The following statement is shocking but true—even though heart disease is thought of mostly as a "man's disease," it kills more than one-third of American women. Hard to believe? Consider these facts…

  • Heart disease is the number-one killer of women in the US.
  • Women age 40 and older who have a heart attack are more likely than men of the same age to die within one year.
  • Women ages 40 to 69 are more likely than men in the same age group to have a second heart attack within five years of the first attack

One problem, say researchers, is that women aren't treated as aggressively for heart disease as men. That's because many doctors-and nearly nine out of 10 women-still don't recognize the extent and severity of women's heart disease.

What can you do to protect yourself? What are the risk factors that so many women are unaware of or do not properly manage?

Reducing Your Risk

Understanding your personal risk factors for heart disease is crucial. Your family history, of course, cannot be changed. If a parent or sibling has heart disease, your own risk is increased. Because women typically suffer heart attacks later in life than men do-possibly because of the estrogen that helps protect them until menopause--if your mother was relatively young (under age 60) when she had a heart attack, you are at even greater risk.

However, you can do something about all the other risk factors. The personal habits and metabolic measurements, such as cholesterol, that make a heart attack or stroke more likely are the same for women and men. Most people do not realize, though, that there are several risk factors that threaten women more than men.

What women need to know to protect themselves from the likelihood of a heart attack…

  • Diabetes. Extra blood sugar (glucose) in the bloodstream may damage arteries. For unknown reasons, this increases heart disease risk for women more than for men.

What to do: Diabetes is most likely to develop in midlife. If you are over age 45, ask your doctor for a fasting blood glucose test, which can detect diabetes. The test should be repeated every three years, or annually if you have a risk factor for diabetes—for example, if you have a family history of the disease or if you are overweight.

Diet, exercise and glucose-lowering medication, such as metformin Glucophage), are effective for controlling diabetes and thus lowering heart disease risk.

  • HDL cholesterol. This is the "good" cholesterol that carries harmful fat away from the arteries. Healthy HDL levels in women are 50 milligrams per deciliter (mg/dL) or higher, versus 40 mg/dL or higher for men. Increasing HDL by 10 mg/dL may reduce heart disease risk by 42% to 50% in women.
  • Triglycerides. High levels of this type of blood fat may increase the risk for heart disease by 32% in men and 76% in women. The reason for this disparity is unknown.

What to do: Anyone over age 20 should have a fasting lipoprotein profile. This blood test measures HDL and triglycerides, along with LDL "bad" cholesterol and total cholesterol. If results are normal, retest every five years.

If any of your levels are abnormal, treatment typically includes dietary changes, regular exercise and, if necessary, a statin drug, such as lovastatin (Mevacor) or simvastatin (Zocor) or the B vitamin niacin to increase HDL

Caution: Niacin can be dangerous for some. Do not use it without consulting your doctor.

  • Smoking. While most women know that smoking raises the risk for lung disease, many do not realize that it also triples a woman's risk for heart disease. In women under age 44, smoking is the most common risk factor for heart disease.

What to do: Stop smoking. After one year, your risk for heart disease will be halved. After 10 years, your risk for stroke will be the same as that of a lifelong nonsmoker. Ask your doctor about nicotine replacement treatments (patches, chewing gum) and other measures that can help you quit.

  • Excess weight. Extra body weight causes an elevation in blood triglycerides. It is especially risky when fat is concentrated around the belly area, because abdominal fat releases hormones and other biochemicals that can increase blood sugar and lower HDL.

What to do: With a measuring tape, measure your waist just above the navel and your hips at the widest part. Divide your waist measurement by your hip measurement.

Example: If your waist is 30 inches and your hips are 40 inches, your waist-to-hip ratio is 0.75

If your waist-to-hip ratio exceeds 0.8, you are at increased risk for heart disease. Work with your doctor to establish realistic diet and exercise goals to help you lose weight.

  • Anger. Anger increases levels of stress hormones that may make arteries more vulnerable to cholesterol buildup. It also raises blood pressure. In our culture, women are taught to hold in their anger-a practice that may be particularly damaging to the heart, according to research. Healthy ways to deal with anger...
  • Practice relaxation techniques, such as deep breathing, meditation and biofeedback. These strategies also can help reduce heart-damaging chronic stress.
  • Try to avoid situations that you know trigger your anger, such as waiting in long lines or saying yes to too many responsibilities.
  • Exercise—it helps distract you from and dissipate anger.
  • Think honestly about what you can and cannot control. Try to accept your limitations.
  • Talk to a behavioral psychologist, who can help you develop ways to handle your anger
  • Lack of support. Studies show that women who are not in supportive environmentsat home, at work or both-have higher blood pressure and higher rates of heart disease. Important types of support to cultivate...
  • Emotional support—someone you can trust with your most intimate thoughts, anxieties and fears, and who trusts you.
  • Social support—someone you enjoy spending time with
  • Informational support-someone you can ask for advice.
  • Practical support—someone who will try to help you out in a pinch.

Kidney Problems Can Signal Heart Disease

Kidney disease can be a sign of heart disease, says Peter A. McCullough, MD, MPH. Because the heart pumps blood to the kidneys to be filtered, the health of these two organs is interrelated. Two simple tests that can measure kidney health also indicate heart health-estimated glomerular filtration rate (GFR) and urine-albumin-to-creatinine ratio. Most insurers cover the costs.

Self-defense: If your doctor doesn't order them as part of your annual physical, ask him/ her to do so.

Warning: Heart Attack Linked to Flu

An analysis of autopsy reports for nearly 35,000 people who died from heart disease over an eight-year period showed that the risk of dying from a heart attack increased by one-third during weeks of flu epidemics, compared with non-epidemic weeks.

Theory: Influenza causes inflammation, which can loosen plaques (fatty deposits) in coronary arteries and cause heart attacks.

If you have heart disease: Ask your doctor about getting an annual flu shot when the vaccine becomes available (usually in October or November).

Better Way to Calculate Heart Attack Risk

Age, sex, blood pressure, cholesterol level and smoking are commonly used to estimate heart attack risk. But up to 20% of female heart attack patients do not have high cholesterol or blood pressure and/or smoke.

New tool: Researchers studied 24,558 healthy women age 45 and older and devised a more accurate risk score that factors in blood levels of the inflammation marker C-reactive protein and parental history of a heart attack before age 60. Women can assess their heart attack risk at

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