Take it to Heart!

Since the media places so much emphasis on reporting about breast cancer, many women may not realize that they are at greater risk of dying from heart disease.
Did you know that heart disease is the leading cause of death in women? It results in twice as many deaths in the US than all types of cancers combined, including breast cancer.
Another important factor to be aware of is that heart disease can be difficult to diagnose in women and symptoms can often present up to 10 years later and it doesn’t always present the same way that it does in men.

Some basic facts:
Heart or cardiovascular disease affects the blood vessels that deliver blood and oxygen to the heart muscle. HDL (which is known as the good cholesterol) helps to control the amount of LDL (which is referred to as the bad cholesterol) in the blood. If extra LDL builds up in the arteries the body’s immune system recognizes LDL as something foreign and an inflammatory reaction takes place. White blood cells are released and gobble up the LDL fat. The white blood cells then get stuck to the walls of the arteries which starts another inflammatory reaction which produces fibrous material that coats the white blood cells. This is called atherosclerotic plaque. The plaque causes narrowing of the arteries which can decrease the amount of blood flow to the heart and results in chest pain or angina.

What causes blocked arteries?
There are two ways that arteries can get blocked. Plaque can build up inside a coronary artery causing severe narrowing and decreased oxygen and nutrient delivery to the heart. The second way is plaque rupturing under pressure and breaking off. A blood clot develops over the ruptured plaque and then blocks the coronary artery.
The above was discovered while conducting research primarily in men. As it happens, there is a third way that plaque can cause heart attacks and was discovered in women.

Finding blocked arteries:
Traditionally noninvasive stress tests would be performed to determine whether the heart is getting enough blood or not. If the test was positive, then the patient would go on to have a coronary angiogram which would show where the blockage was in the heart. Once the blockage was identified, coronary angioplasty, stenting or a bypass would be performed.

Coronary microvascular dysfunction:
It has been determined that approximately 30% of women with angina have normal angiograms. In the past these women were told that their symptoms were nothing to worry about. More recent research has revealed that they have what is known as, coronary microvascular dysfunction which is not picked up with standard tests. Microvascular means that smaller blood vessels are affected and are not seen as easily on traditional angiograms. Microvascular disease can be the reason for fatigue, shortness of breath and generalized chest discomfort in some women.
It is thought to be more common in women because women have smaller blood vessels and an increased inflammation.
As previously mentioned, inflammation results in plaque formation which causes diffuse narrowing and stiffening of the smaller blood vessels. The vessels which normally open up are unable to do so which results in decreased blood and oxygen supply. The microvascular plaque also triggers the inflammatory cycle which results in many tiny blood clots, further narrowing and heart attacks in women.

Which ethnic groups are at higher risk?
Native Americans, African-Americans, Mexican Americans and native Hawaiians are more likely to develop heart disease than Caucasians with European ancestry.

Other risk factors:
Smoking and family history are other risk factors. If you have a mother or sister who was diagnosed with heart disease before age 65, a father or brother who had heart disease before age 55 you should get checked.
Postmenopausal women are at greater risk because of the decreased amounts of circulating estrogen and its protective effects.
Diabetics have as high a risk as people who have already had a heart attack. It is estimated that 65 % of diabetics will die from some type of heart disease.

Some helpful blood tests:
See your doctor and ask him or her if you need your HDL, LDL levels, blood pressure and glucose levels checked.
If you can’t reduce your cholesterol/LDL levels and blood pressure with diet and exercise, then inquire about which medications can help.

Other tests to ask about:
C reactive protein (CRP) is a blood test which determines the degree of inflammation in your body and is used to follow diseases such as rheumatoid arthritis, lupus and pneumonia.
A test known as hsCRP is more specific for blood vessel inflammation. People with higher levels are twice as likely to develop heart disease. Accepted guidelines are still being developed for the interpretation of hsCRP levels. Currently levels below 1 mg/dL are considered low risk, 1-3 mg/dL average risk and over 3 mg/dL high risk.

Here’s what you can do to reduce your risk of heart disease:
Start exercising
Walk instead of driving. Participate in yoga or pilates classes. Health and Human Services recommends that adults exercise for at least 2 1/2 hours per week at a moderate pace. This would be the same as walking 3 to 5 mph. Or 1 hour and 30 minutes of higher intensity activity such as dancing, swimming or jogging. Strengthening exercises should be done twice a week.
Maintain your ideal weight
Eat fresh vegetables, fresh fruit, fish, chicken and occasionally meat. Reduce your carbohydrate and sugar intake. Eat whole grains and fiber.
Ask your doctor to check your blood pressure, cholesterol, blood count (for anemia) and blood sugar.

And most important of all, quit smoking!! Within one year of quitting smoking, the risk of death related to heart disease is cut in half and after 15 years it is almost zero.

References: National Heart, Lung and Blood Institute and National Womens Health Information Center and Institute on Aging.

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