Lady Take Heart

Lady Take Heart

Guidelines for Women to Prevent Heart Disease

Product # 198A

Contents Heart Disease In Women ...............................................................2 No Way To Treat A Lady ................................................................3 How Do I Know If I Have Coronary Heart Disease? .........5 Tests For Heart Disease.................................................................7 Risky Business ...................................................................................9 The Estrogen Connection ............................................................21 Aspirin/Alcohol/Antioxidants..................................................22 What’s A Lady To Do? ..................................................................23 Learn More About It......................................................................24 This book is only to help you learn and should not be used to replace any of your doctor’s advice or treatment.

Copyright © 2010

by Pritchett & Hull Associates, Inc. All rights reserved.

Former copyright under the title Lady Killer © 1995, 2001

For more copies of Lady Take Heart, write to: PRITCHETT & HULL ASSOCIATES, INC. 3440 OAKCLIFF RD NE STE 110 ATLANTA GA 30340-3079

or call toll free: 800-241- 4925 Published and distributed by: Pritchett & Hull Associates, Inc.

Printed in the U.S.A.

Guidelines for Women to Prevent Heart Disease

by Suzanne Cambre, RN, BSHA

Heart Disease In Women Most women believe their biggest threat of dying is from breast cancer. Not so! There is an even bigger “lady killer” and it is a 10 times greater risk than breast cancer. The real threat is heart disease*.

This disease affects more than a half million American women a year.

One in 9 American women 45 – 64 years old will have heart disease. After 65, the number is 1 in 3.

Men still have more heart attacks than women, but women seem to not do as well as men, if they have a heart attack.

In this book, you will learn how: • heart disease differs in women and men • risk factors of heart disease affect women in a special way • to know if you might be having a heart attack and what to do • to make a healthy heart plan for life

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* In this book, we use “heart disease” to mean coronary heart disease (coronary artery disease, CAD, atherosclerotic heart disease).

No Way To Treat A Lady Heart disease doesn’t play fair with the fairer sex. Even though most women with treated heart disease do well, here are some facts that may surprise you.

Women: • may put their own health care needs last • may delay going to the doctor because they think only men get heart disease • may not feel the signals of heart disease in the “classic” ways men do • are most often in their late 60’s or 70’s — though sometimes younger — when heart disease appears (Men tend to have their first heart problems while in their 50’s or 60’s.)

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My heart is smaller?

While women typically get heart disease in their 60’s or 70’s, it can occur at younger ages, especially in diabetics and smokers. In general, women’s hearts and blood vessels are smaller than those in men. They may have other health issues that come with aging. Treatment may be delayed because some doctors still underestimate women’s risks of heart disease. Because of this, women may: • get treatment to open the arteries less quickly or less often than men • have more complications with treatment and surgery to open heart arteries • have a higher risk of dying from a heart attack than men

GOOD NEWS! In the past, most of our knowledge of heart diesase and treatment came from studies on men. Now studies are being done that look at womenʼs special needs. The American Heart Association has started the “Go Red for Women” awareness campaign. Guidelines have been established to help your doctor address your special needs.

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How Do I Know If I Have Coronary Heart Disease?

Your body can signal heart disease by making you feel any or all of these:

weak discomfort or pain in the neck, shoulder, throat, jaw or either arm

short of breath

discomfort, tightness, pressure, pain or burning in the chest

sick to your stomach (nausea) and vomiting

These signals happen more often with physical activity but can happen at rest. They may come and go. Think “heart attack� if any of the signals last longer than 10 minutes. This is most true if you have chest pain and are sweating, sick to your stomach or dizzy.

Women may not feel heart attacks the same way men do. They may have less intense chest pain, more nausea, more weakness or unusual fatigue in the days before a heart attack.

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Heart attack “fakes” often felt by women: • chest wall pain from lifting or carrying heavy objects or from heavy breasts • discomfort from mitral valve prolapse • narrowed tiny heart vessels • gall bladder distress You may be having angina* or a heart attack if you are having chest, arm or throat discomfort; sweating or nausea that can’t be explained. These signals are more likely to be a heart attack if you: • are past menopause (the change of life) • smoke (especially if you take birth control pills) • have diabetes • have any 2 risk factors (See pages 9 –20.)

The risk of dying from a heart attack is greatest in the first few hours. If you feel you are having a heart attack: • Call 911 and be sure your door is unlocked for the rescue team.

• Chew a full strength, non-coated aspirin.

• Call someone to stay with you and try to remain calm until help arrives.

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* Angina is discomfort/pain from narrowed heart arteries.

Tests For Heart Disease A common test for coronary heart disease is the exercise stress test. It works well for men, but it may give false results in women. If the test is normal, that’s great. But in 1 ⁄ 3 of women tested, there can be falsely abnormal findings that lead to further testing.

Better tests for women include: • Myocardial Perfusion Stress Imaging (MPI) This is a nuclear scan done before and after you exercise or take a special drug that mimics exercise.

There is some radiation exposure.

• PET scan (positive emission tomography) This test gives a 3D image of the heart. There is some radiation exposure.

• Stress Echocardiogram Sound waves are used to image the heart. This test can be done with exercise or with a medication that mimics exercise. There is NO radiation exposure with this test, but it does not directly image the coronary arteries.

• Coronary Calcium Score An ultra fast CT scan is done to look for calcium in the coronary arteries.

Calcium is a sign of long standing plaque in the arteries, but need not mean the artery is blocked.

There is some radiation exposure.

2085

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• CRP (c-reactive protein) This blood test looks for a protein that increases in the blood when inflammation or infection is present. (Doctors now think that inflammation might be a cause of coronary disease.) As yet, this protein is not enough to diagnose heart disease, but may be useful in screening for the disease • MRI of the heart This test uses magnetic resonance to look at the anatomy of the heart.

It can be combined with exercise stress testing or a drug that can mimic exercise. There is no radiation exposure.

• CT Angiography This test uses low radiation to image the coronary arteries without an invasive heart catheterization. A “contrast” drug may be administered into the vein to look for plaque and blocked arteries. Smaller heart vessels may not be completely seen.

Be an informed consumer, just as you would be in shopping. Discuss choices with your doctor so you will get the best test for you.

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Risky Business Know your risks of heart disease, and take steps to avoid them. Some risks you are stuck with, but some you can do something about.

Risks you’re stuck with Family history Women with a close family member who had coronary heart disease before age 60 have a higher risk for heart disease.

Age The older you are, the higher your risk for heart disease.

Women are most often past menopause and in their 60’s or 70’s when they first get coronary heart disease.

Women who smoke or have diabetes can have heart disease at younger ages.

Race African American women have a much higher risk of heart disease and stroke than white women and MexicanAmerican women. This may be due to genetics, decreased access to care or lifestyle.

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Risks you can do something about Tobacco — deadly when used as directed About 22% of American women smoke.

If you smoke, you raise your risk of heart attack up to 50%. If you smoke and take birth control pills, or smoke and have other risk factors for heart disease, your risk is even higher. Women smokers who have a heart attack are more likely to have their first attack at a younger age and to die from their attack.

If you inhale someone else’s smoke or use smokeless tobacco, you also increase your chance of having heart disease.

By 2010 there were more women smoking than men. Young women are picking up this deadly habit in record numbers and men are quitting faster than women!

GOOD NEWS! If you stop smoking, your risk of heart disease falls quickly.

Your risk can be the same as a non-smokerʼs within 10 years.

Lung damage is not reversible.

HINT: Call your local lung or heart association for ways to stop smoking, or ask your doctor.

American Lung Association Freedom from Smoking Program 1-800-LUNG-USA Smokenders® 1-800-828-HELP (4357) www.smokenders.com

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High blood pressure Half of American women over age 55 have high blood pressure.

The number of women over 65 with high blood pressure is even greater (66% of white women and 83% of African American women).

High blood pressure: • runs in families • is linked to being overweight • may occur in people who eat too much salt Since most of the time there are no symptoms, it’s very important to have regular blood pressure checks. Desirable blood pressure readings are now considered to be 120/80 or less. Higher than desirable levels of blood pressure need to be closely monitored for possible treatment.

HINT: If you have high blood pressure: • Lose weight ( if you are overweight).

• Cut down on salt/sodium (under 2 grams a day).

• Eat a lot of fruits and vegetables.

• Limit daily alcohol to 1 drink a day. ( Don’t drink at all if you have a drinking problem, or a medical reason not to.)

• Do some kind of exercise regularly.

Also, talk with your doctor about stopping birth control pills.

GOAL: Ideal blood pressure is 120/80 or less. Diabetics should always have blood pressure under 130/80.

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Lowdown on lipids Cholesterol is a lipid (a fat-like substance) made in the liver. Some people make too much. This trait seems to run in families. Others get too much from what they eat. High levels of cholesterol can lead to fatty buildup in the arteries. This may lead to heart attacks.

There are separate players in the “lipid” game. The “good cholesterol” (HDL) protects the heart. The “bad cholesterol” (LDL) leads to clogged arteries.

HDL LDL

LDL

Studies on men show that for every 1% they decrease their cholesterol, they reduce their risk of heart disease by 2% or more. If this is also true for women, we can all benefit by eating in a healthy way.

LDL

LDL

HDL

GOOD NEWS!

HDL HDL

LDL

LDL

Triglycerides are another type of lipid that may be more important in women’s risk for heart disease and is often higher in diabetics. Other lipid particles play a role in the team as well.

My lipid scores: Total cholesterol HDL LDL Triglycerides

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To get a score card of your “players” you will need to get a fasting blood test called a lipid profile. What is normal for you will depend on your score and any of your risks. Optimal scores are: • total cholesterol — under 200 • LDL — under 100, and lower if one is at high risk or has had a heart event already (*NCEP recommends 70) • HDL — 55 or higher • Triglycerides — less than 150

ways to improve your lipid scorecard • Lose weight if you need to.

• Limit alcohol to 112⁄ - 2 oz per day (1 drink).

• Don’t smoke.

• Exercise daily.

• Eat a diet that is low in fat (less than 30% of your total calories).

• Avoid fats that are labeled saturated or trans fat. These are sometimes called hydrogenated fat and can be found in certain items, like stick margarines and many snack foods. Products containing “plant stanols” are helpful.

• Remember, low fat doesn’t mean low calorie.

• Discuss the use of cholesterol lowering drugs with your doctor as diet and exercise alone may not be enough. The family of drugs called “statins” have been extremely helpful in lowering the risk of heart disease by controlling lipids. * National Cholesterol Education Program.

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sample menus Try using the chart below to plan some low-fat/lowcholesterol meals for yourself.

Day 1

Day 2

Day 3

Breakfast

Breakfast

Breakfast

Lunch

Lunch

Lunch

Dinner

Dinner

Dinner

Starch: Fruit: Fat: Beverage:

Protein: Vegetable: Vegetable: Starch: Fat: Fruit: Beverage:

Protein: Vegetable: Vegetable: Starch: Fat: Dessert: Fruit: Beverage:

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Lack of exercise Couch potatoes beware! Lack of exercise puts you at risk for getting heart disease. Aerobic exercise increases your breathing and heartbeat. It’s the best exercise for your heart. For this exercise to help your heart, you should keep it up for at least 30 minutes each time, and try to do this at least 3 times a week (more is better!) Exercise is a very good way to decrease other risk factors like high blood pressure and bad blood fats.

Start all new exercise programs slowly, and build up a little bit at a time. Pick something you enjoy doing.

With a little planning, there’s always time to exercise.

GOAL: Your heart-wise target pulse rate is 220 minus your age times 85%.*

Walking, biking, swimming, dancing, housework and tennis are aerobic exercises.

* Age 50 220 - 50 = 150 150 x .85 = 127.5

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sample exercise plan (ask your doctor or nurse to talk with you about this plan) type of exercise

how long

times per week

notes

HINTS: • Check with your doctor before starting any exercise program if: you are over 50, have risk factors or haven’t exercised in a long time.

• Get a buddy to exercise with you. You can encourage or nag each other to keep going.

• A cheap, easy exercise to start with is walking.

There are walk programs in most malls before the stores open. You will have safety, climate control and can shop afterwards!

• Exercise tapes and videos can help if you want to exercise at home.

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Obesity If you weigh 30% more than you should, you are obese. Women who are apple shaped (weight around the middle) have a higher risk of heart disease than do pear shaped women (weight around the hips). Any weight loss can improve your health. Find a good program to lose the weight slowly (about 2 pounds a week is healthy.)

Talk with your doctor or a dietitian to be sure it is safe for you.

Am I at a healthy weight?

Use the chart below to find your body mass index (BMI). An optimal BMI for good health is 19-25. Over 30 means obesity.

Your BMI score is:

Your Height

19 20 21 22 23 24 25 26 27 28 29 30 31 32 5' 0"

Your Weight (pounds) 97 102 107 112 118 123 128 133 138 143 148 153 158 163

5' 1"

100 106 111 116 122 127 132 137 143 148 153 158 164 169

5' 2"

104 109 115 120 126 131 136 142 147 153 158 164 169 175

5' 3"

107 113 118 124 130 135 141 146 152 158 163 169 175 180

5' 4"

110 116 122 128 134 140 145 151 157 163 169 174 180 186

5' 5"

114 120 126 132 138 144 150 156 162 168 174 180 186 192

5' 6"

118 124 130 136 142 148 155 161 167 173 179 186 192 198

5' 7"

121 127 134 140 146 153 159 166 172 178 185 191 198 204

5' 8"

125 131 138 144 151 158 164 171 177 184 190 197 203 210

5' 9"

128 135 142 149 155 162 169 176 182 189 196 203 209 216

5' 10" 132 139 146 153 160 167 174 181 188 195 202 209 216 222 5' 11" 136 143 150 157 165 172 179 186 193 200 208 215 222 229 6' 0"

140 147 154 162 169 177 184 191 199 206 213 221 228 235

How did you do?

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Diabetes Diabetic women carry a risk equal to a woman who already has coronary disease. It’s that powerful a risk factor — not only for heart disease, but also for stroke, kidney disease and blindness. Diabetic women may also develop heart problems at a younger age than usual.

Some women may have glucose intolerance which does not let them properly use their body’s insulin to control blood sugar.

This may lead to diabetes and the need for oral meds or insulin shots. As you can see, this is one big risk best avoided.

GOAL: • Keep your weight at a good level with a healthy diet. In some cases, limiting sugars (carbohydrates) in your diet is necessary.

• Exercise daily to help your body use it’s sugar properly as well as to lower blood pressure, lose weight and control lipids.

• Have your blood sugar checked at least once a year and more often if you have a family history of diabetes. A specific test to monitor for diabetes is called a “hemoglobin A1c.”

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The metabolic syndrome This fancy name describes a bunch of risk factors which, together, increase your risk of heart disease, diabetes and stroke. They include high blood pressure, waist size, obesity, low HDL, high triglycerides and high blood sugar. If you have 3 or more of the above risks, you should see your doctor to be tested for metabolic syndrome.

Stress Stress is anything in your life that causes you to feel tense, upset or without control. Emotions affect your body, and stress plays a role in your getting heart disease. Do you see yourself in some of these “woman-type” stresses?

• You are the care giver of the family and feel you have to take care of everyone but yourself.

• You may try to be “Super Woman” and juggle too many roles.

• Your job is one that doesn’t allow you to have much control.

• You have unhealthy ways of handling anger: bottling it up or exploding.

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GOALS: ways to manage stress • List the things that stress you.

Avoid the stresses that you can and change others.

• Share the stress load with someone.

Talking about it helps.

• Save time to do something fun.

• Use exercise to reduce stress.

There are books and video and audio tapes at your bookstore or library to help you learn to deal with stress. things that stress me

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what I can do

The Estrogen Connection For many years, it was believed that hormone therapy after menopause (change of life) protected a woman. Several recent studies done on thousands of women suggest that this is not the case. The current thinking is that hormone replacement therapy does not prevent heart disease and may even be harmful.

Also, there may be a higher risk of stroke, blood clots and breast cancer. There is on-going debate about hormone replacement.

As in all health concerns, you need to discuss this issue with your doctor.

The current recommendations are: • Women who need hormone replacement therapy (HRT) to control the physical symptoms of menopause (hot flashes, insomnia, irritability) should discuss options with their doctor and decisions should be based on individual risk.

• HRT should be at the lowest effective dose and taken not longer than 5 years.

• Osteoporosis (weak bones) is in fact helped

by HRT but can be treated by other means (Calcium with Vitamin D, Fosamax®, Actonel®, Evista® and by doing weight bearing exercises.

• Lowering risks from heart disease can be done in other ways (pages 10-20 in this book).

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Aspirin

HINT:

There is evidence that a daily aspirin can decrease the risk of stroke in women 59-79 years of age. Evidence that a daily aspirin helps prevent a first heart attack in women is not as clear. The benefits versus possible risks of daily aspirin therapy (and the dose) need to be discussed with your doctor. If you feel you are actually having a heart attack, chew a non-coated full-strength aspirin and call 911.

As with all medicines, check with your doctor before taking this drug on a daily basis.

Alcohol One study showed that women who drank 1 drink of any alcohol a day (not just red wine) lowered their heart disease risk by 39%. There are many other ways to lower your risk, but if you enjoy a glass of wine, a beer or one cocktail, cheers!

WARNING: Don’t drink if you are pregnant, addicted to alcohol or have a medical reason not to drink.

Antioxidants Some studies show that high supplements of antioxidants may, in fact, be harmful. These supplements may blunt the effect of some medicines including cholesterol lowering drugs. While a daily multivitamin is OK, getting antioxidants in fresh foods is still the best way to maintain heart health.

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What’s A Lady To Do? Don’t smoke or use tobacco products.

Avoid “second-hand smoke”

Keep an eye on your blood pressure. If you get high blood pressure, work with your doctor to control it.

120/80 or less

Check your levels of the good and bad cholesterols.

HDL 45 or more LDL under 100 (lower if you have heart disease)

Eat a heart-healthy diet rich in Omega 3 oils.

under 30% of calories from fat

Exercise on a regular basis.

At least 30 min. daily

Stay at or near the recommended weight for your age, height and body type.

BMI 19 - 25

Have your blood sugar checked from time to time. ( This is most true if you have a family history of diabetes.)

fasting blood sugar under 100

Now that you have learned about the risks of heart disease, you have the choice to limit or avoid them. Your heart is quite literally in your own hands. It’s up to you to take charge of your life and health. Lady, take heart, you have the power. Just use it!

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Learn More About It! American Heart Association “Go Red for Women” www.americanheart.org 1– 800 –242-8721

National Coalition for Women with Heart Disease www.womenheart.org 202–728-7199

NIH (National Heart, Lung and Blood Institute) www.hearttruth.gov 1– 800 –575-9355 WebMD.com Pritchett & Hull Books: Angina Pectoris Wake Up Call (risk factors — heart disease) Blood Pressure Control It’s Heartly Fare (nutrition) Exercise for Heart & Health Mitral Valve Prolapse Saving Your Heart

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Notes

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Pritchett & Hull Associates, Inc. The Heart of Health Education Since 1973 Some of our topics cover: • Heart disease • Heart disease risk factors • Heart surgery • High blood pressure

• • • • • •

Stroke Diabetes Nutrition Exercise Head injury Brain surgery

• • • • •

Home care Asthma Chronic lung disease Hip or knee surgery Bowel surgery

Write or call toll-free for a free catalog of products and prices: 1-800-241-4925

Author:

Reviewers for this book:

Suzanne Cambre, RN, BSHA Piedmont Heart Institute Piedmont Hospital Atlanta, GA 30309

Sara Mobasseri, MD, FACC Medical Director of Women’s Heart Services Piedmont Heart Institute Atlanta, Georgia

Thanks to previous reviewers:

Sarah Rinehart, MD, FACC Clinical Assistant Professor (Cardiology) Medical College of Georgia Clinical Director of Cardiovascular CT and MRI Piedmont Heart Institute Atlanta, Georgia

Nanette Kass Wenger, MD Christi Deaton Warner, RN, PhD, CCRN

We believe that you have the right to know as much as you can about your health.

Our goal is to give you enough facts to get the main points clearly in mind. We do this with medical accuracy, warmth and humor. The result for you: less tension, more healing and a good idea of what to ask your doctor, nurse or others.

Pritchett & Hull Associates, Inc. ®

3440 Oakcliff Road, NE, Suite 110 Atlanta, GA 30340-3079 1-800-241-4925 • www.p-h.com