February is National Heart Month. It shouldn’t be only the month of February where we are inundated with advertising about our hearts. It should be every month. If people understood heart disease is our number one killer, we might pay more attention. If women really understood this risk, they might not only take care of their family, but put more energy into taking care of themselves. Your heart is in your hands. Heart disease and stroke are largely preventable if you work to lower your risks. It’s important to know that there are a range of factors that can raise your risk of heart disease and stroke. The more risk factors you have, the greater your chances of developing heart disease and having a heart attack or stroke.
Risk Factors You Can Control or Treat
These risk factors can be controlled or treated with help from your healthcare professional. You can modify others by changing your lifestyle.
• Blood Pressure
• Physical Activity
Risk Factors You Can’t Control
Unfortunately, there are a number of factors such as age, family history and race, that you can’t control. That’s why it’s so important to understand all of your risk factors, discuss them with your healthcare professional, and address the risk factors that you can control or treat.
• Heredity and Race
• Birth Control Pills
• Alcohol & Illegal Drugs
Lower Your Cholesterol!
Cholesterol is a soft, fat-like substance found in the blood and in all the body’s cells. A high cholesterol level is bad because cholesterol can build up with other substances in the inner walls of arteries. This buildup, called plaque, can narrow the arteries and reduce blood flow. Plaques that rupture can cause blood clots that can totally block blood flow in the artery. Clots also can break off and travel to another part of the body. If a clot blocks an artery that feeds the heart, it causes a heart attack. If it blocks an artery that feeds the brain, it causes a stroke.
High blood cholesterol has no symptoms, and many people have it without knowing it. Find out what your cholesterol levels are, so you can lower them if you need to. If you need to lower your LDL (or “bad” cholesterol), work with your doctor to create a diet low in saturated fat, trans fat and cholesterol, and an exercise plan.
If you’re overweight, work with your doctor to create a diet and exercise plan to help you lose the extra pounds. Diet and increased physical activity are important, but they may not get you to your goal. If these efforts don’t succeed, your doctor may also prescribe medication. Even if you need to take cholesterol-lowering drugs, a healthy diet and increased physical activity are still important.
Reduce High Blood Pressure!
High blood pressure (or hypertension) makes the heart work harder than normal. This makes both the heart and arteries more prone to injury. High blood pressure raises the risk of having a heart attack, stroke, kidney failure, eye damage, heart failure and atherosclerosis (fatty buildups in the arteries).
As a woman, you have an increased risk of developing high blood pressure if you are 20 pounds or more over a healthy weight (for your height and build), have a family history of high blood pressure, or have reached the age of menopause. More than 73% of women ages 65 to 74 have high blood pressure.
What’s more, your risk of developing high blood pressure increases during pregnancy, especially in the last trimester. If not treated, high blood pressure during pregnancy can endanger you and your baby. On the other hand, if you’re taking oral contraceptives, talk to your healthcare provider to evaluate the risks and benefits.
Learn more about blood pressure, such as why you should care, what you can do about it, and how you can track it.
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Smoking is the most preventable cause of death in the United States. If you smoke cigarettes (or cigars), you have a higher risk of illness and death from heart attack, stroke and other diseases. These include lung, mouth and throat cancers; chronic lung diseases and infections; heart failure; and peripheral vascular disease (in the legs and arms). Constant exposure to other people’s tobacco smoke increases your risk, even if you don’t smoke. The good news is that when you stop smoking, your risk of heart disease and stroke can be cut in half just one year later and continues to decline until it’s as low as a non smoker’s risk.
Get Physically Active
Couch potatoes, listen up! If you’re physically inactive you’re much more likely to develop heart disease or have a stroke. Regular, moderate-to-vigorous physical activity improves your cardiovascular fitness and helps reduce your risk of heart disease and stroke. Exercise can help control blood cholesterol, diabetes and obesity. It can also help lower blood pressure. For most healthy people, the American Heart Association recommends at least 30 minutes of physical activity on most or all days of the week to condition your heart and lungs. You don’t have to be an athlete to lower your risk! Moderate activities such as walking, gardening, housework or dancing for at least 30 minutes on most days can help your heart. The time may be broken into shorter periods. If you’ve been inactive, you can start with 10 minutes of physical activity, then work up to more. To help you stay motivated, take the Choose To Move challenge. In this 12 week physical activity program for women you’ll receive exercise advice, nutrition tips and get inspired by the stories of other women, as they reach for their heart-health goals
If you have too much body fat, especially if a lot of it is in your waist area, you’re at higher risk for health problems. These include high blood pressure, high blood cholesterol, high triglycerides, diabetes, heart disease and stroke. Women with excess body fat are at higher risk of heart disease, even if they don’t have other risk factors. Here’s some advice to keep in mind:
• Try to reach a healthy weight, and stay there. To lose weight, most women should eat 1,200 to 1,500 calories a day, but not less than 1,200. Losing one to two pounds or less per week is considered a healthy weight loss. (One pound of fat equals 3,500 calories.)
• Many overweight and obese women have difficulty losing weight. Stay with your plan! Even modest weight loss (5 to 10% of body weight) can help lower your heart disease risk!
• Treatment of obesity and extreme obesity focuses on substantial weight loss over a long time. Beware of fad diets, programs and products that promise rapid weight loss. Work with your healthcare professional, registered dietitian (R.D.), or nutritionist licensed or certified by the state (an L.D. or C.N.). Together you can set up a sensible program of eating and physical activity that will help you reach a healthier weight and stay there.
• Body Mass Index (BMI) is a recommended way to estimate a person’s body fat. BMI assesses your body weight relative to your height. Calculate your BMI risk level.
• Check out our Physical Activity Chart. Based on your weight range, it tells you how many calories you can expect to burn off while doing many common physical activities.
Diabetes most often appears in middle age and among overweight people. But it’s becoming an increasing problem in children and adolescents. It affects many more women than men after age 60. Compared to women without diabetes, women with diabetes have from two to four times higher death rates from heart disease. (CDC – Women’s Health – Diabetes, 9/15/06)
While diabetes is treatable, having it still increases a person’s risk of heart disease and stroke. Many people with diabetes also have high blood pressure and high blood cholesterol. This increases their risk even more. If you have diabetes, it’s critical to have regular medical checkups. Work closely with your healthcare provider to manage your diabetes and reduce or eliminate any other risk factors. If you have a family history of diabetes, ask your healthcare provider for a fasting blood sugar test.
For more information on diabetes, visit www.americanheart/diabetes
The older you get, the more likely you are to develop heart disease or have a stroke. How to reduce this risk is an area of active research.
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Women account for more than 60% of all stroke deaths. Women who are pregnant, take birth control pills and smoke, or have high blood pressure or other risk factors, have a higher stroke risk.
Heredity and Race
If your brother, father or grandfather had a heart attack before age 55, or your sister, mother or grandmother had one before age 65, you may be at risk, too. Your stroke risk is also greater if a parent, grandparent, sister or brother has had a stroke. If you’ve had a heart attack, you’re at higher risk of having a second attack or a stroke. Talk with your healthcare provider about whether taking aspirin regularly is right for you. The risks and benefits of long-term aspirin therapy vary for each person. African Americans have higher rates of cardiovascular disease and stroke than Caucasians. This is partly because African Americans have higher risks of high blood pressure, diabetes and obesity. Compared to white women, black women have higher death rates from cardiovascular disease, high blood pressure, coronary heart disease and stroke. Women of Hispanic origins also face their own unique risk factors.
Stroke-Specific Risk Factors
The risk factors for stroke are mostly the same as those for heart disease. Below are additional stroke risk factors:
Carotid or Other Artery Disease
The carotid arteries in your neck supply blood to your brain. A carotid artery narrowed by fatty deposits (plaque) from atherosclerosis may become blocked by a blood clot. Surgery called carotid endarterectomy may be done to remove the plaque buildup. Peripheral artery disease is the narrowing of blood vessels carrying blood to leg and arm muscles. People with this problem have a higher risk of carotid artery disease, which raises their risk of stroke.
This heart rhythm disorder raises the risk for stroke. The heart’s upper chambers quiver instead of beating effectively, which lets the blood pool and clot. If a clot breaks off, enters the bloodstream and lodges in an artery leading to the brain, a stroke results. Atrial fibrillation can be treated with drugs such as aspirin or warfarin to keep clots from forming.
Other Heart Diseases
People with coronary heart disease or heart failure a higher risk of stroke than people with hearts that work normally. Dilated cardiomyopathy (an enlarged heart), heart valve disease and some types of congenital heart defects also increase stroke risk. Transient Ischemic Attacks (TIAs or “Mini-Strokes”) TIAs are “mini-strokes” that produce stroke-like symptoms but no permanent damage. For example, you might feel your arm and leg on one side go numb, then recover. Or you may suddenly have trouble seeing, feel dizzy and lose your balance, then feel fine.
It’s very important to recognize the warning signs of a TIA or stroke. If you or someone with you has symptoms, even if they go away, call 9-1-1 to get medical help immediately. People with TIAs are usually treated with drugs to keep blood clots from forming.
Sickle Cell Disease
Sickle cell disease (also called sickle cell anemia) is a genetic disorder that mainly affects African Americans. Red blood cells are normally round, but in this disorder they become shaped like sickles. “Sickled” red blood cells are less able to carry oxygen to the body’s tissues and organs. They also tend to get stuck or “clump” in small blood vessels. This can block arteries to the brain and cause a stroke.
Other Factors That Can Affect Your Risk
- Stress : We all feel stress, but we feel it in different amounts and react in different ways. Too much stress over a long time, and unhealthy responses to it, may create health problems in some people. For example, women under stress may overeat, start smoking or smoke more than they otherwise would. Find healthy ways to handle stress. Stop smoking, stay at a healthy weight, and eat foods low in saturated fat, trans fat, cholesterol and sodium.
- Birth Control Pills: Many women (especially obese or older women) taking oral contraceptives experience a small but detectable increase in blood pressure; a small percentage experience the onset of frank hypertension. This is true even with modern preparations that contain low-dose estrogen. The Nurses’ Health Study found that current users of oral contraceptives had an increased risk of hypertension compared with never-users. Absolute risk was small: only 41.5 cases of hypertension per 10,000 person-years could be attributed to oral contraceptive use. Controlled prospective studied have demonstrated a return of blood pressure to pretreatment levels within 3 months of discontinuing oral contraceptives, indicating that their blood pressure effect is readily reversible.
- Cigarette smoking increases the risk of serious CV side effects from oral contraceptive use. Women who use oral contraceptives should be strongly advised not to smoke. Women who have a history of coronary artery disease or certain blood clotting disorders such as deep vein thrombosis should not take oral contraceptives. Any woman with risk factors for CVD such as smoking (already mentioned above), high blood pressure, hypercholesterolemia, obesity, and diabetes should consult their doctor about the risk versus benefits of oral contraceptives in their particular situation.
- Alcohol: Drinking too much alcohol raises blood pressure, can cause heart failure and can lead to stroke. It adds calories, contributes to obesity, and makes it harder to lose weight. If you don’t drink, don’t start. And if you do drink, talk to your healthcare provider about drinking in moderation. For women, a moderate amount of alcohol is no more thank one drink per day. One drink is defined as 1-1/2 fluid ounces (fl oz) of 80-proof spirits (such as bourbon, scotch, vodka, gin, etc.), 1 fl oz of 100-proof spirits, 4 fl oz of wine, or 12 fl oz of beer. If you’re pregnant, don’t drink alcohol in any form! It can cause your unborn child serious problems, including birth defects.
- Illegal Drugs: Intravenous drug abuse carries a high risk of endocarditis (infection of the heart’s lining or valves) and stroke. Cocaine use has been linked to heart attacks and strokes. Illegal drugs can be fatal even in first-time users.
How does your gender and heritage affect your risk? While many people face some risk of cardiovascular disease at different points in their lives, some are more at risk due to their gender, family history or heritage. So it’s a good idea to keep these factors in mind when you discuss your heart health with your doctor. Each one is a vitally important part of what makes you “you.”
Women vs. Men
Women’s health risk may be due to gender difference and gender bias. Factors that may explain the apparent disparity in treatment of men and women include:
• In the past, many of the major cardiovascular research studies were conducted on men. Results of clinical studies under way may help clarify gender differences that may affect diagnosis and treatment of women with heart disease.
• Clinicians and patients often attribute chest pains in women to non-cardiac causes, leading to misinterpretation of their condition.
• The most common warning sign of a heart attack in both men and women is chest discomfort – most heart attacks involve discomfort in the center of the best that last more than a few minutes, or that goes away and comes back. It can feel like uncomfortable pressure, squeezing, fullness or pain. Women, however, are somewhat more likely than men to experience some of the other common symptoms, particularly shortness of breath, nausea/vomiting, and back or jaw pain.
• Women may avoid or delay seeking medical care, perhaps out of denial or not being aware of both typical and atypical heart attack symptoms.
• Since women tend to have heart attacks later in life than men do, they often have other diseases (such as arthritis or osteoporosis) that can mask heart attack symptoms. Increased age and the more advanced stage of coronary heart disease in women can affect treatment options available to physicians. Increased age also can help explain women’s greater mortality after heart attacks.
• Some diagnostic tests and procedures may not be as accurate in women, so physicians may avoid using them. That means the disease process resulting in a heart attack or stroke may not be detected in women until later, with more serious consequences.
• The exercise stress test, or stress ECG, may be less accurate in women. For example, in young women with a low likelihood of coronary heart disease, an exercise stress test may give a false positive result. In contrast, single-vessel heart disease, which is more common in women than in men, may not be picked up on a routine exercise stress test.
• More precise noninvasive and less invasive diagnostic tests tend to cost more. These include thallium, sestamibi or echocardiographic stress tests.
Hispanic women heart disease and stroke statistics: Cardiovascular disease is the No. 1 killer of women of all ethnic backgrounds. But less than half of women realize it. Mexican-American women are at greater risk of cardiovascular disease due to higher rates of obesity, diabetes and metabolic syndrome than white women. In addition, women whose main language is Spanish have the highest prevalence of physical inactivity. Unfortunately, Hispanic women are less likely than white women to know that these things increase their heart disease risk. Only one-third of Hispanic women consider themselves well informed about heart disease, compared to more than 40% of white women.
• Heart disease and stroke are the leading causes of death for Hispanics.
• High blood pressure is a leading cause of heart disease and stroke. The prevalence of high blood pressure for Mexican women over 20 years old is 28.7%.
• Stroke is the No. 3 cause of death for Hispanic* women, behind heart disease and cancer. It’s also a leading cause of serious, long-term disability.
*Source: Heart Disease and Stroke Statistics – 2006 Update
African American women heart disease and stroke statistics
Cardiovascular disease is the No. 1 killer of all American women. African American women are at greater risk for cardiovascular disease than any other ethnic group, yet they are less likely than white women to know that they may have major risk factors. Diabetes, smoking, high blood pressure, high blood cholesterol, physical inactivity, overweight/obesity and family history of heart disease are all greatly prevalent among African Americans and are major risk factors for cardiovascular disease, including stroke. Fewer than half of African American women (41%) consider themselves well informed about cardiovascular disease.*
• African-Americans are at greater risk for heart disease, stroke and other cardiovascular diseases (CVD) than Caucasians. The prevalence of CVD in non-Hispanic black females is 49%, compared to 35% in non-Hispanic white females.
• High blood pressure is a leading cause of stroke. The rate of high blood pressure for non-Hispanic black females age 20 and older is 46.6%.
• The risk of heart disease and stroke increases with physical inactivity. Physical inactivity is more prevalent in women, African-Americans and Hispanics. For non-Hispanic black females age 18 and older, 33.9% are inactive, compared to 21.6% of non-Hispanic white females.
• Source: Heart Disease and Stroke Statistics – 2008 Update
* Survey conducted August 2003.
Cardiovascular disease is often preventable. And don’t think it’s over if you have been diagnosed with CAD, AFIB, or even had a heart attack. Heart Disease is also controllable.