Heart Disease in Women – Part 2
- Article previously published in the Hudson Valley Pilot – see link below
This is the second of a 2 part series
Lowering our risk
While a family history is one of the classic non-modifiable risk factors, there is growing evidence that we have the power to alter our genetic potential, and not only reduce our risk by preventing plaque build up, but actually reverse some of the damage that has already been done. While much of the basic advice (don’t smoke and exercise) has stood the test of time, it can be difficult to sort through the endless trends on social media regarding nutrition and wellness and figure out what advice to follow. Additionally, while our food choices factor in heavily, there is more to risk reduction than just a myopic view on nutrition and weight.
Get Moving
While many of us acknowledge the benefits of being more active, according to the CDC, less than 25% of adults, and only 20% of women, meet the recommendations in the Physical Activity Guidelines for Americans published in 2018. For optimal health, we should all be striving for 150 min of moderate, or 75 min of vigorous exercise a week (if you can talk, but not sing while doing it, consider it moderate, and if you can only answer in 1 word sentences, it is vigorous). As a busy mom of 3, I can certainly appreciate the difficulty in finding the time to do anything for myself, much less commit to going to the gym for 30 min 5 times a week. However, there are any number of ways to “define” physical activity, and those of us not inclined to become gym rats can find inspiration in the AHAs tips to increase activity at home.
But do these small bursts of activity really matter? The evidence is mounting that adding any amount of physical activity to our daily routines can have profound effects. Unfortunately, sitting is the new smoking, as a report in the Journal Circulation advises that sedentary lifestyles double the risk of cardiovascular diseases, diabetes, and obesity, and increase all causes of mortality. Put another way, in addition to physical inactivity, just the mere act of sitting, and not moving for prolonged periods of time can shorten our lives. According to a study published in 2021 in Nature Reviews Cardiology, “replacing sedentary behavior with any intensity of physical activity (that is, movement) will have health benefits, with greater benefits seen when sedentary behavior is replaced with moderate–vigorous-intensity physical activity”. Therefore it is imperative that we all find ways to sit less, move more, and aim to increase our overall fitness.
Reduce Stress
As we all juggle the intensities of modern life, the role that stress plays on women and their risk for CVD is becoming increasingly evident. The AHA reports “high stress levels can raise blood pressure and heart rate, leading to serious medical problems, such as stroke and heart attack. The negative effects of stress may be greater for women younger than age 50 with a history of heart problems”. However, the mind-calming practice of meditation may play a role in reducing your risk of heart disease, according to a scientific statement published in 2017 in the Journal of the American Heart Association. Here, experts reviewed dozens of studies published over the past two decades and found that meditation may improve a host of factors linked with heart disease. Adding that to the relative low risk and low cost of beginning a regular practice, makes it worth including in an overall program for ongoing heart care. Getting benefits does not need to involve having a guru or finding nirvana; it can be as simple as spending one minute a day in mindful deep breathing, often with eyes closed, and muscles and mind relaxed. Adding music or white noise can be beneficial, and as with any new practice, using technology can help make it stick by either setting an alarm, or using an app to guide you.
Prioritize sleep
There is also a growing body of evidence that we should make getting good sleep a priority. As any peri-menopausal woman knows, the amount of sleep disruption that occurs during this transition is profound. Couple that with the increased demands on our time at home, as well as increased rates of depression and insomnia in women and most of us at any age are not getting the sleep we need. The association between good quality sleep and physical and mental health are not hard to understand, but there is a growing body of evidence suggesting that even mild sleep disturbances in women can have profound impact on our cardiovascular risks. A 2018 study in the Journal of the American Heart Association performed on a large racially and ethnically diverse group of women found that mild, prevalent sleep disturbances (perceived poor sleep quality, prolonged time to fall asleep, and insomnia) are associated with elevated blood pressure and evidence of vascular inflammation leading to increased cardiovascular risk in women. There are a myriad of causes for poor sleep quality, too broad for this present article, but I can speak personally to a life of not making sleep a priority, and so I would urge anyone with increased risk for heart disease to recognize the importance of getting good sleep.
Dietary choices
It has become increasingly clear that the standard American diet, which is high in animal protein, unhealthy fats, ultra-processed foods, and added sugar and salt, and low in fish, nuts, whole grains, and fiber rich fruits, vegetables and legumes, not only contributes to increased risk of CVD via it’s impact on weight, but that it also causes significantly increased amounts of inflammation and oxidative stress that are directly damaging to blood vessels and increase the formation of plaque build up. Contrary to popular belief, the low fat diet recommendations made popular in the 1980s actually fueled an epidemic of obesity in this country, and unfortunately exacerbated the risk for CVD because the highly processed carbohydrates and added sugars that replace the fat are stripped of most of their inherent nutritional value, and increase the strain on the liver and pancreas, increasing rates for diabetes and increasing the aforementioned visceral fat, both of which significantly contribute to CV risk. Women in particular have been led to believe that diet foods, low in fat, were good for them.
The AHA now promotes a heart healthy diet as one that incorporates a broad variety of fruits and vegetables, whole grains, heart healthy fats, and getting protein from mostly plant based sources, and when animal products are consumed, to aim for fish, or leaner choices. Additionally, we should all be limiting our intake of highly processed foods, and those with added sugar and salt. So what does this mean for the average home cook, who isn’t a gourmet chef on a cooking show with an endless pantry supply?
Thinking about this can easily feel overwhelming, and as anyone who has ever tried a restrictive diet before knows (think keto, low-fat, no carb), eliminating things from your diet can be difficult to maintain. By forgoing highly processed, prepackaged foods and instead adding color, and increased variety of fruits, vegetables, seeds, nuts and whole grains packed with phytonutrients and healthy fiber you can make smart lifestyle food choices that add to your diet. Additionally, we know that we need fat in our diet, but we should go for things high in unsaturated fats, such as olive oil, fish, avocado, and avoid anything with tropical (palm) oil or high in saturated fat (solid at room temperature).
Of course, making healthier choices can feel like a strain on the wallet, and frankly be difficult for some due to lack of access to adequate shopping. Addressing the politics of food scarcity is beyond the scope of this article, but a few good tips for eating healthy on a budget include using frozen fruits, and canned or frozen vegetables – which are actually just as healthy
and can easily be portioned out without worrying they will go bad before you can get through them all.
How to recognize the symptoms
Lastly, it is clear that a key factor to decrease mortality is the recognition of symptoms. As with men, women’s most common heart attack symptom is chest pain or discomfort, but women are more likely than men to experience some of the other common symptoms, particularly shortness of breath, nausea/vomiting or lightheadedness and back or jaw pain. Symptoms of a stroke include sudden numbness or weakness of the face, arm or leg, particularly on one side only; confusion, or trouble speaking or understanding; double vision or blurriness in one or both eyes; difficulty walking, dizziness or loss of balance; and sudden and severe headache. If any of these symptoms are present, calling 911 and getting to a hospital immediately is crucial to shortening the time to life saving treatments.
CONCLUSION
While it is difficult to determine if the differences in cardiovascular disease and mortality among women compared with men can be totally explained by a delay in women seeking care, healthcare provider delay in recognition and treatment, underlying differences in pathophysiology, women having more co-existing medical problems, or older ages at time of presentation, it is clear that high awareness of heart disease as the leading cause of death in women, and how to recognize and modify risk, are the key strategies to prevention. While much of the focus of this article has been on the alarming trends in women, sadly many of these modifiable risk factors are present in all of us, and making even small changes in our lifestyle can have long term impact. As we celebrate love for those around us this month, I would encourage us to view the preponderance of hearts not only as a reminder to think about our own heart health, but to also especially keep in mind the health of the mothers, wives, sisters, aunts, and girlfriends in our lives.
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