From the National Women's Health Information Center

Do women really need to worry about heart and cardiovascular disease?

Yes. One in three American women dies of heart disease. In 2003, almost twice as many women died of cardiovascular disease (both heart disease and stroke) than from all cancers combined. The older a woman gets, the more likely she is to get heart disease. But women of all ages should be concerned about heart disease. All women should take steps to prevent heart disease.

Both men and women have heart attacks, but more women who have heart attacks die from them. Treatments can limit heart damage but they must be given as soon as possible after a heart attack starts. Ideally, treatment should start within one hour of the first symptoms.

If you think you're having a heart attack, call 911 right away. Tell the operator your symptoms and that you think you're having a heart attack.

How do I know if I have heart disease?

Heart disease often has no symptoms. But, there are some signs to watch for. Chest or arm pain or discomfort can be a symptom of heart disease and a warning sign of a heart attack. Shortness of breath (feeling like you can't get enough air), dizziness, nausea (feeling sick to your stomach), abnormal heartbeats, or feeling very tired also are signs. Talk with your doctor if you're having any of these symptoms. Your doctor will take a medical history, do a physical exam, and may order tests.

How can I tell if I am having a heart attack?

Not everyone has all of the warning signs of heart attack. And sometimes these signs can go away and come back.

Signs of heart attack include:

• Pain or discomfort in the center of the chest
• Pain or discomfort in other areas of the upper body, including the arms, back, neck, jaw, or stomach
• Shortness of breath (feeling like you can't get enough air), breaking out in a cold sweat, nausea (feeling sick to your stomach), or feeling faint or woozy

Some women have more vague symptoms, such as:

• Unusual tiredness
• Trouble sleeping
• Problems breathing
• Indigestion (upset stomach)
• Anxiety (feeling uneasy or worried)

If you think you, or someone else, may be having a heart attack, wait no more than five minutes before calling 911. Tell the operator the symptoms and that you think you or the other perons is having a heart attack.

Should I take a daily aspirin to prevent heart attack?

Aspirin may be helpful for women at high risk, such as women who have already had a heart attack. Aspirin can have serious side effects and may be harmful when mixed with certain medicines. If you're thinking about taking aspirin, talk to your doctor first. If your doctor thinks aspirin is a good choice for you, be sure to take it exactly as your doctor tells you to.

Do women of color need to worry about heart disease?

Yes. African American and Hispanic American/Latina women are more likely to get heart disease because they tend to have more risk factors such as obesity, lack of exercise, high blood pressure, and diabetes than white women. Women of color also are more likely than white women to die of heart disease. If you're a woman of color, take steps to reduce your risk factors.

What steps can I take to prevent heart disease?

• Know your blood pressure. Your heart moves blood through your body. If it is hard for your heart to do this, your heart works harder and your blood pressure will rise. People with high blood pressure often have no symptoms, so have your blood pressure checked every 1 to 2 years. If you have high blood pressure, your doctor may suggest you make some lifestyle changes, such as eating less salt and exercising more. Your doctor may also prescribe medicine to help lower your blood pressure.



• Don't smoke. If you smoke, try to quit. If you're having trouble quitting, there are products and programs that can help, such as nicotine patches and gums, support groups and stop-smoking programs. Ask your doctor or nurse for help.



• Get tested for diabetes. People with diabetes have high blood glucose (blood sugar). People with high blood sugar often have no symptoms, so have your blood sugar checked regularly. Having diabetes raises your chances of getting heart disease. If you have diabetes, your doctor will decide if you need diabetes pills or insulin shots. Your doctor can also help you make a healthy eating and exercise plan.



• Get your cholesterol and triglyceride levels tested. High blood cholesterol can clog your arteries and keep your heart from getting the blood it needs. This can cause a heart attack. Triglycerides are a form of fat in your blood stream. High levels of triglycerides are linked to heart disease in some people. People with high blood cholesterol or high blood triglycerides often have no symptoms, so have your blood cholesterol and triglyceride levels checked regularly. All women age 20 and older should have their blood cholesterol and triglyceride levels checked at least once every 5 years. If your cholesterol or triglyceride levels are high, talk to your doctor about what you can do to lower them. You may be able to lower your cholesterol and triglyceride levels by eating better and exercising more. Your doctor may prescribe medication to help lower your cholesterol.



• Find healthy ways to cope with stress. Lower your stress level by talking to your friends, exercising, or writing in a journal.



• Maintain a healthy weight. Being overweight raises your risk for heart disease. Eat a healthy diet and exercise at a moderate intensity for at least 30 minutes most days of the week. Start by adding more fruits, vegetables, and whole grains to your diet. Take a brisk walk on your lunch break or take the stairs instead of the elevator.



• If you drink alcohol, limit it to no more than one drink (one 12 ounce beer, one 5 ounce glass of wine, or one 1.5 ounce shot of hard liquor) a day.

How can I lower my bad cholesterol level?

If you are overweight, losing weight can help lower your total cholesterol and LDL ("bad cholesterol") levels. Calculate your Body Mass Index (BMI) to see if you are at a healthy weight. If not, try making small changes like eating an apple instead of potato chips, taking the stairs instead of the elevator, or parking farther away from the entrance to your office, the grocery store, or the mall. (But be sure to park in a safe, well-lit spot.)

What type of diet is best to lower cholesterol?

Eat foods low in saturated fats, trans fats and cholesterol.

Eat more of these foods: Fish, poultry (chicken, turkey — breast meat or drumstick is best), and lean meats (bake broil, roast or poach foods; remove the fat and skin before eating); fat-free or low-fat milk, cheeses, and yogurt; fruits and vegetables (try for 5 a day); cereals, breads, rice, and pasta made from whole grains, such as oatmeal, rye, whole wheat or whole grain bread, brown rice and whole wheat pasta.

Eat less of these foods: fats (butter, lard) and oils, packaged and processed foods, organ meats (liver, kidney, brains) and egg yolks.

Do birth control pills or using the patch increase my risk for heart disease?

Taking birth control pills or using the birth control patch is generally safe for young, healthy women. But birth control pills and the patch can pose heart disease risks for some women, especially women older than 35; women with high blood pressure, diabetes, or high cholesterol; and women who smoke.

Recent studies show that women who use the patch may be exposed to more estrogen (the female hormone in birth control pills and the patch that keeps users from becoming pregnant) than women who use the birth control pill. Research is underway to see if the risk for blood clots (which can lead to heart attack or stroke) is higher in patch users. Talk with your doctor if you have questions about the pill or patch.

If you are taking birth control pills or using the patch watch for signs of trouble, such as blurred or double vision, pain in the upper body or arm, problems breathing, spitting up blood, bad headaches, swelling or pain in the leg, breast lumps, unusual (not normal) heavy vaginal bleeding, and yellowing of the skin or eyes. If you have any of these symptoms, call 911.

Does hormone therapy at menopause increase a woman's risk for heart disease?

Hormone therapy (HT) can help with some symptoms of menopause, including hot flashes, vaginal dryness, mood swings, and bone loss, but there are risks, too. For some women, taking hormones can increase their chances of having a heart attack or stroke. If you decide to use hormones, use them at the lowest dose that helps for the shortest time needed. Talk with your doctor if you have questions about HT.