Often unfortunately overlooked in women’s preventive health care is the large role of heart and blood vessel disease. Women are accustomed to thinking of themselves as relatively protected against heart trouble by their estrogens. It is true that in the first 5 decades of life a woman has far less chance of having a heart attack than a man her age. But by age 60, women catch up with men their age and have exactly the same chance of a heart attack.

Unfortunately for those women (and their families!) who do have a heart attack, the chance of surviving and even of surviving without a residual of disability is far poorer than for a man. There is lots of debate as to why this is true but theories include that some women with heart attacks are being hurt by spasm of the walls of arteries. Another scientific observation is that the fatty plaque that builds up inside arterial walls in women with heart disease is more evenly distributed than is true in men. This may make it harder to successfully run a bypass graft around a local area of blockage. And it may make it harder to use a tiny catheter balloon to open up a small area of blockage and to put a mesh tube called a stent into the narrowed area of the artery to keep it open.

Women are often to have a different symptom picture from their heart disease than is true of men. The typical man experiences angina (heart pain) in the central part of the chest under the sternum bone. Women often don’t feel discomfort in that spot but may instead feel pain off to the side or up into the neck or even shoulder. Some women just notice extra heartburn or burping and assume that the stomach or esophagus is acting up when the heart is the real problem.

Diabetes, which is more common in women than men, is particularly hard on the heart. Most cardiologists now consider diabetes in a patient to be the equivalent of having had a heart attack already. The sugar fluctuations, inflammatory changes in blood vessels, and skewing of the cholesterol and triglyceride patterns associated with diabetes causes stiffening and narrowing of the arteries including those that supply the heart.

More and more women are being found to have Polycystic Ovary Disease and/or Metabolic Syndrome. Both of these conditions are often associated with blood fat patterns that cause atherosclerosis (hardening of the arteries). Tight control of sugars and insulin levels along with improvement in blood lipid (fat and triglyceride) patterns is extremely important in preventing these patients from severe cardiac disease.

Smoking, which has increased in young women in recent decades, has a bad impact on the heart. This is especially true as the estrogen level falls near menopause. And women who have had their ovaries removed and smoke are at particularly high risk.

So, what can be done to protect your heart? Start with healthy life style: exercise regularly and keep weight under control. Exercises that use your large body muscles like the thighs and gluts are very helpful in building up good cholesterol (HDL). Get regular blood pressure checks and correct an elevated pressure. Avoid or cease smoking. Eat foods with low saturated fats, low transfats, very low in high fructose corn syrup, and low glycemic index (foods not prone to shoot your sugar way up – melons, grapes and peaches for instance shoot sugar through the roof). Include almonds in your diet; these are good for the cholesterol. Walnuts are especially helpful in building up your good HDL cholesterol and in lowering the inflammation in the body that makes the artery lining prone to attract cholesterol plaque. Red wine (and to a lesser extent grape juice and white wine) and especially port (all taken in moderation) are helpful in building up good cholesterol. The ingredient in these beverages that helps cholesterol is available in much more concentrated and nonalcoholic form as Resveretrol, available as a liquid food supplement but hard to find-try Sam’s. If you know that your cholesterol profile is not ideal, eating oat meal and taking fish oil or Omega 3 or DHA or EPA or krill oil supplements (all basically help in the same ways) can improve the fat pattern and help your health.

If your blood lipid pattern fails to improve with diet and exercise and the above supplements there are presciption medications that can improve the pattern and protect your heart. These include ‘Statin’ drugs like Zocor, Lipitor, Crestor. Other types of prescription medications include long lasting versions of Niacin (a B vitamin) and Zetia (which blocks dietary absorption of fats) and pharmaceutical grade Omega 3 products.

It is wise if you’re over 40, and probably even at a younger age, to check cholesterol at least every couple years. Ideally this would be a test that breaks down the blood fats into their types, both good and bad.

For people with a strong family history of heart disease or a high personal concern, some screening tests include the EBT (also known as ‘Calcium Score’ of the heart) test, available through cardiology offices. Even more sophisticated is 64 slice CT imaging of the heart, also available through certain cardiology offices.
Women should keep alert for possible heart related symptoms and seek urgent, prompt evaluation if they suspect a problem. Delay could be very costly.

Virginia Physicians for Women encourages you to take your heart health to heart, to do screening and preventive measures so that you will never face a day when you really have a heart attack. We will be happy to do cholesterol screening for you at your visit with us and to discuss individual programs to help keep you healthy and vigorous, able to do the things you want to do, able to ‘be there’ for your family!

John R. Partridge, M.D., F.A.C.O.G.