February is American Heart Awareness Month—our annual opportunity to focus attention on women’s risk of heart disease.

The last 50 years have seen enormous progress in the understanding and treatment of this condition. There is great optimism that we will soon identify dozens of heart disease genes that will open new pathways for diagnosis and treatment.

But at the moment, heart disease is taking a tremendous toll. More women will die from this condition than from any other illness. In fact, 35 percent of American women over the age of 35 will die of a heart attack.

The most common cause of heart attacks is related to a buildup of plaque, a fatty, cholesterol-filled material inside the lining of the coronary blood vessels, which supply blood to the heart.

We already know much about preventing heart disease. Here are five important factors you can discuss with your doctor to better understand your risk of a heart attack and how to lower your risk.

1. High Blood Pressure (Hypertension). This condition is very common, very easy to diagnose, and comparatively easy to treat—and the association between high blood pressure and heart attack is not disputed. Almost a third of U.S. adults have hypertension (a blood pressure greater than 140/90). Unfortunately, half of the American population with hypertension is not being adequately treated. For every increase in blood pressure by 20/10, the risk of heart attack doubles. The good news is that treatment of high blood pressure reduces the risk of heart attack by up to 25 percent. Be mindful that a blood pressure of 120/80 is now called pre-hypertension and warrants attention to improving diet, exercise, and weight loss.

2. High Cholesterol (Hyperlipidemia). This condition does seem to get as much attention as it deserves. Having low levels of HDL (“good” cholesterol) is a greater predictor of risk in women than in men; so are high levels of triglycerides and high levels of a lipid particle called lipoprotein(a). Regrettably, lipoprotein(a) is not commonly included on routine cholesterol profiles; it is important as a risk factor for heart attack in pre-menopausal women.

There are many safe and effective treatments for high cholesterol—most importantly, the statin drugs. The use of statins can reduce the risk of a heart attack by more than 40 percent, and these drugs have a very good safety profile. There is much controversy about cholesterol treatment in the management of lower-risk patients, but there is no controversy about high-risk patients’ need for treatment. Lower-risk patients should improve their diet and increase exercise.

3. Diabetes Screening. Diabetes doubles the risk of heart attack in men, and triples the risk of heart attack in women.  Eight percent of the United States adult population has been diagnosed with diabetes, and yet 25 percent of the U.S. population remains undiagnosed. Diabetes is common and easy to diagnose with simple blood tests. Recognizing the presence of this disease can focus care on preventing heart attacks and other complications of diabetes.

4. Lifestyle Improvements. Taking an honest assessment of your diet, exercise, and smoking habits will help you make improvements to reduce your risk of heart disease. Despite advertised quick fixes for diet and weight control, I know of no magical supplement that will enable you to lose weight, eat what you want, and abandon exercise. There are no shortcuts.

One-sixth of American women smoke, one in four is obese, and more than one-half are sedentary. High-fat sweetened foods and a sedentary lifestyle contribute to these startling statistics. It is important to change your lifestyle. Even incremental changes can result in a lowering of risk.  Just 20 minutes of vigorous exercise three times a week can reduce your mortality by 27 percent, and adding 30 minutes of moderate activity on the remaining days can reduce mortality by 50 percent.  Set realistic goals. A weight-loss goal of just 10 percent to start is enough to reap a benefit, and is more likely to be achieved than trying to change your lifestyle drastically. Quitting smoking is a challenge, but will also lead to huge benefits to your health.

5. Vascular imaging. For the patient whose risk is uncertain, two tests are worth considering: coronary calcium scoring and testing of the carotid artery intima-media thickness. These tests can provide much-needed insight.

Coronary artery calcium scoring is done in a CT scanner. Admittedly, the test uses less radiation than other CT studies. (This test should not be confused with CT coronary angiography, which has similarities, and which should be reserved for a limited number of higher-risk patients.)  The  test shows calcification from atherosclerosis in the coronary arteries to the heart and compares the score to those of other women of the same age.  This test can help refine risk in the patient with borderline risk factors, an ambiguous cholesterol profile, or a family history that’s of concern. When a patient’s risk is otherwise unclear, calcium scoring can give clarity. The test is unlikely to be covered by insurance, and may cost up to $400 out of pocket, but compared with the cost of Lipitor for one year, which is more than $1,000, its value is evident. If your risk is lower than expected, this test might prevent you from using Lipitor.

Another imaging test, carotid intima-media thickness, uses ultrasound to measure thickening of the carotid arteries in the neck. By using ultrasound, this test is radiation-free, and it detects non-calcified atherosclerosis that the CT scan would miss. Potentially it is more appropriate for younger patients who do not yet have calcified arteries. The test requires skill to get reliable measurements

Other useful tests exist, and more are soon to come, but we need to first do the best job possible with currently available tools. Control of blood pressure, cholesterol, diabetes, and diet; discontinuing smoking; and increasing exercise are reliable methods that will reduce the risk of heart attack.


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  • Roz Warren June 5, 2012 at 2:03 pm

    The use of statins can reduce the risk of a heart attack by 40 percent? Does that apply to both women and men? Where exactly does that statistic come from? And do studies show that taking a statin will actually increase a woman’s life expectancy?

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