That men and women are different is certainly not news. One
popular book even suggests that we come from different planets.
But recent research suggests that it's more than plumbing and
light years that separate us: Our wiring is different too. In
particular, our cardiovascular system. Leading heart doctors are in
favor of different ``his and hers'' approaches to attack-proof your
heart.
Heart disease is the leading killer of both men and women. So
share this article with the heart that's dearest to you.
HER PLAN
One out of every three women currently under 40 will eventually
develop heart disease. More than 505,000 women of all ages died
from it in 1996 -- 11 times as many as died from breast cancer.
``In the past, many doctors didn't know that heart disease was a
major cause of death in women, let alone the leading one,'' says
Dr. Marianne J. Legato, professor of clinical medicine at Columbia
University College of Physicians and Surgeons in New York City.
``Although awareness and treatment have improved somewhat,
especially in large cities, the death rate from a first heart
attack is twice as high in women under 50 as it is for men of the
same age.''
It's up to you to ask for more tests or seek another opinion if
you feel that your doctor is dismissing your concerns, risks or
symptoms.
Aim for a total cholesterol of less than 150 milligrams per
deciliter, an LDL (bad) of 130 milligrams per deciliter or less, an
HDL (good) of 45 milligrams per deciliter or higher and
triglycerides of less than 150.
``For women, a low HDL is much more predictive of heart disease
than a high total cholesterol,'' says Dr. Debra Judelson, medical
director of the Women's Heart Institute at the Cardiovascular
Medical Group in Los Angeles.
``HDL over 60 milligrams/deciliter is a positive protector
against heart disease,'' Legato adds. It may edge your total
cholesterol up, but you're still protected against heart disease if
your total cholesterol/HDL ratio is 4.0 or less.
Judelson suggests that you ask your doctor to tack on one more
measurement to your regular cholesterol test: lipoprotein (a), a
protein strand that's attached to bad cholesterol molecules. When
researchers from the Framingham Heart Study tested these levels in
more than 3,000 women, they found that participants with
lipoprotein (a) above 25 mg/dl doubled their risk of heart disease.
In addition to abnormal cholesterol, you're more likely to
develop heart disease if you have these risk factors:
+ Smoking (ups the odds at least two-to fourfold -- more if you
take birth control pills)
+ Diabetes (raises your risk four to six times)
+ Blood pressure higher than 135/85
+ Family history of early heart disease
+ Premature (before age 38) menopause (either naturally or
through removal of the ovaries) and not taking hormone replacement
therapy (HRT)
+ Overweight
+ Sedentary lifestyle
It's important to redesign your diet. A low-fat diet is
appropriate for most women, but certain women with a low HDL level
can actually increase their risk for heart disease from cutting
back on all fats. Most women (and men) will improve their health
with a Mediterranean-style diet consisting of lots of fruits and
vegetables, with most of the fat coming from olive oil, canola oil,
olives, avocados and nuts.
Olive oil raises good HDL and lowers your risk, says Dr. Stephen
Devries, director of the Heart Center at the University of Illinois
in Chicago.
Because diabetes increases the risk of heart disease more for
women than men, you should use whole-grain carbohydrates such as
whole-wheat bread and brown rice rather than refined ones such as
white bread and white rice, says Dr. Walter Willett, chairman of
the department of nutrition at the Harvard School of Public Health.
In his study of more than 64,000 nurses, Willett and his
colleagues found that those who ate large amounts of refined
carbohydrates doubled their chances of developing type 2 diabetes,
while those who consumed mostly whole grains didn't raise their
risk at all.
Doctors think that women have heart attacks later in life than
men because estrogen protects them until menopause, Legato says.
But lately, doctors are being a little more careful about
prescribing HRT because a large study suggested that it actually
increased the risk of death in women who already had heart disease
when they began treatment.
Although doctors won't have the lowdown on HRT until even bigger
studies are completed in 2005, many physicians think that HRT is
safe -- and beneficial -- if you have risk factors for heart disease
but haven't developed the condition yet. Your best bet: ``Discuss
HRT with your doctor before menopause so that you'll have a plan in
place once it happens,'' Judelson says.
Recognize the symptoms. ``In women, the signs of a heart attack
can be very different than they are in men,'' says Dr. Lynn Smaha,
president of the American Heart Association. Instead of crushing
chest pain, you may have lighter chest, stomach, or abdominal pain;
nausea or dizziness; shortness of breath; heart palpitations;
fatigue and weakness.
If you experience these symptoms, Judelson advises that you
immediately chew a full-strength (325 milligram) aspirin (it'll
significantly improve your survival rate if you are indeed having a
heart attack.) and head to the ER immediately.
``Don't let them dismiss you until you've received a thorough
evaluation, including an electrocardiogram,'' Judelson says. ``I've
had too many patients who were sent home with a clean bill of
health from the ER who indeed had heart disease.''
HIS PLAN
One out of every two men currently 40 and under will eventually
develop heart disease. More than 450,000 men died from it in 1996 --
12 times more than died of prostate cancer.
``You may think that it's the other guy who will get heart
disease,'' says Dr. Kenneth Goldberg, director of the Male Health
Center in Dallas. ``But all my patients with heart disease thought
it was going to be the other guy. At least open yourself up to the
possibility that it could happen to you. And then work as hard as
you can to prevent it.''
Shoot for a total cholesterol of less than 150 milligrams per
deciliter (mg/dl), an LDL (bad) of less than 130 mg/dl, an HDL
(good) of 45 mg/dl or higher and triglycerides of less than 150.
The most important number in that equation is LDL. ``In men,
studies show that a high LDL increases the risk of developing heart
disease more than a low HDL or high triglycerides, and treatment of
LDL is most effective in reducing cardiac risk,'' says Dr. Debra
Judelson, medical director of the Women's Heart Institute at the
Cardiovascular Medical Group in Los Angeles.
An abnormal cholesterol level is not the only tip-off that a
heart attack may be in your future, says Dr. Stephen Devries,
director of the Heart Center at the University of Illinois in
Chicago. Consider these other clues:
+ Smoking (increases your risk at least two- to fourfold)
+ Diabetes
+ Blood Pressure higher than 135/85
+ Family history of early heart disease
+ Overweight
+ Sedentary lifestyle
``Make sure that you are checked for risk factors and that you
get the information you need to lower your individual risk,''
Devries says. If you have several risk factors for heart disease,
your doctor might recommend a treadmill exercise test (also called
a stress test) to get an even better idea of how your heart is
working, he says.
Simply walk on a treadmill while your blood pressure and changes
in your heart's electrical activity are monitored. Based on the
results of this test, your doctor may recommend other tests or
encourage you to make some lifestyle (exercise and diet) changes.
If your cholesterol and/or blood pressure is particularly high, he
may also prescribe medication.
Trim the fat -- especially the saturated kind -- from your diet,
Devries says. ``Most men need to cut back on the fat found in a
typical American diet. Meat should be considered a treat, not a
part of every meal. Pasta, stir-fries and fish should substitute
for many of the meat meals. In the dairy department, try low-fat
milk and cheese,'' he says.
Recognize the symptoms. If you're having the following symptoms,
chew a full-strength (325 milligram) aspirin (it'll help break up
clots associated with your attack) and get to the hospital as soon
as possible: Uncomfortable pressure, fullness, squeezing or pain in
the center of the chest that lasts more than a few minutes or that
quickly fades in and out. The pain may spread to the shoulders,
neck, or arms, and it may be accompanied by lightheadedness,
sweating, nausea, or shortness of breath.
