - especially when linked to smoking or high blood pressure. * Triglyceride levels - can also raise your risk for heart disease. Levels that are borderline high (150-199 mg/dL) or high (200 mg/dL or more) may need to be treated in some people. A simple blood test called C-Reactive Protein, or CRP, can help predict the risk for women with the so-called metabolic syndrome, including low HDL, obesity, high blood sugar, etc. Women, of all ages, with CRP levels above 3.0 mg/L were more than twice as likely as women whose CRP levels were normal (less than 1.0 mg/L) to suffer from heart attacks, strokes, cardiac surgeries and death. This may alert even young women to make a bigger effort to improve their health. How do I know if I have heart or cardiovascular disease? Are there any tests? Heart disease is often called a "silent" killer because it often has no symptoms. However, some symptoms can alert you to a possible problem. Chest or arm discomfort, especially while under stress or during activity, is a classic symptom of heart disease and a warning sign of a heart attack. You may also have fatigue without any apparent reason, shortness of breath, dizziness, nausea, or abnormal heartbeats (palpitations). Talk with your health care provider if you think you may be having any heart disease symptoms. Your health care provider will first conduct a complete medical history and a physical exam. There are many tests for heart disease, and the choice of which and how many tests to perform depends on a person’s symptoms and history of heart problems. A health care provider will most often start with simple tests, which may lead to more complex tests. More than one test may be needed because each test gives different information. Tests can be either invasive or noninvasive. Invasive tests involve the insertion of needles, instruments, or fluids into the body, while noninvasive tests do not involve these actions. What are the signs of heart attack and stroke? Not all of the warning signs of heart attack or stroke appear for everyone, and sometimes these signs can disappear and return later. Treatments are most effective if given within one hour of when the attack begins. If you have any of these symptoms, call 911 right away. The signs of heart attack are: chest discomfort or uncomfortable pressure; fullness, squeezing, or pain in the center of the chest that lasts longer than a few minutes, or comes and goes; spreading pain to one or both arms, back, jaw, or stomach; and cold sweats and nausea. As with men, women’s most common heart attack symptom is chest pain or discomfort, but women are somewhat more likely than men to have some of the other warning signs, particularly shortness of breath, nausea, vomiting, and back or jaw pain. The signs of stroke include: sudden numbness or weakness of face, arm, or leg, especially on one side of the body; sudden confusion, trouble speaking, or difficulty understanding speech; sudden trouble seeing in one or both eyes; sudden trouble walking, dizziness, or loss of balance or coordination; sudden severe headache with no known cause; blurred or double vision; drowsiness; and nausea or vomiting. What are palpitations or "extra" heartbeats? Are they dangerous? "Extra" heartbeats, also called palpitations, or premature ventricular contractions (PVCs) happen when there is irritation in the lower part of the heart’s pumping chambers. PVCs interrupt the normal heart rhythm and cause an irregular beat that can feel like a "missed beat" or a "flip-flop" in the chest. If the PVCs are combined with dizziness or shortness of breath, your health care provider should be informed right away. What is an arrhythmia? Can you have a heart arrhythmia without having heart or cardiovascular disease? Most people have felt their hearts beat very fast, felt a fluttering in their chests, or noticed that their hearts skipped a beat. Almost everyone has also had chest pains or felt dizzy, faint, or out of breath at some time. While these experiences of heart arrhythmias-changes in the regular beat of the heart-can create anxiety, they are harmless for most people. As adults age, they are more likely to get arrhythmias, and usually these experiences are not dangerous. Do not panic if you have a few flutters or your heart races once in a while. If you have questions about your heart rhythm or symptoms, talk with your health care provider. Is it safe to take an aspirin a day to prevent heart disease? If you have already had a heart attack, aspirin helps lower the risk of having another one. Aspirin also helps keep arteries open in a person who has had a heart bypass or other artery-opening procedure, such as coronary angioplasty. But because of its risks, aspirin is NOT approved by the Food and Drug Administration for preventing heart attacks in healthy people, and it may even be harmful for some, especially those with no risk of heart disease. Talk to your health care provider about whether taking aspirin is right for you. Do birth control pills and hormone therapy (HT) increase a woman’s risk for heart disease? Birth control pills cause little increased risk for heart disease for women who have not gone through menopause (when periods stop). However, birth control pills can pose heart disease risks for some women, particularly those with high blood pressure or who smoke. Talk with your health care provider about whether birth control pills are best for you. In the past, hormone therapy (HT), including estrogen plus progestin, was thought to help protect women against heart disease, but recent findings by the Women’s Health Initiative (WHI) study, sponsored by the National Heart, Lung, and Blood Institute, showed that HT poses more risks than benefits. The study found that HT could increase a woman’s risk for heart disease, stroke, and pulmonary embolism (blood clot in the lung), as well as breast cancer. Hormones are not recommended for women with heart disease or for a woman who has had a stroke. If you have gone through menopause, talk with your health care provider about whether hormones are right for you. If you are taking birth control pills or HT, watch for trouble signs, such as abnormal bleeding, breast lumps, shortness of breath, dizziness, severe headaches, or pain in your calves or chest, and report these symptoms to your health care provider immediately. Also, talk with your health care provider about how often you should have an exam. How can I reduce my risk for heart and cardiovascular disease? * Regular physical activity - at least thirty minutes a day, in ten-minute or longer increments, of moderate activity on most (if not all) days of the week.. * Quit smoking - To help you stop smoking, you can get help through support groups, special behavior change programs, and medication. Smoking more than triples a woman’s chance of having a heart attack. If you quit smoking, your risk is cut in half in two years; ten years later, the odds return to nearly normal. * Eat a well-balanced diet- cut out empty carbohydrates. * Check and control blood pressure, cholesterol, and blood sugar levels. Treat these problems with prescribed medications, diet, and exercise. * Lose weight - Extra weight, especially if carried around the middle, increases your chances of a heart attack. Obseity also leads to diabetes, another risk factor. Doctors recommend a diet with reduced calories and lots of vegetables and whole grains, plus physical activity done in the manner described above. Source: National Women’s Health Information Center For more information . . . You can find out more about heart and cardiovascular disease by contacting the National Women’s Health Information Center online at www.4Woman.gov or call (800) 994-9662. National Heart, Lung, and Blood Institute (NHLBI) Phone Number: (301) 592-8573 Internet Address: http://www.nhlbi.nih.gov/index.shtml National Cholesterol Education Program The Heart Truth American Heart Association Texas Heart Institute American College of Cardiology |
