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Heart Disease & Women, Heart Attack Causes, Risks, Tests - LDL/ HDL Cholesterol - Irregular Heart Beats, PVCs and Electrocardiogram

Heart Disease and Women

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Heart Disease & Women

Do women need to worry about heart disease?
Heart disease is the number one killer of American women, so heart disease is definitely a woman's concern. One in ten American women 45 to 64 years of age has some form of heart disease, and this increases to one in five women over 65. Coronary heart disease is a disease of the blood vessels of the heart that causes heart attacks.

Post-reproductive age women are most at risk
Cardiovascular disease is the leading cause of death for both men and women in the United States. The risk for women significantly increases after menopause.

  • Cardiovascular diseases claim more female lives every year than the next 16 causes of death combined, and almost twice as many as all forms of cancer.
  • More than 250,000 women each year die of coronary heart disease.
  • This compares to 46,000 deaths from breast cancer.
  • Pre-menopausal women are also at risk for cardiovascular disease if they have cardiac risk factors such as smoking, hypertension, diabetes, elevated cholesterol and family history of premature cardiovascular disease.
  • Cardiovascular disease increases as we age, particularly after the menopause.

How do I know if I have heart disease? Are there medical tests to alert me? 
Cardiovascular disease can be silent but usually has symptoms.

  • Lack of blood flow to the heart muscle can cause symptoms of chest discomfort, shortness of breath, fatigue and sometimes palpitations and dizziness.
  • Talking to your doctor about your symptoms, along with good routine follow-up care are necessary first steps to determine if any further evaluation is necessary.
  • Many cardiac risk factors can be controlled, modified or eliminated, including hypertension, diabetes, elevated cholesterol, smoking and obesity/physical inactivity.

I had my lipid (fat) levels checked but I do not understand the results. What do they mean?

  • A person's blood lipid analysis is determined to some degree by diet and genetic factors.
  • A routine fasting blood lipid analysis provides a measure of three things: total cholesterol, HDL-cholesterol (good cholesterol), LDL-cholesterol (bad cholesterol), and triglycerides.
  • Increases in all but the good HDL-cholesterol have been shown to increase the risk of heart disease. In fact, a low HDL-cholesterol level is also a cardiac risk factor.
  • The results of the blood lipid analysis will determine if it is necessary to take a cholesterol lowering medication and follow a low fat, low cholesterol diet.
  • Practice guidelines to manage cholesterol levels are set by the National Cholesterol Education Panel (NIH). You should discuss the results of your blood tests with your doctor to determine what it means for your health and risk of heart disease.

I read that women show different signs than men do prior to a heart attack. What can I do to make sure the emergency room treats me correctly? 
Nearly 90% of women with a heart attack will have chest pain the same as men. Historically, however, chest pain has not been perceived to be of great prognostic value in women, or a great clue that heart disease is really present. Chest pain can have different origins and women can experience uncharacteristic features of cardiac chest discomfort. The likelihood of chest pain coming from the heart depends to a great extent on the person's particular cardiac risk profile. For example, a pre-menopausal women who smokes is as likely to have cardiac chest pain as a postmenopausal woman with hypertension. All chest discomfort in women must be taken seriously and evaluated for its source, whether cardiac or otherwise. One should not wait to seek medical attention if there are symptoms of chest discomfort with or without physical exertion. Some studies have shown that women who tell their doctors about chest pain are not treated as aggressively as are men. Women who are not satisfied with a physicians evaluation of their chest discomfort should be persistent and seek another opinion. 

How much difference can diet and exercise REALLY have on the health of my heart? 
Following a low fat, low cholesterol diet and exercise are excellent health habits for all to follow.

  • It helps lower one's blood lipid analysis, blood pressure and blood sugar. These are all factors that contribute to the development of arteriosclerosis (hardening and blockage of the blood vessels).
  • Studies have shown that increasing levels of leisure-time physical activity are associated with decreased risks of coronary heart disease.
  • Physically active women have an approximate 60-75% lower risk of heart disease than sedentary women. Physical activity includes such activities as daily walking, climbing stairs, gardening etc.
  • Unfortunately, over 50% of all women in the U.S. are physically inactive.

I have a friend who is 38 years old. She has irregular heart beats or PVCs. Her doctor said that a woman's system changes as she enters menopause and can result in PVCs. Are they dangerous? Can you explain PVCs and menopause? 
A 38 year old woman who experiences irregular heart beats or "PVCs" (premature ventricular contractions) may have extra beats which are relatively harmless or it may be a sign of some form of heart disease.

  • If a woman has palpitations (the sensation of fast and/or irregular heart beat) or other symptoms such as dizziness or shortness of breath, she should inform her doctor.
  • Your doctor can take a careful history and perform a physical exam.
  • In some cases, further testing of your heart may be necessary to determine the specific heart rhythm that may be causing the sensation of palpitations.
  • In some individuals, caffeine products, alcohol and stress can provoke extra beats.
  • Menopause alone does not predispose a woman to palpitations unless she has other medical conditions/or cardiac risk factors that could lead to heart disease.
  • However, menopause creates an estrogen deficient state that poses a risk to the cardiovascular system. This is because estrogens have a number of properties that protect the blood vessels and lowers LDL-cholesterol levels, while raising the HDL-cholesterol.

What are the biggest factors which increase my chances for heart disease?
The three biggest risk factors for cardiovascular disease that you can do something about are:

  • Cigarette smoking
  • High blood pressure
  • High blood cholesterol

Other risk factors
Other risk factors, such as overweight and diabetes, also are conditions you have some control over. Even just one risk factor will raise your chances of having heart-related problems. But the more risk factors you have, the more likely you are to develop cardiovascular diseases.

  • Various studies show that physical inactivity is a risk factor for heart disease. Heart disease is almost twice as likely to develop in inactive people as in those more active.
  • Excess body weight in women is linked with coronary heart disease, stroke, congestive heart failure, and death from heart-related causes.
  • The more overweight you are, the higher your risk for heart disease.
  • Diabetes, or high blood sugar, is a serious disorder that raises the risk of coronary heart disease. The risk of death from heart disease is about three times higher in women with diabetes.
  • Diabetic women also are more apt to have high blood pressure and high blood cholesterol.
  • The risk of heart attack or stroke is higher for women who both smoke and use high-dose birth control pills (oral contraceptives).

How can I reduce my risk of heart disease?
Regular physical activity can help you reduce your risk of coronary heart disease. Being active helps women take off extra pounds, helps to control blood pressure, lessens a diabetic's need for insulin, and boosts the level of "good" HDL-cholesterol.

General recommendations to avoid heart disease

  • Quit smoking
  • Cut back on foods high in fat, saturated fat, and cholesterol
  • Check blood pressure and cholesterol levels
  • Get more exercise
  • Lose weight if you are overweight

What are the main tests for coronary heart disease?
Diagnostic tests are usually needed to confirm the presence and assess the severity of coronary heart disease. Often, more than one test is needed because different tests supply different information. Also, patients vary in their symptoms and may need more than one test to find out the heart’s condition. The primary tests used to diagnose heart disease are described below. Many are not invasive procedures -- they are done outside the body, and are painless. 

These tests include:

  • Electrocardiogram (ECG or EKG) makes a graphic record of the heart’s electrical activity as it beats. This can show abnormal heartbeats, muscle damage, blood flow problems, and heart enlargement.
  • Stress test (or treadmill test or exercise ECG) records the ECG during exercise, usually on a treadmill or exercise bicycle. Some heart problems show up only when more effort is asked of the heart, as happens during increased activity. So the exercise ECG may be done even if the resting ECG is normal.
  • Other exercise tests may be done with an ECG or a nuclear scan to assess heart muscle concentration or blood flow in the heart. Older women may not be able to exercise due to arthritis, osteoporosis or another condition. For them, a stress test can be done without exercise by using a medication that increases blood flow. 

    Note: Different standards exist for reading the EKG in women as compared to men. Make sure your doctor knows them.

What is the connection between hormone replacement therapy (HRT) and heart disease?
Hormone replacement therapy - a term for prescription hormone pills that are taken daily - can be used to relieve the symptoms of menopause. Some women are prescribed pills that contain only estrogen (oestrogen). A woman with a uterus may take estrogen combined with a second hormone called progestin (progestogen).

Estrogen
Estrogen pills have several important benefits. They can help you feel more comfortable as your body adjusts to lower estrogen levels by decreasing hot flashes, night sweats, or vaginal dryness. They also help to prevent osteoporosis, a thinning of the bones that makes them more likely to break. Many studies also have found that estrogen pills help protect women from developing coronary heart disease, but more research is needed before we will know this for sure. 

Possible estrogen risks
Estrogen therapy also has risks. It may increase the chances of developing gallbladder disease, and it may worsen migraine headaches. It may also increase the risk of breast cancer. But by far, the biggest risk of taking estrogen pills is cancer of the uterus, but this risk is greatly decreased by taking progestin, another hormone. Finally, we don't yet know whether this combination will boost the risk of breast cancer. Studies are now under way to find answers to these important questions. There are also some studies which show that estrogen may decrease the chance of developing or decrease the severity of Alzheimer’s disease.

Benefits versus risks
In the meantime, a woman and her doctor must decide whether the benefits of hormone therapy are worth the risks. If you are considering this treatment, you will need to consider your overall health and your personal and family history of heart disease, uterine and breast cancer, and osteoporosis. 

Check ups and self-tests
If you are now on hormone therapy, check with your doctor to be sure you are taking the lowest possible effective dose.

  • At least every 6 months, you and your doctor should discuss whether you need to continue treatment.
  • Be alert for signs of trouble - abnormal bleeding, breast lumps, shortness of breath, dizziness, severe headaches, pain in your calves or chest - and report them immediately.
  • See your doctor at least once a year for a physical examination.

Acknowledgments
Material excerpted from the National Heart, Lung, and Blood Institute’s pamphlet, Women and Heart Disease, the NHLBI’s The Healthy Heart Handbook for Women and the Office on Women's Health in the Department of Health and Human Services Heart Disease and Stroke in Women: the facts.


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