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Heart Risk Assessment

 

Women and Heart Disease

 

Heart disease is the leading cause of death in women.

Adapted in part from an educational program developed by The Preventive Cardiovascular Nurses Association Why is knowledge of heart disease so important?

Here are the facts:

  • More than 500,000 women die annually from cardiovascular disease, more than from cancer, lung disease, osteoporotic fractures, AIDS and accidents combined.
  • Today, there are 50 million American women in the US who are over the age of 50, so we can anticipate these numbers will continue to increase.
  • Eight million women are living with heart disease.
  • Women are not aware of the symptoms of heart disease and how these may differ between women and men.
  • Women need to be aware of the importance of “knowing your numbers” – cholesterol, blood pressure, body mass index and blood sugar.

Now is the time for women to engage their primary healthcare providers in a dialogue about heart health.

Are you aware?

Since 1997, the percentage of women who know that heart disease is the leading cause of death among women has increased. Caucasian women are most aware; African-American women have become more aware, but awareness among Hispanic women remains unchanged. Yet 51% of all the women surveyed still think their greatest health problem is breast cancer – Wrong!

Healthcare professionals also may be unaware

  • A 2003 survey indicated only 38% of women have discussed heart health with their healthcare provider.
  • The one-year death rate for men following a heart attack is 25%, for women it is 38%; only part of this gap can be explained by age
  • Recommended treatments for heart disease
    • Aspirin
    • Referrals to cardiac rehab programs
    • Cholesterol-lowering medicines are less likely to be used in women.

“… The medical community has viewed women’s health almost with a ‘bikini’ approach, looking essentially at the breast and reproductive system, and almost ignoring the rest of the woman as part of women’s health.” Nanette Wenger, MD Chief of Cardiology, Grady Hospital Professor of Medicine, Emory University

What can you do?

  • Seek medical advice for warning signs.
  • Act promptly with acute symptoms.
  • Seek information related to your own risk level.
  • Make appropriate modifications in lifestyle to reduce your risk.

Symptoms of heart attack require immediate action!

  • Common symptoms may include
  • uncomfortable pressure, fullness, burning or squeezing sensation in the chest
  • shortness of breath
  • nausea, vomiting, dizziness, sweating
  • Symptoms can vary greatly and may be different in women than me
  • You know your body – trust your instincts

Differences in Heart Attack Symptoms

Men

  • Sub-sternal chest pain or pressure
  • Rest pain
  • Pain down left arm and shoulder
  • Weakness

Women

  • Pain in chest, upper back, jaw or neck
  • Shortness of breath
  • Flu-like symptoms: nausea or vomiting, cold sweats
  • Fatigue or weakness
  • Feelings of anxiety, loss of appetite, malaise

What are your risk factors for heart disease?

Things you cannot change

  • Age
  • Family history
  • Gender

Things you can change

  • Physical inactivity
  • Psychosocial factors
  • High blood pressure
  • Obesity
  • Diabetes
  • High cholesterol and triglycerides, low HDL

What can you do to reduce your risk?

1. Stop Using Tobacco!

  • Female smokers have 2-6 times the risk of sudden cardiac death than non smokers. The risk is higher for heavy smokers.
  • Second-hand smoke increases cardiac risk.
  • The health benefits of quitting smoking begin immediately.
  • Many people who quit smoking successfully first tried and failed many times.
  • Call your local hospital or lung association and ask about low cost or free programs to help you or someone you care about stop smoking.

2. Avoid Developing/Aggressively Treat Type 2 Diabetes

  • Type 2 diabetes has increased 50% in the last 10 years.
  • 2 of 3 persons with diabetes die of cardiovascular disease.
  • Diabetes increases a woman’s risk of heart disease 3-7 times (2-3 times in men).
  • Diabetes markedly reduces the success rate when a woman undergoes bypass surgery or balloon angioplasty procedures.
  • Type 2 diabetes can be prevented by improving diet and physical activity levels.
  • People at risk for diabetes that follow a diet and exercise plan (with only a modest weight loss) can decrease their risk of developing diabetes by almost 50%.
  • People with diabetes should be treated as aggressively as those with known heart disease.

3. Avoid/Aggressively Treat the Metabolic Syndrome

  • Certain “risk factors” for heart disease tend to cluster together and markedly increase your risk:
    • overweight, especially when carried around the waist
    • high blood pressure
    • cholesterol abnormalities (low HDL and high triglycerides)
    • elevated blood glucose
  • People with these risk factors need to be treated very aggressively for heart disease prevention: lifestyle changes are key!

4. The Blood Lipid Profile – Know Your Numbers

  • Total Cholesterol Goal: < 200 mg/dL
  • Low Density Lipoprotein Cholesterol or LDL Goal: < 100 mg/dL
  • Triglycerides Goal: < 150 mg/dL
  • High Density Lipoprotein Cholesterol (HDL) > 40 mg/dL for men, > 50 mg/dL for women

5.Get Treated if You Have an Undesirable Lipid Profile

  • LDL cholesterol is the main target of treatment
  • Second focus is triglyceride/HDL
  • Lifestyle is the key:
    • dietary changes
    • exercise
    • weight loss
  • Depending on level of risk, medication may be initiated along with diet.

6. Know Your Blood Pressure

  • OPTIMAL: <120 systolic (SBP) and <80 diastolic
  • PREHYPERTENSION: 120-139 systolic or 80-89 diastolic
  • STAGE 1 HYPERTENSION: 140-159 systolic or 90-99 diastolic
  • STAGE 2 HYPERTENSION: >160 systolic or >100 diastolic

7. Make Lifestyle Changes that Affect High Blood Pressure

  • Lose weight (decreases SBP 1.5 mm Hg for every 2lbs lost)
  • Dietary Approaches to Stop Hypertension: DASH diet:
  • (decreases SBP 8-14 mmHg)
  • Reduce salt in the diet (decreases SBP 2-8 mmHg)
  • Engage in 30-45 minutes aerobic exercise per day
  • (decreases SBP 4-9 mmHg)
  • Limit alcohol (decreases SBP 2-4 mm Hg)
  • Avoid tobacco products

8. Avoid Obesity

  • Obesity is a growing epidemic in U.S.
  • Increases risk of: high blood pressure, cholesterol abnormalities, and Type 2 diabetes
  • Current focus is on taking small steps: small changes in dietary patterns and increasing “incidental” exercise
  • Visit www.smallstep.gov for information about Small Steps you can take, such as:
    • choose fat free over whole milk
    • park further from the store and walk
    • share an entrée
    • walk to a co-worker’s desk instead of e-mailing

9. Don’t Rely on Hormone Replacement

  • Postmenopausal HT is no longer recommended as a strategy to prevent heart disease.
  • Hormone therapy, generally short term, may still be used to treat symptoms of menopause - this is a decision between a woman and her healthcare provider.

Where does exercise fit in?

  • EVERYWHERE!
  • Exercise helps lower blood pressure.
  • Exercise helps prevent diabetes.
  • Exercise helps raise HDL (good cholesterol).
  • Exercise helps weight management.
  • Exercise helps manage stress.
  • Exercise helps bone health.

In summary . . .

  • Know the symptoms of heart disease.
  • Know your risk factors for heart disease.
  • Visit your healthcare provider:
  • Discuss your risk factors
  • Ask questions about your heart tests
  • Maintain a healthy lifestyle.
  • Remember that heart disease is largely preventable.

Other Information Sources