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The Cardiologist Interview
First the bad news: Heart disease is the leading cause of death in women, though heart disease and stroke are more common in older women. Now the heartening news: Preventive measures can go a long way toward sustaining a woman’s cardiac health.
We asked Dr. Wendy Post, an expert in preventive cardiology and women’s health, our most heart pounding health questions. Wendy is associate professor of medicine in the cardiology division of Johns Hopkins University School of Medicine and a cardiologist at the Johns Hopkins Ciccarone Center for the Prevention of Heart Disease and the Echocardiography Laboratory..
Is heart disease in women becoming a bigger issue of late or improving?
The number of people who die of heart disease has been decreasing over the last 20 years however, the statistic actually applies to men only—most people don’t know that. Cardiovascular mortality in women has not been decreasing like it has in men. We don’t understand why exactly. National Institutes of Health have required in recent years that studies must include men and women. Many more studies are being done now. A lot more research needs to be performed in women.
Let’s talk about warning signs in women. What should women know/look out for?
The type of presentation of a man with a heart attack is like the fist to the chest, squeezing pain in the middle of the chest or the left side. Women tend to be more likely to present with shortness of breath, extreme fatigue or nausea without typical pain. It is difficult to diagnose. Women tend to get heart disease ten years later than men in the post-menopausal years. Women with very high cholesterol or diabetes—even women in pre-menopausal years—can have heart problems, however. The American Heart Association slogan is “Know your numbers,” and that’s my most important piece of advice: Know your cholesterol and blood pressure. All adults should be screened for risk factors, including impaired fasting glucose, a pre-diabetes state. With the epidemic of obesity, more and more women and even girls are developing the metabolic syndrome, a constellation of risk factors, low HDL cholesterol, high triglyceride levels, hypertension and abdominal obesity. Women need medical advice about lifestyle modification and the potential need for medical therapy to prevent heart disease.
How much does heredity determine and how much should we know about family history?
A family history of heart disease at a young age is a risk factor for cardiovascular disease. Know your first-degree-relative family history. If you have first-degree family with heart disease at a young age, you should see a doctor to be screened for premature cardiovascular disease, which means heart attack or stroke in women before 65, men before 55. Heredity is important to your risk. Overall risk is related to interaction between genetic makeup and environment, diet, exercise and other things you have control over.
What should we really eat?
It’s important, in addition to a low saturated fat diet, to limit the intake of foods with a high glycemic index, like donuts, for instance, or white bread versus whole grain, that get broken down into sugar. When you eat them the sugar goes up…the insulin. Opt for foods high in fiber, complex carbs, a diet high in fruits and vegetables. There are good fats and bad fats. The oil you use is important—choose mono-unsaturated and poly-unsaturated fats. Maintain a healthy weight and limit your portions. Salmon is good—fish in general is good except it has a lot of calories, and you don’t want to fry it. High fat in fish like salmon is especially good. Limit fats in beef. Limit beef to a lean cut no larger than your fist or hand. High protein, low saturated fat foods are found in the South Beach Diet and the Dash Diet, the latter being aimed at lowering blood pressure. It is high in fruits and vegetables, high in calcium and low in saturated fat. People with high blood pressure should limit intake of sodium. Some data say that Omega 3 fatty acids may help prevent heart disease.
How much exercise do we really need?
People should try to exercise most days of the week. At least three to five days, get 30 minutes of aerobic exercise. To lose weight, get 60 minutes a day.
5 Things Women Can Do to Fight Heart Disease
- Exercise.
- Limit caloric intake if you are overweight.
- Know your numbers: cholesterol and blood pressure.
- Follow your doctor’s advice for preventive strategies.
- Consider aspirin in women over 65.
- Treat high cholesterol with statin medications.
5 Healing Foods
- Salmon
- Blueberries
- Broccoli
- Almonds and other nuts in moderation
- Whole grains
Special thanks to Dr. James Weiss, the Michael J. Cudahy Professor of Cardiology and Associate Dean for Admissions, The Johns Hopkins University School of Medicine, for his assistance with this article.