Heart Health & Cancer
from the AHA
For better or worse, thoughts of cancer breeze into many women’s minds almost as easily as thoughts of Matthew McConaughey or breaking through the glass ceiling at work. Cancer just seems to have what it takes to grab headlines and capture the attention of movie stars and the general public alike. Heart disease, on the other hand, often has trouble just getting a mention in the news, and it sorely lags in the race for the greatest number of fundraising galas.
Yet heart disease is a major health player—and, many would argue, the major player—in women’s lives. Yes, cancer certainly deserves much of its billing; it’s the leading killer of women in midlife. But heart disease never lurks far behind, and in women over 65 it takes over the infamous top spot. Overall, heart disease kills about 315,000 women each year. Cancer claims about 270,000.1
So, while you read headline after headline about discoveries in cancer prevention, don’t forget to pay some attention to your heart health as well. To get you started, here’s a primer.
What Is Heart Disease?
In scientific circles the term heart disease can encompass any number of conditions that affect the heart. Most commonly, though, it’s used to describe coronary heart disease, a condition whereby fat, cholesterol, and other matter build up inside the blood vessels that feed the heart. This buildup can lead to chest pain and possibly a heart attack.
Not Just a “Man’s Disease”
Men learn from an early age that heart disease is something of which they need to be aware. But usually women don’t—despite the fact that heart disease kills one in every four women overall in the United States.2 That heart disease is so often seen as a “man’s disease” can have negative, even deadly, consequences. Women may fail to take important steps to lower their risk or might not even seek help when they may be having a heart attack (see sidebar).
The first step in reversing this trend is to understand the healthy steps women can take to protect their hearts.
The positive message about heart disease is that it’s very preventable. Eighty percent of cases could be avoided through healthy lifestyle changes. And the good news (or bad news, depending on how you look at it) is that there’s a lot of room for improvement on this front. The vast majority of women ages 40 to 60 have at least one heart disease risk factor they can change.2 Close to 20 percent have three or more.
It’s important to not wait until you start to feel bad to make healthy changes. The famous Framingham Heart Study found that two out of three women who died suddenly from heart disease had no previous symptoms.3
So what can you do to lower your risk? Some pretty simple things, really:
Don’t smoke. As we all know, smoking is a key heart disease risk factor that also boosts the risk of multiple cancers, stroke, diabetes, and osteoporosis. You’ve heard it before: if you smoke, stopping is the single best thing you can do for your health. Cutting exposure to passive smoke can also lower your risk. So avoid those smoky bars, smoky parties, and even smoky friends and family members.
Keep blood pressure, blood sugar, blood cholesterol, and triglycerides under control. Seeing a doctor to be tested for each of these regularly is a key part of heart health. “Women need to know their numbers,” says JoAnn Manson, MD, DrPH, professor of medicine and the Elizabeth Fay Brigham professor of women’s health at Harvard Medical School. Unhealthy levels of any of these can significantly raise risk. Together—especially when combined with obesity—they can be very dangerous. Don’t delay getting screened. Diabetes, high blood pressure, and poor cholesterol levels are typically “silent” conditions that most people don’t even know they have.
For women low-HDL “good” cholesterol, high triglycerides, and high blood sugar (signaling diabetes) are particularly strong predictors of risk—more so than in men. “Women with diabetes can have up to seven times the risk of heart disease compared with women without diabetes,” says Dr. Manson. “Men with diabetes have two to three times the risk.”
A healthy lifestyle filled with exercise and a good diet can go a long way toward keeping these numbers under control. If you have high or unhealthy readings, a doctor may also prescribe medication.
Keep your weight—and waist—in check. It’s a common theme of health messages but with good reason: keeping weight in check is a great way to lower heart disease risk. It not only helps control important risk factors like poor cholesterol levels and diabetes but also has an independent effect on risk as well.
Body mass index (BMI) is the most common measure when looking at links between weight and disease. BMI estimates “fatness” using a calculation of height and weight. Scores of 30 (say, 5 foot 6 inches, 185 pounds) and over are considered “obese”; between 25 (say, 5 foot, 6 inches, 150 pounds) and 30 are considered “overweight.” “BMI has a very important effect on risk if you measure above 30, and you still have considerable risk even if you fall between 25 and 30,” says Dr. Manson.
After menopause waist size rather than weight alone begins to be more important because a greater amount of fat around the middle has been linked to heart risk. Most guidelines recommend that all women try to keep waist size less than 35 inches. But women should shoot for lower numbers rather than bump up against the upper level of 35 inches. “Risk increases even above 30 or 32 inches,” says Dr. Manson.
Get active. Studies show that regular activity can cut the risk of heart disease by 30 to 50 percent. And it doesn’t take exercising at Olympic levels to get real benefit: just brisk walking 30 minutes a day will make a difference. If you’ve been a couch potato for years, it’s never too late to get up and out the door. Any amount of exercise is better than none.
One great way to get motivated and to keep track of your activity is to get a pedometer and shoot for 10,000 steps throughout each day (about 5 miles). It’ll not only lower your risk of heart disease, diabetes, high blood pressure, and abnormal cholesterol levels but will help keep your weight in check and boost your mood (see sidebar).
Eat a healthy diet. For boosting heart health, it’s hard to beat a good diet rich in healthy fats, whole grains and fiber, and fruits and vegetables. A 2000 Nurses’ Health Study paper found that a high-quality healthy diet could lower the risk of heart disease by close to half compared with a poor-quality diet.4
“A Mediterranean-type diet is a great way to do it,” says Dr. Manson. Choose a lot of fruits and vegetables, whole-grain foods (like whole-wheat bread and oatmeal), fish, nuts, flaxseed, and healthy fats like monounsaturated and polyunsaturated fats found in canola oil and olive oil. Also key is avoiding refined starches (like white bread and white rice) as well as hydrogenated trans fats and saturated fats (found in foods like high-fat dairy products and red meat).5
Keep alcohol to one drink a day or less. Be sure to avoid more. The heart-health benefits of drinking a moderate amount of alcohol are well publicized, and many studies back this up. So feel free toast to your heart health, but don’t go overboard. Too much alcohol can actually raise the risk of heart disease, and even modest amounts can raise cancer risk. Of course, alcohol comes with a lot of potential baggage, so if you don’t drink, there’s no need to start. Talk to a doctor if you feel you need more guidance about risks and benefits.
Aspirin. There’s a lot of evidence that many women could benefit from taking a single low-dose aspirin every day.6,7 In women who already have heart disease, aspirin can lower the risk of heart attack and stroke. In many women 65 and older, aspirin can help prevent a first heart attack or stroke. Even in women 55 and older, aspirin can be beneficial if a woman has a number of cardiovascular risk factors. In general, for healthy women under 55 though, aspirin isn’t recommended. “Aspirin does have risks,” says Dr. Manson, such as gastrointestinal bleeding and increased risk of a bleeding stroke. “So it’s really only for women who are over age 65 or those 55 and older with risk factors for cardiovascular disease.” For all women, the risks of aspirin need to be balanced with its possible benefits. Women with bleeding disorders or other conditions that could be exacerbated by aspirin shouldn’t take it. Your doctor is the best person to consult about whether aspirin may be right for you.
Vitamin D. While the scientific sun has set on nutrients like beta-carotene, vitamin E, and folic acid as a way to prevent heart disease, vitamin D seems to be gaining some momentum. It’s too early to say with confidence that boosting vitamin D can promote heart health, but kicking up intake to 800 to 1,000 international units (IU) per day—levels that most experts agree can have general health benefits—seems reasonable, says Dr. Manson. “Before going higher than that, I’d wait for the results of large-scale clinical trials, which are in the works.”
Depression, stress, and poor sleep. There is growing evidence that depression, chronic stress, and inadequate sleep can increase the risk of heart disease as much as many of its standard risk factors. “Depression and chronic stress are associated with high levels of stress hormones, such as cortisol and adrenaline, and these hormones can have adverse affects on blood pressure, diabetes risk, and abdominal obesity, putting additional burdens on the heart,” says Dr. Manson. Women who are overstressed or feel that they may be suffering from depression should seek medical attention. Physical activity is also a great way to reduce stress and improve mood.
Bringing It All Together
“The main point that women need to truly take to heart,” concludes Dr. Manson, “is that heart disease is a leading cause of death in women and that women need to start early in life to protect themselves and focus on prevention and early treatment. We can take charge and control our destiny, even with a family history of the disease.” This means following a heart-healthy lifestyle; knowing your numbers for things like blood cholesterol, blood pressure, and blood sugar; and taking steps to control them if needed. Being aware of the symptoms of heart attack and seeking care immediately at its first signs are also critical.
All in all, it’s a fairly simple prescription that will pay off for years to come.
More About Heart Health…
Postmenopausal Hormones, Birth Control Pills, and Your Heart
Gone are the days when postmenopausal hormones were widely prescribed to lower the risk of heart disease and other chronic conditions. The groundbreaking Women’s Health Initiative study has shown that they just don’t have the heart-health benefits and in some instances can actually raise the risk of heart attack and stroke, particularly in older women well past menopause.
In younger women in the midst of menopause, however, there actually seem to be few, if any, heart-related risks, so hormones may be okay for alleviating the hot flashes and night sweats that can occur during menopause. Even in younger, healthy women, Dr. Manson adds, “hormones should be used short-term and at the lowest effective dose.”
Low-dose birth control pills can also be a reasonable option for younger women approaching menopause and looking for some relief from perimenopausal symptoms while also providing birth control. Older, higher-dose pills have been linked to heart disease, but newer lower-dose formulations have less heart risk and appear safe in women who don’t smoke or have other heart disease risk factors. In women who do smoke, the pill can still greatly increase the risk of heart attack, stroke, and blood clots—which is yet one more good reason to quit.
As with all prescription medicines, it’s important to talk in detail with a physician about the risks and the benefits of postmenopausal hormones or birth control pills before starting on them.
Heart Attack? Don’t Wait to Call 9-1-1
As the primary caregivers in most families, women are used to putting their needs behind those of others; but when it comes to a possible heart attack, you have to put yourself first and call 9-1-1 as soon as possible. Research shows that women postpone getting help longer than men do.2 If you have any of these symptoms, call 9-1-1 immediately:
- Chest pain or discomfort that lasts for more than a few minutes or goes away and comes back
- Upper-body discomfort in one or both arms, the back, the neck, the jaw, or the stomach
- Shortness of breath with or before chest discomfort
- Nausea, vomiting, lightheadedness or fainting, or breaking out in a cold sweat8
What’s Out of Your Control: Age and Family History
Most of us don’t like to be told that things are out of our control, but when it comes to chronic conditions like heart disease, it’s just a fact of life that we can’t do anything about some of the factors that affect our risk. Still it’s good to know what these factors are and how they may affect you so that you can take steps to protect yourself—like seeing a doctor sooner rather than later if you happen to be at increased risk. And when it comes to heart disease, there really aren’t many factors out of your control.
Age is one very important factor. For women the risk of heart disease really begins to rise around age 55. This is partly due to simply getting older, but it is also likely linked with menopause, when natural protection from the hormone estrogen drops.
Family history is also important. Having a family member who’s had heart disease generally increases the risk. This is especially true if a father or brother has had a heart attack before age 55 or a mother or sister had one before age 65.2
3.Kannel WB, Wilson PW, D’Agostino RB, Cobb J. Sudden coronary death in women. American Heart Journal. 1998;136(2):205-12.
4.Stampfer MJ, Hu FB, Manson JE, Rimm EB, Willett WC. Primary prevention of coronary heart disease in women through diet and lifestyle. New England Journal of Medicine. 2000;343(1):16-22.
5.Hankinson SE, Colditz GA, Manson JE, Speizer FE, eds. Healthy Women, Healthy Lives: A Guide to Preventing Disease from the Landmark Nurses’ Health Study. New York: Simon & Schuster; 2001.
6.Mosca L, Banka CL, Benjamin EJ, et al. Evidence-based guidelines for cardiovascular disease prevention in women: 2007 Update. Circulation. 2007;115(11):1481-501.
7.Aspirin for the prevention of cardiovascular disease: U.S. Preventive Services Task Force recommendation statement. Annals of Internal Medicine. 2009;150(6):396-404.
8.What Are the Signs and Symptoms of a Heart Attack? National Heart, Lung, and Blood Institute, U.S. Department of Health and Human Services Web site. Available at: http://www.nhlbi.nih.gov/health/dci/Diseases/HeartAttack/HeartAttack_Signs.html. Accessed July 1, 2009.