One in four American women dies from heart disease.
“Heart disease is a generic term used to group different types of problems that affect the heart. The most common, coronary artery disease, or CAD, describes plaque buildup in the arteries or vessels of the heart,” said Dr. Sandra Chaparro, a cardiologist with UHealth — the University of Miami Health System. “It is the number one killer of American men and women.”
Menopause and heart disease
Family history, being overweight, a sedentary lifestyle and high blood pressure are all risk factors for heart disease. But did you know the risk for heart disease increases in women with menopause?
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During menopause estrogen levels decrease, which can be bad news. “Estrogen has an important regulatory effect on blood pressure and cholesterol,” said Dr. Viviana Navas, a cardiologist with Cleveland Clinic in Weston. As estrogen levels decrease, some women could become hypertensive and see their “bad” cholesterol increase, she said.
“The decade after menopause starts, between ages 50 and 60, is when we see more coronary artery disease in women,” Navas said. That risk continues to increase over time.
But hormone replacement therapy does not decrease the risk of CAD, she said. In fact, the therapy has been shown to increase risk for blood clots and some cancers. “The only time we recommend hormone replacement therapy is to deal with the unpleasant effects of menopause like hot flashes, and it is used for the short term, maybe a few months,” Navas said.
As a woman approaches menopause, she should control other risk factors. That means to stop smoking, treat high-blood pressure, keep cholesterol in check and start exercising. “Just going through menopause is going to increase the risk,” Navas said. “If they have anything they can change on their own to decrease the risk, they should do it.”
A heart-healthy diet depends on eating the right types of protein, carbohydrates and fats, said Dr. Arthur Agatston, a cardiologist and medical director of the Center for Wellness and Prevention for Baptist Health South Florida. ”You want good fats, good carbs, lean proteins and plenty of fiber,” he said.
Being overweight increases your risk of heart disease. “But the epidemic of obesity is not being caused by the amount of fat and it’s not the amount of calories,” said Agatston, creator of The South Beach Diet series of books on heart-healthy eating.
“Calories count, but counting calories doesn’t work to sustain weight loss,” he said. Agatston said widespread obesity has been caused mainly by recommendations for low-fat and high-carbohydrate diets.
“Now people around the world are having the wrong carbohydrates,” Agatston said. “When you consume excess carbohydrates, things like white rice and white pasta, you have exaggerated swings in blood sugar and when your blood sugar drops, you get hungry. That’s when you want to supersize.”
Sitting all day is a risk factor for heart attack, stroke and diabetes. Some call sitting the “new smoking” because of its harmful effects. “The fact that we’re sitting in one place all day over a computer or screen has certainly played a role,” Agatston said. “Sedentary jobs also contribute.”
Agatston, who uses a standing desk, said to be smart about how you get moving. “Walking on the treadmill for 20 minutes at the same speed every day is not as constructive as interval exercise, when you are doing different speeds,” he said.
It’s like when you are “stop and go” when driving a car, he said. You will burn more gas that way than if you stay at a consistent speed. “That’s true for people also. When you are going at different speeds, for different exercises, and using different muscles, that’s much better,” he said.
Aerobic exercises like running, dancing, Zumba classes, swimming and bicycling can get your heart rate up. Core exercises like Pilates also help.
Symptoms in women
Women sometimes don’t have the typical heart attack signs, such as chest pressure on the left radiating to jaw pain or pain in the left arm, Navas said. Women’s symptoms can include indigestion, discomfort in the middle of the chest and other atypical symptoms, she said. “A woman needs to know that if something feels strange, she should seek medical attention, because a woman can present in a very different way,” Navas said.
“If you’re having a heart attack, even if you don’t have the typical symptoms, you’re going to feel very lousy,” she said. “Either call 911 or go to the closest emergency room. It’s not something you want to wait out.”
Tests and treatment
A family history and physical exam give clues about existing heart disease, Chaparro said. An electrocardiogram gives information about the rhythm of the heart, and blood work is done to look for enzymes released when the heart has been damaged. A progression of further testing, including ultrasound, echocardiogram, nuclear medicine tests, CT scans, cardiac MRIs or more invasive testing, like cardiac catheterization, is used as needed.
When you are diagnosed with heart disease, a doctor will typically recommend an antiplatelet, a medicine similar to aspirin that prevents platelets to minimize risk of clotting, Chaparro said. Statins are a group of medicines that have been used for decades to reduce cholesterol and to reduce inflammation inside the vessels to lower chances of a heart attack, she said. Other medications can be used for weak heart muscles or a heart rate that is too high.
A stress test may be recommended if you’ve had chest pains, shortness of breath or other symptoms. A stress test is a non-invasive way to find out if there is enough blood supply to an area of the heart. “With that information, a doctor can decide if the patient needs an invasive test,” Chaparro said. It’s typically recommended for patients with a strong family history, a physical exam, blood test and EKG that raises some questions about a possible obstruction, she said.
The coronary calcium scan, a CT scan developed by Agatston to measure calcium buildup in plaque in the arteries, is now widely used for patients with moderate risk of heart disease who meet certain criteria. The scan gives the patient a score, called the Agatston score, that indicates risk. The lower the score, the better.
“We have women with cholesterol over 300 with squeaky clean vessels. They are not at risk for heart disease. And then other women with cholesterol of 200 or less who have a lot of plaque,” he said.
Blood tests do not reveal the same information, Agatston said. “The calcium scan is quick, non-invasive and has about the same amount of radiation as a mammogram,” he said. “It’s the best predictor of future heart attack and stroke. There are tons of data showing that.”