Heart Disease 15

Heart Disease

We used to think of heart disease as a man’s problem. Now 

we know that it is the number one killer of women, just as it 

is of men. Yet women are more likely than men to be both 

underdiagnosed and undertreated. Fortunately, you have the 

power to impact your heart health in many ways! Commit to 

a healthy lifestyle that includes heart-healthy eating, regular 

physical activity, and not smoking. Understand the warning signs 

of a heart attack, because they can be different for women than 

for men. Let your doctor be your partner in helping you. And no 

matter how old you are, take action to protect your heart.

A woman’s disease

Many women may not be aware that 

they are at risk of heart disease. Many 

doctors also make the mistake of thinking that heart disease strikes men more 

often than women. In fact, some research 

shows that doctors are more likely to 

diagnose and treat heart disease in a man 

than a woman, even if the two have the 

same symptoms.

Another problem is that until about 15 

years ago, women were often not included in heart disease research. We assumed 

that the results of research involving men 

applied to women as well. Now we know 

this is not the case.

Still, we have learned a lot about heart 

disease in women—how to find out if 

you have the disease, how to treat it, and, 

most important, how to prevent it.

Coronary artery disease (CAD)

When people talk about heart disease, 

they usually mean coronary artery disease (CAD). It is the most common 

type of heart disease. With CAD, plaque 

builds up on the walls of the arteries that 
16 The Healthy Woman: A Complete Guide for All Ages

carry blood to the heart. Over time, this 

buildup causes the arteries to narrow and 

harden, called atherosclerosis (a-thuhroh-skluh-ROH-suhss). When this happens, the heart does not get all the blood 

it needs. This can lead to:

l	 Angina (an-JEYE-nuh)—chest pain 

or discomfort that happens when the 

heart doesn’t get enough blood.

l	 Heart attack—happens when a clot 

mostly or completely blocks blood 

flow to the heart muscle. Without 

blood the heart will start to die. If 

a person survives a heart attack, the 

injured area of the heart muscle is replaced by scar tissue. This weakens the 

pumping action of the heart.

How Your Heart Works

Your heart is a fist-sized muscle in the middle of your chest. An electrical system 

regulates its pumping action. With each heartbeat, blood is pumped through a large 

network of blood vessels. The blood supplies oxygen and nutrients to all the cells. It 

also picks up carbon dioxide and waste products from the cells. Arteries are the blood 

vessels that carry oxygen-rich blood away from the heart to all the parts of the body. 

The coronary arteries supply fresh blood to the heart itself, so it can work. Blood vessels that return blood from the body to the heart are called veins (vayns).

The heart has four chambers. The two upper chambers are called atria (AY-tree-uh). 

The two lower chambers are called ventricles. A system of inlet and outlet valves 

works to keep the blood flowing in the right direction.

Aorta

Pulmonary 

Artery

Left 

Atrium

Left 

Ventricle

Right 

Ventricle

Right 

Atrium

Superior 

Vena Cava

Arteries: red

Veins: blue

Although there are different types 

of heart disease, the main type 

discussed here is coronary artery 

disease.
Heart Disease 17

Heart Attack: Warning Signs

Many people think a heart attack is fort. If you feel such a symptom, you may 

sudden and intense, like a “movie” not be sure what’s wrong. Your symptoms 

heart attack, where a person clutches may even come and go. Even those who 

his or her chest and falls over. have had a heart attack may not recognize 

their symptoms, because the next attack The truth is that many heart attacks can have entirely different ones. start slowly, as a mild pain or discomLungs

Trouble breathing (shortness of breath)

Stomach

Upset stomach, urge to 

throw up

Other Signs

In addition, some women 

may feel very tired, sometimes for days or weeks 

before a heart attack 

occurs. Women may also 

have heartburn, a cough, 

or heart flutters or lose 

their appetite.

Head 

Lightheadedness

Arm(s), Back, Jaw, Neck, 

Between Shoulders

Pain, discomfort, 

numbness

Chest

Pain, pressure, fullness 

or squeezing (lasts more 

than a few minutes or 

comes and goes)

Skin

Cold sweat

If you think that you are having a heart women often have less-common heart 

attack, you must act quickly to prevent attack symptoms, which might be misdidisability or death. Wait no more than a agnosed by a woman or even her doctor. 

few minutes—5 at most—before calling If you think you’re having a heart attack, 

911. Treatments for opening clogged don’t let anyone tell you that you’re overarteries work best when given within the reacting or to wait and see. Get emerfirst hour after a heart attack starts. gency help right away. Ask for tests that 

can show if you are having a heart at- Women are more likely than men to die tack. It’s better to be safe than sorry. of a heart attack. One reason is that 
18 The Healthy Woman: A Complete Guide for All Ages

Who is at risk of getting heart 

disease?

Risk factors are conditions or habits that 

make you more likely to develop heart 

disease. The more risk factors you have, 

the greater your chances of getting heart 

disease. Some risk factors, such as your 

age or family history, cannot be changed. 

But many risk factors can be changed by 

making simple changes in the way you 

live.

Risk factors that you can change

Abnormal blood cholesterol and triglyceride 

levels

Cholesterol (koh-LESS-tur-ol) and 

triglycerides (treye-GLIH-suh-ryds) 

are types of fat found in your blood and 

other parts of the body. They are carried 

in the blood by lipoproteins (lip-uhPROH-teens). Your body needs small 

amounts of these substances to work 

well. But too much can lead to plaque 

buildup on your artery walls. In fact, 

plaque is made up mostly of unused 

cholesterol.

A blood test will help measure your levels of:

l	 Low-density lipoprotein (LDL) or 

“bad” cholesterol—High levels lead 

to buildup of cholesterol in arteries.

Unique to Women

l	 Low HDL cholesterol is more 

dangerous than having high LDL 

cholesterol.

l	 High triglycerides combined with 

low HDL cholesterol can mean a 

very high risk of heart disease.

l	 High-density lipoprotein (HDL) or 

“good” cholesterol—High levels are 

good. HDL cholesterol travels from 

other parts of your body to your liver, 

where it is processed to be removed 

from the body. This lowers the total 

cholesterol level in the body. 

l	 Total cholesterol—LDL cholesterol 

plus HDL cholesterol

l	 Triglycerides

Ask your doctor for the results of your 

blood test and find out your risk in the 

Risk factors that you can change 

(pages 18–25):

• Abnormal blood cholesterol and 

triglyceride levels

• High blood pressure 

• Cigarette smoking

• Diabetes 

• Being overweight or obese

• Metabolic syndrome

• Lack of physical activity

• Heavy alcohol use

• Sleep apnea

Risk factors that you cannot change 

(page 26):

• Age (55 years and older for women)

• Family history of early heart disease

Other possible risk factors (pages 

26–28):

• Depression, anxiety, and stress

• Lower income

• Not enough sleep
Heart Disease 19

table below. These numbers help measure and triglyceride levels. In addition, modyour chances of getting heart disease. erate physical activity for at least 30 minNearly half of U.S. women are at border- utes on 5 or more days of the week can 

line high or high risk of heart disease. raise your HDL cholesterol levels. This 

Some people have a tendency toward can help reduce your heart disease risk.

high cholesterol. But most cases of high If lifestyle changes do not bring your 

cholesterol and triglyceride levels are from cholesterol and triglyceride levels back to 

eating unhealthy foods, not exercising, normal, your doctor may prescribe one or 

and other lifestyle choices. In many cases, more of these types of medicines:

adopting a heart-healthy lifestyle can statins

lower total cholesterol, LDL cholesterol, l	

l	 bile acid resins (REZ-ins)

Cholesterol and Triglyceride Levels and Heart Disease Risk

Cholesterol and triglyceride levels are measured in milligrams (mg) per deciliter (dL) 

of blood.

Total Cholesterol Level Risk Group

Less than 200 mg/dL Desirable

200–239 mg/dL Borderline high

240 mg/dL and above High

LDL Cholesterol Level Risk Group

Less than 100 mg/dL Optimal (ideal)

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 Cholesterol Level Risk Group

Less than 40 mg/dL High

60 mg/dL and above Somewhat protective

Triglyceride Levels Risk Group

Less than 150 mg/dL Desirable

150–199 mg/dL Borderline high

200 mg/dL and above High
20 The Healthy Woman: A Complete Guide for All Ages

l	 fibrates

l	 cholesterol absorption inhibitors

High blood pressure (hypertension)

Blood pressure is the force your blood 

makes against the walls of your arteries. Your blood pressure is highest when 

your heart pumps blood into your arteries. This is called systolic (siss-TOL-ihk) 

pressure. It is lowest between beats, when 

the heart relaxes. This is called diastolic 

(deye-uh-STOL-ihk) pressure. 

Your blood pressure varies throughout 

the day. But if your blood pressure stays 

above normal most of the time, then you 

have high blood pressure, or hypertension. If your blood pressure is borderline 

high, then you have prehypertension. This 

means that you don’t have high blood 

pressure now but are likely to develop it 

in the future.

High blood pressure is called the “silent 

killer” because you can have no symptoms. 

But years of high blood pressure can 

damage artery walls, causing atherosclerosis and heart disease. High blood pressure 

is a common problem among women, especially African American women.

If you have hypertension or prehypertension, you may be able to lower your 

blood pressure by:

l	 losing weight if you are overweight or 

obese

l	 getting 30 minutes of moderateintensity physical activity on most 

days of the week

l	 limiting alcohol to one drink per day

l	 quitting smoking if you smoke

l	 eating foods that are good for your 

heart

l	 reducing stress

If lifestyle changes do not lower your 

blood pressure back to normal, your doctor may prescribe medicine. Some types 

commonly used to treat hypertension 

include:

l	 diuretics (deye-yoo-RET-ihks)

l	 beta blockers

l	 calcium channel blockers

l	 angiotensin (an-jee-oh-TEN-suhn) 

converting enzyme (ACE) inhibitors

l	 angiotensin II receptor blockers 

(ARBs)

If you have hypertension or prehypertension, you should also know that you may 

be at increased risk of developing type 2 

diabetes (see Diabetes section on page 

21). You should get tested for type 2 diaSpecial Concerns for African 

American Women

African Americans often do not respond well to ACE inhibitors or ARBs 

when these drugs are used by themselves. But African American patients 

do respond well to either type of drug 

if it is used in combination with another medicine for treating hypertension, 

such as a diuretic or calcium channel 

blocker.

Cholesterol Test: How Often?

Have your blood cholesterol and triglyceride levels tested at least once 

every 5 years and your blood pressure 

checked every 1 to 2 years. 
Heart Disease 21

betes if your blood pressure readings:

l	 are too high

l	 are borderline high 

l	 have been steadily increasing for the 

last several years but are still in the 

normal range

Cigarette smoking

The more you smoke, the higher your 

risk of heart disease. In fact, about half 

of all heart attacks in women are due to 

smoking. What’s more, if you smoke and 

also take birth control pills, you are at 

high risk of heart disease.

If you are among the nearly 1 in 5 

women in the United States who 

smokes, now is the time to quit. Talk to 

your doctor if you need help. There are 

medicines that can help you quit. Counseling and support groups can also be 

helpful.

Diabetes

Diabetes is a disease in which blood 

glucose (sugar) levels are too high. Type 

2 diabetes—the most common type—

usually begins after the age of 40, often 

in people who are overweight or obese. 

Uncontrolled diabetes can damage artery walls, leading to atherosclerosis and 

heart disease. In fact, uncontrolled diabetes raises a woman’s risk of heart disease more than it does for a man. Also, 

women with diabetes do not recover as 

well from a heart attack as men with 

diabetes do.

If you have type 2 diabetes and are overweight or obese, you might be able to 

lower your blood glucose levels back to 

normal by losing weight. If this doesn’t 

work, your doctor might give you medicines or insulin, a hormone that lowers 

blood glucose levels. 

Blood Pressure Categories

Systolic (mmHg)* Diastolic (mmHg)*

Normal Less than 120 Less than 80

Prehypertension 120–139 80–89

Hypertension 140 or higher 90 or higher

*mmHg means millimeters of mercury.

For more information on type 2 diabetes, see the Type 2 Diabetes chapter on 

page 69.
22 The Healthy Woman: A Complete Guide for All Ages

Being overweight or obese

The more overweight you are, the higher 

your risk of heart disease—even if you 

have no other risk factors. Being overweight or obese also raises your chances 

of developing diabetes, high blood pressure, and high blood cholesterol.

Being overweight or obese is common 

among women in the United States, especially among African American and 

Hispanic women.

How do you know if you are overweight 

or obese? Use the chart below to find 

your height and weight. The point at 

which the two meet is your body mass 

index (BMI).

Normal weight Overweight Obese

BMI 19 20 21 22 23 24 25 26 27 28 29 30 35 40 45

Height Weight (lb.)

4’7” 82 86 90 95 99 103 108 112 116 120 125 129 151 172 194

4’8” 85 89 94 98 103 107 112 116 120 125 129 134 156 178 201

4’9” 88 92 97 102 106 111 116 120 125 129 134 139 162 185 208

4’10” 91 96 100 105 110 115 119 124 129 134 138 143 167 191 215

4’11” 94 99 104 109 114 119 124 128 133 138 143 148 173 198 222

5’0” 97 102 107 112 118 123 128 133 138 143 148 153 179 204 230

5’1” 100 106 111 116 122 127 132 137 143 148 153 158 185 211 238

5’2” 104 109 115 120 126 131 136 142 147 153 158 164 191 218 246

5’3” 107 113 118 124 130 135 141 146 152 158 163 169 197 225 254

5’4” 110 116 122 128 134 140 145 151 157 163 169 174 204 232 262

5’5” 114 120 126 132 138 144 150 156 162 168 174 180 210 240 270

5’6” 118 124 130 136 142 148 155 161 167 173 179 186 216 247 278

5’7” 121 127 134 140 146 153 159 166 172 178 185 191 223 255 287

5’8” 125 131 138 144 151 158 164 171 177 184 190 197 230 262 295

5’9” 128 135 142 149 155 162 169 176 182 189 196 203 236 270 304

5’10” 132 139 146 153 160 167 174 181 188 195 202 207 243 278 313

5’11” 136 143 150 157 165 172 179 186 193 200 208 215 250 286 322

6’0” 140 147 154 162 169 177 184 191 199 206 213 221 258 294 331

6’1” 144 151 159 166 174 182 189 197 204 212 219 227 265 302 340

6’2” 148 155 163 171 179 186 194 202 210 218 225 233 272 311 350

6’3” 152 160 168 176 184 192 200 208 216 224 232 240 279 319 359

6’4” 156 164 172 180 189 197 205 213 221 230 238 246 287 328 369

6’5” 160 169 177 186 194 202 211 219 228 236 245 253 295 337 380

6’6” 164 173 182 190 199 208 216 225 234 242 251 260 303 346 390

6’7” 169 178 186 195 204 213 222 231 240 249 251 266 311 355 400

BMI calculators can be found at some of the Web sites listed at the end of this chapter.
Heart Disease 23

Once you have found your BMI, check it 

against the ranges below:

Normal weight: BMI = 18.5–24.9

Overweight: BMI = 25–29.9

Obese: BMI = 30 or higher

For women, a waist size of more than 35 

inches also increases heart disease risk. 

This is because fat located in the abdomen increases atherosclerosis more than 

fat located in other areas, such as the hips.

If you are overweight, obese, or your 

waist size is more than 35 inches, losing 

weight can help prevent health problems 

like heart disease and diabetes. Work 

with your doctor to create a weight-loss 

plan that stresses heart-healthy foods 

and regular physical activity.

Metabolic syndrome

Having metabolic (met-uh-BOL-ihk) 

syndrome doubles your risk of getting 

heart disease or having a stroke. You 

have it if you have any 3 of these 5 risk 

factors:

l	 waist measurement of more than 35 

inches

l	 triglyceride level more than 150 mg/dL

l	 HDL cholesterol level less than 50 

mg/dL

l	 systolic blood pressure greater than or 

equal to 130 mmHg or diastolic blood 

pressure greater than or equal to 85 

mmHg

l	 blood glucose level after fasting for 

at least 8 hours of greater than 110 

mg/dL

Taking steps to eliminate these risk factors will improve your heart and, overall, 

health.

Lack of physical activity

Lack of physical activity increases your 

heart disease risk, even if you have no 

other risk factors for heart disease. It 

also increases your chances of developing high blood pressure and diabetes and 

of being overweight or obese. If finding 

time to be physically active seems like an 

impossible challenge, take heart. As little 

as 30 minutes of moderate-intensity 

physical activity on most, if not all, days 

of the week helps protect your heart. You 

can even split this time into three segments of at least 10 minutes each.

Drinking alcohol

Heavy drinking causes many heartrelated problems. More than 3 drinks 

per day can raise blood pressure and triglyceride levels. Too much alcohol also 

can damage the heart muscle, leading to 

heart failure. Overall, people who drink 

heavily on a regular basis have more 

heart problems than either moderate 

drinkers or nondrinkers.

However, moderate drinkers are less 

likely to develop heart disease than people who don’t drink any alcohol or who 

drink too much. Red wine drinkers in 

particular seem to be protected to some 

degree against heart disease. Red wine 

contains flavonoids (FLAY-vuh-noidz), 

which are thought to prevent plaque 

buildup. Red grapes, berries, apples, and 

broccoli also contain flavonoids.

Drinking more than one drink per day 

increases the risks of certain cancers, 

including breast cancer. And if you are 

pregnant, planning to become pregnant, 

or have another health condition that 

could make alcohol use harmful, you 

should not drink.
24 The Healthy Woman: A Complete Guide for All Ages

With the help of your doctor, decide 

whether moderate drinking to lower 

heart attack risk outweighs the possible 

increased risk of breast cancer or other 

medical problems. If you do decide to 

drink alcohol, remember that moderation is the key.

Sleep apnea

Has anyone ever told you that you snore? 

Loud snoring can be a sign of sleep 

apnea (AP-nee-uh), a sleep disorder 

that can raise your chances of having 

a heart attack. With obstructive sleep 

apnea—the most common type—the tissue in the back of the throat relaxes and 

blocks airflow to your lungs. This lowers 

the oxygen level in your blood, which 

makes your heart work harder and often 

leads to high blood pressure. Also, these 

repeated pauses in breathing cause fragmented sleep, which results in daytime 

sleepiness.

Women are more likely to develop obstructive sleep apnea after menopause. 

Heart-Healthy Eating

Eating a healthy diet is a powerful way to impact 

your heart health. It can lower and possibly eliminate 

many key risk factors for heart disease, including:

• high cholesterol and triglyceride levels

• high blood pressure

• diabetes

• obesity and overweight

When striving to eat heart healthy, a special eating plan called the DASH eating plan 

can help guide your food choices. It also will help lower your blood pressure if it is too 

high. DASH stands for Dietary Approaches to Stop Hypertension. The DASH eating plan:

• stresses low-cholesterol foods that are good for your heart, such as fruits and vegetables; whole-grain breads and other foods; low-fat (1 percent) or fat-free milk and 

dairy products; nuts, seeds, and beans; and moderate amounts of skinless poultry 

and fish*

• is rich in magnesium, potassium, calcium, protein, and fiber

• is low in saturated fat, trans fat, and total fat

• limits red meat, sweets, and sugary drinks

*Oily fish like salmon, herring, and tuna contain omega-3 fatty acids, which have 

been shown to reduce your risk of dying of heart disease. Also, taking omega-3 fatty 

Alcohol

If you drink alcohol, 

drink no more than 

one drink per day. One 

drink is counted as:

• 5 ounces of wine 

• 12 ounces of beer

• 11⁄2 ounces of 80-

proof hard liquor
Heart Disease 25

Other things that may increase the risk 

of obstructive sleep apnea are:

l	 being overweight or obese

l	 smoking

l	 using alcohol or sleeping pills

l	 a family history of sleep apnea

If you think that you have sleep apnea, 

talk with your doctor. Your doctor might 

suggest a sleep test to see how severe 

your sleep apnea is. Mild cases often can 

be helped by lifestyle changes, such as 

losing weight and not drinking alcohol 

before bed. If you have severe obstructive 

sleep apnea or another type, your doctor may suggest other treatments, such 

as using a machine that props open your 

airway during sleep or having surgery. 

A SPECIAL DEVICE HELPS PEOPLE WITH SLEEP APNEA 

BREATHE FREELY AND SLEEP SOUNDLY.

acids in capsule form might help women with heart disease or high triglyceride levels. 

If you have these problems, ask your doctor if you should take omega-3 supplements.

If you need to lower your blood pressure, eating less sodium also might help. Sodium 

is found in table salt and processed foods, such as canned soups, snacks, and deli 

meats. Many grocery stores sell salt substitutes that provide the flavor of salt without 

the sodium.

Another eating plan, called the Therapeutic Lifestyle Changes (TLC) eating plan, is designed for people whose LDL cholesterol levels are too high. The TLC eating plan will 

help to reduce your LDL cholesterol and lower your chances of developing heart disease. If you already have heart disease, it will lessen your chances of a heart attack 

and other heart-related problems. On the TLC eating plan, you should eat as follows:

• Less than 7 percent of the day’s total calories from saturated fat. Lowering saturated fat is the most important dietary change for reducing blood cholesterol.

• Less than 200 mg of dietary cholesterol a day.

• No more than 25 to 35 percent of daily calories from total fat (includes saturated 

fat calories).

• Just enough calories to reach or maintain a healthy weight. (Ask your doctor or registered dietitian what is a reasonable calorie level for you.)

For more information on heart-healthy eating, see the Nutrition chapter on page 317.
26 The Healthy Woman: A Complete Guide for All Ages

Risk factors that you cannot 

change

Age

Women develop heart disease about 10 

to 15 years later than men. This is because until you reach menopause, your 

ovaries make the hormone estrogen, 

which protects against plaque buildup. 

But once you reach menopause, your 

ovaries stop making estrogen and your 

risk of developing heart disease goes up. 

By age 70, women have about the same 

chances of developing heart disease as 

same-aged men.

Even apart from the increased risk 

brought on by menopause, getting older 

is a risk factor for heart disease in women. With age, arteries stiffen and thicken. 

Also, systolic blood pressure often goes 

up. These and other changes contribute 

to plaque buildup in artery walls.

Family history of early heart disease

Women with a father or brother who 

developed heart disease before age 55 

are more likely to develop heart disease. 

Women with a mother or sister who 

developed heart disease before age 65 

are also more likely to develop the disease. These trends suggest that you can 

inherit genes that increase your risk of 

heart disease. Still, young women with a 

family history appear to be less aware of 

their risks and less careful about living a 

heart-healthy lifestyle than men with a 

family history.

Other possible risk factors

Depression, anxiety, and stress

Negative emotions— such as depression, 

anxiety, and anger—have all been shown 

to increase your chances of developing 

or dying of heart disease. We don’t know 

why this is so. Perhaps being depressed, 

anxious, or angry leads to behaviors that 

put your heart health at risk, such as 

smoking, drinking, and eating high-fat 

foods. It is also possible that negative 

emotions affect the body in ways that 

trigger atherosclerosis or blood clot formation within arteries.

Stress also appears to be linked to heart 

health in some way. Here are some 

examples: 

l	 Work stress. Feelings that you have 

little control over what happens to you 

at work or that you are not being rewarded enough for the work that you 

do have been linked to getting heart 

disease.

l	 Stress at home. If you are caring for a 

disabled or ill spouse, the stress of this 

role may raise your risk of heart attack.

l	 Combined stress. Being stressed both 

at work and at home has been shown 

to increase your chances of having a 

heart attack or severe angina more 

than either type of stress by itself.

l	 Low social support. People with few 

friends or family to help them deal 

with stress are more likely to develop 

heart disease. 

Other conditions such as chronic 

kidney failure can raise your risk of 

heart disease. Discuss your health 

and your risk with your doctor. This 

information will help your doctor decide how best to care for you.
Heart Disease 27

If you’re unhappy with your life or feel 

distressed in some way, talk to your doctor. Although we don’t know if treating 

emotional problems or reducing stress 

can lower your chances of getting heart 

disease, doing so can boost your emotional health and overall well-being.

Lower income

Research shows that lower income adults 

have an increased risk of heart disease. 

Also, children born into lower income 

families are more likely to have heart 

disease in adulthood. There are many 

possible reasons for this link. For instance, low-income adults are less likely 

to be physically active and eat a hearthealthy diet, and they are more likely to 

smoke.

It can be difficult to eat a heart-healthy 

diet in lower income neighborhoods. 

Many of these neighborhoods lack a 

grocery store that sells fresh fruits and 

vegetables. Or if they do, these items 

may be too costly. People in some of 

these neighborhoods have dealt with 

these problems by forming food co-ops 

that buy fresh fruits and vegetables in 

bulk and then sell them at low prices.

Also, it can be difficult to be physically 

active in neighborhoods that are unsafe. 

Some communities have dealt with this 

problem by creating physical activity 

programs at local recreation centers or 

churches. Contact your local parks department and churches to see if any such 

programs exist in your community.

Not enough sleep

Most adults need 7 to 9 hours of sleep 

to feel well rested during the day. Your 

heart needs a good night’s sleep too. 

Sleeping 5 hours or less each night doubles the risk of high blood pressure for 

people between the ages of 32 and 59. 

One reason for this may be that feeling 

cranky, tired, and stressed due to lack of 

sleep makes it harder to follow a heartFor more information on managing 

stress, see the Mental Health chapter on 

page 207. 
28 The Healthy Woman: A Complete Guide for All Ages

healthy lifestyle. Try these tips to get the 

good quality sleep your heart needs:

l	 Go to bed and wake up at the same 

time each day (even weekends).

l	 Engage in a relaxing activity before 

bed, such as reading or taking a bath.

l	 Make sure your bedroom is dark, quiet, 

and cool.

l	 Use your bed for sleep and sex only.

l	 Don’t eat or become physically active 

for several hours before sleep.

l	 Avoid alcohol, caffeine, and nicotine 

close to bedtime.

Can menopausal hormone therapy 

prevent heart disease?

Some research has shown that women 

who start estrogen or certain types of 

hormone therapy around the time of 

menopause are less likely to get heart 

disease. But a very large study by the U.S. 

National Institutes of Health (NIH) 

had different results. The NIH research 

found that:

l	 Estrogen alone didn’t affect the risk of a 

heart attack. Estrogen did increase the 

risk of stroke. Estrogen also increased 

the risk of blood clots in the legs.

l	 Estrogen plus progestin may have 

slightly increased the risk of a heart 

attack. Progestin is a man-made form 

of the female hormone progesterone 

(proh-JESS-tuh-rohn). Estrogen plus 

progestin raised the risk of stroke and 

blood clots in the legs and lungs.

Researchers continue to study this issue. 

The age at which menopausal hormone 

therapy is started may be the key to 

whether this therapy reduces your chances of getting heart disease. Most of the 

women in the NIH study did not start 

menopausal hormone therapy until after 

the age of 60, yet menopause happens for 

most women after the age of 45. Some 

experts think that many of the women 

in the NIH study may have already developed atherosclerosis because of many 

years in which their estrogen levels were 

low. This would explain why estrogen did 

not protect against heart disease in the 

study.

More research on younger women may 

support the use of some kind of menopausal hormone therapy to prevent heart 

disease. And more research will be needed to ensure that the benefits of such a 

therapy outweigh its risks. 

For now, the safest option for menopausal hormone therapy is to stick 

with the lowest dose for the shortest 

time to treat menopausal symptoms or 

prevent osteoporosis (OSS-tee-oh-puhROH-suhss), but not to prevent heart 

disease. For more information on 

menopausal hormone therapy, see the 

Healthy Aging chapter on page 221.

Can antioxidant or folic acid 

supplements prevent heart 

disease?

Antioxidants (an-tee-OKS-uh-duhnts), 

such as beta carotene and vitamins A, C, 

and E, and folate are substances found 

naturally in many foods. They can also 

be taken as dietary supplements, either 

in pill form or added to food. Some early 

research suggested that taking antioxidant supplements might prevent atherosclerosis. But more recent research has 
Heart Disease 29

not found this to be the case. The best 

way to get your antioxidants is by eating 

fruits, vegetables, whole-grain products, 

and nuts.

As with antioxidants, some early research 

suggested that taking folic acid supplements might reduce the risk of heart 

disease. But more recent research has not 

found this to be the case. Currently, the 

American Heart Association does not 

recommend that women use folic acid 

supplements to prevent heart disease. 

Even so, you need some folic acid in 

your diet to help your body make blood 

cells. Folic acid also is very important for 

women who are or plan to become pregnant.

Questions to Ask Your Doctor or Nurse

Getting answers to these questions will give you vital information about your heart 

health and what you can do to improve it. You may want to bring this list with you 

to your visit with your doctor or nurse.

1. What is my risk of heart disease?

2. What is my blood pressure? What does it mean for me, and what do I need to do 

about it?

3. What are my cholesterol numbers? (These include total cholesterol, LDL or “bad” 

cholesterol, HDL or “good” cholesterol, and triglycerides.) What do they mean for 

me, and what do I need to do about them?

4. What are my “body mass index” and waist measurement? Do they indicate that I 

need to lose weight for my health?

5. What is my blood glucose level, and does it mean I’m at risk of diabetes?

6. What other screening tests for heart disease do I need? How often should I return 

for checkups for my heart health?

7. What can you do to help me quit smoking?

8. How much physical activity do I need to help protect my heart?

9. What is a heart-healthy eating plan for me? Should I see a registered dietitian or 

qualified nutritionist to learn more about healthy eating?

10. How can I tell if I’m having a heart attack?
30 The Healthy Woman: A Complete Guide for All Ages

Diagnosing heart disease

If your doctor suspects that you have 

heart disease, there are a number of tests 

that she can perform to find out for sure. 

You may get just one test or more than 

one. It’s normal to feel worried or anxious before having tests. Tell your doctor 

if your fears are keeping you from getting the tests you need.

Test What it tells your doctor

Electrocardiography (ih-lek-troh- Shows how well your heart performs under the stress of physical activkar-dee-OG-ruh-fee), or ECG or ity using electrodes placed on the body

EKG

Perfusion imaging A safe, radioactive substance is injected into the blood and viewed 

with a special camera to look for blockage in your coronary artery or 

damage to your heart muscle due to a heart attack 

Echocardiography (ek-oh-kar-dee- Sound waves create a moving picture of your heart as it beats, which 

OG-ruh-fee) can show if your heart is damaged or not getting enough blood 

Coronary angiography (an-jee-OG- Detects problems in blood flow in a coronary artery using x-ray and a 

ruh-fee) dye that is injected into the blood

Blood tests Show if you’ve had a heart attack by detecting substances that are 

released into the blood when the heart muscle is damaged

Computed tomography (tuh-MOG- Uses x-ray to show plaque buildup and to detect early stages of 

ruh-fee) (CT) atherosclerosis

Computed tomography Uses x-ray to produce three-dimensional pictures of the heart and its 

angiography coronary arteries to detect blockages

Gated single photon (FOH-ton) A safe, radioactive substance is injected into the blood and viewed 

emission computed tomography, with a special camera to look for problems with blood flow to the heart, 

or gated SPECT heart damage, or problems pumping blood throughout the body

SOME TESTS, SUCH AS ELECTROCARDIOGRAPHY AND 

ECHOCARDIOGRAPHY, ARE DONE WHILE ExERCISING TO 

SEE HOW THE HEART PERFORMS UNDER STRESS.

Treating heart disease

If you have heart disease, it is extremely 

important to control it. You can help to 

do this by:

l	 eating a heart-healthy diet

l	 quitting smoking if you smoke

l	 getting regular physical activity

l	 losing weight if you are overweight or 

obese

For more information on healthy eating, see the Nutrition chapter on page 

317. For more information on physical 

activity, see the Fitness chapter on page 

337.

l	 reducing stress

l	 taking medicines as directed by your 

doctor
Heart Disease 31

Medicines

Along with making lifestyle changes, 

you may need medicines to help control 

your heart disease. These medicines can 

include:

l	 cholesterol-lowering medicines

l	 beta blockers, calcium channel blockers, or ACE inhibitors to lower blood 

pressure and lighten the workload for 

the heart

At times, other medicines may be needed:

l	 Antiplatelet medicines stop blood cells

called platelets from clumping together and forming clots.

l	 Anticoagulants stop clots from forming

in your arteries and blocking blood flow.

l	 Nitrates, such as nitroglycerin (neyetruh-GLISS-ur-uhn), widen the coronary arteries, which helps lessen chest 

pain.

l	 Thrombolytic (throm-buh-LIT-ihk) 

agents break up blood clots that form 

during a heart attack. The sooner these

drugs are given to someone having a 

heart attack, the better they are at preventing heart damage.

Aspirin

One well-known antiplatelet medicine is aspirin. In fact, 

aspirin is given right away to anyone suspected of having a 

heart attack. Your doctor may also suggest that you take aspirin every day if you are at risk of heart disease. If you are 

younger than 65 years and are at low risk of heart disease, 

your doctor will probably not suggest that you take aspirin.

Aspirin may not be good for some women because it can 

cause side effects. These include bleeding in the stomach, 

intestines, and brain. If you’re thinking about using aspirin 

to treat or prevent heart problems, talk with your doctor first.

Special procedures or surgery

If lifestyle changes and medicines do not 

improve your heart disease symptoms, 

your doctor may suggest special procedures or surgery. These include:

l	 Angioplasty (AN-jee-uh-plass-tee). 

This procedure is usually done right 

away if coronary angiography shows 

problems in blood flow in a coronary 

artery. A thin tube with a balloon at one 

end is threaded into a coronary artery 

that has narrowed because of plaque 

buildup. Once in place, the balloon is 

inflated to push the plaque against the 

artery wall. This opens the artery more 

so that blood can flow freely. 

l	 Stent. A stent is a mesh tube used to 

hold open a narrowed or weakened 

artery. It is put in place during an angioplasty. Some stents are coated with 

a medicine to keep arteries from narrowing or becoming blocked again. 

Not all people who have angioplasty 

need a stent.

l	 Coronary artery bypass surgery. In 

this procedure, a short piece of vein 

or artery from another part of your 
32 The Healthy Woman: A Complete Guide for All Ages

body is used to reroute blood around 

a blockage in a coronary artery. This 

restores blood flow to the heart.

Other types of heart disease

Other types of heart disease that affect 

many women include heart failure and 

arrhythmias (uh-RITH-mee-uhz). These 

can result from coronary artery disease 

or other problems.

Heart failure

Heart failure happens when the heart 

can’t pump enough blood throughout 

the body. Heart failure doesn’t mean that 

your heart has stopped or is about to 

stop working. It means that your heart 

can’t fill with enough blood or pump 

with enough force, or both. 

Heart failure develops over time as 

the pumping action of the heart grows 

weaker. 

It’s more common in people older than 

65 years. Coronary artery disease, high 

blood pressure, and diabetes are leading 

causes.

Heart failure can affect the left side, the 

right side, or both sides of the heart. 

Most cases involve the left side, in which 

the heart can’t pump enough blood to 

the rest of the body. As a result, blood 

and fluid back up in the lungs and you 

feel short of breath. 

When the right side of the heart is affected, blood backs up in the body, causing swelling, mainly in the lower legs 

and ankles. If both sides of the heart are 

failing, which is often the case, you also 

feel tired and weak because not enough 

blood is flowing to your muscles.

Heart failure usually can’t be cured. Treatment often involves making lifestyle 

changes and taking medicines. If you have 

severe heart failure, you may need a mechanical heart pump or a heart transplant.

Arrhythmia

An arrhythmia is a problem with the 

speed or rhythm of the heartbeat caused 

by a disorder in the heart’s electrical 

system. There are many types of arrhythmias. Most are harmless, but some can 

be serious or even life threatening.

The most common type of serious arrhythmia is atrial fibrillation (fib-ruhLAY-shuhn), or AF. With AF, the walls 

of the atria quiver very fast (called fibrillation) instead of beating normally. 

As a result, blood isn’t pumped into the 

ventricles as it should, and it pools in the 

atria. This can cause blood clots to form 

in the atria. If a clot breaks off, it might 

get stuck in a blood vessel and cut off 

blood supply to the brain. This is a type 

of stroke. People with AF sometimes 

take blood thinners to prevent clots and 

medicines to slow the heart rate.
Heart Disease 33

Arrhythmias that start in the ventricles 

can be very dangerous. With ventricular 

fibrillations (v-fib), blood is not pumped 

out to the body. If the heart stops pumping entirely, the condition is known as 

sudden cardiac arrest. In a sudden cardiac arrest, a person will faint within 

seconds and die within minutes if not 

treated quickly. 

Living with heart disease

If you are taking medicines or have undergone special procedures or surgery 

to treat coronary artery disease, you still 

need to stick with those healthy lifestyle 

changes to keep plaque from clogging up 

your arteries again. Follow your doctor’s 

advice on what foods to eat, how to ease 

back into a physical activity routine if 

you have had surgery, and how to reduce 

stress. And if you smoke, it is vital that 

you quit.

Taking care of your emotional health is 

also important. People with heart disease are often depressed, especially those 

who have had a heart attack. If you have 

heart disease and find yourself feeling 

depressed or “blue,” talk with your doctor 

about ways to get help. 

Treating depression may do more than 

just help you feel better emotionally. If 

you have had a heart attack, antidepressants may lower your chances of having 

a second heart attack or dying of heart 

disease. So don’t wait to seek help if you 

are feeling down.

Good news about heart health

More women are becoming aware that 

they are at risk of heart disease, which is 

the crucial first step. Even better, more 

women are also taking heart-healthy 

action.

If you haven’t already joined this growing trend of heart-savvy women, now 

is the time to start. Urge your children 

and other family members to join you in 

your efforts to lower heart disease risk. 

Living heart healthy takes effort. But the 

rewards can mean a healthier, longer life 

for you and your loved ones. n

Cardiac Arrest

A sudden cardiac arrest is not the 

same as a heart attack. In a heart attack, the heart usually does not suddenly stop beating. But sudden cardiac 

arrest may happen during recovery 

from a heart attack.

Sudden cardiac arrest requires immediate treatment with a defibrillator 

(dee-FIB-ruh-lay-tur), a device that 

sends an electrical shock to the heart 

to restore normal rhythm.

If you suspect that someone is in 

sudden cardiac arrest, call 911 immediately. With every minute of delay 

in providing defibrillation, the chances 

of surviving sudden cardiac arrest 

drop rapidly.
34 The Healthy Woman: A Complete Guide for All Ages

One Woman’s Story

gest

On a Wednesday I told my doctor that my right hand had been numb for about a 

month. He agreed that it sounded like carpal tunnel syndrome. But he also suged I have an electrocardiogram (ECG or EKG), which turned out to be abnormal. On 

hearing this, I figured it was due to rushing and not eating breakfast or lunch.

The next day I stayed home from work. I couldn’t say exactly why—just that I felt extra sensitive and couldn’t imagine being around a lot of people. The same thing happened on 

Friday. I left my laptop open at work with unfinished spreadsheets neatly displayed. I left 

personal letters, without stamps, waiting to be mailed. This was not at all like me. 

After an errand, I could no longer dismiss 

the feelings of radiating pain—heartbeats 

of pain. My chest felt heavy. It felt like a 

pair of really big hands was squeezing my We must make 

chest, like an elephant’s enormous feet 

were pressing outward on my chest. When 

my husband came home I told him my 

ourselves our 

back and chest hurt and that I needed to 

go to the hospital. number one cause 

Blood tests at the hospital showed that I 

had not had a heart attack, and the cardiologist said, “You’re young and a woman. I and, as with me, 

think it’s probably acid reflux, and women 

have abnormal EKGs. Let’s schedule a be given another 

stress/echo test this week. Since it’s the 

weekend, you’ll feel better at home.” 

I didn’t believe for one minute that I had chance at life.

acid reflux. But did I say anything? No. But 

it’s easy to feel stupid against someone in 

a position of authority. 

As it turns out, much worse back pain sent me back to the hospital. I had an angiogram, 

and the next day I signed papers for open-heart surgery or another angiography with stent 

deployment. My life was forever changed that day, the day I was told I had coronary artery 

disease—premature heart disease, which I inherited from my father, who died young.

My mission is to send a warning to women. We must make ourselves our number one 

cause and, as with me, be given another chance at life. You are your own best advocate 

and you deserve to be heard. 

Lois

La Habra, California
Heart Disease 35

For More Information...

Office on Women’s Health, HHS

200 Independence Ave SW, Room 712E

Washington, DC 20201

Web site: www.womenshealth.gov/heart 

www.womenshealth.gov/faq/heartdis.htm

Phone number: (800) 994-9662, 

(888) 220-5446 TDD

National Heart, Lung, and Blood Institute 

Health Information Center, NIH

PO Box 30105

Bethesda, MD 20824-0105

Web site: www.nhlbi.nih.gov

www.hearttruth.gov

Phone number: (301) 592-8573, 

(240) 629-3255 TTY

Office of Women’s Health, FDA

5600 Fishers Ln

Rockville, MD 20857

Web site: www.fda.gov/womens

Phone number: (888) 463-6332

WISEWOMAN – Well-Integrated Screening and Evaluation for Women Across the 

Nation, CDC

4770 Buford Hwy NE, MS K-77

Atlanta, GA 30341-3717

Web site: www.cdc.gov/wisewoman

Phone number: (800) 232-4636, 

(888) 232–6348 TTY

American Heart Association

7272 Greenville Ave

Dallas, Tx 75231

Web site: www.americanheart.org

Phone number: (800) 242-8721

Sister to Sister

4701 Willard Ave, Suite 223

Chevy Chase, MD 20815

Web site: www.sistertosister.org

Texas Heart Institute Heart Information 

Center

PO Box 20345 

Houston, Tx 77225-0345

Web site: www.texasheartinstitute.org/HIC

Phone number: (800) 292-2221