Women’s risk factors for heart disease

Heart disease is often thought of as a health problem for men, but more and more women die of heart disease each year than men, and from any other disease including breast cancer. One challenge is that some heart disease symptoms in women may be different from those in men.

Fortunately, women can start taking the steps needed to understand their unique symptoms of heart disease which can also reduce their risk of this deadly disease. Kathleen Stergiopoulos, MD, PhD, cardiologist, Stony Brook University Hospital and co-director of the Women's Heart Program, Stony Brook University Heart Institute has the answers.

Q: What are the symptoms of a heart attack for a woman? Are they different in women than in men?

A: "The most common heart attack symptom in women is some type of pain, pressure or discomfort in the chest," says Dr. Stergiopoulos. "However, the pain is not always severe or characterized as a pain. Pain may not be the most prominent symptom, rather shortness of breath, indigestion, palpitations, neck, shoulder, jaw, or back pain. Associated symptoms may be unusual nausea, vomiting, sweating, lightheadedness, or unusual fatigue."

Many women present to medical care well into a heart attack, after much heart damage has occurred, because their symptoms are not typical of a heart attack, or they did not think they were at risk. If a women experiences any symptoms or thinks she may be having a heart attack, call for emergency medical help. Dr. Stergiopoulos reminds women to not drive yourself to the emergency room.

Q: What are the risk factors for heart disease in women?

A: Traditional risk factors for coronary artery disease that affect both men and women are:
• High blood pressure (hypertension)
• High cholesterol
• Diabetes
• Family history of heart disease
• Tobacco use
• Age

"However, other factors such as the metabolic syndrome (a combination of abdominal fat, high blood pressure, high blood sugar, and high triglycerides) can affect women more than men," says Dr. Stergiopoulos. "In addition, mental stress and depression can have a greater impact on women than on men."

Q: What can women do to reduce their risk of heart disease?

A: "There are several lifestyle changes that women can make to reduce their risk of heart disease," Dr. Stergiopoulos gives these tips:

• Exercise 30-60 minutes of aerobic activity such as walking on most days of the week: women who need to lose weight or sustain weight loss should accumulate a minimum of 60-90 minutes of moderate-intensity physical activity on most, and preferably all, days of the week
• Maintain a healthy weight
• Quit or don't start smoking
• Eat a diet that is low in saturated fat, cholesterol and salt
• Visit your doctor on a regular basis
• Have your blood pressure checked
• Have your cholesterol checked - blood pressure goal is less than 120/80 mmHg
• Medication is indicated if blood pressure is greater than 140/90, or greater than 130/80 in diabetics or patients with kidney disease
• Treat known risk factors for heart disease, with the advice of your doctor
• Some women benefit from a daily "baby" aspirin, but check with your doctor prior to starting any new medication

Q: Is heart disease something only older women should worry about?

A: "No. Women under the age of 65 who have any risk factors for heart disease should pay close attention to their symptoms," says Dr. Stergiopoulos. "Women of all ages should take their heart seriously."

Q: Can taking vitamins reduce a woman's risk of a heart attack?

A: Dr. Stergiopoulos says it is uncertain whether taking any vitamins can help reduce your risk of having a heart attack or developing heart disease. Antioxidant vitamin supplements (for example, vitamin E, vitamin C, and beta carotene) should not be used for the prevention of heart disease in women. Folic acid, with or without B6 and B12 supplementation, should not be used for the prevention of heart disease in women.

Q: What is a "heart healthy" diet?

A: "The answer is simply this— you must consistently choose healthy eating patterns, and healthy food selections," Dr. Stergiopoulos suggests eating a variety of foods including:

• Fruits and vegetables
• Whole grains, high fiber
• Fish, especially oily fish, at least twice per week
• No more than one drink of alcohol per day
• Less than 2.3 grams of sodium per day
• Saturated fats less than 10% of calories, less than 300 mg cholesterol per day
• Limited trans fatty acid intake (main dietary sources are baked goods and fried foods made with partially hydrogenated vegetable oil)
Q: What is an ideal body weight?

A: Dr. Stergiopoulos recommends women maintaining or losing weight through an appropriate balance of physical activity, calorie intake, and formal behavioral programs when indicated to maintain the goal of having a body mass index, or BMI, between 18.5 and 24.9 kg/m² and waist circumference less than 35 inches.

Q: Should I avoid secondhand smoke? Can secondhand smoke increase your risk of having a heart attack?

A: "Second-hand smoke is a risk factor for having a heart attack," says Dr. Stergiopoulos. "If you are regularly around smokers, encourage them to quit or go outdoors to smoke. This is especially important if you have had a heart attack or have been diagnosed with heart disease."