Heart disease is the No. 1 killer of women, so you have to be proactive with your health.
Your Health
The Heart of a Woman
Although women have very different symptoms of heart disease than men, recommendations for optimal heart health remain the same.

Dr. Tracy Stevens asks female patients to measure their waist with a tape measure about every two weeks. The cardiologist and director of St. Luke’s Muriel I. Kauffman Women’s Heart Center says a woman’s waist diameter should be less than 35 inches (or her height in inches, divided by two), particularly as midline bulge develops with age.

Although area cardiologists diagnose asymptomatic heart disease in women who are in their 30s to 80s, one-third of women after age 65 will be diagnosed with this disease. It is the No. 1 killer of American women, taking the lives of 32 percent, which is six times as many as the number of women who die of breast cancer.

Nearly half a million American women’s deaths annually result from heart disease, including heart attacks and strokes. Smokers risk having a heart attack 19 years earlier than nonsmoking women, while diabetics are two to three times more likely to have heart attacks.

“Above age 45, the development of atherosclerosis [in women] is more of an issue,” says Steven Freeman, D.O. and a general cardiologist with MidAmerica Cardiology at KU Medical Center. “There’s also a debate about hormones being protective in women. Do we artificially try to continue post-menopausal hormone treatment but with increased risk of developing breast cancer?”

Diagnosing the problem
Diagnosing heart disease in women can be tricky because most diagnostic data came from studies with middle-aged white men until recently. Symptoms may include new and lasting jaw pain, neck discomfort and pain between the shoulder blades that limits normal physical activity.

Other symptoms may include indigestion that won’t go away with antacids, shortness of breath, or new or overwhelming fatigue that lasts for a week or longer. In fact, more and more physicians consider overwhelming fatigue the most common symptom before a woman has a heart attack. A general sense of malaise, nausea, or pain in arm, neck or leg arteries are other symptoms.

EKGs provide minimal benefit in diagnosing women’s heart disease, partially because the ‘brain’ on the machine is calibrated to data about men. A traditional treadmill test is not sufficiently accurate on its own, and for women who can’t physically do the treadmill test, a chemical stress test may be used. An echocardiogram in combination with the stress test provides more accurate data.

“With a traditional stress test, 35 percent of women receive a false positive [for heart disease] and 25 percent receive a false negative,” says Dr. Linda Crouse, cardiologist with MidAmerica Heart, Vascular and Vein Specialists (previously Kramer & Crouse Cardiology). “A stress echo or stress nuclear test is 90 percent accurate.” Steven believes the 64-slice coronary CAT scan is at the forefront of diagnostic tools, while cardiac catheterization or an angiogram is the ‘gold standard’ for diagnosis.

Preventing heart disease
Besides smoking, obesity is another huge risk factor. “There tends to be a positive correlation with high blood pressure, high lipids, high cholesterol and diabetes,” Steven says. “[We need to] try to get people off of high-fat, high-cholesterol foods. If you’re diabetic, you need to work with carbohydrates as well.”

Tracy says another contributing factor is that, “We’re consuming foods we’re not genetically programmed to eat [such as] simple sugars, including sodas, fried foods, high sodium and processed meats. We should eat foods that don’t have nutrition labels.”

Simple sugars are found everywhere, from sports drinks to high-carbohydrate foods and syrups. “Alcohol is OK, one drink per day for women, but it can raise triglycerides (blood sugars) as you consume more and more,” she notes.

Tracy recommends eating breakfast that includes good quality protein, and Linda recommends following a “prudent diet” with plenty of fresh fruits, vegetables and fish, avoiding fried foods and eating less red meat. But diet isn’t the only cause — or cure — for high cholesterol. Family history may play a significant role in the development of high cholesterol.

“Every woman should check her cholesterol once a year and particularly the LDL number, which should be less than 100 if you have any two risk factors,” Linda says. “[It should be] less than 130, with no risk factors, before menopause.” Diabetics should have an LDL of 70 or less and be very aggressive with their heart care.

Additionally, women should do ongoing abdominal strength training and get at least 2 1/2 hours of exercise per week, going no longer than two days without it. Getting good quality sleep and reducing stress are also vital for heart health.