The Smart Woman’s Guide to Avoiding Heart Disease

Okay, ladies, admit it. There are a lot of things we do better than men. We can make dinner, talk to Mom, balance the checkbook, and solve Jenny’s boyfriend problems all at the same time. We can dance in high heels, find the perfect present for the in-laws, and keep our desks and our living rooms equally clean and organized.

But there’s one area where we’re still falling short.

We’re dying more often.

From heart disease.

• Within the first two weeks after suffering a heart attack, women are twice as likely to die as men.
• Within a year of suffering a heart attack, about a quarter of men will die, compared to over a third of women.
• About a fifth of men suffering a heart attack will be disabled because of heart failure; nearly half of women will be.
• After a heart bypass surgery, women are two to three times likely to die as men.
• Since 1984, more women than men have died each year form heart disease. That gap continues to widen.

We can blame some of these statistics on the fact that doctors and researchers are still learning about how heart disease affects women. For the longest time, women’s symptoms were misunderstood. Doctors didn’t recognize them, and sent women home when they should have gotten them into treatment immediately.

But we have to take on some of the responsibility ourselves. Studies show women experience more benefits from lifestyle changes (like stopping smoking and getting regular exercise) than men do, yet not enough of us are implementing these changes in our lives.

Though heart health isn’t really a competition, women need to know they’re falling behind, and make changes to protect themselves.

7 Ways Heart Disease is Different in Women Than in Men

To outsmart heart disease, we need to know how it works—and more specifically, how it works in women.

Though most past research was focused on men, more recent studies have looked particularly at women and how the disease acts differently in them. From what we’ve learned so far, here’s what we need to do to reduce risk of a heart attack or stroke:

1. Watch HDL cholesterol levels: If you’re getting your blood tested regularly (and you are, right?), you know about three cholesterol numbers: total, LDL, and HDL. You may also know that the ideal numbers are: a) lower than 200 for total cholesterol, b) lower than 100 (100-129 is still okay) for LDL “bad” cholesterol, and c) higher than 50 for HDL “good” cholesterol. (Men can get away with 40.) Most women have higher HDL numbers than men prior to menopause, as female hormones raise the levels. After menopause, however, HDL drops to levels similar to those in men, which can increase risk of heart disease.

2. Get your triglycerides down: Along with your cholesterol numbers, your blood test will show you where your triglycerides are. Ideally, your number is 150 or lower. If it’s higher than that, it puts you at a greater risk of heart disease than if a man’s is higher than that. Triglycerides are fats in the blood, and they can lead to artery narrowing and blood clots. A 2012 study found that triglycerides were a better measure of stroke risk in postmenopausal women than cholesterol levels. In fact, those with higher levels were twice as likely to suffer a stroke during the study period. An earlier 2002 study also found that triglycerides had a greater impact on heart disease risk in women compared to men.

3. Avoid/control diabetes: Like triglycerides, diabetes creates a greater risk of heart disease in women than in men. The 2002 study listed above noted it, and the Cleveland Clinic states that women with diabetes are up to five times more likely to develop cardiovascular disease than women without it. An earlier 1991 study also found that diabetes is “a strong determinant of coronary heart disease, ischemic stroke, and cardiovascular mortality among middle-aged women.

4. Test yourself for inflammation: If you cut yourself, your body goes to work to heal that cut. You may notice it gets red and swollen. That’s “inflammation,” a signal that your immune cells are doing their job. More and more women today, however, are experiencing “chronic internal inflammation.” This is a condition in which the immune system revs up to fix something, but there’s nothing to fix, so the body’s systems are left on high alert—something that can wear us down over time. Overweight and obesity, stress and anxiety, hormonal imbalances, high blood pressure, poor diet, and more can trigger this type of inflammation. And, you guessed it—it’s a key risk factor for women. A 1998 study found that among women, higher levels of CRP (C-reactive protein)—a marker in the blood that signals inflammation—was a strong independent risk factor for cardiovascular disease. Just recently, the Food and Drug Administration (FDA) approved the PLAC test (which measures vascular inflammation) for predicting risk of cardiovascular disease as well, and stated, “…the test is better at discerning this risk in women, particularly black women.”

5. Treat depression: Emory University startled the world when it published a study in 2014 showing that younger women (under the age of 55) suffering from depression were twice as likely to experience a heart attack than if they weren’t depressed. Researchers looked at depression in over 3,000 people with known or suspected heart disease, and found that for each one-point increase in symptoms of depression, women 55 and younger had a seven percent increased risk of heart disease. The American Heart Association also recently issued a statement suggesting that depression be considered a risk factor for heart disease.

6. Get enough sleep: A 2003 study found that women who got five or fewer hours of sleep a night were at a higher risk for heart disease and heart attack. A later 2013 study also found that poor sleep raised inflammation levels in women, but not in men—again, increasing risk of heart disease.

7. Watch your weight: Belly fat is a risk factor for everyone, but it can be even more dangerous for women. A 2002 study found that obesity and weight gain before a diagnosis of diabetes were associated with an increased risk of future heart disease. An earlier 1990 study also found that obesity was an important “determinant of coronary heart disease in women,” and that even mild-to-moderate overweight increased risk in middle-aged women.

Risk Factors for Both Genders

In addition to the above, it’s good for women to be aware of other risk factors they share with men. These include:

• Smoking
• Hypertension (high blood pressure)
• Family history of heart disease
• Elevated levels of homocystein (amino acid in the blood)
• Sedentary lifestyle
• Unhealthy diet
• Having a history of preeclampsia during pregnancy
• Age (being over 55 for women)

Symptoms are Different—Don’t Delay Seeking Help

Another thing that’s different between women and men are the symptoms of a heart attack. You’ve probably heard this by now, but it bears repeating, as the issue remains serious. According to a recent study by Harvard’s School of Public Health, women are still dismissing or denying warning signs of a heart attack more often than men.

We women are used to taking care of other people. We’ll be fine, we think. It will pass. And we have so much to do! Researchers noted women were more likely to think they’d get better in a few days than men were, and would delay saying anything, even to loved ones.

It can be difficult to be sure if what you’re feeling is related to your heart. When in doubt, always seek help for the following symptoms:

• Excessive or unexplained fatigue
• Shortness of breath
• Jaw or throat pain
• Pain in one or both arms
• Upper abdominal pain (may feel like indigestion)
• Chest pain or uncomfortable pressure
• Dizziness
• Nausea and/or vomiting
• Cold sweat or flu-like feeling

It’s Time to Change the Tide on Heart Disease

You already know you need to exercise regularly, eat a healthy diet, avoid smoking, and get regular checkups to lower your risk of heart disease. Now you know the extra things you need to do as a woman to protect yourself.

Get started today, and spread the word. It’s time women learned to do as good a job taking care of themselves as they do all the loved ones in their lives.

Sources:

“Women and Heart Disease Facts,” Women’s Heart Foundation, http://www.womensheart.org/content/HeartDisease/heart_disease_facts.asp.

Holli A. DeVon, Samar Noureddine, “20 Things You Didn’t Know About Women and Heart Disease,” Journal of Cardiovascular Nursing, October 2014; 29(5):384-385, http://www.nursingcenter.com/lnc/JournalArticle?Article_ID=2544225&Journal_ID=54006&Issue_ID=2544216.

Mayo Clinic Staff, “Cholesterol levels: What numbers should you aim for?” Mayo Clinic, September 21, 2012, http://www.mayoclinic.org/diseases-conditions/high-blood-cholesterol/in-depth/cholesterol-levels/art-20048245.

Jeffrey S. Berger, et al., “Lipid and Lipoprotein Biomarkers and the Risk of Ischemic Stroke in Postmenopausal Women,” Stroke, February 2, 2012, doi: 10.1161/STROKEAHA.111.641324, http://stroke.ahajournals.org/content/43/4/958.

Jeanine E. Roeters, et al., “Risk factors for coronary heart disease: implications of gender,” Cardiovascular Research, February 15, 2002; 53(3):538-49, http://cardiovascres.oxfordjournals.org/content/53/3/538.

“Women Diabetes & Cardiovascular Disease,” The Cleveland Clinic, http://my.clevelandclinic.org/services/heart/disorders/cad/diabetes-women-cardiovascular-disease.

Manson JE, et al., “A prospective study of maturity-onset diabetes mellitus and risk of coronary heart disease and stroke in women,” Arch Intern Med., June 1991; 151(6):1141-7, http://www.ncbi.nlm.nih.gov/pubmed/2043016.

“FDA clears test that helps predict the risk of coronary heart disease,” FDA, Press Release, December 15, 2014, http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm426799.htm.

Paul M. Ridker, et al., “Prospective Study of C-Reactive Protein and the Risk of Future Cardiovascular Events Among Apparently Healthy Women,” Circulation, 1998; 98:731-733, http://circ.ahajournals.org/content/98/8/731.full.

Nader Rifai, Paul M. Ridker, “Population Distributions of C-reactive Protein in Apparently Healthy Men and Women in the United States: Implication for Clinical Interpretation,” Clinical Chemistry, April 2003; 49(4):666-669, http://www.clinchem.org/content/49/4/666.long.

Jennifer Johnson McEwen, “Study shows depression in younger women linked to higher risk of death from heart disease,” Emory University, Woodruff Health Sciences Center, Press Release, June 19, 2014, http://news.emory.edu/stories/2014/06/jjm_depression_heart_disease_younger_women/campus.html.

“Women play dangerous waiting game with heart symptoms,” Heart and Stroke Foundation of Canada, Press Release, October 28, 2014, http://www.eurekalert.org/pub_releases/2014-10/hasf-wpd102314.php.

Najib T., et al., “A Prospective Study of Sleep Duration and Coronary Heart Disease in Women,” Arch Intern Med. January 27, 2003; 163(2):205-209, http://archinte.jamanetwork.com/article.aspx?articleID=215006.

Aric A. Prather, et al., “Gender differences in the prospective associations of self-reported sleep quality with biomarkers of systemic inflammation and coagulation: Findings form the Heart and Soul Study,” Journal of Psychiatric Research, September 2013; 47(9):1228-1235, http://www.sciencedirect.com/science/article/pii/S0022395613001441.

Cho E, et al., “A prospective study of obesity and risk of coronary heart disease among diabetic women,” Diabetes Care, July 2002; 25(7):1152-8, http://www.ncbi.nlm.nih.gov/pubmed/12087011.