How women can keep their hearts healthy

Tips from Keiko Aikawa, MD, on how to avoid cardiovascular disease.

February is Heart Health Awareness Month, so it’s the perfect time to address the prevalence of cardiovascular disease in women and discuss ways to decrease risk for the development of the disease.

Cardiovascular disease is the leading cause of death in women in the United States. It kills more women than cancer, chronic lung disease, Alzheimer’s disease and accidents combined. Women typically develop cardiovascular disease 10 years later in life than men. After menopause, the incidence and severity of heart disease increase significantly. Women under the age of 45 who develop heart disease, however, have a worse prognosis compared to older women.

Between 1997 and 2012, women’s awareness of their own risks for heart disease has risen from 30 percent to 54 percent, due, in part, to a strong campaign by the American Heart Association to raise awareness and educate the public. But the level of awareness is still not where it should be. Trends of heart attacks are decreasing for men, but are increasing for women. Death rates for cardiovascular disease in women ages 35—55 years old are increasing and can partially be explained by the obesity epidemic.

When I see patients, I always ask about risk factors that may put them at increased risk for heart disease such as obesity and a sedentary lifestyle. Diabetes and smoking are greater risk factors for heart disease in women than in men. Menopause, including surgical menopause, increases a woman’s risk of heart disease because estrogen is protective against cardiovascular disease. I also look for evidence of abnormal lipids including high LDL cholesterol, low HDL cholesterol and elevated triglycerides. Autoimmune diseases such as lupus or rheumatoid arthritis are less well-known risk factors.

Additionally, pre-eclampsia, pregnancy-induced hypertension and gestational diabetes are early indicators of a woman’s future cardiovascular risk.

Next, I ask patients about their family history. Having a first-degree relative with premature coronary artery disease — defined as younger than 55 years old in men and younger than 65 years old in women — increases one’s risk.

Once you know your risk factors, you can take steps toward prevention. Here are some of my recommendations for living a heart-healthy life:

• Avoid smoking. Smoking as few as one to four cigarettes a day can double your risk for cardiovascular disease.
• Maintain a healthy weight and exercise. It’s important to keep a healthy weight and aim to have a body mass index of less than 25 kilograms/meters squared and a waist circumference of less than 35 inches. To support these goals, engage in moderate exercise for at least 30 minutes, five days per week with sustained aerobic activity for at least 10 minutes at a time. (Additional benefits occur when one participates in moderate exercise for five hours per week.)
• Eat a heart-healthy diet. This includes limiting sodium intake to less than 1,500 mg per day and sugar intake to five tablespoons or less per week, limiting foods high in saturated fats and cholesterol, and avoiding trans fats.
• Treat other illnesses and diseases that put you at risk. Ensure that you are treating any diagnoses of hypertension, hyperlipidemia and diabetes mellitus with lifestyle modification or medications.
• Test for high cholesterol. I would recommend that women older than 20 have their lipids checked at least once to see if you’re at risk.

The advice I give to those who want to improve or maintain heart health is this: living a heart-healthy life often requires a lifestyle change. There is not a “diet” that one must get through or an exercise program one must try. It requires a mental shift in how you view exercise and diet and how you prioritize your heart health in your life.

I see many patients who work long, hard hours and have busy family lives and find themselves too busy or too tired to exercise, and too busy or tired to cook a healthy meal or go grocery shopping. It’s a very difficult situation where they cannot make their health a priority due to external pressures. I stress to my patients that when they make time for themselves and their health, they will see huge benefits in the long run so that they can continue to live happy and healthy lives into the future.

Dr. Aikawa is a cardiologist at PacMed.