| Save Your Heart For Her -------------------------------------------------------------------------------- Hearts are different in men and women. Here's the best advice for women. By Karen Cicero, Prevention The idea that men and women are different is certainly not news. One popular book even suggests that we come from different planets. But research suggests that it's more than plumbing and light years that separate us: Our wiring is different too; in particular, that set of wires and pumps known as the cardiovascular system. When we asked leading heart doctors to tell us how you can attack-proof your heart, they nixed a one-sex-fits-all plan in favor of this "his and hers" approach. But they also asked us to remind you of one way that we're all alike: Heart disease is the leading killer of both men and women. Her Plan: No More Queen of Denial One out of every three women currently under 40 will eventually develop heart disease; more than 450,000 women of all ages died from it in 2004—11 times as many as died from breast cancer. And almost 30 percent of all women in the U.S. live with heart disease. Didn't know that? You're not alone. "In the past, many doctors didn't know that heart disease was a major cause of death in women, let alone the leading one," says Marianne J. Legato, MD, a professor of clinical medicine at Columbia University College of Physicians and Surgeons in New York City. "Although awareness and treatment have improved somewhat, especially in large cities, the death rate from a first heart attack is twice as high in women under 50 as it is for men of the same age."The bottom line: It's up to you to ask for more tests or seek another opinion if you feel that your doctor is dismissing your concerns, risks, or symptoms. Think Down With Cholesterol Aim for a total cholesterol of less than 150 milligrams per deciliter (mg/dl), an LDL (bad) of 130 mg/dl or less, an HDL (good) of 45 mg/dl or higher, and triglycerides of less than 150. "For women, a low HDL is much more predictive of heart disease than a high total cholesterol," says Debra Judelson, MD, medical director of the Women's Heart Institute at the Cardiovascular Medical Group in Los Angeles. "HDL over 60 mg/dl is a positive protector against heart disease," adds Dr. Legato. It may edge your total cholesterol up, but you're still protected against heart disease if your total cholesterol/HDL ratio is 4.0 or less. Dr. Judelson suggests that you ask your doctor to tack on one more measurement to your regular cholesterol test: lipoprotein (a), a protein strand that's attached to bad cholesterol molecules. When researchers from the Framingham Heart Study tested these levels in more than 3,000 women, they found that participants with lipoprotein (a) above 30 mg/dl doubled their risk of heart disease. Rate Your Risk In addition to abnormal cholesterol, you're more likely to develop heart disease if you have these risk factors: Smoking (ups the odds at least two- to fourfold more if you take birth control pills) Diabetes (raises your risk four to six times) Blood pressure higher than 135/85 Family history of early heart disease Premature (before age 38) menopause (either naturally or through removal of the ovaries) Overweight Sedentary lifestyle Take the Test Don't settle for the treadmill test, where you simply walk on a treadmill while your blood pressure and heart's electrical activity are measured. "Although it's a good starting point for men, a treadmill test is counterproductive for women because it produces so many false positives and false negatives," says Dr. Legato. So where do you begin? With an exercise echocardiography, also known as a stress echo test. While you're on a treadmill, a machine translates sound waves into pictures that show your heart's size, shape, movement, and pumping ability. Redesign Your Diet A low-fat diet is appropriate for most women, but certain women with a low HDL level can actually increase their risk for heart disease from cutting back on all fats. Most women (and men) will improve their health with a Mediterranean-style diet consisting of lots of fruits and vegetables, with most of the fat coming from olive oil, canola oil, olives, avocados, and nuts. Olive oil raises good HDL and lowers your risk, says Stephen Devries, MD, director of the Heart Center at the University of Illinois in Chicago. (Prevention recommends that you limit total fat to 25 percent of daily calories, with no more than 7 percent as saturated fat.) Because diabetes increases the risk of heart disease more for women than men, you should use whole grain carbohydrates such as whole wheat bread and brown rice rather than refined ones such as white bread and white rice, says Walter Willett, MD, chairman of the department of nutrition at the Harvard School of Public Health. In his study of more than 64,000 nurses, Dr. Willett and his colleagues found that those who ate large amounts of refined carbohydrates doubled their chances of developing type 2 diabetes, while those who consumed mostly whole grains didn't raise their risk at all. What about HRT? Doctors think that women have heart attacks later in life than men because estrogen protects them until menopause, says Dr. Legato. But in recent years, hormone replacement therapy (HRT), taken by millions of women to reduce menopausal symptoms and protect their hearts, was dealt a series of blows. In the 1990s, several studies found that estrogen actually increased deaths in women who already had heart disease. Then, in July 2002, the largest study of its kind The Women's Health Initiative (WHI) found that not only did HRT not prevent heart attacks, it actually increased a woman's risk for heart attack, stroke, blood clots and breast cancer. The government, which funded the study of more than 160,000 postmenopausal women, told the participants to stop taking the pills. In October 2004, researchers sifting through the WHI results found that HRT doubles a woman's chances of developing dangerous blood clots, with the highest risk for overweight women or those over 60. On the strength of this evidence, most doctors are now hesitant to prescribe HRT, especially to women who have risk factors for any of these conditions. No Excuses! In a recent study, women cited low self-esteem as their biggest barrier to a heart-healthy lifestyle, says Lori Mosca, MD, PhD, director of preventive cardiology research and education at the University of Michigan in Ann Arbor. And how are you going to break free? "Work on becoming more optimistic," suggests Maryann Troiani, PhD, a psychologist in Barrington, IL, and author of Spontaneous Optimism (Castlegate, 1998). "Optimism and confidence go hand in hand." She suggests ridding your vocabulary of negative words such as "try" and "but" because they don't give you a sense of commitment to your goal. Talk more to cheerful people and less to unhappy ones. "We feed off of each other's emotions," she says. And walk tall rather than shuffle your feet. "If you look the part and talk the part, chances are you'll feel the part," says Dr. Troiani. Recognize the Symptoms "In women, the signs of a heart attack can be very different than they are in men," says Lynn Smaha, MD, clinical cardiologist and former president of the American Heart Association. Instead of crushing chest pain, you may have lighter chest, stomach, or abdominal pain; nausea or dizziness; shortness of breath; heart palpitations; fatigue; and weakness. If you experience these symptoms, Dr. Judelson advises that you immediately chew a full-strength (325 mg) aspirin (it'll significantly improve your survival rate if you are indeed having a heart attack; if not, it won't hurt) and head to the ER immediately. And if the docs say that they can't find anything wrong? "Don't let them dismiss you until you've received a thorough evaluation, including an electrocardiogram," says Dr. Judelson. "I've had too many patients who were sent home with a clean bill of health from the ER who indeed had heart disease." |
| Save Your Heart for Him -------------------------------------------------------------------------------- Hearts are different in men and women. Here's the best advice for men. By Karen Cicero, Prevention The idea that men and women are different is certainly not news. One popular book even suggests that we come from different planets. But research suggests that it's more than plumbing and light years that separate us: Our wiring is different too; in particular, that set of wires and pumps known as the cardiovascular system. When we asked leading heart doctors to tell us how you can attack-proof your heart, they nixed a one-sex-fits-all plan in favor of this "his and hers" approach. But they also asked us to remind you of one way that we're all alike: Heart disease is the leading killer of both men and women. His Plan: Stop Being the King of Denial One out of every two men currently 40 and under will eventually develop heart disease; more than 410,000 men died from it in 2004—13 times more than died of prostate cancer. "You may think that it's the other guy who will get heart disease," says Kenneth Goldberg, MD, director of the Male Health Center in Dallas. "But all my patients with heart disease thought it was going to be the other guy. At least open yourself up to the possibility that it could happen to you. And then work as hard as you can to prevent it." Think Down With Cholesterol Shoot for a total cholesterol of less than 150 milligrams per deciliter (mg/dl), an LDL (bad) of less than 130 mg/dl, an HDL (good) of 45 mg/dl or higher, and triglycerides of less than 150. The most important number in that equation is LDL. "In men, studies show that a high LDL increases the risk of developing heart disease more than a low HDL or high triglycerides, and treatment of LDL is most effective in reducing cardiac risk," says Debra Judelson, MD, medical director of the Women's Heart Institute at the Cardiovascular Medical Group in Los Angeles. Rate Your Risk An abnormal cholesterol level is not the only tip-off that a heart attack may be in your future, says Stephen Devries, MD, director of the Heart Center at the University of Illinois in Chicago. Consider these other clues: Smoking (increases your risk at least two- to fourfold) Diabetes (doubles your risk) Blood pressure higher than 135/85 Family history of early heart disease Overweight Sedentary lifestyle Take the Test "I tell people to take charge of their health. Make sure that you are checked for risk factors and that you get the information you need to lower your individual risk," says Dr. Devries. If you have several risk factors for heart disease, your doctor might recommend a treadmill exercise test (also called a stress test) to get an even better idea of how your heart is working, he says. You simply walk on a treadmill while your blood pressure and changes in your heart's electrical activity are monitored. Based on the results of this test, your doctor may recommend other tests or encourage you to make some lifestyle (exercise and diet) changes. If your cholesterol and/or blood pressure is particularly high, he may also prescribe medication. Redesign Your Diet Trim the fat especially the saturated kind, advises Dr. Devries. "Most men need to cut back on the fat found in a typical American diet. Meat should be considered a treat, not a part of every meal. Pasta, stir-fries, and fish should substitute for many of the meat meals. In the dairy department, try low-fat milk and cheese," says Dr. Devries. No Excuses! When researchers at the University of Michigan in Ann Arbor asked 186 men what stood in their way of achieving a heart-healthy lifestyle, their number one answer was you guessed it time (Jour. of Women's Health, vol 7, no 6, 1998). "In the short term, staying late at the office instead of hitting the gym or making your doctor's appointment may seem like it's the best thing to do for your career and family," says Dr. Goldberg. "But you can't climb the corporate ladder or be there for your family from a hospital bed. You need to prioritize your time by putting your health first and foremost." Recognize the Symptoms A third of the men who responded to a Men's Health magazine survey said that they wouldn't seek care if they experienced severe chest pain and shortness of breath. Duh! Don't be stupid. If you're having the following symptoms, chew a full-strength (325 mg) aspirin (it'll help break up clots associated with your attack) and get to the hospital ASAP: Uncomfortable pressure, fullness, squeezing, or pain in the center of the chest that lasts more than a few minutes or that quickly fades in and out. The pain may spread to the shoulders, neck, or arms, and it may be accompanied by lightheadedness, sweating, nausea, or shortness of breath. "Remember: The longer you delay getting to the hospital, the more likely that the attack will be fatal," cautions Dr. Goldberg. Surprising Physical Signs of Heart Disease Many people associate heart disease with obvious symptoms like chest pain. But there are some not- so-obvious connections, like swollen feet or bleeding gums, that should also merit a heart check from your doctor. Heart disease symptoms in women or in men are indications that you feel or experience, while a heart disease sign is something your doctor can see or find. Obvious heart disease symptoms include shortness of breath or chest pain. But your doctor may also look for some surprising heart disease signs during an examination. Knowing the signs of heart disease is important because you may have heart disease signs before you have any of the common heart disease symptoms. Letting your doctor know about these early warning signs could help you get an early jump on heart disease. "Signs like ankle swelling or weight gain do not necessarily mean you have heart disease, but taken together with other symptoms of heart disease, laboratory studies, and family history, they are an important part of making a diagnosis of heart disease or heart failure," says Carl E. Orringer, MD, associate professor of medicine at the Case Western Reserve University School of Medicine and director of preventive cardiovascular medicine at the University Hospitals Case Medical Center in Cleveland. Swelling of Your Feet and Lower Legs Retention of fluid in the feet and legs is known as peripheral edema. Edema may appear as "sock marks" at the end of the day. Mild peripheral edema is common. Your doctor may check for this sign by pressing a finger against your ankle or shin bone to see if a depression is left behind. This is called "pitting edema." Edema may be a warning of heart failure because, when your heart is not pumping well, fluid from inside your blood vessels tends to leak out into surrounding tissues. The legs and ankles are common areas for edema because of the effects of gravity. "Peripheral edema may be caused by a host of issues,” says Dr. Orringer. “The bottom line is that most people with peripheral edema do not have heart disease, but it could be an important sign if there are other signs and symptoms of heart failure." Male Pattern Baldness "If you watched any of the royal wedding, you might have noticed that Prince William is balding on the top of his head. This type of balding of the crown of the head in young men may be a sign of an increased risk for heart disease," says Orringer. Several large studies have confirmed the link between baldness and heart disease. Compared to men with a full head of hair, men with crown loss have an increased risk of heart disease of about 23 percent. Men with complete loss of hair on the top of their head have an increased risk of 36 percent. The combination of hair loss, high blood pressure, and high cholesterol pushes the risk even higher. This link may be due to too much of the male hormone testosterone, which interferes with hair growth on the head and causes hardening of the arteries. That doesn't mean you are doomed to heart failure if you are bald, but it does suggest you should be screened more carefully for other signs and symptoms of heart disease. Yellow Bumps on Your Skin Xanthomas are deposits of fat that build up under the skin. They may appear as small yellow bumps or as flat, wide plaques on your elbows, knees, hands, feet, or buttocks. A type of xanthoma called "xanthelasma palpebra" appears on the eyelids. These yellow, fat deposits can potentially be signs of heart disease because they may indicate high levels of fats in the blood. "Xanthomas may be a sign of a rare, inherited type of blood disorder in which high levels of triglycerides accumulate in the blood. Xanthomas may also be a sign of increased cholesterol and they may disappear once cholesterol levels are under control," explains Orringer. Gum Disease Swollen, sore, or bleeding gums are usually a sign of poor oral hygiene, but may also be an important heart disease sign. "The association between gum disease and heart disease is the real deal," says Orringer. "There is plenty of research available now that backs up this connection." Gum disease and heart disease may be linked because they are both signs of poor circulation, or there could be common bacteria that are involved in both gum disease and plaque build-up inside coronary arteries. The link may also have something to do with the body's response to prolonged inflammation. In any case, taking better care of your teeth and gums is a good way to cut down your risk for heart disease. Signs of Heart Failure Heart failure means the heart is not functioning as well as it should. It doesn't mean the heart has failed. Another term for heart failure is congestive heart failure, or CHF. Heart failure gradually gets worse over time. Some early warning signs may include: Weight gain. If your heart starts to fail and fluid starts to build up in your tissue, causing edema, you might see a sudden weight gain.Frequent urination. Heart failure may cause decreased blood flow to the kidneys, which causes you to retain more fluid. One of the signs of this fluid may be frequent urination.Cataracts. Although the exact connection is not known, studies show that people who have cataracts are at higher risk for heart disease, high blood pressure, and high cholesterol. "This link is probably more of an association than a sign of heart disease," says Orringer.Nighttime cough. "One of the signs of heart failure may be the build-up of fluid in the chest and heart when lying flat at night. This pressure can cause a nighttime cough," explains Orringer. Remember that all these heart disease signs may have many different causes. They do not mean you have or will get heart disease. But combined with other heart disease signs and symptoms, your blood tests, and your family history, they give your doctor the best chance to find heart disease early and keep you in good health. |
