by Tieraona Low Dog, MD
The numbers are staggering. Cardiovascular disease claims more lives of American women than the next 16 causes of death combined. Roughly 500,000 women will have a heart attack this year, and while mortality trends for heart disease in men have decreased during the past 20 years, they have increased for women.
Within one year of having a heart attack, 42 percent of women die compared to 24 percent of men. Cardiovascular disease is particularly concerning in minority communities, with death rates 69 percent higher for black women than white women. Many think heart disease is something that happens to “old people,” yet it is the second-leading cause of death among women ages 45 to 64, and third for women ages 25 to 44.
While risk factors are the same for men and women - elevated serum lipids, hypertension, obesity, sedentary lifestyle, and smoking - some affect us differently. For instance, after age 45, cholesterol levels tend to plateau in men but increase steadily in women, and by age 55, women often have higher concentrations then men. The combination of low HDL-C (good cholesterol) and elevated triglycerides is particularly dangerous for women, increasing the risk of death tenfold. We also know that high blood pressure and high fasting blood glucose levels are stronger risk factors for women and that smoking increases our risk twofold to fivefold.
While these statistics are disturbing, there is something that we can do to protect ourselves. First, every woman should know her level of risk for heart disease. You can calculate your risk by going to the American Heart Association Web site, www.goredforwomen.org. The next step is obtaining good medical advice for reducing your risk if it is elevated. Tremendous advances in pharmaceutical interventions have saved countless lives. Nevertheless, experts agree that an integrated approach is best when it comes to promoting heart health. It is estimated that up to 80 percent of heart disease can be prevented by simply making healthy lifestyle and dietary choices. We will take a look at some of the areas that can mean the difference between optimal and poor health.
The role of diet
There are two types of diets that really stand out as being beneficial for the cardiovascular system: the Dietary Approaches to Stop Hypertension, or DASH diet, and the Mediterranean diet. These diets are similar in that they emphasize fruits and vegetables, low-fat dairy products, whole grains, fish, poultry, and nuts. Intake of saturated and trans-fats are limited, as are red meat, sweets, and sugar-containing beverages. The Mediterranean diet emphasizes olive oil as the primary fat and allows for modest amounts of alcohol.
The American Heart Association and the National Institutes of Health support the DASH diet as a healthy lifestyle choice for preventing heart disease. Studies have shown that the DASH diet can significantly reduce blood pressure, especially in African American and elderly populations. Researchers believe that the diet acts as a natural but potent diuretic. Diuretics are generally considered a first line therapy for the treatment of hypertension.
In the 1950s, nutritionist Dr. Ansel Keys observed that men living on the island of Crete had a particularly low incidence of heart disease and cancer and lived to be quite old. This observation led Dr. Keys to conduct a 15-year, seven-nation comparative study to investigate how regional diets affected health outcomes. The seven nations included Greece, Finland, Japan, Italy, the Netherlands, Yugoslavia, and the United States. He found those consuming a Mediterranean-style diet had lower rates of cardiovascular deaths, even though they did not have lower cholesterol levels than countries with higher cardiovascular disease such as northern Europe and the United States. Large clinical trials have since supported Keys’ early study and observations.
There is also evidence that soy protein is good for the heart. A meta-analysis of 38 clinical trials concluded that consumption of soy protein in place of animal protein significantly lowers total cholesterol, LDL-C (bad cholesterol), and triglycerides. The FDA found the evidence compelling enough to formally approve a health claim that allows foods containing 6.25 grams of soy protein per serving (assuming four servings, or 25 g/d soy protein) to state that the food reduces the risk of heart disease on the label.
There are numerous cookbooks and Web sites that can help you easily learn to incorporate these dietary approaches into your journey for better health. For more information see the resource list.
Omega-3 fatty acids
Omega-3 fatty acids are essential fatty acids that are necessary for human health but cannot be manufactured by the body; they must be consumed in food.
There are two primary sources of omega-3 fatty acids in the diet - one is from fish, the other is from plants. Eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) are the two principal fatty acids found in fish. DHA can also be found in other marine sources, such as algae. Alpha-linolenic acid (ALA) is found in certain vegetable oils (e.g., flax, soybean, canola), walnuts, and some green vegetables (e.g., spinach, kale). The body is able to convert small amounts of ALA into EPA and DHA. Because this conversion is relatively small, vegetarian sources of omega-3 fatty acids may not confer the same cardiovascular benefits as those found in fish.
Omega-3 fatty acids benefit the hearts of healthy people, as well as those at high risk of, or those who already have, cardiovascular disease. Researchers believe that omega-3 fatty acids, principally EPA plus DHA, benefit the heart by reducing the risk of arrhythmias, which can lead to sudden cardiac death, decreasing triglyceride levels, and slowing the progression of atherosclerosis in people with coronary artery disease.
The American Heart Association recommends that patients with coronary artery disease take at least 1 gram per day of EPA plus DHA, and those with elevated plasma triglycerides take 2 to 4 grams per day. In 2003, the European Society of Cardiology recommended the inclusion of fish oils as standard therapy for post-infarction management based upon data showing a risk reduction of 45 percent to 81 percent for sudden cardiac death - the most common cause of mortality among patients surviving a heart attack.
Unfortunately, many Americans consume a diet that is low in omega-3 fatty acids. And there are growing concerns about the safety of eating fish, as they accumulate toxins such as mercury, dioxins, and polychlorinated biphenyls (PCBs) that can have deleterious effects on health if exposed to excessive amounts, especially during pregnancy or in young children. (See Web sites listed in orange box for more information on which types of fish are high in omega-3 fatty acids and low in contaminants.)
For those who are limiting their consumption of fish but want the heart-healthy benefits of fish oil, supplement manufacturers appear to be doing a pretty good job providing high-quality supplements. Consumer Labs recently tested 41 commercially available fish oil supplements. None of them contained any detectable levels of mercury or unsafe levels of PCBs or dioxins. There is also an FDA-approved, omega-3 fish oil preparation, Lovaza® (formerly Omacor by Reliant Pharmaceuticals) that is available by prescription.
High-quality fish oil supplements should not have a fishy odor when you open the bottle (this is usually a sign of rancidity). If you have problems burping up a fishy taste, try keeping your fish oil capsules in the freezer.
Alcohol
Numerous studies have shown that moderate amounts of alcohol have a beneficial effect upon the heart by raising HDL-C, reducing plaque accumulation in the arteries and mildly inhibiting platelet aggregation. Conversely, three or more drinks per day can raise triglycerides and eventually damage the heart. Women who drink two or more servings of alcohol per day may also increase their risk of breast cancer. So, if you enjoy having a drink, don’t have more than one serving per day (i.e., 5 ounces wine, 12 ounces beer, 1 ounce liquor), and if you don’t drink, there is no reason to start for “health” purposes.
Smoking
Smoking is the single most preventable cause of death in the United States. Half of all heart attacks in middle-aged women are attributable to tobacco. Women who smoke are at increased risk for stroke, and this risk increases even more if you take birth control pills. So if you smoke, make today the day you quit. Your risk of heart attack begins to decline within months of smoking cessation, reaching the level of people who have never smoked within three to five years.
Weight loss and exercise
Roughly 25 percent of women report no regular physical activity. The numbers are even higher for those 55 and older. Moderate exercise reduces cholesterol, triglycerides, blood pressure, and the risk of stroke while helping to maintain a healthy weight and fitness level. Studies repeatedly show that regular exercise reduces abdominal fat, the type most associated with developing diabetes and high blood pressure. The Nurses’ Health Study revealed that just walking at a brisk pace at least three hours per week can reduce coronary events by 30 percent to 40 percent.
Even modest weight loss can give you an edge against heart disease. For instance, blood pressure is reduced when excess body weight is lost, even if ideal body weight is not achieved. A review of 11 weight-loss studies found that the average systolic and diastolic blood pressure reduction per kilogram (2.2 pounds) of weight loss was 1.6/1.1 mm Hg, respectively. Obesity is often associated with elevated triglycerides and low levels of HDL-C, which is a particularly dangerous combination for women. Weight loss in most overweight women increases HDL-C and lowers triglyceride levels.
One special note: Low-fat diets for weight loss can actually lower HDL-C levels, so make sure that instead of simply eliminating fat, you replace saturated fats with healthy fats such as olive or canola oils.
The mind-body connection
There is little debate that excessive and/or prolonged stress can be hard on the heart, both figuratively and physiologically. Prolonged stress can elevate blood pressure and cholesterol. Depression after a heart attack can indicate a higher risk of recurrence. Mind-body programs have been shown to lower blood pressure, and when combined with nutritional counseling, actually reduce or reverse blockages in coronary arteries. A review of 37 studies found a 34 percent reduction in cardiac mortality, a 29 percent reduction in recurrence of heart attack, and significant positive effects on dietary and exercise habits, weight, smoking, cholesterol, and blood pressure in patients who underwent counseling in health education and stress management.
In summary, women can do a great deal to give themselves an edge against heart disease. Start today. Know your risk. Seek medical advice to reduce your risk. Adopt a heart-healthy diet. Be creative with food. Engage in regular exercise. Go for walks. Be watchful of the scale. Treat your body as your best friend. Nourish it with things other than just food. Keep an eye on your mental health. Learn healthy coping skills. Practice patience. Give yourself permission to rest and play. The old saying, “An ounce of prevention is worth a pound of cure,” is the key to optimal heart health.
