Heart Disease

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• What is heart disease?
• Do women need to worry about heart disease?
• Do women of color need to worry about heart disease?
• What can I do to prevent heart disease?
• What does high cholesterol have to do with heart disease?
• What do my cholesterol and triglyceride numbers mean?
• How can I lower my cholesterol?
• How do I know if I have heart disease?
• What are the signs of a heart attack?
• One of my family members had a heart attack. Does that mean I'll have one too?
• Sometimes my heart beats really fast and other times it feels like my heart skips a beat. Am I having a heart attack?
• Should I take a daily aspirin to prevent heart attack?
• Does taking birth control pills increase my risk for heart disease?
• Does using the birth control patch increase my risk for heart disease?
• Does hormone replacement therapy (HRT) increase a woman's risk for heart disease?

See also...

• Diabetes: Overview
• Heart Healthy Eating
• How to Talk to Your Doctor About Heart Disease and Heart Health
• Menopause and Menopause Treatments
• Obesity and Weight Loss
• Physical Activity
• Stress and Your Health

What is heart disease?

Heart disease is a number of abnormal conditions affecting the heart and the blood vessels in the heart. Types of heart disease include:

• Coronary artery disease (CAD) is the most common type and is the leading cause of heart attacks. When you have CAD, your arteries become hard and narrow. Blood has a hard time getting to the heart, so the heart does not get all the blood it needs. CAD can lead to:
  • Angina. Angina is chest pain or discomfort that happens when the heart does not get enough blood. It may feel like a pressing or squeezing pain, often in the chest, but sometimes the pain is in the shoulders, arms, neck, jaw, or back. It can also feel like indigestion (upset stomach). Angina is not a heart attack, but having angina means you are more likely to have a heart attack.
  • Heart attack. A heart attack occurs when an artery is severely or completely blocked, and the heart does not get the blood it needs for more than 20 minutes.
• Heart failure occurs when the heart is not able to pump blood through the body as well as it should. This means that other organs, which normally get blood from the heart, do not get enough blood. It does NOT mean that the heart stops. Signs of heart failure include:
  • Shortness of breath (feeling like you can't get enough air)
  • Swelling in feet, ankles, and legs
  • Extreme tiredness
• Heart arrhythmias are changes in the beat of the heart. Most people have felt dizzy, faint, out of breath or had chest pains at one time. These changes in heartbeat are, for most people, harmless. As you get older, you are more likely to have arrhythmias. Don't panic if you have a few flutters or if your heart races once in a while. If you have flutters AND other symptoms such as dizziness or shortness of breath (feeling like you can't get enough air), call 911 right away.

Do women need to worry about heart 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.

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 can I do to prevent heart disease?

You can reduce your chances of getting heart disease by taking these steps:

• 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 (DASH Eating Plan) 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:
  • Nicotine patches and gums
  • Support groups
  • Programs to help you stop smoking

Ask your doctor or nurse for help. For more information on quitting, visit Quitting Smoking.

• Get tested for diabetes . People with diabetes have high blood glucose (often called 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. 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.

• Maintain a healthy weight. Being overweight raises your risk for heart disease. Calculate your Body Mass Index (BMI) to see if you are at a healthy weight. 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.

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

What does high cholesterol have to do with heart disease?

Cholesterol is a waxy substance found in all parts of the body. When there is too much cholesterol in your blood, cholesterol can build up on the walls of your arteries and cause blood clots. Cholesterol can clog your arteries and keep your heart from getting the blood it needs. This can cause a heart attack.

There are two types of cholesterol:

• Low-density lipoprotein (LDL) is often called the "bad" type of cholesterol because it can clog the arteries that carry blood to your heart. For LDL, lower numbers are better.
• High-density lipoprotein (HDL) is known as "good" cholesterol because it takes the bad cholesterol out of your blood and keeps it from building up in your arteries. For HDL, higher numbers are better.

All women age 20 and older should have their blood cholesterol and triglyceride levels checked at least once every 5 years.

What do my cholesterol and triglyceride numbers mean?

• Total cholesterol level - Lower is better. Less than 200 mg/dL is best.

Total Cholesterol Level	Category
Less than 200 mg/dL	Desirable
200 - 239 mg/dL	Borderline high
240 mg/dL and above	High

• LDL (bad) cholesterol - Lower is better. Less than 100 mg/dL is best.

LDL Cholesterol Level	Category
Less than 100 mg/dL	Optimal
100-129 mg/dL	Near optimal/above optimal
130-159 mg/dL	Borderline high
160-189 mg/dL	High
190 mg/dL and above	Very high

• HDL (good) cholesterol - Higher is better. More than 60 mg/dL is best.
• Triglyceride levels - Lower is better. Less than 150mg/dL is best.

How can I lower my cholesterol?

You can lower your cholesterol by taking these steps:

• Maintain a healthy weight. 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.)
• Eat better. Eat foods low in saturated fats, trans fats, and cholesterol.

Eat more:

• Fish, poultry (chicken, turkey--breast meat or drumstick is best), and lean meats (round, sirloin, loin). Broil, bake, roast, or poach foods. Remove the fat and skin before eating.
• Skim (fat-free) or low-fat (1%) milk and cheeses, and low-fat or nonfat yogurt
• Fruits and vegetables (try for 5 a day)
• Cereals, breads, rice, and pasta made from whole grains (such as "whole-wheat" or "whole-grain" bread and pasta, rye bread, brown rice, and oatmeal)

Eat less:

• Organ meats (liver, kidney, brains)
• Egg yolks
• Fats (butter, lard) and oils
• Packaged and processed foods

There are two diets that may help lower your cholesterol:

• Heart Healthy Diet
• Therapeutic Lifestyles Changes (TLC) Diet
• Get moving. Exercise can help lower LDL ("bad cholesterol") and raise HDL ("good cholesterol"). Exercise at a moderate intensity for at least 30 minutes most days of the week. Take a brisk walk on your lunch break or take the stairs instead of the elevator.
• Take your medicine. If your doctor has prescribed medicine to lower your cholesterol, take it exactly as you have been told to.

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.

What are the signs of a heart attack?

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

Symptoms of a 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
• Other symptoms, such as 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 a few minutes—five at most—before calling 911.

One of my family members had a heart attack. Does that mean I'll have one too?

If your dad or brother had a heart attack before age 55, or if your mom had one before age 65, you're more likely to develop heart disease. This does not mean you will have a heart attack. It means you should take extra good care of your heart to keep it healthy.

Sometimes my heart beats really fast and other times it feels like my heart skips a beat. Am I having a heart attack?

Most people have changes in their heartbeat from time to time. These changes in heartbeat are, for most people, harmless. As you get older, you're more likely to have heartbeats that feel different. Don't panic if you have a few flutters or if your heart races once in a while. If you have flutters AND other symptoms such as dizziness or shortness of breath (feeling like you can't get enough air), call 911.

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.

Does taking birth control pills increase my risk for heart disease?

Taking birth control pills is generally safe for young, healthy women. But birth control pills 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. Talk with your doctor if you have questions about the pill.

If you're taking birth control pills, watch for signs of trouble, including:

• Eye problems such as blurred or double vision
• Pain in the upper body or arm
• Bad headaches
• Problems breathing
• Spitting up blood
• Swelling or pain in the leg
• Yellowing of the skin or eyes
• Breast lumps
• Unusual (not normal) heavy bleeding from your vagina

If you have any of these symptoms, call 911.

Does using the birth control patch increase my risk for heart disease?

The patch is generally safe for young, healthy women. 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 patch.

If you're using the patch, watch for signs of trouble, including:

• Eye problems such as blurred or double vision
• Pain in the upper body or arm
• Bad headaches
• Problems breathing
• Spitting up blood
• Swelling or pain in the leg
• Yellowing of the skin or eyes
• Breast lumps
• Unusual (not normal) heavy bleeding from your vagina

If you have any of these symptoms, call 911.

Does hormone replacement therapy (HRT) increase a woman's risk for heart disease?

Hormone replacement therapy (HRT) 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 HRT.

For more information . . .

You can find out more about heart disease by contacting the National Women's Health Information Center at 1-800-994-9662 or the following organizations:

National Heart, Lung, and Blood Institute (NHLBI)
Phone Number(s): (301) 592-8573
Internet Address: http://www.nhlbi.nih.gov/index.htm

National Cholesterol Education Program
National Heart, Lung, and Blood Institute (NHLBI)
Internet Address: http://www.nhlbi.nih.gov/about/ncep/

National High Blood Pressure Education Program
National Heart, Lung, and Blood Institute (NHLBI)
Internet Address: http://www.nhlbi.nih.gov/about/nhbpep/index.htm

Act In Time to Heart Attack Signs Campaign
National Heart Attack Alert Program
National Heart, Lung, and Blood Institute (NHLBI)
Phone Number(s): (301) 592-8573
Internet Address: http://www.nhlbi.nih.gov/actintime/

The Heart Truth
National Awareness Campaign for Women about Heart Disease
National Heart, Lung, and Blood Institute (NHLBI)
Internet Address: http://www.nhlbi.nih.gov/health/hearttruth/index.htm

American Heart Association
Phone Number(s): (800) 242-8721
Internet Address: http://www.americanheart.org

WomenHeart
Phone Number(s): (202) 728-7199
Internet Address: www.womenheart.org

All material contained in this FAQ is free of copyright restrictions, and may be copied, reproduced, or duplicated without permission of the Office on Women's Health in the Department of Health and Human Services. Citation of the source is appreciated.

This FAQ was reviewed by:

Patrice Desvigne-Nickens, M.D.
Leader, Cardiovascular Medicine SRG
Clinical and Molecular Medicine Program
Division of Heart and Vascular Diseases
National Heart, Lung, and Blood Institute

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Current as of February 2007