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Heart disease: leading cause of death

Heart disease is the leading cause of death and disability of women in the United States. When many people hear the term “heart disease,” they think of it as a man’s disease, but this is not true.

Because of this misconception, women are sometimes less likely to be ppropriately diagnosed and treated. According to the National Center for Health Statistics, one in nine women between the ages of 45 to 64 develops symptoms of some form of cardiovascular disease. After age 65, this ratio climbs to one in three women. Despite significant reductions in the death rates from coronary heart disease from the 1980s to today, heart disease remains at No. 1 as the leading cause of death in women, ahead of cancer, lung disease, stroke, and Alzheimer’s disease.

The most common form of heart disease is called “coronary artery disease.” CAD involves atherosclerotic plaque buildup in the arteries that supply blood to your heart. Many women with CAD are asymptomatic. A significant blockage in a coronary artery may cause symptoms such as chest pain, chest pressure or shortness of breath on exertion. If the artery becomes severely or completely blocked, oxygen and nutrients cannot get to the heart muscle which results in damage to the heart or a “heart attack.”

Risk factors which accelerate plaque buildup include smoking, diabetes, age, high blood pressure, high cholesterol, family history of heart disease, and obesity.

Once you are diagnosed with heart disease, you will have it for the rest of your life. If you make changes in your habits and control your risk factors, the condition of your blood vessels can remain stable for many decades allowing you to live an active and healthy life.

Risk factors

A risk factor is a condition or habit that increases the chances of developing a disease or having it worsen. Some risk factors, such as age or a family history of early heart disease are out of your control. Most risk factors, however, are affected by your lifestyle choices.

Risk factors that you can control include smoking, high blood pressure, high blood cholesterol, obesity, being sedentary and diabetes. You can reduce these risks by making lifestyle changes and, in some case, taking medicine.

Smoking cigarettes increases the risk of heart attack and stroke, as well as lung cancer and other serious diseases. Even smoking one to two cigarettes a day increases your risk. The rewards of quitting are big. Your heart disease risk drops by more than half one year after you stop. If you quit for two to three years, your risk is almost indistinguishable from that of a nonsmoker.

High blood pressure can lead to heart disease, stroke, congestive heart failure, and kidney disease. Blood pressure is considered high when it is 140/90 or above, but your risk of heart disease is raised even at 120-139/80-89. A low-salt diet and weight loss can sometimes lower your blood pressure, but medications are commonly needed if your blood pressure remains consistently high.

High blood cholesterol, especially LDL (low-density lipoprotein or “bad” cholesterol), can lead to blockages in the arteries — and a possible heart attack. The higher your LDL, the higher your risk of heart disease. Ideally, your LDL should be less than 130. If you have known cardiovascular disease or diabetes, then guidelines suggest the LDL should be less than 100 or ideally less than 70.

HDL (high-density lipoprotein or “good” cholesterol) helps remove cholesterol from your blood. 60 or higher is protective while a level less than 40 increases your heart disease risk.

Elevated triglycerides also increase your risk of cardiovascular events. Your lipid profile should be routinely checked by your primary care provider. If they are mildly abnormal, initial treatment may involve improving your diet and losing weight. If they are significantly abnormal, medication may be needed. The most common cholesterol medications being a class of medicines called “statins” which effectively lowers the LDL and have been shown to reduce cardiovascular events such as heart attacks.

Diabetes is a major risk factor for heart disease, stroke, kidney failure and other diseases.

Diabetes is such a strong risk factor for heart disease that we commonly call it a coronary artery disease equivalent. Adults who are overweight, physically inactive, or who have a family history of diabetes are more at risk to develop the disease. Improving your diet, losing weight, and controlling you blood sugar can significantly reduce your risk of heart disease.

People who are overweight or obese are more likely to develop heart disease, even if they have no other risk factors. Obesity also increases the risk of stroke, congestive heart failure, and other diseases such as hypertension, high cholesterol, and diabetes which further increase your risk of heart disease.

Being sedentary or not getting regular physical increases your risk for heart disease. Having a higher fitness and activity level, reduces your risk of heart disease, stroke and death.

Are you at risk?

Heart disease can be prevented. The most effective way to prevent heart disease is to control your risk factor. Every risk factor is important. A woman with just one risk factor is far more likely to develop heart disease. Risk factors compound and make each other worse, so having two or more risk factors is especially serious. There are several models to calculate your personal risk, the most common being the Framingham risk score. Working with your primary care provider, you can calculate your personal risk and learn steps you can take to reduce your chances of developing heart disease.

Preventing heart disease is in your control. The first step is to visit your primary care provider to get a thorough checkup. If you smoke, now is the time to quit. If you are overweight or sedentary, work on improving your diet and starting an exercise program. Know your numbers.

Find out your numbers for blood pressure and cholesterol and make sure you have been screened for diabetes. If you find that you are at risk, work with your provider to reduce your risk factors for heart disease and achieve heart health.

Steven Weinsier is a cardiologist at Cooley Dickinson Hospital in Northampton.

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