Hot Flashes - Getting to the Heart of the Matter

Cardiovascular disease is the number one killer in the United States, and more than one in five Americans suffer from some type of cardiovascular ailment. The conditions falling under this umbrella of illnesses include heart attack, stroke, hypertension (high blood pressure), heart failure and peripheral vascular disease.

While most people envision the typical heart patient as the hard-driving type A male executive, women are increasingly being diagnosed with some type of cardiovascular disorder. Even worse, women are dying from heart attacks and strokes without ever being diagnosed. More alarming, over half the women surveyed recently in an American Heart Association study did not realize that the biggest threat to their lives is heart disease. In fact, almost half a million women die each year due to cardiovascular disease.

Plus, women tend to manifest cardiovascular problems differently than men, and often do not display the classic symptoms we’ve all been taught to identify. While chest pain is still the most common symptom in either gender, women more frequently exhibit less common symptoms, such as nausea, shortness of breath or difficulty breathing, extreme fatigue or weakness, and jaw pain. Women are also more likely to die from a heart attack, with mortality rates at 42% within one year compared to 24% for men.

While men tend to develop heart disease earlier, women tend to lose the protective effects of estrogen once they’ve gone through menopause. Researchers think estrogen may affect the amount and type of lipoproteins in the blood, increasing HDL (high-density lipoprotein) and lowering LDL (low-density lipoprotein).

To achieve this end, experts from the AHA joined with other national health organizations to create a clever set of guidelines to help women say goodbye—or ALOHA—to cardiovascular disease. These guidelines are outlined in an article written by Dr. Lori Mosca and published in a 2004 issue of the AHA’s journal Circulation. They include:

A – Assess Your Risk

The first step, assessing your risk, is determining how likely you are to develop cardiovascular disease. These guidelines use the Framingham Risk Assessment Calculator and assign a ranking of high, intermediate or low, based on: your age, blood pressure reading, total and HDL cholesterol levels, and whether or not you smoke. Your score is read as your risk in the next 10 years of either having a heart attack or dying from heart disease.

L – Lifestyle Recommendations or Changes

Next, the panel recommends looking at any lifestyle changes you can make. These include not smoking and avoiding secondhand smoke whenever possible. Also, maintain a healthy weight for your height and age. The website of the Centers for Disease Control and Prevention provide both an English and a metric BMI calculator, along with a scale to indicate your weight status (http://www.cdc.gov/nccdphp/dnpa/bmi/calc-bmi.htm). Be aware that your BMI score doesn’t indicate your fitness level and won’t take into account the percent of body fat compared to muscle.

Optimize your diet by including lots of fresh fruits and vegetables, whole grains and legumes, fish and other proteins that are lower in saturated fats. Try to minimize or even eliminate added trans fats when possible. Trans fats are a type of fat created when hydrogens are added to a fat molecule. This commonly occurs when liquid fats are transformed into solids. The process changes the configuration of the molecule, but also adds stability and prolongs its shelf life—these types of fats are often used in snack foods and processed foods. Just like saturated fats, trans fats raise LDL (low-density lipoprotein)—or “bad”—cholesterol, but they also lower HDL—or high-density lipoprotein—cholesterol, which is known as “good” cholesterol.

Try to get at least 30 minutes of moderate physical activity each day, although some sources indicate that 30 minutes 5 days a week may be sufficient. These 30 minutes can be split up into three 10-minutes increments, if that’s more convenient. In any case, try to get moving any way that you can. Park farther away from the building than you usually do. Take the stairs instead of the elevator. Walk for 10 minutes before or after lunch. As your fitness improves, your ability to exercise will increase.

O – Other Interventions

Additional interventions consider lowering high blood pressure, maintaining healthy levels of cholesterol, and controlling blood sugar levels in those with type 2 diabetes. The optimal blood pressure reading for all women is 120/80. The numbers simply measure the pressure in your arteries when the heart is contracting (known as systolic blood pressure—the top number) and relaxing (known as diastolic blood pressure or the bottom number). If your blood pressure stays higher than 140/90 and cannot be reduced through some of the lifestyle changes recommended above, the panel recommends talking with your doctor about other treatment options.

The panel also suggests cholesterol readings are more critical for women with intermediate and high risk. These readings look at various types of cholesterol, including HDL and LDL, which were mentioned previously. The type of lipoprotein is an indication of its composition, including levels of protein, cholesterol, and phospholipids. HDL is predominantly protein, while LDL has a much higher percentage of cholesterol. Total cholesterol readings are optimally less than 200 mg/dL, with LDL making up less than 100 mg/dL and HDL topping 50 mg/dL. Triglycerides, a type of fat found in the blood, should be less than 150 mg/dL.

Type 2 diabetes is often associated either with cardiovascular disease or at least an increased risk of various cardiovascular disorders. Again, healthy lifestyle habits can go a long way toward lowering your blood sugar, including dietary changes, exercise and maintaining a desirable weight. While initially blood glucose readings are indicative of problems metabolizing glucose, long-term blood sugar control is measured through an HbA_1c reading. This reading—known as glycosylated hemoglobin—tells how much glucose (sugar) is attached to the hemoglobin in your blood. The hemoglobin is the component in your blood that carries oxygen from your lungs to your tissues. This reading gives you an average of a 2-3 month blood sugar reading.

H – Highest Priority For Therapy – Women At Highest Risk

The panel notes that women at highest risk, meaning those who have already been diagnosed with cardiovascular disease, diabetes, or kidney disease, are those most likely to benefit from preventive therapy. A variety of pharmaceutical interventions, which they gave a class I rating, may be appropriate in this group, including drugs to thin the blood, lower blood pressure or cholesterol, or control abnormal heart rhythms.

A – Avoid Medical Therapies Called Class III

Postmenopausal hormone therapy, while showing no benefit in reducing heart disease risk, even increased the risk of heart attack, stroke and blood clots in some women. Some antioxidant supplements were shown in clinical trials to increase the risk of bleeding and hemorrhagic stroke in some patients. While antioxidants offer many positive health benefits, they have not been shown to reduce the risk of cardiovascular disease. Finally, long-term aspirin therapy is not recommended for patients at low risk. It may actually increase the chance of stomach ulcers and bleeding.