HEALTH MATTERS
By: Dr. Banu Mahalingam
If you ask women to tell you what the Number One cause of death among women is, few will be able to tell you.
The answer is cardiovascular or heart disease. It outnumbers deaths from all other causes combined.
Annually, 500,000 women die from cardiac-related health problems, including heart attack, stroke, hypertension and heart failure. Fifty percent of all women will die of cardiovascular disease; 38 percent of women who have heart attacks die within a year, compared to 25 percent of men. Sixty-three percent of women who die from coronary heart disease had no previous symptoms.
Understanding risk factors and being aware of preventative measures is vitally important.
Studies and trials have made it clear that heart disease is largely preventable when certain risk factors high blood pressure, diabetes, high cholesterol, smoking, physical inactivity are modified. Yearly physicals are a must in order to monitor these risk factors.
High blood pressure readings include systolic numbers greater than 130 and diastolic numbers greater than 85. Aim for readings lower than 140/90, striving for 120/80. If, after three months of modifying lifestyle behaviors, your blood pressure is still at or above 140/90, consult your doctor about medications that can help you lower your blood pressure.
"The older you get, the higher your risk for heart disease. Due to the protective effect of estrogen, women lag 10 years behind men until menopause, and then the risk is the same." Banu Mahalingam, M.D.
Cardiologist University Medical Center at Princeton |
As part of your yearly physical, expect to have blood work. The screen for diabetes is a fasting blood glucose level greater than 125 mg/dl, especially if risk factors such as obesity and family history are present. If you are a diabetic, the goals are to maintain fasting blood glucose levels between 80-120 and hemoglobin A1-C less than 7.
Following the American Diabetes Association diet is quite useful. The diet calls for less than 30 percent fat, less than 10 percent saturated fat, and less than 300 mg cholesterol. Regular physical activity is strongly recommended, and medications (oral or insulin) are available if needed.
The benefits that smoking cessation would confer are innumerable, including reducing the incidence of heart attacks, strokes and peripheral vascular disease (cramping pain in your legs that prevents you from walking). Lifestyle modification is key, as is limiting total exposure to cigarette smoke, both active and passive. The importance of quitting smoking and avoiding passive smoke cannot be overstated.
Counseling, nicotine patches and gum, and other medications are available to help patients overcome nicotine addiction.
A careful diet, weight management and regular exercise are all necessary to manage lipids and prevent high cholesterol readings (exceeding 200). The HDL ("good" cholesterol) should be greater than 40, while the LDL ("bad" cholesterol) should be less than 130. Trigylcerides should be less than 200, and below 150 if you are diabetic.
The issue of hormone replacement therapy has been much discussed recently.
The National Heart, Lung and Blood Institute of the National Institutes of Health has stopped early a major clinical trial of the risks and benefits of combined estrogen and progestin in healthy menopausal women, due to an increased risk of invasive breast cancer. The large multi-center trial, a component of the Women’s Health Initiative, also found increases in coronary heart disease, stroke and pulmonary embolism in study participants on estrogen plus progestin. compared to women taking placebo pills.
There were noteworthy benefits of estrogen plus progestin, including fewer cases of hip fractures and colon cancer, but on balance the harm was greater than the benefit. The study, which was scheduled to run until 2005, was stopped after an average follow-up of 5.2 years.
These results do not apply to women who had a hysterectomy before joining WHI and are participating in the study of estrogen alone. The balance of risks and benefits for women in the estrogen alone study is still uncertain. It is important to note that, to date, women in the estrogen alone study have not shown an increased risk of breast cancer.
Specific study findings for the estrogen plus progestin group, compared to placebo, include:
A 41 percent increase in strokes;
A 29 percent increase in heart attacks;
A doubling of rates of venous thromboembolism (blood clots);
A 22 percent increase in total cardiovascular disease;
A 26 percent increase in breast cancer;
A 37 percent reduction in cases of colorectal cancer;
A one-third reduction in hip fracture rates;
A 24 percent reduction in total fractures, and
No difference in total mortality (of all causes).
Do not initiate hormone replacement therapy for the sole purpose of cardio-protection.
Just as cessation of smoking is necessary, so is physical activity and weight management.
A good goal is to achieve a minimum of 30 minutes of moderate level activity, such as brisk walking, at least four times a week. Incorporate activity into your day-to-day routine, gradually increasing your activity level. Doing this will help with weight management.
Diet and exercise combine to help women achieve gradual and sustained weight loss.
For a successful diet, opt for well-balanced meals which are high in fiber, low in saturated fats and rich in anti-oxidants, particularly Vitamins C and E and beta carotene. Replace whole milk with skim milk and limit alcohol intake to less than one drink per day. Talk to your doctor about the benefits of taking a baby aspirin (81 mg) daily to reduce the risk of stroke and heart disease.
During your annual physical, ask your doctor to check your fasting cholesterol and talk to him or her about checking your C Reactive Protein and homocysteine.
The older you get, the higher your risk for heart disease. Due to the protective effect of estrogen, women lag 10 years behind men until menopause, and then the risk is the same. Family history is a very significant risk factor, particularly if there is evidence of disease in family members less than 60 years of age.
While you are unable to control your age, gender or family history, focus on the many risk factors that are within your control, modify them, and visit a cardiologist once a year.
For women with heart disease, know that newer medications have been proved as effective in preventing progression of disease and recurrence of symptoms, so follow up with your cardiologist every three to six months.
Dr. Banu Mahalingam is a board-certified cardiologist on staff at University Medical Center at Princeton. This article was prepared in collaboration with Lorraine Seabrook.