Heart Disease and Women
Source: National Heart, Lung, and Blood Institute

CORONARY HEART DISEASE is a woman's concern. Every 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. Heart disease is the number one killer of American
women. In addition, 1.6 million women have had a stroke, and
90,000 women die of stroke each year. This fact sheet tells you
what kinds of habits and health conditions increase the chances
of developing these diseases--and how you can help keep your
heart healthy.

What Are These Diseases?

Both heart disease and stroke are known as cardiovascular
diseases, which are disorders of the heart and blood vessel
system. Coronary heart disease--the main subject of this fact
sheet--is a disease of the blood vessels of the heart that causes
heart attacks. A heart attack happens when an artery becomes
blocked, preventing oxygen and nutrients from getting to the
heart. A stroke occurs when not enough blood gets to the brain,
or in some cases, from bleeding in the brain. Some other
cardiovascular diseases are high blood pressure, angina (chest
pain), and rheumatic heart disease.


Who Gets Cardiovascular Diseases?

Some women have more "risk factors" for cardiovascular diseases
than others. Risk factors are habits or traits that make a person
more likely to develop a disease. Some risk factors for
heart-related problems cannot be changed, but many others can be.

The three biggest risk factors for cardiovascular disease that
you can do something about are cigarette smoking, high blood
pressure, and high blood cholesterol. 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--and the more concerned you should be about protecting
your heart health.


MAJOR RISK FACTORS

Smoking

Smoking by women in this country causes almost as many deaths
from heart disease as from lung cancer. If you smoke, you are two
to six times more likely to suffer a heart attack than a
nonsmoking woman, and the risk increases with the number of
cigarettes you smoke each day. Smoking also boosts the risk of
stroke.

Cardiovascular diseases are not the only health risks connected
to smoking. Women who smoke are much more likely to develop lung
cancer than nonsmoking women. Cigarette smoking is also linked
with cancers of the mouth, larynx, esophagus, urinary tract,
kidney, pancreas, and cervix. Smokers also are more likely to
develop other kinds of lung problems, including bronchitis and
emphysema.

Smoking during pregnancy is also linked to a number of problems.
They include bleeding, miscarriage, premature delivery, lower
birth weight, stillbirth, and sudden infant death syndrome, or
"crib death." Also, young children who breathe in cigarette smoke
have more lung and ear infections.

There is simply no safe way to smoke. Although low-tar and
low-nicotine cigarettes may reduce the lung cancer risk
somewhat, they do not lessen the risks of heart diseases or
other smoking related diseases. The only safe and healthful
course is not to smoke at all.


High Blood Pressure

High blood pressure, also known as hypertension, is another major
risk factor for coronary heart disease and the most important
risk factor for stroke. Even slightly high levels can increase
your risk. High blood pressure also boosts the chances of
developing kidney disease.

Older women have a higher risk of high blood pressure, with more
than half of all women over age 55 suffering from this condition.
High blood pressure is more common and more severe in black women
than it is in white women. Using birth control pills can
contribute to high blood pressure in some women.

Blood pressure is the amount of force exerted by the blood
against the walls of the arteries. Everyone has to have some
blood pressure, so that blood can get to the body's organs and
muscles. Usually, blood pressure is expressed as two numbers,
such as 120/80 mm Hg. Blood pressure varies through the day and
in response to your activities. It is considered high when it
stays above normal levels over a period of time.

High blood pressure is called the "silent killer" because most
people who have it do not feel sick. That means it is important

to have it checked each time you see your doctor or other health
professional. But because blood pressure changes often, your
health professional should check it on several different days
before deciding if your blood pressure is too high. If your blood
pressure stays at 140/90 mm Hg or above, you have high blood
pressure.

Although high blood pressure can rarely be cured, it can be
controlled with proper treatment. If your blood pressure is not
too high, you may be able to control it entirely through weight
loss if you are overweight, regular physical activity, and
cutting down on alcohol, table salt and sodium. (Sodium is an
ingredient in salt that is found in many packaged and processed
foods, baking soda, and some antacids.)

But if your blood pressure remains high, your doctor will
probably prescribe medicine in addition to the lifestyle changes
described above. The amount you take may be gradually reduced,
especially if you are successful with the changes you make in
your lifestyle.

During pregnancy, some women develop high blood pressure for the
first time. Other women who already have high blood pressure may
find that it gets worse during pregnancy. Without treatment, such
high blood pressure can be life-threatening to both mother and
baby. Since you can feel perfectly normal and still have high
blood pressure, it is important to get regular prenatal checkups
so your doctor can find and treat a possible high blood pressure
problem.

Blood pressure tends to get higher as you age. That means even if
your blood pressure is normal now, it makes sense to take steps
to prevent high blood pressure in the years to come. You will be
less likely to develop high blood pressure if you are physically
active, maintain a healthy weight, limit your alcohol intake, and
cut down on table salt and sodium.


High Blood Cholesterol

High blood cholesterol is another very important risk factor for
coronary heart disease that you can do something about. Today,
about one-quarter of American women have blood cholesterol levels
high enough to pose a serious risk for coronary heart disease.

Blood cholesterol levels among women tend to rise sharply
beginning at about age 40, and continue to increase until about
age 60. The higher your blood cholesterol level, the higher your
heart disease risk.

The body needs cholesterol to function normally. It makes enough
to fill its needs. But cholesterol also is taken into the body
through the diet. Over a period of years, extra cholesterol and
fat circulating in the blood settle on the inner walls of the
arteries that supply blood to the heart. These deposits make the
arteries narrower and narrower. As a result, less blood gets to
the heart and the risk of coronary heart disease increases.

Getting Your Cholesterol Checked

Getting your blood cholesterol level checked is a relatively
simple process. Your doctor or other health professional will
take a small sample of your blood and measure the amount of
cholesterol. When you have this test for the first time, it is
important to have the following measurements taken:

Total Blood Cholesterol.

For all adults, a desirable level of total blood cholesterol is
less than 200 mg/dL. A level of 240 or more means you have high
blood cholesterol. But even "borderline-high" levels (200-239)
boost your risk of coronary heart disease.

High Density Lipoprotein.

You also will need a measurement of your level of high density
lipoprotein, or HDL, if an accurate result is available.
Lipoproteins are the packages that carry cholesterol through the
bloodstream. HDL is often called "good cholesterol" because it
helps remove cholesterol from the blood, preventing it from
piling up in the arteries.

If your HDL level is less than 35, your risk of heart disease
goes up. This is true even if your total cholesterol level is
within a desirable range. The good news is that if your HDL level
is 60 or above, you have a lower risk of developing heart
disease.

Low Density Lipoprotein.

Your doctor also may want to measure your level of low density
lipoprotein, or LDL. LDL is often called "bad cholesterol"
because it carries most of the cholesterol in the blood, and if
the LDL level is too high, cholesterol and fat can build up in
the arteries. An LDL level below 130 is desirable, while levels
of 130-159 are "borderline-high." An LDL level of 160 or above
means you have a high risk of developing coronary heart disease.

If your LDL level is not checked during your first test, your
doctor still may want to measure it if your initial tests show
that you have any of the following:

Treatment
After studying your total cholesterol, HDL and LDL levels, and
other risk factors for heart disease, your doctor may recommend a
treatment plan for you. Lowering LDL cholesterol is the main goal
of treatment. Cutting back on foods rich in fat, especially
saturated fat, and in cholesterol, can lower both total and LDL
cholesterol. Weight loss for overweight persons and increased
physical activity may also lower blood cholesterol levels.

Losing extra weight and becoming more physically active, as well
as quitting smoking, also may help boost HDL cholesterol levels.

Your doctor may also suggest that you take cholesterol-lowering
medications. This recommendation will depend on how high your LDL
cholesterol level remains after you have made the diet and
lifestyle changes described above. The need for medicine will
also depend on whether you have any other risk factors for
coronary heart disease.


OTHER IMPORTANT RISK FACTORS


Physical Inactivity

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.

So by getting regular physical activity--even mild to moderate
exercise--you'll lower your risk of heart disease. The best
exercises to strengthen your heart and lungs are aerobic ones,
such as brisk walking, jogging, cycling, and swimming. Do them
for 30 minutes, three or four times a week.

But even low-intensity activities, such as gardening and
housework, can help lower your risk of heart disease if done
daily.


Overweight
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.

Overweight contributes not only to cardiovascular diseases, but
also to other risk factors, including high blood pressure, high
blood cholesterol, and the most common type of diabetes.
Fortunately, these conditions often can be controlled with weight
loss and regular physical activity.

What is a healthy weight for you? There is no exact answer. Check
the "What Should You Weigh?" table for the weight range suggested
for women of your height. Ranges are given because women of the
same height and amounts of body fat can differ in their amounts
of muscle and bone. Weights above the suggested ranges are
believed to be unhealthy for most people.

Body shape as well as weight may affect heart health.
"Apple-shaped" individuals with extra fat at the waistline may
have a higher risk than pear-shaped people with heavy hips and
thighs. If your waist is nearly as large, or larger, than the
size of your hips, you may have a higher risk for coronary heart
disease.


Diabetes

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.

Diabetes is often called a "woman's disease" because after age
45, about twice as many women as men develop diabetes. While
there is no cure for this disorder, there are steps a person can
take to control it. Being overweight and growing older are linked
with the development of the most common type of diabetes in
certain people. Losing excess weight and boosting physical
activity may help postpone or prevent the disease. For lasting
weight loss, get regular exercise and eat foods that are low in
calories and fat.


Stress

In recent years, you may have heard a lot about the connection
between stress and heart disease. In particular, you may have
heard that "type A" behavior--being aggressive, competitive, and
constantly concerned about time--is linked to the development of
heart disease. But while some studies have shown this connection
in men, there is no evidence that type A behavior in women is
linked with coronary heart disease.

Employment outside the home is another factor that often has been
connected to women s heart disease. But so far, studies show no
difference in rates of coronary heart disease between homemakers
and employed women. However, more research is needed before we
can rule out stress as a risk factor for women.


Birth Control Pills

Women who use high-dose birth control pills (oral contraceptives)
are more likely to have a heart attack or a stroke because blood
clots are more likely to form in the blood vessels. These risks
are lessened once the birth control pill is stopped.

The risks of using low-dose birth control pills are not fully
known. Therefore, if you are now taking any kind of birth control
pill or are considering using one, keep these guidelines in mind:


OTHER FACTORS THAT AFFECT YOUR HEART DISEASE RISK


Alcohol

Several recent studies have reported that moderate drinkers--
those who have one or two drinks per day--are less likely to
develop heart disease than people who don't drink any alcohol.
If you are a nondrinker, this is not a recommendation to start
using alcohol. And certainly, if you are pregnant or have
another health condition that could make alcohol use harmful,
you should not drink. But if you're already a moderate drinker,
you may be less likely to have a heart attack.

But remember, moderation is the key. More than two drinks per day
can raise blood pressure, and the "Dietary Guidelines for
Americans" recommend that for overall health women should have no
more than one drink a day. Further, binge drinking can lead to
stroke. People who drink heavily on a regular basis have higher
rates of heart disease than either moderate drinkers or
nondrinkers.

Keep in mind, too, that alcohol provides little in the way of
nutrients--mostly just extra calories. So, if you are trying
to control your weight, you may want to cut down on alcohol and
substitute calorie-free iced tea, soda, or seltzer.


Hormones and Menopause

Should menopausal women use hormone pills? There is no simple
answer to this question. Menopause is caused by a decrease in
estrogen and other hormones produced by a woman's ovaries. At
this time, some women begin to take prescription hormone pills
every day. Some women take pills that contain only estrogen.
Others take estrogen combined with a second hormone called
progestin.

Estrogen has several important benefits. Taking estrogen pills
may relieve "hot flashes" and generally help you feel more
comfortable as your body adjusts to lower estrogen levels. They
also help to prevent osteoporosis, a thinning of the bones that
makes them more likely to break in later life. Estrogen pills
also may help protect women from developing coronary heart
disease, but more research is needed before we will know this for
sure.

Estrogen pills also have risks. They may increase the chances of
developing gallbladder disease, and they may worsen migraine
headaches. They also may increase the risk of breast cancer.

But by far, the biggest risk of taking estrogen pills is cancer
of the uterus. Women on estrogen pills after menopause are up to
six times more likely to develop uterine cancer than women not on
this treatment. It is important to point out that women are much
more likely to die of coronary heart disease than from uterine
cancer. Still, the cancer risk exists and must be taken seriously
and discussed with your doctor.

To reduce the risk of uterine cancer, some doctors now prescribe
estrogen in combination with the hormone progestin. But we don t
yet know how this newer "combo" treatment affects the risks of
heart disease, osteoporosis, and breast cancer.

At present, a woman and her doctor must decide whether the
benefits of hormone pills are worth the risks. If you are
thinking about starting this treatment, you will need to consider
your overall health and your personal and family history of heart
disease, osteoporosis, and uterine and breast cancer.

If you are now taking hormone pills, 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.


Aspirin

You may have heard that taking aspirin regularly can help prevent
heart attacks. Is this a good idea for you? Maybe.

A recent study found that women who took a low dose of aspirin
regularly were less likely to suffer a first heart attack than
women who took no aspirin. But since this was the first study to

show this benefit in women, more research is needed before we can
be sure that aspirin is safe and effective in preventing heart
attacks in women.

What we do know for sure is that aspirin is a powerful drug with
many side effects. It can increase your chances of developing
ulcers and having a stroke from a hemorrhage. Because of these
serious risks, you should not take aspirin to prevent a heart
attack without first discussing it with your doctor.


PREVENTING HEART DISEASE

You now know something about the kinds of habits, health
conditions, and other factors that affect your chances of
developing heart disease. Just as important, you know that by
taking an active role in your own heart health, you can make a
difference. A little prevention can have a big payoff--a
longer, healthier, more active life.


If you would like to know more about keeping your heart healthy,
the National Heart, Lung, and Blood Institute (NHLBI) has
available free fact sheets on the following subjects:
preventing high blood pressure, preventing high blood
cholesterol, quitting smoking, and the heart benefits of physical
activity.

Contact:

NHLBI Information Center
P.O. Box 30105
Bethesda, MD 20824-0105
(301) 251-1222

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES
Public Health Services
National Institutes of Health
National Heart, Lung, and Blood Institute

NIH Publication No. 95-3654
Reprinted August 1995


------------------------------------------------------------
Blood Cholesterol Levels

Desirable Borderline-High High
------------------------------------------------------------
Total less than 200-239 mg/dL 240 mg/dL
Cholesterol 200 mg/dL and above

LDL less than 130-159 mg/dL 160 mg/dL
Cholesterol 130 mg/dL and above

------------------------------------------------------------
HDL a low HDL cholesterol is less than 35 mg/dL
Cholesterol

-----------------------------------------------------------
What Should You Weigh?
Desirable Weights for Women 25 and Over*

(Height, Small Frame, Medium Frame, Large Frame)

4'10" 92-98 96-107 104-119
4'11" 94-101 98-110 105-122
5'0" 96-104 101-113 109-125
5'1" 99-107 104-116 112-128
5'2" 102-110 107-119 115-131
5'3" 105-113 110-112 118-134
5'4" 108-116 113-125 121-138
5'5" 111-119 116-130 125-142
5'6" 114-123 120-135 129-146
5'7" 118-127 124-139 133-150
5'8" 122-131 128-143 137-154
5'9" 126-135 132-147 141-158
5'10" 130-140 136-151 145-163
5'11" 134-144 140-155 149-168
6'0" 138-148 144-159 153-173
--------------------------------------------------------------
*While wearing indoor clothing and 2-inch heels.

Source: Metropolitan Insurance Company Actuarial Tables, 1959.


__________________________________________________
Move It and Lose It

(Activity, Calories Burned per Hour*)

Light Activity 240
Cleaning house
Playing golf

Moderate Activity 370
Walking briskly (3.5 mph)
Gardening
Bicycling (5.5 mph)

Strenuous Activity 580
Jogging (9 min. per mile)
Swimming

Very Strenuous Activity 740
Running (7 min. per mile)
Skiing
*For a healthy
140-pound woman.

Source: Dietary Guidelines for Americans, U.S. Department of
Agriculture/U.S. Department of Health and Human Services, 1990.
--------------------------------------------------------------


Use this chart to record your progress toward your healthy heart goals:

Smoking
Quit date________________________

Total Cholesterol
Desirable level: under 200 mg/dL
Date | Level
______________________ ________________________
______________________ ________________________
______________________ ________________________
______________________ ________________________
______________________ ________________________
______________________ ________________________


Blood Pressure
Normal: under 140/90 mm Hg
Date | Blood Pressure
______________________ ________________________
______________________ ________________________
______________________ ________________________
______________________ ________________________
______________________ ________________________
______________________ ________________________


Weight
Goal____________________________
Date | Weight
______________________ ________________________
______________________ ________________________
______________________ ________________________
______________________ ________________________
______________________ ________________________
______________________ ________________________

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