What is coronary artery disease (CAD)? Coronary artery disease is the process of atherosclerosis or plaque build-up in the arteries that supply blood to the heart muscle. With exertion there is insufficient blood flow to the heart muscle producing chest pain or angina.
How are women different from men when it comes to heart disease? The heart and arteries in women are smaller. Hormonal changes throughout life affect the cardiovascular system in unique ways. Women most often present with atypical symptoms. On average, women tend to present about ten years later than men with heart disease. Women are more likely to die from a heart attack than men.
The higher death rate in women vs. men after a heart attack is alarming. The reason appears to be because women have atypical symptoms . This can lead to misdiagnosis by healthcare professionals. Often patients will ignore the symptoms themselves or present much later for a medical evaluation. Typical symptoms of angina are chest pressure, shortness of breath and pain in the left arm. Atypical symptoms are fatigue, throat tightness, jaw pain, back pain, nausea and dizziness. These latter symptoms are much later in women.
How to make a diagnosis of heart disease? There are a variety of tests that can be helpful. Some include EKG, Echocardiogram, Stress testing (stress test, stress echocardiogram and nuclear stress test), CT scan of the heart and heart catheterization. It is also important to have the blood pressure, weight, glucose and cholesterol checked regularly.
The development of heart disease is multi-factorial. We must recognize which ones are within our power to change and develop a game plan to do so.
Risk factors for cardiovascular disease that are non-modifiable include:
- advanced age
- postmenopausal status (Women are postmenopausal about a third of their lives.)
- positive family history of heart disease
Risk factors for heart disease that are modifiable are:
- abnormal cholesterol levels
- physical inactivity
Complete smoking cessation is recommended for all women. Counseling and drug therapy have both been shown to be effective. However, for any smoking cessation program to be successful, the smoker must be motivated to quit. Avoidance of passive or second-hand smoking is important as well.
Blood pressure should be maintained at less than 140/90. Ideal blood pressure is less than 120/80. Anything between 120-140/80-90 is considered pre-hypertension. Medications are often needed to lower the blood pressure to the target range. Avoiding excessive caffeine intake, limiting alcohol usage, following a low-sodium diet, exercising regularly, maintaining an ideal body weight and limiting certain medications such as decongestants can assist in lowering the blood pressure as well. Remember that high blood pressure may be completely asymptomatic and requires periodic monitoring.
Diabetes is considered to be an independent risk factor for heart disease. All women with diabetes need frequent follow up with their physicians approximately every three months. Goals for treatment include maintaining blood glucose in an acceptable range, Hba1c (three month average blood sugar) < 7%, LDL or bad cholesterol < 70mg/dl and triglycerides < 150 mg/dl.
Following a heart healthy diet is recommended for everyone. Further restriction of dietary fats and drug therapy are considered depending on the lipid levels and cardiovascular risk factors. Generally, goals are total cholesterol < 200, HDL or good cholesterol >50, LDL or bad cholesterol optimally Maintaining an ideal body weight is recommended. The goal is BMI or body mass index between 18.5-24.9 kg/m2. For women with BMI’s between 25-34.9, the waist circumference should be less than 35 inches.
Nutrition guidelines include a well-balanced, low-fat/ high-fiber diet. Reduced sodium options are generally better. Five servings of fruits and vegetables are recommended on a daily basis. The DASH diet is a good example to follow. Alcohol intake for women should be limited to no more than one glass per day.
Exercise is a major key to managing one’s cardiovascular risks. One should strive for 30 minutes of moderate intensity exercise most days of the week. This can be broken into as little as 10-minute segments. Exercise is very helpful in managing depression and stress as well.
One out of every four women die from heart disease. Remember that women are more likely to have atypical symptoms, and it is better to get atypical symptoms checked out rather than ignore them.
PREVENTION is the key to preventing heart disease in women. It is up to you.
Stacie Bush-Veith, MD
Executive Wellness Physician at Heart Hospital of Austin