Heart Health Basics for Women

Heart disease is a serious concern for men and women alike. But recent studies reveal that cardiovascular disease affects women's bodies differently. After decades of being overlooked in heart health research, women are finally getting some attention -- and rewriting the rules on cardiovascular health. See how heart disease develops in women, discover how heart attack symptoms can vary between sexes and learn how accurate diagnostic tests really are.


Women's bodies react differently to heart disease.

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Not long ago, health experts thought heart disease was something only men had to worry about. Case in point: When the American Heart Association held its first public conference for women in 1964, the name of the event was Hearts to Husbands. The sole objective? To teach wives how to keep their spouses healthy—with no mention of how heart disease might be affecting them.

"We've come a long way," says Jennifer Mieres, M.D., a cardiologist at North Shore--LIJ Health System in New York and a spokesperson for the American Heart Association's Go Red for Women awareness campaign. "Now, there's no mistaking that heart disease is an equal-opportunity killer." In fact, it kills 1 out of every 2.6 American women, making it the No. 1 cause of death for both sexes nationwide.

Yet even as public awareness of female heart disease grows, researchers still are parsing out the particulars. Women historically have been underrepresented in heart studies, partly due to concerns that female hormone fluctuations would distort the results. But therein lies the rub: We're not just smaller versions of men.

A wave of newer studies reveals that women's unique chemical makeup combined with anatomical differences (such as smaller arteries and veins) affect how heart disease develops in us, how accurate diagnostic tests are, and how well we respond to certain medications.

So Better Homes and Gardens took a closer look at the latest research to see where men and women split when it comes to matters of the heart. The findings might surprise you--and might even save your life.

Women's arteries can look clear -- even when they're not.

Persistent chest pain, shortness of breath, unexplained fatigue. Fully 83 percent of men with these symptoms have deposits of plaque in their major arteries, a condition called arteriosclerosis that's easily picked up by an angiogram.

But in 50 percent of women who report such symptoms, their majorarteries appear healthy, according to a landmark 2006 study. That's because women tend to develop deposits of plaque diffusely in the smaller arteries near the heart, says Dr. Jennifer Mieres -- an equally dangerous condition known as microvascular disease, which is treatable with medication.

If you're experiencing heart symptoms but your angiogram comes back normal, ask your doctor about having an exercise stress test (see the section below for more on that) or an MRI, both of which are better at detecting this problem.

Women have been pushing themselves too hard in workouts.

To ensure a workout provides sufficient aerobic exercise, health experts have long told us to exert ourselves until the heart hits 65-85 percent of its maximum rate (measured in beats per minute). But it turns out the classic formula for calculating peak heart rate -- 220 minus a person's age -- applies only to men, who have a higher maximum than women do, according to a recent study in the journal Circulation.

The updated peak heart rate formula for women: 206 minus 88 percent of your age. For a 40-year-old woman, that's about 171 beats per minute (206 - [.88 x 40]), meaning the target rate during exercise is 111-145 beats per minute.

This new formula also might prevent false positives on cardiac stress tests, which are designed to pick up on problems by monitoring (among other variables) how closely the heart comes to hitting its max.

Statins warrant a second look.

Roughly 13.5 percent of American women between the ages of 45 and 64 take statins, drugs aimed at preventing harmful LDL cholesterol from building up in arteries.

But when researchers broke out the stats by sex in a large study in 2009, they discovered the drugs significantly lower the risk of heart attack or death only for women who already have heart disease. (Healthy men, on the other hand, do see a preventive benefit.) And the concerns don't stop there.

Statins can cause side effects in women such as:
-- Muscle pain
-- GI distress
-- Memory problems

Women also have a greater risk of developing type 2 diabetes  while on the drugs than men do. "For many women who do not already have heart disease, the adverse effects of statins outweigh the benefits they're likely to derive,' says Viola Vaccarino, M.D., chair of epidemiology at the Emory University Rollins School of Public Health in Atlanta.

What to do if you've been taking a statin for high cholesterol and are experiencing side effects: Ask your doctor if you need to continue. For some women the answer will be yes (say, because of existing heart disease); if that's the case, ask about switching to a water-soluble type, which might be less risky.


Emotions take a greater toll.

Chronic stress doubles the risk of heart disease by elevating resting heart rate and ratcheting up blood pressure.

And women have special reason to be concerned. Research conducted at the University of Cincinnati suggests that women experience greater levels of acute and chronic stress than men do, and stress-related mental illnesses, including depression, occur at least twice as often among women as men.

"Getting control over stress isn't just about your day-to-day happiness; it's critical to your health," says Nieca Goldberg, M.D., director of New York University's Women's Heart Program in New York City.

It's wise to rethink an aspirin regimen.

Many women started popping aspirin regularly when their doctors informed them it could help prevent a heart attack, but this recommendation was based on studies of men.

Newer findings from Harvard University show that aspirin does not prevent a first heart attack or death in healthy women under 65. Because habitual aspirin use can cause stomach ulcers, if you're taking aspirin preventively, talk with your doctor about whether you should stop. Bear in mind that some younger women -- such as those with risk factors for heart disease or stroke -- can benefit from a low-dose aspirin regimen, says Dr. Mieres, M.D., a cardiologist at North Shore--LIJ Health System in New York and a spokesperson for the American Heart Association's Go Red for Women awareness campaign.

If you suspect you're having a heart attack: The American Heart Association advises chewing and swallowing one 325 mg aspirin tablet while you're waiting for help to arrive. This can prevent blood from clotting in compromised arteries.   

Drinking is more dangerous for women.

Granted, for men and women alike, one alcoholic drink a day can benefit the heart -- in fact, it can lower a woman's heart disease risk by 17 percent. But beyond that, alcohol seems to affect men and women very differently.

Several years ago, Japanese researchers found that women who drank 2 - 4 drinks per day were 45 percent more likely to die of heart disease than female nondrinkers. On the other hand, men who drank that much were 19 percent less likely than male nondrinkers to die from heart disease. The study didn't look at the reasons for these surprising differences, but it's probably best to imbibe moderately while scientists search for answers.

His-and-hers heart attack symptoms.

In the movies, heart attacks follow a familiar pattern: The actor freezes, clutches his chest, and promptly keels over on the golf course. But for up to 33 percent of female heart attack sufferers, this Hollywood version of events never happens.

Instead, they experience nausea, extreme weakness, lethargy, skin clamminess, upper back pain, and shortness of breath. These subtler symptoms frequently are overlooked by patients and doctors alike, putting lives at risk, says cardiologist Nieca Goldberg, M.D.


Steven List's Heart Attack Experience

Who: Steven List, male, 57, Austin

Key heart attack symptoms: tingling in left arm, stabbing sensation in chest

His story: "My heart attack happened during my regular after-work karate class. About an hour into my session, I started feeling funny. Just...uncomfortable. This wasn't like me. I worked out at least three times a week. I didn't drink, and I hadn't smoked in 13 years. At my checkup eight weeks earlier, my doctor had given me a clean bill of health."

"I sensed that something was up. I got an odd sensation in my lower chest--it felt almost like a spasm of my diaphragm muscle. I definitely hadn't experienced anything like that before. Feeling that I shouldn't continue exerting myself, I left the karate floor and went into the changing room to relax. I tried sitting. I tried walking back and forth. I splashed some cool water on my face."

"But my chest discomfort only intensified, and within a few minutes it had sharpened into some of the worst pain I'd ever felt--like someone pushing a spear into my chest. By then I was lying on the floor, and my left arm had started tingling. That's when I became certain I was having a heart attack. Scared for my life, I waved down a fellow student and asked him to call 911."

"At the hospital, a team wheeled me straight into the E.R., ran an EKG, and administered several medications. Then the cardiologist came in and said we should proceed immediately to an angiogram to check things out, and then maybe angioplasty or bypass surgery, depending on what he found. In the end, they inserted a stent, which is basically a little support tube that was snaked into my artery to hold it open. It was truly amazing. The entire heart attack experience took just 4 1/2 hours from start to finish, and I came away with no heart muscle damage, no major surgery, and a new lease on life."


Sue Andrew's Heart Attack Experience

Who: Sue Andrews, 53, Cleveland

Key heart attack symptoms: dizziness, intermittent achiness and weakness

Her story: "It happened three years ago, around 9:30 on a normal Monday morning. I had just begun giving a presentation to my colleagues when I noticed I was becoming very dizzy and clammy--almost like you'd feel if you were having an anxiety attack. I also felt pressure in my chest, which then subsided and morphed into a pain across my shoulder blades. That's weird, I thought. I'm not nervous or anxious, so I guess I'm just coming down with something. I went ahead with my presentation, trying to hurry it a bit because I wanted to get it over with. At one point I had to pull up a chair and sit down to alleviate the dizziness. Apparently I hid my distress well because a number of my coworkers later told me they never suspected anything was wrong.

"I finally wrapped up the meeting about 40 minutes later. Still feeling strange, I went to the office kitchen, got myself a glass of water and made my way back to my desk. When the feeling didn't pass, I called my husband and said, 'I think I must be getting some kind of flu. I'm going to head home and go to bed.' He offered to pick me up instead."

"Fortunately, my husband insisted I see a doctor. So we went to a local walk-in clinic, where the physician on duty listened to my symptoms and performed an EKG. The results were 'slightly off,' he said, so he instructed me to go to the emergency room for some blood tests. No one mentioned anything to me about the possibility of a heart attack.

"I got to the E.R. around 12:30. After repeating my symptoms at the checkin desk, I was informed I'd have to wait my turn. So I tried to make myself comfortable in the waiting room as I watched people come and go. When a man came in with chest pains, they rushed him in ahead of everybody. I looked at him, thinking, I wonder if he's having a heart attack--never believing that I might be, too. Fully three hours after I arrived, they called me in. I repeated everything to the nurse. A team took blood samples and started doing lots of tests. Finally a doctor came in and announced, 'We're going to admit you. You've had a heart attack.' I don't know which is more incredible--that it took so long for me to get a diagnosis, or that I survived the wait."

Get a healthier heart, one day at a time.

Good news: Because women tend to develop heart disease later in life than men do, preventive measures have more time to work their magic, says cardiologist Nieca Goldberg, M.D. These include exercising regularly, eating a diet that's rich in whole foods, maintaining a healthy weight, and not smoking. To help meet these important goals, start with a few simple moves.

7 a.m. Sprinkle slivered almonds on your cereal. Research shows that these nuts can lower the risk of heart disease by reducing levels of harmful LDL cholesterol. In addition, antioxidants and vitamin E found in almond skins might prevent plaque from forming on artery walls. Bonus points if your cereal is made with whole grains, which help keep blood pressure in check.

8 a.m. Time your toothbrushing session. Recent studies show a strong association between gum disease and heart disease, possibly because unhealthy gums cause systemic inflammation. So don't rush your morning brush. The American Dental Association says you need at least two minutes to clean teeth and gums thoroughly. Use your wristwatch to time yourself or pick a brush with a built-in timer light.

9 a.m. Distance yourself from your destination. People who take at least 5,000 steps during the day (about 30 minutes of walking total) are 40 percent less likely than sedentary people to develop metabolic syndrome, a precursor to heart disease. So wherever you're headed, try parking down the block or in a far corner of the lot, suggests Nanette Wenger, M.D., a cardiologist at the Emory University School of Medicine. A few mini-walks can help you hit the target.

10 a.m. Stand up and stretch. Midmorning is one of most productive times of day, when concentration and focus are at their peak. But don't get too attached to your chair: Prolonged periods of sitting are associated with higher levels of cholesterol -- and an increased risk of heart-related death. Aim to unseat yourself for a few minutes every hour.

12:30 p.m. Keep the junk out of lunch. You already know to eat something made with fresh, whole ingredients -- such as a crunchy green salad topped with grilled chicken and low-fat dressing. Just watch out for the "halo effect." This is the sneaky tendency to overindulge in junk food like chips and soda after eating a virtuous entree. Remember: Heart health doesn't end at the main dish.

2:30 p.m. Nibble a high-fiber, high-protein snack. Great choices include hummus with whole wheat crackers and apple slices with a smear of natural peanut butter. In addition to delivering heart-healthy nutrients, snacks with this nutritional profile sate your appetite better than processed foods like cookies, Dr. Goldberg explains. This makes you less likely to overeat at dinner.

4 p.m. Take a sanity break. Stress often strikes in late afternoon as productive daylight hours dwindle. Don't get frazzled. Take a 10-minute breather and do something relaxing, such as listening to music or e-mailing a friend. "Decompressing in stressful situations brings down your blood pressure and helps you feel more in control," says cardiologist Jennifer Mieres, M.D.

6 p.m. Drink (in moderation). The American Heart Association recommends that women consume no more than one alcoholic drink per day. At dinner or happy hour, get more bang from your beverage by choosing red wine. It contains antioxidants and compounds such as resveratrol that are associated with lower heart disease mortality.

9 p.m. Power down your gadgets. Surfing the Web, texting on your cell, and watching TV can interfere with sleep by stimulating the brain, so stop screen-based activities about an hour before bedtime. Your heart will thank you, says Dr. Mieres: "Women who get at least 6 hours of sleep every night have less plaque buildup in their blood vessels than women who sleep less."

10 p.m. Hug your family goodnight. A loving touch--whether it's from a massage, a snuggle session, or a good bear hug--spurs the release of oxytocin, a chemical that can bring down blood pressure by enhancing the flexibility of blood vessels, says Dr. Goldberg. How's that for sweet dreams?

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