What You Need To Know About Heart Disease

This information was provided by Debra R. Judelson, MD, AMA-WPC Governing Council Member. Dr. Judelson specializes in cardiovascular disease and internal medicine.

• Younger women are not immune to heart problems; these just occur more often in people as they get older. Increasing age is a significant risk factor, but heart problems can and do occur before the age of 50. When women do have heart problems at an early age, it is predominantly in those with significant but common risk factors, such as untreated elevated LDL cholesterol, diabetes, elevated blood pressure, cigarette smoking or family history of early heart disease. If a woman does not get her blood pressure or cholesterol checked, if she smokes cigarettes or assumes that a family history of heart attacks in her young male relatives doesn't apply to her, she won't be doing her part in identifying her risk factors. If she refuses recommended diet, exercise, or medication treatment for risk factors, she is closing her eyes to the obvious.

• Women who don't view heart disease as one of their major risks are often neither concerned nor knowledgeable about disease symptoms. If they do have chest symptoms, they often don't recognize the potential for a cardiac cause and stay home when ill because they hope it will go away or are too embarassed to ask for emergency help. If they do seek medical attention, women often try to explain what they think the problem is (indigestion, a pulled muscle) and minimize the problem, rather than just describing their symptoms and how severe they are. The woman with a heart attack who call the paramedics telling them she thinks she is having a heart attack will get a quicker response than some who says they ate bad food and now they think they have food poisoning. When women get to the emergency room, they need to make sure they are promptly checked for a cardiac cause for symptoms.

• Women are quite good about going to the doctor for routine gynecologic care. While many gynecologists recognize that their patients depend upon them for more than female-only issues, this is not always obvious to the doctor. If women are not seeing an internist or family doctor for other medical problems, they need to tell their gynecologist so that appropriate preventive testing and care can be provided.

• Heart disease is such a major cause of death and disability that many lines of research are being followed to try to discover why it occurs. Each new potential risk factor or screening test sheds light on a new area for research, but this does not mean that the basics can be ignored.

• Every day we read or hear someone who died or suffered a massive heart attack as their first symptom of heart disease.

What We Now Know:

• Recent clinical trials have shown that the overwhelming majority of women with heart disease have at least one of the major known cardiac risk factors: tobacco use, high blood pressure, diabetes or elevated cholesterol. This is especially true for younger women with heart disease because of the risk factors of smoking and/or diabetes. It doesn't mean that special studies such as coronary calcium scores are worthless, that C-reactive protein, homocysteine, or fancy lipid studies cannot help you. It does mean that you need to find out what your risks are and address those that are easily available while you determine if testing for other risks are needed. No one test tells us everything about a women's health.

• The Nurses Health Study showed us that women who entered the study in good health and followed a healthy life style (normal weight, active regular exercise, normal blood pressure, normal lipids, nonsmoker, and no diabetes or family history of early heart disease) had a reduced risk for cardiac events by 83%. This tells us that we can dramatically reduce cardiac events with the basics. We don't need sophisticated screening tests in most people. These can be reserved for those with a family history of early coronary disease, unexpected or premature cardiac events or symptoms.

• Most hospital emergency rooms have improved their evaluation and care of women with potential cardiac emergencies. The biggest delay is in women calling for emergency help.

• The basics remain important: 
  • see your doctor for a complete medical evaluation, lipid profile, blood sugar and blood pressure check,
  • maintain a healthy lifestyle with a diet rich in fruits and vegetables, fish, and healthy oils,
  • match calorie intake to activity,
  • exercising for at least 30 minutes everyday,
  • limit salt use, 
  • avoid concentrated sweets and saturated as well as trans fats,
  • avoid tobacco use and exposure, and
  • make sure your doctor knows what medications or drugs you are using, what medical problems exist in your blood relatives, what new stresses you face and any symptoms of problems that you are experiencing.

• For women approaching their mid-40s to 50s, decreasing estrogen production is associated with a change in your metabolism, as weight increases in your abdomen area, your lipids worsen with a drop in HDL and rise in LDL, your blood pressure creeps up and may be elevated for the first time in your life, and your energy may seem sapped. This is a time to make sure you have a comprehensive medical evaluation to address these changes and identify if other health problems have surfaced. You need to start a dialogue with your doctor about what you prefer or need to learn about menopausal symptoms. Certainly, finding all this information out earlier is an advantage, but for women that have not been evaluated, these symptoms are a wake up call to take care of your own health.

Disclaimer: This material is provided for informational purposes only and does not indicate endorsement by the AMA. Contact your physician if you have a medical or health concern.