Heart of the Matter

By Stacey Wilson

These eight basic facts about heart disease and prevention should help you combat women’s top health threat.

Almost all of us know, when we see a pink lapel ribbon, that it represents the fight against breast cancer. As vitally important as that battle may be, it pales in comparison to the challenge posed by the modern female’s most formidable enemy: heart disease.

“It’s now the number one killer of women in America,” says Dr. Maureen Mays, director of the OHSU Preventive Cardiology program, noting that one out of every three women will die of heart disease or stroke. In fact, more women die of heart disease than of the five next most common causes combined.

Dr. Diana Rinkevich, director of the Heart Disease in Women Program at OHSU, says awareness has increased in the last few years as the American Heart Association’s “Go Red” campaign has brought attention to the disease. But there’s still much to be done. “It’s simply not enough,” Rinkevich says. “Women are still smoking, eating poorly, and leading sedentary lives. In fact, most smokers die of heart disease, not lung cancer.”

Here, Dr. Mays and Dr. Rinkevich offer a few must-know facts (and debunk a few fictions) about heart disease, and they explain how you can protect yourself and the women in your life from our most daunting enemy.

1 Heart disease 101.
It’s a major health threat, but what exactly is heart disease? “Most commonly, it’s represented by a condition called arteriosclerosis, or blockages in the arteries,” says Dr. Mays. “The coronary arteries accumulate plaque, a combination of cholesterol and white blood cells that builds up until a blockage occurs.” Symptoms of arteriosclerosis may include shortness of breath, palpitations (irregular heartbeats or a “flip-flop” feeling in the chest), weakness or dizziness, tooth or jaw ache, and nausea. If a blockage ruptures inside the artery, this can cause a heart attack and trigger more profound symptoms such as chest pain, discomfort in the arm, or a sensation akin to heartburn, all of which can last up to 30 minutes or longer. “You can also have a ‘silent’ heart attack, meaning there’s no pain,” says Dr. Mays. “This is even more dangerous, because heart muscle could be damaged, yet you might not know you have heart disease.”

2 Women are (a little) safer than men.
“In general, women without serious risk factors start to suffer from heart disease about 10-to-15 years later than men, and are pretty well protected from it until their mid- to late 60s,” says Dr. Rinkevich. Hormones might have something to do with a lower incidence of the disease in younger women, but members of certain high-risk groups can develop heart disease at an earlier age. These include diabetics, smokers, and women who have gone through early menopause (or had their ovaries removed), have a severe form of high cholesterol, or have a significant family history of heart disease. “Unfortunately, an average of 10,000 women under the age of 45 have heart attacks each year in this country,” says Dr. Rinkevich.

3 No family history, no problem?
Not so fast. Dr. Mays says she often treats women who have no known family connection to heart disease. “I recently treated a 39-year-old who had two stents,” she says, referring to a wire-mesh tube used to open a blocked artery. “It happens more often than most people realize.” If a patient has no knowledge of her family history with respect to heart health, the American Heart Association considers the woman at risk, simply because of unanswered questions. “How do we know whether one of our older or more distant relatives had heart disease?” Dr. Mays asks. “Or perhaps you’re adopted and don’t know your birth parents’ health histories. We can never know for sure.”

4 Know your numbers.
This has to be an easy one: high cholesterol is bad, low good, right? Actually, the total cholesterol count isn’t deemed to mean much anymore. “You have to know the goals for each part of the cholesterol panel to understand your risk,” Dr. Mays says. For women, the level of HDL (high-density lipoprotein, or “good” cholesterol) should be 50 or higher; the level of LDL (low-density lipoprotein, or “bad” cholesterol) should be less than 100; and the level of triglycerides (the fats) should be less than 100 — or at least below 150. “I’ve had patients with a total of 300 who are perfectly healthy because their HDL is over 100, but others who are at 150 and in bad shape,” says Dr. Mays, who advises women to monitor their blood pressure and blood sugar levels in conjunction with regular doctor visits. “We know a great deal about what increases risk for heart disease; managing those known risk factors can absolutely change your life.”

5 Alcohol is alcohol is alcohol.
Finally, some positive news: people who consume one alcoholic drink per day appear to suffer from heart disease less often than people who don’t. “We don’t really know why,” Dr. Mays says. “We just know that they do better!” And contrary to popular belief, the alcoholic beverage doesn’t have to be red wine. Any alcohol is fine, as long as the drink doesn’t exceed one serving (5 ounces of wine, 12 ounces of beer, or 1.5 ounces of hard alcohol). If one drink always turns into four, however, “that’s definitely not good,” says Dr. Mays. “We don’t want to promote drinking too much as a healthy habit.”

6 Sit-ups could save your life.
That punishing abs class may very well reward you beyond bikini season. A reduction in belly fat directly cuts women’s risk for diabetes. “This is significant because diabetes erases all protection from heart disease in women,” Dr. Rinkevich says. “Recently, we’ve seen declines in heart disease mortality in nearly all populations except in women with diabetes.” More than nine million women in the United States suffer from Type 2 diabetes, a late-onset disease caused primarily by poor diet and obesity. In a typical scenario, the fat cells centered in the belly block the action of insulin, which is necessary to lower blood sugar — and improperly regulated blood sugar can lead to heart disease. The apparent effects are striking, according to Dr. Rinkevich. “In fact, a 23% increase in mortality was observed in women with diabetes in the last few years, compared to a 27% decrease for nondiabetic women,” she says. So get crunching!

7 Treatments are not one-size-fits-all.
Unlike treatments for cancer, which usually incorporate chemotherapy and radiation, heart disease treatments can run the gamut. To narrow the field of possibilities, Dr. Mays asks herself an important first question about each patient: What in this person specifically led to heart disease? “Is she a smoker? Is there a genetic link? Is it high ‘bad’ cholesterol or low ‘good’ cholesterol?” she says. “A doctor who isn’t asking these questions probably isn’t a good fit.” If a heart disease patient smokes, she must quit immediately. Patients with high blood pressure and high cholesterol are often put on a statin drug, such as Lipitor, and advised to eat foods low in saturated fats. And those struggling with obesity are encouraged to start exercising as soon as they are able, or at the very least, to become more active. “Every woman is different,” says Dr. Mays. “So be sure you are working with a doctor who respects that your case is truly unique.”

8 Screen, test, prevent. (Repeat.)
We can’t change our family history or our age (if only!), but with the help of early testing, we can seek to control many of the factors that contribute to heart disease. Dr. Mays, who specializes in preventive cardiology, says there are dozens of tests that women who are experiencing symptoms can undergo to gauge their cardiac health. These include noninvasive procedures such as an exercise stress test, a resting electrocardiogram (EKG or ECG), magnetic resonance imaging (MRI), or an echocardiogram. She also suggests the lipoprotein (a) test, which measures the level of a dangerous type of inherited LDL. “As funny as this sounds, I want to keep people away from cardiologists as much as I can,” says Dr. Mays. “Testing women and determining risk while they’re still relatively healthy is more important than they know.”

For more information about preventing heart disease, call the OHSU Women’s Heart Program at 503-494-1775.