Jennifer Mieres, M.D., is Associate Professor of medicine and Director of Nuclear Cardiology at NYU School of Medicine, a Fellow of the American College of Cardiology and the American College of Physicians, and is board certified in cardiovascular diseases and nuclear cardiology. She is on the forefront of treating women of color who have heart disease.
Terri Ann Parnell, R.N., is an award-winning cardiovascular nurse who is widely published in professional literature.
Carol Turkington is a medical writer, author, and veteran journalist specializing in women's health.
Heart Disease: Women's Heart Disease Is Different from Men's
The lifestyle of most Americans promotes heart disease, and we are a population of "heart attacks waiting to happen." Consider the facts: Cardiovascular disease (which includes heart disease and stroke) is the leading cause of death of American women. In 2004, more than 460,000 women died from cardiovascular disease, compared to 410,000 men. Although most of us fear breast cancer, thanks to the amount of press given this subject, the truth is that women are far more likely to die of heart disease.
Here is a quick look at the numbers: One in eight women will develop breast cancer in her lifetime and one in twenty-six will die of it, but one in three women will die of cardiovascular disease. In fact, a fifty-year-old woman faces a 46percent risk of developing heart disease and a 31 percent risk of dying from it. Of all the cardiovascular diseases, coronary heart disease, which can lead to a heart attack, and stroke are the number one and three killers of American women.
In this book we focus on reducing your risk of heart disease. By following the steps we outline you will also reduce your risk of a stroke, since many of the same factors that place you at risk for heart disease also increase your chances of having a stroke.
Heart disease and its debilitating effects can be prevented by first recognizing that you are at risk, knowing the signs and the factors that predispose you to heart disease, and then taking simple steps to live a heart-healthy lifestyle.
The Causes of Heart Disease in Women
When it comes to the prevention, diagnosis, and treatment of heart disease, men have traditionally received more attention than women. However, women are at equal risk for heart disease and heart attacks. Although women typically develop heart problems about seven to ten years later in life than men, by about age sixty-five, a woman's risk of heart disease is almost the same as a man's. Blockage of the coronary arteries that supply blood and nutrients to the heart is the leading cause of coronary artery disease and heart attacks in men and women. Certain factors can increase your risk of heart disease. The more risk factors you have, the greater your chance of having a heart attack or stroke. Inaddition, certain risk factors tend to speed the development of atherosclerosis--the narrowing of arteries due to the buildup of fatty substances. That's why it is important that you identify and eliminate or modify any risk factors you have. Risk factor modification with lifestyle changes as well as taking medication, if needed, can slow the progression of atherosclerosis and help prevent a heart attack.
Although men and women share similar factors that increase their risk of heart disease, such as smoking, high blood pressure (hypertension), diabetes, sedentary lifestyle, high cholesterol, and family history of heart disease, certain factors play a bigger role in the development of heart disease and heart attacks in women. Overall, compared to men, many more women are obese, have a sedentary lifestyle, or have hypertension and diabetes. These particular risk factors play a much more important role in leading to heart disease and heart attacks in women than they do for men.
Why Women of Black and Latino Heritage Have Different Risk Factors From Caucasian Women
The fact that African-American and Hispanic women have as much as a 69 percent higher risk of heart disease than Caucasian women is due in part to their higher incidence of risk factors, including high blood pressure, obesity, physical inactivity, diabetes, and metabolic syndrome. (Metabolic syndrome is a group of risk factors, including abdominalfat, high blood pressure, high cholesterol levels, and insulin resistance or glucose intolerance.) Yet the results of a recent survey indicate that among Black women and Latinas, there is less awareness that being overweight, smoking, physical inactivity, high cholesterol, and a family history of heart disease increase their heart disease risk.
Poor control of cardiovascular risk factors may also account for part of the difference. A recent study published by the American Heart Association found that Black women had higher rates of high blood pressure, diabetes, and high cholesterol than white women. About 56 percent of the Black women in the study had adequate blood pressure control, versus 63 percent of the white women. Furthermore, Black women, despite their higher risk of heart disease, were 10 percent less likely to receive aspirin (to lower the risk of a blood clot, which can block an artery) and 27 percent less likely to receive cholesterol-lowering drugs, known as statins. The results of this study should drive home the fact that women need to be more aware of heart disease risk factors and how to control them. As women, we need to stop underestimating our risk of heart disease.
Color Matters: Why Black Women and Latinas Are at High Risk
Kathleen, a forty-five-year-old African-American woman was referred to me for a stress test because she recently experienced shortness of breath when climbing stairs. At herrecent checkup, she was told she was about thirty-five pounds overweight, her blood sugar was elevated, and she was diabetic and needed to start taking medications to control her blood sugar levels. The nurse-practitioner discussed the importance of taking her medications and starting a weight-control program to prevent the horrible complications of diabetes, which include heart disease. This visit was an eye-opener for Kathleen because her father had his first heart attack when he was fifty, and her older brother, who is also diabetic, had heart surgery at age fifty-five. This family history made her determined to change her diet and lifestyle so that she would be around to see her children graduate from high school.
Kathleen and her husband both worked long hours, Kathleen as a legal secretary and he as an elementary school teacher. She reflected on their lifestyle and realized that they were both overweight, he had hypertension, and their diet and family history placed them both at risk for heart disease.
Like Kathleen, most women never dream that they are at risk for heart disease, nor do they have any idea that simply being a woman of color places them at particularly high risk. In fact, one out of every two women of color in the United States will die of heart disease.
Like so many women who experience the early signs of a heart attack or heart disease, Kathleen thought that she was just getting older and her shortness of breath was most likely due to her weight and age. As it turned out, Kathleen's stress test did not show any signs of lack of bloodsupply to the heart muscle with exercise, but it revealed that her blood pressure was very high during exercise, placing her at risk for heart disease and stroke. Her elevated blood pressure was the cause of her shortness of breath when walking or climbing stairs.
In addition to taking medications for diabetes, Kathleen was started on medication to reduce her blood pressure. She learned that controlling her weight and changing her diet were very important in reducing her risk for heart disease and stroke. Her nurse-practitioner explained the importance of understanding the signs and symptoms of heart disease as well as knowing and controlling her risk for heart disease. Kathleen also learned that by changing her lifestyle, her risk factors for heart disease could be controlled and a heart attack could be prevented. She left the office that day promising herself to change her eating habits as well as lose weight because she did not want to follow in her father's or brother's footsteps.
HEART SMART FOR BLACK WOMEN AND LATINAS. Copyright © 2008 by Jennifer H. Mieres and Terri Ann Parnell. All rights reserved. No part of this book may be used or reproduced in any manner whatsoever without written permission except in the case of brief quotations embodied in critical articles or reviews. For information, address St. Martin's Press, 175 Fifth Avenue, New York, N.Y. 10010.