• Risk Factor Modification for Women

     
     
     
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    12/20/2013

    By now you've probably heard or read that heart disease is the #1 killer of women. But unless something causes you pain or interferes with your day-to-day activities, like most of us, you probably put it out of your mind. You might think, "I'm too young," "I exercise every day," or "I've always had really low cholesterol." Please don't think that for whatever reason you are uniquely immune.

    You are special. But so are the more than one half million women in the United States alone who die of cardiovascular disease each year, according to the American Heart Association's "Evidence-Based Guidelines for Cardiovascular Disease Prevention in Women." Those women probably didn't think it would happen to them either. Why take your chances when there are so many things you can do right now to reduce your risk of having heart attack or stroke?

    Cardiovascular disease progresses over time. You can't pop a few pills to cure it. And, you don't suddenly wake up one day and have it. It may seem that way if you have had a heart attack or stroke, but both result from a disease process that has gone on for some time. According to the American Heart Association, nearly two-thirds of women who die suddenly from coronary heart disease had no previously recognized symptoms. So, prevention is truly your best weapon of defense.

    You can take control of your own health by determining and monitoring your personal risk profile and managing any behaviors and habits that put you at risk. Don't wait until you have a heart attack. If you think changing aspects of your lifestyle is inconvenient, remember the alternative-the devastating consequences of heart attack or stroke.

    You can reduce your odds of having a heart attack or stroke, suffering from angina, or developing blockages in the arteries that supply blood to your limbs (peripheral artery disease) or kidneys (renal artery disease) by knowing your individual risk factors and what to do about them.

    The following categories of risk factors are the same for men and women, but many of them include special considerations that are very important for women to know.

    Risk Factors You Can't Control

    • Increasing age (including menopausal changes)
    • Gender
    • Family history of heart disease (which includes ethnicity)

    Risk Factors You May Be Able to Control

    • Smoking and using other tobacco products
    • High cholesterol levels
    • High blood pressure
    • Diabetes
    • Physical inactivity
    • Being overweight or obese
    • Metabolic syndrome
    • Stress
    • High levels of C-reactive protein

    The more risk factors you have, the greater your chance of developing heart disease. Also, the greater the level of each risk factor, the greater the risk. By decreasing these risk factors, you may reduce your risk of developing heart disease.

    Special Risk Considerations for Women

    Each of us has a unique combination of advantages and disadvantages when it comes to developing cardiovascular disease that makes up our personal profile of risk factors.

    According to WomenHeart: The National Coalition for Women with Heart Disease, non-preventable risk factors that might influence a woman's risk of heart disease include a family history of early heart disease, age (55 or older), and race/ethnicity (African American, Hispanic and Native American women are at greater risk). But you can work on controlling many other risk factors by eating a healthy diet, exercising, and managing stress.

    Now that you are aware of the risks of cardiovascular disease in women, it is important to know and monitor your own personal risk. Start by seeing your family doctor every two years to track measurements such as your weight, blood pressure, cholesterol levels, and blood sugar. Between doctors' visits, monitor your BMI, diet, and level of activity.

    Stop Smoking!

    If you smoke, the good news is you can do something right now to reduce your risk for cardiovascular disease-stop smoking! Women who smoke, especially those who are overweight and those who take birth control pills and other hormone-based contraceptives, are among the most at risk.

    About 80 percent of women under 40 who have heart attacks are smokers, but according to "Women and Smoking: An epidemic of smoking-related cancer and disease in women" posted by the American Cancer Society, the risk of heart disease is greatly reduced as soon as 1 to 2 years after you quit. After 10 to 15 years of not smoking, your risk of stroke returns to what it would be if you had never smoked.

    Talk to your doctor about tools and techniques to help you stop smoking or look online for a support group. Many of them are specifically for women. SmokefreeWomen, for example, is just one of many groups that can help you quit for good.

    Find Your Waistline

    Next, find your waistline! If you can't because it is as big as or bigger than your hips, get rid of the fat around your middle. Losing as few as 10 pounds can make a difference. The National Heart, Lung, and Blood Institute offers an excellent tool for measuring your body fat or body mass index (BMI) to make sure it is where it should be-under 25.

    We now know that body shape is also an indicator of your risk for heart disease. Think apples and pears. Women shaped like apples are storing more fat around their middles. Pear-shaped women are bigger through their hips, thighs, and bottoms. Recent studies indicate that people shaped like apples are more at risk for heart disease, high blood pressure, and diabetes.

    To a certain extent, you can blame your shape on genetics, but you can reduce your risk of heart disease by maintaining a healthy weight no matter what your shape. This is especially critical if your father had a heart attack before age 50 or your mother before 60. 

    It is a good idea to measure your waist from time to time to make sure it is less than half your height. The risk begins to increase at 31.5 inches with a significant jump at 37 inches. You can also calculate your waist to hip ratio. Divide your waist measurement by the measurement of the widest part of your lower body. If the ratio is less than .80 you're a pear. If it's more, you're an apple.

    If you're a pear, you are not necessarily in the clear. Carrying more weight in the lower half of your body may offer some protection against heart disease but not if you're overweight. And, pears can become apples, too, especially after menopause. There is also some evidence that pear-shaped women are more at risk for other problems, such as ovarian cancer, breast cysts, and endometriosis.

    If your BMI or body shape is not what it should be, the advice is simple: eat less and exercise more. Doing it is the difficult part. Your doctor can help. You can also visit your local library or surf the Internet for free information, tools, and support. For example, the National Heart, Lung, and Blood Institute  offers an interactive menu planner and popular commercial sites, such as SparkPeople.com, also offer free tools to track your progress in reaching your goals and connect with others for support.

    Cholesterol Levels

    High levels of LDL cholesterol-the so-called bad cholesterol-can increase the build-up of plaque in the arteries of the heart. It's also unhealthy to have low levels of HDL, or "good" cholesterol. The ideal blood cholesterol level for you depends on your age, gender, and history of heart disease, but for most people with coronary artery disease, the target LDL cholesterol level is 100 mg/dL or below, and the target HDL cholesterol level is above 50 mg/dL for women.

    Learn More About Menopause

    Younger, premenopausal women are not immune to heart disease-especially if they smoke or have diabetes-but they do have a lower risk of heart disease than men. But unfortunately that advantage doesn't extend beyond menopause. A woman's LDL, or bad, cholesterol rises as much as 10 percent in the years before and after menopause begins-the time period that coincides with a significant drop in levels of estrogen.

    Estrogen replacement. It may seem logical that estrogen replacement therapies would offer the same benefit, but recent studies have found that's not the case. Estrogen replacement therapies do not seem to lower the risk of heart disease in women after menopause, and in fact, it may cause other problems.

    The Women's Health Initiative, a study by the National Institutes of Health, has raised serious concerns about the risks of hormones for postmenopausal women. Because of these findings, the U.S. Food and Drug Administration (FDA) requires a warning on products used for postmenopausal women that contain estrogen.

    Iron after menopause.Another reason researchers believe the risk of heart disease is lower in younger women is because they lose iron when they menstruate. That may initially seem like a bad thing, but after menopause, when women no longer lose that iron, it builds up in organs such as the heart and increases the risk of heart disease. If you are taking iron supplements, check with your doctor to make sure you should continue to take iron after menopause.

    Blood pressure after menopause. Watch for increases in blood pressure after menopause. Some studies have shown an increase of three times what it was before menopause.

    Early menopause. Whether it occurs naturally or as a result of surgery, menopause before age 40 is associated with an increased risk for cardiovascular disease, according to the Women's Heart Foundation (see their risk assessment quiz.)

    Women and Diabetes

    Women with diabetes are at greater risk for developing heart disease than men. In fact, it is such a serious risk factor for women, that before menopause, women with diabetes have the same risk for heart disease as men. Visit the American Diabetes Association for more information on prevention or help living with diabetes.

    Ask About Your Birth Control Pills

    Birth control pills may place women at higher risk of high blood pressure and blood clots that can cause stroke or heart attack. Women over age 35, smokers, and women with high blood pressure, diabetes, or unhealthy cholesterol levels are most at risk. The birth control patch may pose an even greater risk because of its higher levels of estrogen.

    The connection between birth control pills and risk of heart disease remains unclear. If you have other risk factors, such as a history of heart disease in your family or if you are a smoker, talk to your physician about your concerns and options.

    Complications During Pregnancy

    New evidence suggests that women who developed certain pregnancy complications, such as preeclampsia (a condition in which the mother develops hypertension and significant amounts of protein in the urine during pregnancy) or gestational diabetes, are at greater risk of developing heart disease.

    A 2007 study published in the British Medical Journal found that women with preeclampsia have double the risk of developing heart disease later in life. As for women with gestational diabetes, 20 to 60 percent will develop type 2 diabetes within five years of their pregnancy, according to the American Diabetes Association, putting them at six times greater risk of heart disease.

    If you have experienced pregnancy complications such as these, it is imperative that you work closely with your doctor to aggressively manage these risk factors for the rest of your life.

    Monitoring C-Reactive Protein

    Studies have suggested that c-reactive protein (CRP), a protein in the blood that indicates inflammation in the body, may indicate greater risk of heart disease. Evidence suggests that CRP may be a stronger marker of heart disease in women than in men. CRP levels can be monitored through a simple blood test. Ask your doctor if you should have this test.

    Helpful Tools

    If you are committed to monitoring your risk factors and doing everything you can to reduce your risk for heart disease, you'll find many tools and support networks online. GoRedForWomen.org, the National Cholesterol Education Program, and the AHA risk assessment are just a few examples of sites with tools to help you assess you risks and plan heart healthy nutrition and fitness programs. However, you may need to know your blood pressure and cholesterol levels to get an accurate assessment.