Women at high risk for heart disease

HEART disease is “ageless.”  Whatever a woman’s age, she needs to take action to protect her heart health. Coronary heart disease is the most common form of heart disease.  Often referred to simply as “heart disease,” it develops over time and can start as early as the teenage years.  During mid-life, a woman’s risk for heart disease starts to rise dramatically.  In part, this is because a woman’s body stops producing estrogen. Also, mid-life is a time when women tend to develop factors that increase their risk for heart disease.

Heart disease doesn’t stop developing either — unless treated, it continues to worsen.  Medical experts say one in 14 women aged 45-64 has heart disease, and this increases to one in seven for women over age 65.  But it’s never too late to take steps against heart disease.  By taking action, older women and especially those who already have heart disease can reduce their risk of  developing heart-related problems. Often, making lifestyle changes is all that’s needed.  In fact, women can lower their heart disease risk by as much as 82 percent just by leading a healthy lifestyle.  So, whatever your age, start taking steps to improve your heart health.

Here’s more about how heart disease and its risk factors can affect women of every age:

Young Women
-  Lifestyle-related factors that increase heart disease risk are increasingly common among girls, teenagers, and young adults.
- Physical activity levels drop sharply as girls become teenagers, and about 14 percent of young women are physically inactive.
- Almost 15 percent of girls ages 6-19 are overweight.
- About 30 percent of girls in grades 9-12 reported using tobacco in 2001; about 80 percent of smokers begin before age 18.

Middle-Aged Women
• At menopause, a woman’s heart disease risk starts to increase significantly.
• Each year, about 88,000 women ages 45-64 have a heart attack.
• About half of women who have a heart attack before age 65 die within eight years.
• Heart disease rates are two to three  times higher for postmenopausal women than for those of the same age who have not yet undergone menopause.
• Postmenopausal hormone therapy, with estrogen alone or with progestin - once thought to lower risk — is not recommended for long-term use to prevent heart disease. It is now even more vital that women take other steps to reduce their heart disease risk.
• The lifetime risk of developing high blood pressure for women aged 55 is about 90 per cent.
• Beginning at age 45, more women than men have a total cholesterol over 200 md/dL — borderline high or higher.

Older Women
• About 24 million women aged 60 and older have high blood pressure.
• Most women over age 65 have obvious heart disease or “silent” atherosclerosis (“hardening of the arteries”). In silent atherosclerosis, there are no symptoms but fatty plaques have built up in arteries.  Lowering cholesterol is especially important to keep heart disease and atherosclerosis from worsening.
• Each year, about 372,000 women aged 65 and older have a heart attack.
• The average age for women to have a first heart attack is about 70-and women are more likely than men to die within a few weeks of a heart attack.
     
For Women with Heart Disease
• Heart disease has no quick fix-even if a special procedure, such as an angioplasty, is performed, heart disease will worsen unless treated with lifestyle changes and medication.
• About 35 percent of women who have had a heart attack will have another within six years.
• About half of women who have a heart attack will be disabled with heart failure within six years.  Heart failure is a life-threatening condition  in which the heart cannot pump enough blood to supply the body’s needs.

FACTORS THAT INCREASE WOMEN’S HEART DISEASE RISK
Those beyond your control:
- Family history of early heart disease
- Being 55 or older

Those you can take action against:
- Smoking
• High blood pressure-about 25 percent of women have hypertension, the condition’s medical name; uncontrolled high blood pressure can lead to heart failure.
• High blood
• Overweight/obesity — about 62 percent of women are overweight, including about 33 percent who are obese
• Physical inactivity — more women than men are physically inactive, with more than 25 percent of women engaging in no leisure-time physical activity and more than 60 per cent of women do not meet the recommended amount of at least 30 minutes a day of moderately intense physical activity, such as brisk walking
• Diabetes

Some heart healthy advice

WHAT CAN women do to prevent coronary artery disease?
In response to these concerns, the American Heart Association recently published specific guidelines for preventing and treating coronary artery disease in women. These guidelines address lifestyle changes, medications and supplements, and hormone therapy in menopausal women.
Ask your doctor which recommendations are appropriate for you.

Lifestyle changes
- Stop smoking, and avoid secondhand smoke.
- Do at least 30 minutes of moderate-intensity activity, such as brisk walking, on most days of the week.
- Eat a heart-healthy diet and limit saturated fat to less than ten percent of calories, cholesterol intake to less than 300 mg, and avoid trans fats.
- Keep your body mass index (BMI) between 18.5 and 24.9 and your waist circumference less than 35 inches.
- If you have coronary artery disease, be evaluated for depression.
- If you drink, do so in moderation (an average of one drink per day for women). If you do not drink, don’t start.
- Adopt the DASH (Dietary Approaches to Stop Hypertension) eating plan, and reduce daily salt intake if you have high blood pressure.

Medications
- When high blood pressure (140/90 mm Hg or higher) cannot be controlled with lifestyle approaches, consider medications to control it.
- Lipid-lowering medication (usually statins) and lifestyle changes are recommended for women at intermediate to high risk of coronary artery disease.
- Women with diabetes should keep their haemoglobin level at less than seven percent.
- Daily, low-dose aspirin is recommended for most women who are at intermediate to high risk of coronary artery disease. The routine use of  low-dose aspirin in women at low risk of coronary artery disease is not  recommended.
- Beta-blocker medications, which slow heart rate and reduce the workload on the heart, are recommended for women who have had a heart attack or those who have chronic chest pain — Angiotensin-converting enzyme (ACE) inhibitor medications, which lower blood pressure and reduce the workload on the heart, should be used by most women at high risk for coronary artery disease.
- Angiotensin II receptor blocker (ARB) medications, which also lower blood pressure and reduce the workload on the heart, should be used by high-risk women with heart failure who cannot take ACE inhibitors.

Hormone therapy
- Combined estrogen plus progestin (HRT) or estrogen-only hormone therapy (ERT) should not be taken solely to prevent coronary artery disease in postmenopausal women. Although hormone therapy is not recommended for coronary artery disease prevention, some women may take it for relief from menopausal symptoms. Most doctors recommend that you carefully weigh the benefits against the risks of taking hormone therapy before considering it.