A Woman’s Heart: Keeping it Healthy

Risk Factors are traits or habits that make a person more likely to develop a disease. Some risk factors for heart related problems cannot be changed, but others can be. The three major risk factors for heart disease that you can do something about are cigarette smoking, high blood pressure, and high blood cholesterol. Other risk factors, such as overweight, diabetes, and physical inactivity, also are conditions you have some control over. It is important to realize that these risk factors can be reduced at any age.

For years, women have had an advantage over men when it came to heart health. Women had far less heart disease and fewer heart attacks. However, in the last 50+ years many things have changed that have affected heart health for women. For one, people are living longer. For women this means they are living longer after menopause, the point at which their risks for heart disease increases. Also, more women smoke and take birth control pills, both of which can cause damage to the heart. Men and women both eat more high-fat foods and are less active than years ago; two more factors that can lead to heart problems.

Generations of women

On the other hand, we are learning more about which foods and lifestyles promote healthy hearts and which do not. More research is being done on women’s health problems, including heart disease. And health care professionals have found better ways to diagnose and treat heart problems, particularly in women, over the last 10 years — a big plus for women.

One thing that has not changed, though, is women’s mistaken ideas about heart disease. Too many of us still think it is a man’s disease. The fact is that women over age 65 are as likely as men over age 65 to die from heart disease. Also, many women think breast cancer is the number one threat to women’s health. In fact, heart disease kills more women than all cancers, diabetes, and accidents combined.

This book is not meant to scare you about your health, but to tell you ways to lower your risks for the most common health problem ­for women – heart disease. And there is good news. Many women can control or even end most of the risks linked to heart disease by eating healthier diets and adding a few good habits, like exercise, stopping smoking, and cutting down on alcohol. So keep reading and learn how you can have a healthier life, not just a longer one.


This booklet is about coronary artery disease, sometimes called coronary heart disease. This disease occurs when the arteries that supply blood to the heart become clogged from plaque build-up, called atherosclerosis. Heart disease can lead to angina, or chest pain, and eventually heart attacks. It also can put you at risk for strokes and peripheral vascular disease, disease of the arteries that go to your arms and legs.


You know yourself better than anyone else. So, the first thing you should do is assess your health and risks for heart disease now. Review the list of risk factors below. Some of these are risk factors you can’t change or control. For example, your age or a family history of heart disease. Other risk factors you can control, such as, smoking and exercising. Putting a check by the risk factors you have will help make you aware of your risk factors. Later, we will give you some suggestions for lifestyle changes you can make that will reduce your chances of developing heart disease.

Risk Factors For Heart Disease

Check any that apply to you.
❒ Smoke cigarettes
❒ Smoke and take birth control pills
❒ Have high blood pressure
❒ Have high cholesterol
❒ Have high triglycerides
❒ Have diabetes
❒ Have a family history of heart disease; “family” includes parents, grandparents, brothers, or sisters
❒ Are overweight
❒ Are past menopause (no longer having monthly periods)
❒ Get angry quickly, feel stressed often

While any one risk factor will raise your chances of developing heart related disease, the more risk factors you have the more concerned you should be about prevention. If you smoke cigarettes and have high blood pressure, your chance of developing heart disease goes up dramatically. If your cholesterol levels are also high, your risk can be 8 times that of women who have no risk factors.


Family History of Heart Disease

You are more likely to develop heart disease if you have blood relatives who have heart disease, especially if they suffered a heart attack or stroke before age 55. If you are African-American, your family history risk factor for heart disease is higher than women who are white. This is mainly because African-Americans have higher average blood pressure levels. You are at a higher risk for high blood pressure if either of your parents have it. If your family has a history of high cholesterol, you should have your cholesterol levels tested. Of they are high, your doctor can give you options.


Women with diabetes have a greater risk of heart disease compared with women of the same age without diabetes. This is due in part because plaque build up in the arteries is common with diabetes. Also, people with diabetes often have high blood pressure, high cholesterol, and are overweight. All of these are added risks for heart disease, heart attack, and stroke. Also, diabetes can double the risk of a second heart attack in women. Because diabetes adds so much risk, it is very important that women with diabetes keep their blood sugar levels under control.


Stop Smoking

Stopping smoking is the single best thing you can do to lower your risk of a heart attack. For a woman, smoking a pack a day increases your risk 5 to 10 times that of a nonsmoker. Your risk is even higher if you smoke and take birth control pills.

The bad effects of smoking are many. Smoking damages the walls of your blood vessels allowing more fatty deposits (atherosclerosis) to build up, and reduces your good cholesterol (high density lipoprotein) that can help prevent plaque from forming. Smoking also narrows your blood vessels and increases your heart rate and blood pressure, which makes your heart work harder. The carbon monoxide in cigarette smoke replaces the oxygen in your blood, which also makes your heart work harder to get the oxygen it needs.

It is never too late to quit smoking. Within two years of quitting, your risk of coronary artery disease drops dramatically. And after 10 years of quitting, your risk drops to that of someone who has never smoked. It may take you several tries to quit completely. Although there is no single best way to quit, below are some tips to help you.

• Make a real commitment — Plan ahead to quit. Set a date. Just before your quit-day clean your house and car of all tobacco smells, lighters, ashtrays, etc. If you are a heavy smoker, you may need to cut down gradually. Set dates for stepping down from each level of smoking until it is zero. Talk to your health care professional about smoking cessation programs and other stop smoking aids like nicotine replacement with gum or patches.

• Identify smoking triggers ­—­ Make a list of the times or situations that usually trigger you to smoke. Either avoid these triggers until you quit or change your response. For instance, don’t have an alcoholic drink for a while if you usually smoke when you drink. Take a walk every night after dinner instead of having a cigarette or have a glass of orange juice when you are on the phone if you usually smoke then.

• Get support — Depending on how much advice and support you need, you can get professional counseling, join a support group, go into an inpatient program, or just call a friend to give you encouragement. Letting people know you are quitting and asking for help makes it harder to relapse and therefore easier to succeed.

• Find out more — For more information on ways to quit or to find support groups to help you stop smoking, call or visit the websites of the American Lung Association, the American Heart Association, and the American Cancer Society.

Eat Less Fat & Cholesterol, More Fiber

“You are what you eat” couldn’t be more true than when you link the foods you eat with your risk for heart disease. Good health in general and especially good heart health depends on eating the right amount and a variety of foods. For instance, the right amount of fat and cholesterol in your body provides energy and helps keep up cell walls. But too much fat and cholesterol is stored as body fat and some of it ends up clogging your arteries. It’s important to get enough fiber, too. Fiber helps lower cholesterol and blood pressure and helps keep your arteries open. Fiber can also reduce your risk of colon cancer.

Below are suggestions for low-fat, low-cholesterol and high fiber foods.
Fruits and Vegetables
• Fresh, frozen, canned or dried vegetables & fruits (fresh fruits and vegetables are better choices than canned)
• Apples, oranges, and grapefruits are high fiber choices
• Squash, peas, and carrots are high fiber choices
Whole Grains
• Bread, bagels, breadsticks, pita bread
• English muffins, plain rolls
• Corn tortillas
• Hot and cold cereals
• Rice, pasta
• Popcorn (plain or light microwave)
• Pretzels, no-oil tortilla chips
• Whole grain breads, plain bagels, pita are higher fiber choices
Dairy products
• Skim and 1% milk, buttermilk, nonfat dry milk
• Fat-free yogurt and frozen yogurt
• Fat-free and low-fat cheese
Fish, poultry, meat, and legumes (except nuts, eggs, and shrimp)
• Any fish or shellfish (except shrimp or squid)
• Water-packed tuna or salmon
• Poultry, ground turkey (without skin)
• Lean cuts in small portions of beef, veal, lamb, pork, Canadian bacon
• Low-fat luncheon meats
• Dried beans and peas, lentils
• Egg substitutes, egg whites
• Soybeans, oats and barley are high fiber choices
• Fats, Use Sparingly
• Unsaturated oils — corn, sunflower, soybean, sesame, cottonseed, canola, olive, peanut
• Diet or “tub” margarine, reduced-fat margarine
• Fat-free and reduced-fat salad dressings
• Fat-free sour cream and cream cheese
Daily Dietary Guidelines To Reduce Fat, Cholesterol
• Limit total calories to 1,600 – 2,000 (if you are active)
• Reduce total fat grams to 30 percent of calories
• 30% of a 1,600 calorie diet = 53 fat grams
• 30% of a 2,000 calorie diet = 65 fat grams

To find recipes for low fat, low cholesterol, high fiber meals, visit your local library or book store. There is plenty of information on preparing heart-healthy meals. The key to eating healthy, low-fat meals is planning. Planning healthy meals for the week, reduces the chance of stopping at the donut shop in the morning or the fast food “drive-thru” for dinner.

Exercise Regularly

Not only does regular exercise make you feel better, it can add years to your life. Regular exercise reduces the risk of heart attack to about half that of someone who doesn’t exercise. It’s time to recognize how important exercise is for your heart and quality of life. While one-fourth of the deaths from chronic disease — mostly diseases of the heart and blood vessels — are caused by lack of exercise, 70% of women do not exercise on a regular basis.
Benefits of Regular Exercise:
• Your heart can pump more blood with less effort.
• Your coronary arteries will get larger, letting blood flow easily.
• Your HDL cholesterol (good cholesterol) levels will go up and your LDL cholesterol (bad cholesterol) and triglycerides levels will go down.
• Your blood pressure may go down.
• You will have more energy, sleep better, and deal with stress better.
• When combined with a low fat, low cholesterol diet, exercise will help you lose body fat, stay flexible, and tone your muscles.

Where Do I Start?

If you don’t exercise now or exercise less than 3 times per week, you need to condition your heart safely. Start with a moderate activity, like brisk walking, almost every day for 30 to 40 minutes. Walking is one of the aerobic exercises that is very good for your heart. Other good exercises include race-walking, swimming, dancing, cycling, rowing, stair or step machines, ski machines, and cross country skiing. To get the most benefits from exercise, focus on frequency, not intensity. Choose an activity you really like; that way, you are more likely to keep it up.
If you are over age 60 or if you have a chronic health condition like heart disease, diabetes, or breathing problems talk with your doctor before starting a new exercise program.

Maintain a Healthy Weight

Good eating habits and regular exercise go a long way to help you stay fit and keep up a healthy weight.
• If you’re overweight — you are more likely to have heart disease, high blood pressure, or diabetes. Getting down to a healthy weight for your size reduces your risk for heart attack. Even losing 10 pounds can make a difference in your risk. The best way to keep up a healthy weight is to eat right and get regular exercise. Remember, don’t make yourself miserable. If you plan low-fat meals that you really like and pick an exercise that you enjoy, you will be much more likely to keep up a healthier lifestyle.

• If you are underweight — you may not be getting enough nutrients to keep up good health. Losing weight later in life you’ll be losing mainly muscle, not fat. Refer to the Eat Heart-Smart section for the right kinds of foods to eat and the least number of calories and fat grams to keep up a healthy weight.

Drink Alcohol in Moderation

Drinking too much alcohol has been proven to do much harm to your body. It raises blood pressure and damages organs, especially the liver. Too much alcohol increases your risk of death from all causes, including cancer and stroke. However moderate levels of alcohol (one drink a day for women) usually isn’t harmful. In fact, this level of alcohol can increase your levels of HDL, the good cholesterol. So, if you drink, drink moderately.

Manage Stress Better

There are two ways that stress can affect your heart — directly and indirectly. In a very stressful situation, your body produces more adrenaline which makes your heart beat faster; breathing quickens and blood pressure rises. Stress can also lead to smoking or drinking to reduce the stress. Stress can also lead to anger which, over time, can be harmful to your heart.

Here are some ways to stay calm and manage your stress better
• Exercise regularly Exercise can make you feel more calm because your body produces less adrenaline. This may lessen your body’s natural response (faster heart beat and breathing, rise in blood pressure) in stressful situations. Regular exercise can be especially helpful if you are dealing with a long-term stressful situation; for instance, a job of high stress, a sick spouse or child, or the loss of a loved one.
• Relax There are lots of ways to relax. Take a bath, walk your dog, meditate, get a massage, watch a funny video. Not only does relaxing help take pressure off your heart, but it usually improves your mental health, too, which gives you more energy.
• Don’t Try to do it all. If some of your stress comes from regularly taking on too much work or other activities, start saying no or give all or part of the responsibility to someone else. You really don’t have to do it all, so don’t let it stress you out.
• Enjoy your friends Friends give each other support during times of stress. Friends can even help you find ways to exercise, relax, listen to your troubles, or reduce your workload.
• Get professional help if you need it — Sometimes we “can’t see the forest for the trees.” We get so wrapped up in the stress, we can’t see what’s causing it. Therefore, we can’t figure out how to get rid of it or control it. That’s when your doctor or a behavioral specialist can help.

Treat High Blood Pressure

High blood pressure, called hypertension, is when your heart pumps blood with a force that puts too much pressure on the walls of your arteries. Over a long period, high blood pressure can cause wear and tear on your arteries. Fat deposits are more likely to form once arteries have been damaged from high blood pressure. This damage increases your risk of heart disease, heart attack, and stroke. High blood pressure can be caused by a specific disease or condition, like kidney disease, pregnancy, or a hormonal disorder. It usually goes away when the disease or condition ends. The most common kind of high blood pressure is called “essential” hypertension. Essential high blood pressure has no known cause. It seems to run in families, and may be linked to high salt intake or to people who were overweight at a young age.

Women are at a lower risk for high blood pressure than men. But don’t assume that you don’t have high blood pressure just because you’re a women. High blood pressure can be present for years without symptoms. Have your blood pressure checked every two years. After age 40, when blood pressure in women naturally starts to go up, have your blood pressure checked every year.

High blood pressure can often be controlled by one or more of the following:
• Quit smoking
• Reduce weight to a healthy level; give up salt and foods high in sodium
• Exercise
• Drink alcohol in moderation
• Manage stress
• Taking blood pressure medicine as prescribed by your doctor


Studies show that by the time a woman reaches menopause, when her supply of the hormones estrogen and progesterone are almost depleted, her risk for heart disease begins to rise. If menopause happens naturally, the risk rises gradually with age. If menopause happens as a result of surgery, the risk of heart disease rises sharply. Although there is nothing you can do to prevent menopause, you should consider hormone replacement therapy (HRT). Hormone replacement therapy replaces our body’s natural hormones — estrogen, progesterone and testosterone — with man-made hormones. Prescribed to treat many of the symptoms of menopause, HRT has been found to reduce the risks of heart disease. Hormones keep the level of HDL (good cholesterol) high. Without hormones the level of LDL cholesterol rises sharply. Estrogen may also reduce spasm in the walls of the arteries, which is one cause of heart attacks.

HRT is not for everyone; there are side effects which may outweight the benefits. HRT may increase your risks for other health problems, such as high blood pressure, liver or gall bladder disease, phlebitis, and blood clotting problems. Also, if you (or someone in your family) have breast cancer, endometrial cancer, uterine fibroids, or advanced heart disease, HRT may cause these diseases to get worse.

When deciding whether to take hormone replacement therapy, learn as much as you can about it. Then ask your doctor to review your risks for heart disease as compared to the health risks HRT may present .

Menopause and Natural Remedies

If you have chosen natural remedies (e.g. herbs or vitamin therapy) to relieve your symptoms of menopause and not hormone replacement therapy, you should know that there is no evidence that natural remedies lower your risks for heart disease.


Many lives have been saved by knowing and reacting to the warning signals of heart attack.

Warning Signs of Heart Attack
• Pressure, fullness, squeezing, or pain in the center of the chest that lasts more than a few minutes
• Chest pain that spreads to the shoulders, neck, and/or arms
• Lightheadedness, fainting, sweating, nausea, shortness of breath
• Fast heartbeats
• Severe weakness

If you are having a heart attack, you may have more than one symptom. Have someone call 911 or get you to the hospital right away.


If after reviewing the risk factors, you think you have some risk for heart disease, you should schedule a checkup with your doctor. There are many diagnostic tests, including some especially for women, that can help your doctor find your level of risk. Even before you begin any lifestyle changes like diet and exercise to reduce your risk, it is a good idea to see your doctor first. You can get advice and suggestions that apply to your specific risks.

Get cholesterol and other levels checked

Test: Basic blood test. Measures total cholesterol and HDL (high-density lipoproteins – good cholesterol)
When: Every 5 years starting at age 20.
Target Levels: 200 or below Total Cholesterol; 55 or above HDL
Test: Blood test including lipid profile. Measures total cholesterol, HDL, LDL (low-density lipoprotein – bad cholesterol) and triglycerides.
When: If you are not at the target levels for Total Cholesterol and HDL and have other risk factors, your doctor may suggest this more thorough test at any age.

Target Levels: Total cholesterol and HDL targets are same as above. The target level for LDL is below 160 or below 95 for people at high risk. Also, more “pattern” LDL (mostly large LDL particles) is better than “pattern” LDL (small dense LDL bits). The target for triglycerides is 200 or below especially if you have low HDL cholesterol or pattern B LDL cholesterol. Your triglyceride target should be 70 or below if you are at very high risk.

Tests Especially for Women: Researchers have found more tests that seem to better predict risk for heart disease in women than in men. They are not routine, so you should talk with your doctor if, when, and where you should get these tests.
• Nuclear stress test or stress echocardiogram instead of a treadmill electrocardiogram
• Blood tests that measure your levels of homocysteine,
lipoprotein(a), LDL pattern, fibrinogen, and magnesium.

Get blood pressure checked

Your blood pressure is usually checked when you go to the doctor’s office. You should get your blood pressure checked at least every one to two years, more often if you have a family history of high blood pressure. A blood pressure of 120 over 80 is normal for a healthy young adult. Normal blood pressure may be higher than that for an older person. In any case, your doctor will know what’s normal for you and what to suggest if your blood pressure is too high.

Ask your health professionals about heart healthy dietsIf you have few or no risk factors for heart disease, a diet containing the foods listed under the “Eat Heart-Smart” section will keep you that way. But if you have special risks for heart disease, such as diabetes or very high triglyceride levels, your doctor may suggest a special diet plan to lower your specific risk.

If you are going through menopause, ask about Hormone Replacement Therapy (HRT)
As mentioned earlier, some doctors recommend hormone replacement therapy to treat symptoms of menopause and because of the risk-lowering effects on heart disease and osteoporosis. Check with your doctor or your gynecologist for all the information on the benefits and risks of taking HRT.

If you have blood relatives who have (or had) heart disease at early ages, alert your doctor.
Knowing your family’s health history is important, especially their history of heart disease. If you have blood relatives who have developed heart disease before age 50, tell your doctor. The earlier you begin to prevent other risks, the less likely you will follow in their footsteps.


Heart disease is the number one cause of death in men and women in the United States. However, many women are not aware of this and, therefore, they don’t do anything about it. The good news is that medical science is continually finding ways to detect and lower the risks of heart disease, especially in women. So now more than ever, you can take charge of your heart health. Reading this book is a good start. Read it more than once, make notes, be honest with yourself about your health. Begin changing bad habits, like smoking, and develop good habits, like exercising and eating healthier foods. You will find that almost any changes you make in how you eat or how you live that will promote good heart health will benefit your overall health as well. Changing habits isn’t easy, but experience shows that it works. It’s never too late to start. Cardiovascular diseases remain the leading cause of death for American women. But the message is clear: by taking an active role in your own heart health, you can make a difference!

Facts About Women’s Heart Disease

Some Findings That May Surprise You
¸ One out of every three women aged 40 and younger will develop coronary heart disease in their lifetime.
¸ Women over age 65 are as likely as men over age 65 to die from heart disease
¸ Women who experience heart attack symptoms are less likely than men to go to the emergency room.
¸ Doctors are less likely to diagnose heart disease or heart attack in women.
¸ Women tend to have heart attacks at older ages than men.
¸ Women who have coronary artery disease at younger ages may be predisposed to have particularly aggressive disease or have more risk factors that override the protective effect of estrogen.

More women fear cancer, yet heart disease is by far the leading killer.

If you’re surprised by one or more of these facts, it’s time to learn more about heart disease — the leading cause of death among American women.

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