Healthy Hearts Without Hormone Therapy
For:
Hormone Therapy: The Answers Are In, October 2002
The belief that heart disease is a male problem still lingers. Younger women do have lower rates of heart disease than men the same age. But this does not mean that young women never have heart attacks. Their risk rises if they smoke, are overweight, have diabetes and/or high cholesterol, and lead sedentary lives. And at younger ages, heart disease may be more dangerous for women than men. Women's risk after menopause rises sharply, and eventually, around the age of 70, equals men's risk. Nevertheless, survey after survey has shown that the majority of women worry about cancer, particularly breast cancer, more than heart disease.
Heart attacks kill 236,000 American women annually, compared to 43,600 killed by breast cancer, and 59,000 by lung cancer. Heart disease (in all its forms) kills 11 times more women each year than breast cancer in the U.S. and Canada.
But the good news is that half of all premature deaths from heart disease could probably be prevented by simple life-style changes. Good health habits are an essential line of defense.
What women can do
• Don't smoke. Smoking is probably the worst thing you can do to your heart. Among young and middle-aged women, who seldom have CHD, an estimated 65% of all heart attacks can be attributed to cigarette smoking. No level of smoking is safe, and the risk of chest pains and heart attack rises with every cigarette smoked daily. A good idea: avoid other people's smoke, too.• Eat right. Base your diet on fruits, vegetables, whole grains, and nonfat or low-fat diary products. Eat fish two or three times a week; choose only small portions of skinless, light-meat poultry and well-trimmed, low-fat cuts of meat. Fat should supply less than 30% of your total calories; keep animal fats to a minimum. Consume no more than 300 milligrams of cholesterol daily. Eat a small amount of walnuts or other nuts at least a few times a week. Replace saturated fats with monounsaturates: for example, use canola and/or olive oil rather than butter. A high fiber intake (from fruits, vegetables, and especially whole grains) is associated with a reduced risk of heart disease.
• Stay active. Physical fitness is associated with a low risk of heart disease. Yet 25% of American women do not exercise at all. For heart benefits, a minimum program would be 30 minutes of brisk walking daily. More is definitely better. But if you are sedentary and over 50, get medical advice before beginning an exercise program.
• Keep your weight at a healthy level. Being overweight is bad for anybody's health, and the percentage of obese people in the U.S. and Canada is rising. If your weight is creeping up year by year, it's important to cut calories and develop good exercise habits. Being overweight directly increases your risk for CHD, as well as diabetes, which further increases the risk of heart disease, especially for women.
• Know your blood pressure, and keep it under control. Half of all women over 55 have elevated blood pressure, and chronically elevated blood pressure (hypertension) is a major risk factor for heart disease and stroke. Blood pressure is expressed in two numbers: systolic (the higher number, when the heart beats) and diastolic (lower number, between heart beats). Optimal pressure is 120/80 or less. Levels of 130/85 to 140/90 are called high-normal; at this point, life-style modifications will be needed, along with careful monitoring. Levels above 140/90 are defined as hypertension and require medical treatment (only one of the numbers has to be this high for you to be considered hypertensive). Women benefit from treatment—that is, drugs and life-style changes—as much as men. More black women get hypertension, and they tend to develop it about 10 years earlier than white women; studies have shown that they benefit most from treatment.
• Know your blood cholesterol levels. High blood cholesterol levels—above 200 milligrams per deciliter—put women at risk for CHD, especially when the HDL reading is below 35 milligrams per deciliter. (Some researchers now believe that HDL below 45 puts a woman at risk.)
• If need be, consider cholesterol-lowering statin drugs. These are now the first line of treatment if diet and exercise don't work. Statins improve blood cholesterol levels more effectively than hormone therapy, and with fewer side effects. A less expensive form of therapy is the supplement Cholestin, which contains lovastatin. It should be taken under medical supervision.
• If need be, consider aspirin. You'll need to discuss this with your doctor, after determining your heart disease risk factors. A daily baby aspirin (81 milligrams)—or half an adult aspirin every other day—is enough. We also recommend that every 15 days you substitute one whole aspirin (325 milligrams) for your smaller dose, in order to get a booster effect.
• Consider alcohol. Moderate drinking—for a woman, no more than one drink a day—may reduce the risk of developing CHD. One drink is defined as 5 ounces of wine, 12 ounces of beer, or 1.5 ounces of 80-proof liquor. Nondrinkers should probably not start drinking just for potential heart benefits.
• Know your family history. If heart attacks, strokes, and other forms of cardiovascular disease run in your family, you should pay special attention to your other risk factors.
• Do what you can to alleviate stress. If you are chronically depressed or angry, this may increase your risk for heart attack. Depression can be successfully treated. Women in the workplace have never been shown to have higher rates of cardiovascular disease than women who stay home—despite occasional scary articles claiming that women who work like men will have heart attacks like men. As one researcher put it, "remunerative employment does not in itself increase coronary risk."
Having too much to do is not necessarily bad for your heart. Much depends on how you perceive the level of demand, and how much you enjoy it. Some aspects of working women's lives do raise concerns. Working at jobs with high levels of demand and little room for decision-making can contribute to hypertension and poor health, and women tend to hold a disproportionate number of such jobs—waitresses, computer operators, clerical jobs. The Framingham Heart Study showed that women in clerical jobs have more heart attacks than those who stay at home. Furthermore, for many employed women, even highly paid professionals, a job at work is followed by a job at home. But data on the consequences of work overload for women have yet to be gathered and analyzed.
UC Berkeley Wellness Letter, July 2000
