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Feminine hearts: women should not underestimate their risk of developing heart disease.

Although most women fear breast cancer, heart attack is the number one killer of American women--over 233,000 women die annually from heart attacks. Each year, approximately 18,900 females under age 65 die from coronary heart disease, with 35 percent under age 55. Younger women are also not immune to the ravages of this disease. "Data recently published by the Centers for Disease Control indicates that the number of younger women ages 35 to 44 suffering a sudden death actually increased during the '90s," says Sumeet Chegh, M.D., director of the heart rhythm research laboratory at Oregon Health Science University in Portland.

Women are often misdiagnosed because their symptoms are less obvious and differ from men's. Evidently, acute fatigue is a more common sign of an impending heart attack for women than chest pain. A study in the October 2003 issue of Circulation, which focused on more than 500 women who had suffered heart attacks in the previous four to six months, found that 70 percent experienced high levels of fatigue prior to their heart attacks. Forty-eight percent reported disturbed sleep for more than a month before their attacks and, surprisingly, only 30 percent experienced aching, tightness or pressure in their chests. In fact, 43 percent reported not having any chest pains during their heart attacks.

Risk Factors

There are a number of coronary disease risk factors. Some unchangeable risk factors include increasing age and heredity. Race is also a factor: African Americans have a greater incidence of heart disease than white Americans, largely because they tend to have higher average blood pressure levels, a heart disease risk factor.

What You Can Do

Fortunately, you can control other heart disease risk factors. The most well-known factor is cholesterol levels. High cholesterol levels in the blood contribute to the amount of plaque in the arteries, thereby increasing the incidence of coronary artery disease. It's best to keep your total cholesterol level below 200 milligrams per deciliter. Anything between 200 and 240 is problematic and levels above 240 are usually very dangerous.

In addition, keeping your weight at an optimal level through exercise and a low-fat diet is crucial for heart attack prevention. According to the landmark Framingham Heart Study, overweight people are more likely to develop heart disease, even if they have no other risk factors. Researchers, working under the auspices of the National Heart, Lung and Blood Institute (NHLBI) followed study participants for 50 years, from 1948 to 1998. After adjustment for known risk factors (e.g., age, gender, smoking, hypertension and cholesterol levels), heart failure risk for women increased 7 percent for each increment of one in the body-mass index (i.e., a measure of excess weight for height). Maintaining a healthy body weight is also closely associated with reducing high blood pressure and your chance of developing diabetes, two other heart failure risk factors.


High blood pressure, or hypertension, is a reading of 140/90 or greater. Although a higher percentage of men than women have high blood pressure until age 55, from ages 55 to 74 the percentage of women is a little higher. According to a study reported in the November 2003 issue of Circulation, high blood pressure and elevated levels of the inflammation marker C-reactive protein (CRP) may work together to increase cardiovascular risk in women. Researchers evaluated data obtained from 15,215 women and found that when levels of both CRP and blood pressure were elevated, the risk of heart attack increased eight times. Although heredity plays a part in the incidence of high blood pressure, cardiovascular exercise can greatly reduce both high blood pressure and cholesterol.


Close to 2.5 million American women are estimated to have high blood sugar or diabetes, according to the Society for Women's Health Research. Over 80 percent of diabetics die from a heart or blood vessel disease. Diabetic women's risk of heart attack is over double non-diabetic women's risk. Although diabetes can be hereditary, it can sometimes be controlled with exercise.

It is estimated that at least 20 percent of diabetics are overweight, which impacts glucose metabolism problems, including insulin resistance, a problem central to diabetes. Aerobic exercise mitigates this problem by opening bindingsites for insulin to be used by cells. In addition, weight-bearing exercise can be helpful because it also lowers insulin resistance and increases lean muscle. Because lean muscle mass increases metabolism, it helps burn excess body fat and thus lower heart disease risk. "I always recommend to all my female patients, not just diabetic ones, to do some kind of weight-bearing exercise at least every other day to decrease the risks of heart disease," says John Bauer, an internist in Portland, Oregon.


It doesn't take much daily exercise to help strengthen your heart as well as decrease cholesterol levels. The American Heart Association recommends 30 to 60 minutes of moderately vigorous exercise three to four times per week. This can be jogging, running, swimming, aerobics or walking briskly (i.e., at least three miles per hour). The Nurses' Health Study at Brigham and Women's Hospital, which studied 121,700 women from 1976 to 1992, revealed that women who engaged in exercise at least three hours per week decreased their heart attack risk by 30 to 40 percent compared to sedentary women. Exercise's benefits on the heart may stem from its ability to reduce blood vessel inflammation, a risk factor for heart attacks.

A study by Johns Hopkins researchers found that women's fitness levels are more accurate indicators of their heart disease risk than electrical recordings of the heart. Nearly 3,000 women, ages 30 to 80, underwent treadmill exercise tests, a measure of fitness which identifies women at risk for death from heart disease. Peak exercise capacity was obtained from measuring the length of time women could exercise during a treadmill test and their heart rate recovery or HRR (i.e., peak heart rate minus heart rate two minutes after exercise). Overall, scientists found that women who performed below average in peak exercise capacity and recovery rate were 3.5 times more likely to die of heart disease than women who were above average.

Alcohol Consumption

Moderate alcohol consumption may also help protect against heart disease. The Nurses' Health Study discovered that women who drank all average of one alcoholic drink a day decreased their heart disease risk by 40 percent. However, alcohol consumption may increase a woman's risk of breast cancer, so ask your doctor to assess your personal health and risk factors regarding alcohol.

Weight and blood pressure control as well as exercise are excellent preventative measures but can't guarantee you won't have a heart attack. If you experience any symptoms, such as fatigue, sleep disturbances or even indigestion, symptoms not always associated with heart attack, consult your doctor. It may save your life.

RELATED ARTICLE: A disparity of awareness.

African-American and Hispanic women face the highest risk of death from heart disease and stroke, but have the lowest risk factor awareness of any racial or ethnic group according to an American Heart Association survey. "African-American and Hispanic women have higher prevalence rates of high blood pressure, obesity, physical inactivity, diabetes and metabolic syndrome than white women. Yet they are less likely than white women to know that being overweight, smoking, physical inactivity, high cholesterol and a family history of heart disease increase their heart disease risk," says Lori Mosca, M.D., M.P.H., Ph.D., director of preventive cardiology at New York-Presbyterian Hospital/Columbia University Medical Center and lead author of an analysis of the survey results published in the February issue of Circulation.

For instance, 44 percent of white women listed being overweight as a risk factor, compared to just 36 percent among both Hispanic and African-American women. While 35 percent of white women knew that a family history of heart disease increased a woman's risk, 22 percent of Hispanic and just 12 percent of African-American women knew it.

"The percentage of Hispanic women who reported seeing, hearing or reading information on heart disease in the past 12 months dropped from 68 percent in the 2000 survey to 61 percent in 2003. That was significantly behind the 82 percent and 74 percent reported for white and African-American women," Mosca states. "Even though awareness among African Americans still lags behind whites, there have been substantial gains. The improvements are much lower among Hispanics and we need to pay attention to that because they are the country's fastest-growing ethnic group."

RELATED ARTICLE: A call to action.

The American Heart Association's "Go Red for Women" campaign invites women to take charge of their heart health, make it a top priority and live stronger, longer lives. "Heart disease and stroke claim more women's lives each year than the next seven causes of death combined and nearly twice as many as all forms of cancer, including breast cancer," says Gerald Pohost, M.D., chairman of the Division of Cardiology at the University of Southern California and president of the American Heart Association in Los Angeles County. "Our focus is to empower women to reduce their risk of heart disease. The 'Go Red For Women' campaign outlines a plan to help women take action against heart disease and make heart disease prevention a part of their life, because your heart is your life."

By calling (888) MY-HEART or visiting, women can receive a Heart Health Tool Kit with tips and information, including:

* A comprehensive brochure with information on heart disease and stroke risk factors and warning signs

* A bookmark with information on how women can reduce their risk for heart disease and stroke

* A wallet card with questions to ask your doctor and a chart to track blood pressure, cholesterol and weight

* An American Heart Association red dress pin to wear to show support for the women and heart disease cause

* Women will also receive information about the following free American Heart Association lifestyle programs:

* Choose To Move offers women practical ways to add more physical activity into their existing routines over 12 weeks

* Simple Solutions helps women incorporate simple healthy changes to their lives

The American Heart Association also encourages women to form walking teams with neighbors and friends. For more information on "Go Red For Women," including where to purchase products that benefit the cause, call (888) MY-HEART or visit

RELATED ARTICLE: To your health!

When his mother-in-law died from heart disease, Glen Ellen winery's chief operating officer, Ken Lizar, and his wife Jennifer felt compelled to educate women about their risk. After thorough research, Jennifer was surprised to learn the real statistics. "I was shocked to learn that less than 10 percent of women understand how prevalent a killer heart disease is among women. We continue to think heart disease is just something men experience," she states. "Nothing could be farther from the truth."

The "Together We Can Win the Fight" campaign is a Glen Ellen creation that features heart health information in grocery store wine aisles. Wine boxes, labels and point of sale displays all help generate awareness and inform women they are at a greater risk for heart disease than any other disease. Also, for every bottle of red wine sold, Glen Ellen will donate a portion of the proceeds with a maximum donation of $200,000 to the American Heart Association.

"The American Heart Association's goal is to educate women about heart disease and stroke--and literally save lives," says Cindy Keitel, immediate past chair of the Western states affiliate. "Companies like Glen Ellen help elevate and enlighten a large group of consumers which we are trying to reach on many levels."

RELATED ARTICLE: 10 ways to take charge of your health.

1. Make a date with a doctor. Each year on your birthday, schedule a check-up. Have your blood pressure, cholesterol and glucose levels checked. Ask your doctor to help you reach or maintain a healthy weight.

2. Tune in whorl you tune up. Add more physical activity to your life by stepping, marching or jogging in place, for at least 15 minutes a day, while watching your favorite TV shows. Increase your activity by five minutes each week until you're getting a minimum of 30 minutes most days of the week.

3, Grab some [H.sub.2.O] when you on. Take a water bottle with you wherever you go. It'll keep you hydrated and the bottle's weight will strengthen your arms.

4. Out of Sight, out of mouth. Hide packages of unhealthy food in the pantry. Put raw veggies, fruits and healthy snacks in the front of the refrigerator or pantry so that's what you see first, if you keep grabbing healthy foods a minimum of 21 times, it will soon become a habit.

5. Eat lean to be lean. Eating foods high in saturated fat can lead to high cholesterol. To help keep your cholesterol levels down, try foods low in saturated fat in moderation, such as lean chicken or turkey (roasted or baked, with skin removed), fruits and veggies, low-fat or nonfat yogurt or pasta.

6. Don't let salt lick you. To help lower high blood pressure, watch your salt intake. It may be disguised in food labels as: sodium alginate, sodium sulfite, sodium caseinate, disodium phosphate, sodium benzoate, sodium hydroxide, monosodium glutamate (MSG) and sodium citrate.

7. Kick butts. If you smoke, quit. Here's a four-step way to snuff your habit. On Day 1, cut the number of cigarettes you smoke in half. On Day 3, cut the number of cigarettes you smoke in half again. On Day 5, cut your smoking in half again. On your Quit Day--quit!

8. Avoid fad diets. Excess weight increases your risk of heart disease, stroke and diabetes. To achieve steady, painless weight loss, take it easy. If you eat 200 to 300 calories less each day and exercise at least 30 minutes on most days (i.e., five days a week), you'll get closer to your goal and be able to achieve steady and painless weight loss.

9. If you slip, don't quit! If you get off your exercise schedule, have a cigarette or mess up on a meal, immediately get back on track toward reestablishing a healthy lifestyle.

10. Celebrate your successes! To maintain momentum with exercise, weight loss or smoking cessation, keep track of your achievements and reward yourself by doing something you enjoy.


BBC News, "Fatigue 'could signal heart attack,'" 4 November 2003, (21 December 2003).

Brigham and Women's Hospital, "Women and Cardiovascular Disease," 18 June 2003, (21 December 2003).

Chris Woolston, "Eight Steps to Preventing Heart Disease," AHealthyMe, 12 May 2004, (23 December 2003).

Jersey Shore University Medical Center-Meridian Health, "Women may learn heart attack risk after treadmill exercise," 1 October 2003, News/oct0203.cfm (1 November 2003).

NIH/National Heart, Lung and Blood Institute, "Framingham heart study finds strong link between overweight/obesity & risk for heart failure," 31 July 2002, nhla-fhs072902.php (15 November 2003).

The Society for Women's Health Research, "Hidden diabetes destroying women's hearts," 14 February 2001, (14 November 2003).

Walter Reed Army Medical Center Web site, "Silent Epidemic: The Truth About Women and Heart Disease," HeartHealth/Silent.htm (22 November 2003).

Liz Nakazawa is a freelance writer specializing in health topics. She lives with her husband in Portland, Oregon.
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Title Annotation:Women's Health
Author:Nakazawa, Liz
Publication:American Fitness
Geographic Code:1USA
Date:Jul 1, 2004
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