The Path to a Healthy Heart. A handbook for women. MeridianHealth.com

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2 Table of Contents Determine Your Risk What is Heart Disease...5 Major Risk Factors of Heart Disease...7 What s Your Risk...7 Nine Critical Questions to Ask Your Doctor...10 Create a Plan Manage Yourself...11 See a Doctor...13 Get Lab Results...14 Keys to Survival Know the Warning Signs...17 Steps for Survival...18 For More Information...18 ( 3

3 Determine Your Risk Heart disease is the leading cause of death among women. That s why the hospitals of Meridian Health are providing a women s heart program for you and the people you love. Together we can make a positive impact on the health of women throughout New Jersey. What is Heart Disease? When you hear the term heart disease, what is your first reaction? Like many women, you may think, That s a man s disease or Not my problem. But here is the heart truth: heart disease is the number one killer of women in the United States. Coronary heart disease is the most common form of heart disease. It is a disorder of the blood vessels of the heart that can lead to a heart attack. A heart attack happens when an artery becomes blocked, preventing oxygen and nutrients from getting to the heart. Often referred to simply as heart disease, it is one of several cardiovascular diseases, which are diseases of the heart and blood vessel system. Other cardiovascular disorders include congestive heart failure, stroke, high blood pressure, angina (chest pain), and rheumatic heart disease. Heart disease is a lifelong condition once you get it, you ll always have it. Procedures such as bypass surgery and angioplasty can help correct blood and oxygen to flow to the heart more easily, but the arteries can remain damaged. In addition, the condition of your blood vessels will steadily worsen unless you make changes in your daily habits. Many women die of complications from heart disease or become permanently disabled. That s why it is so vital to take action to prevent and control this disease. The information in this handbook and consultation with your physician can get you started on the right path to a healthier heart. ( 5

4 A recent survey of women ages 40 to 70 in Monmouth and Ocean counties showed that many women have risk factors but don t consider themselves at risk. The Survey Found That: Seventy-eight percent of women surveyed qualify as being at risk for a first heart attack, having one or more primary risk factors for heart disease. Only 53 percent of these women considered themselves to be at risk for heart disease or heart attack. Some More Surprising Facts: One in two women in the United States dies of heart disease or stroke while one in 30 dies of breast cancer. Thirty-eight percent of women will die within one year after having a heart attack. Within six years of having a heart attack, about 46 percent of women become disabled with heart failure. Two-thirds of women who have a heart attack fail to make a full recovery. The fact is that heart disease can affect anyone. Fortunately, it s a problem you can do something about. This handbook will help you learn about your own risk of heart disease and take steps to prevent and control it. For women in midlife, taking action is particularly important. Once a women reaches menopause, her risk of heart disease and heart attack jump dramatically. One in eight women between the ages of 45 and 64 has some form of heart disease, and this increases to one in three women over 65. Your heart is an amazing pumping machine that continuously delivers oxygenated blood vessels. The average woman s heart beats approximately 100,000 times per day, pumping well over a gallon of blood per minute. When you have heart disease, blood flow to the heart muscle can become restricted or come to a stop resulting in a heart attack. That s why it s so important to keep your heart healthy and to be able to recognize the symptoms of heart disease, which can be subtle, especially in women. Major Risk Factors of Heart Disease Older women and those with a family history of heart disease are more at risk. However, there are six major risk factors that you can do something about: Smoking High blood pressure High blood cholesterol Being overweight Physical inactivity Diabetes What s Your Risk Take a moment to complete the following women s heart health quiz, which can help determine your general risk for heart disease. 1. My age: Under 65 (0 points) Over 65 (2 points) Help offset your risk for heart disease by getting plenty of physical activity, eating nutritiously, seeing your doctor regularly and managing stress. 2. I have been diagnosed with high blood pressure. No. My blood pressure is normal. (0 points) Yes. I have high blood pressure. (2 points) Normal blood pressure is 120/80 or below; those with blood pressure greater than 140/90 should consult a physician. 3. I have been diagnosed with diabetes. No (0 points) Yes (2 points) Diabetes, which is defined as a fasting blood sugar level of 100 or above, can increase your risk for heart disease. 6) ( 7

5 4. My cholesterol level is: Below 200 mg/dl (0 points) mg/dl (1 point) Above 240 mg/dl (2 points) I don t know my cholesterol level (2 points) Have your blood cholesterol level checked regularly. A level of 240 mg/dl or above roughly doubles your risk of coronary artery disease. 5. I have a family history of heart disease. No (0 points) Yes (3 points) Healthy habits such as eating right, not smoking, and exercising regularly are especially important if you have a family history of heart disease. We can t change the genes we re born with, but we can work to eliminate all controllable risk factors. 6. My body weight is: About right or slightly less than norm. (0 points) Over the norm by less than 20 pounds. (1 point) Over the norm by more than 20 pounds. (2 points) Keeping your weight within normal range increases your chances of good health and a longer life. Studies have found that obese people (more than 30 pounds overweight) are more prone to develop higher blood pressure, enlarged hearts, and thicker walls in the heart s pumping chambers. A low-fat diet coupled with plenty of physical activity can help prevent these conditions. 7. My normal exercise pattern is: An hour a day, at least four times a week. (0 points) Three or four hours a week, but all at once. (1 point) I only walk around the house/office. (2 points) Just 30 minutes of activity (such as swimming, bicycling, or a brisk walk) at least four times a week can help maintain heart health. 8. My eating habits: I eat nutritious foods and indulge in sweets/fats only occasionally. (0 points) I don t plan meals, which means I could eat more healthfully. (1 point) I eat whatever I want to eat, even if it s high in saturated fats or calories. (2 points) To maintain good overall health, eat low-fat, high-fiber foods at every meal. 9. My tobacco use: I don t smoke, or I quit more than three years ago. (0 points) I smoke one pack a day. (4 points) I smoke two or more packs a day. (5 points) If you ve never smoked or have completely quit, congratulations! If you do smoke, stop now! Studies show that three years after quitting smoking, your heart becomes almost as healthy as it would have if you d never smoked at all. Women s Heart Health Quiz Results: 7 or fewer points: Good job! You re at reduced risk for heart disease, but it s still a good idea to visit your physician on a regular basis and get your blood pressure and cholesterol checked. Keep exercising regularly and continue good eating habits points: You may be at moderate risk for heart disease. See your physician regularly for exams and to get your blood pressure and cholesterol checked. With lifestyle changes like quitting smoking, eating low-fat foods, and staying active, there s room for improvement and a healthier heart! points: Unfortunately, you may be at risk for heart disease. See your physician soon and discuss the answers you gave to this quiz. Take a positive approach, starting today change your lifestyle to incorporate physical activity that you enjoy, eat flavorful low-fat and high-fiber foods, and if you smoke, quit right now. 8) ( 9

6 If you wish you scored better on your test, talk with your physician about your heart health and ask the following nine questions. If you need a physician, call Meridian Health Line at for a free referral. Nine Critical Questions to Ask Your Doctor 1. Does my physician have special training in women s heart disease? 2. What are my risk factors for heart disease, and what can I do to lower my risk? 3. What are the warning signs of heart disease or heart attack? 4. What should I know about the effects of menopause on my health? 5. What is my blood pressure, cholesterol, and body mass index? 6. What is the best way for me to quit smoking? 7. Are my risk factors for heart disease the same as or different from those for stroke? 8. What is the latest information on low-dose aspirin for heart-attack prevention and treatment? 9. If I experience any symptoms that I think could be heart related such as indigestion, fatigue, shortness of breath, or chest pain, what steps do I need to take? Create a Plan. Most women think that cancer is their leading killer. They re wrong. It s heart disease. In fact, each year nearly twice as many women die of cardiovascular disease as from all forms of cancer. But it doesn t have to affect you. The following information is intended to help you understand in more detail how certain factors can affect your chances for heart disease and how to help control them. Manage Yourself Healthy Lifestyle Maintaining a healthy lifestyle is important to your future health, and your weight is an important part of this. Overweight women are much more likely to develop heart-related problems, even if they have no other risk factors. A long-term study showed even a modest weight gain of 11 to 17 pounds after age 18 significantly increases a woman s risk of coronary heart disease. Good nutrition and proper exercise are also important in maintaining a healthy heart. As little as 30 minutes of moderate activity on most, and preferably all, days is helpful. For most women, commitment to healthy life habits is basically what it takes to prevent or control heart disease. Chart your plan to better heart health by doing the following: Cut back on foods high in fat, saturated fat and cholesterol, and eat more fruits and vegetables. Be more physically active. Lose weight if you are overweight. Get your blood pressure and blood cholesterol levels checked. If you smoke, stop. Smoking Cessation If you re concerned about your heart health, it s time to quit smoking. According to the American Heart Association, cigarettes are the leading cause of preventable deaths in this country. Surprisingly, out of the women who smoke in the United States, almost as many die from heart disease as from lung cancer. Women smokers are two to six times more likely to suffer a heart attack as non-smoking women, and the risk increases with the number of cigarettes smoked. Smoking also boosts the risk of stroke. 10 ) ( 11

7 Stress Management Everyone feels stress. Responsibilities associated with work, family, and the larger community combine to render our population the most stressed out in recent history. The good news is that if you are feeling stress, there are ways you can reduce it, thus lowering your risk for heart disease. Consult your physician to learn more. Feeding Your Needs You are what you eat, at least when it comes to your heart. Eating balanced nutritious meals lessens your risk of heart disease in three ways: by reducing high blood cholesterol levels, controlling high blood pressure, and taking off extra pounds. Use these guidelines to help you choose a tasty and healthful diet: Eat a variety of foods. Balance the food you eat with physical activity maintain or improve your weight. Choose a diet with plenty of grain products, vegetables, and fruits. Choose a diet low in fat, saturated fat and cholesterol, and moderate in sugars, salt, and sodium. If you drink alcoholic beverages, do so in moderation. Get Moving According to the USDA s Dietary Guidelines for Americans, the physical activities listed below can help reduce your risk of heart disease: Walking at a brisk pace (three to four miles per hour) Conditioning or general calisthenics Racket sports such as badminton and table tennis Mowing the lawn Golf (pulling a cart or carrying your clubs) Jogging Swimming (moderate effort) Cycling (moderate speed: 10 miles per hour or less) Gardening Housework Dancing See a Doctor High Blood Pressure Management Over time, high blood pressure, or hypertension, can damage the blood vessels, allowing cholesterol and other substances to build up. High blood pressure also increases the workload on the heart, which can affect the heart s pumping ability and may lead to a heart attack. Untreated high blood pressure increases the risk of coronary artery disease and other heart problems, and it is the most serious risk factor for stroke. Even slightly high levels double your risk. Talk to your physician and make sure your blood pressure is at the recommended level of 120/80 or below. High blood pressure is also the number one risk factor for congestive heart failure. Heart failure is a life-threatening condition in which the heart cannot pump enough blood to supply the body s needs. Congestive heart failure occurs when excess fluid starts to back up into the lungs, causing tiredness, weakness, and breathing difficulties. Cholesterol Management Found in the bloodstream and tissues, cholesterol is an important building block of cells in the body. But too much cholesterol in the blood may lead to hardening of the arteries, or atherosclerosis, which can contribute to heart attack or stroke. Today, about one-quarter of American women have blood cholesterol levels that pose a serious risk of coronary heart disease. Evidence supports the belief that lowering total cholesterol can help reduce the risk of heart attack, stroke, and death for almost everyone, 12 ) ( 13

8 including many women with average to high cholesterol levels. This is especially true for those women already at risk for heart disease. Talk to your physician and make sure your cholesterol level is under 200. Diabetes Management Diabetes is a stronger risk factor for coronary artery disease in women than in men, increasing risk three - to sevenfold. Women with diabetes are more likely to have higher blood pressure, higher triglyceride levels, low levels of good cholesterol, and problems with how well the heart can pump. Diabetes may double the risk of death from coronary artery disease. If you have diabetes, talk to your physician about a management plan. Estrogen (Hormone Replacement Therapy) Hormone replacement therapy or HRT is a general term for the use of female hormones (estrogen or estrogen and progesterone) by women who have gone through menopause. The benefits of using HRT remain very controversial. Talk to your physician about whether hormone replacement therapy is right for you. Get Lab Results Total cholesterol is the most common measurement of blood cholesterol. Your physician will interpret your cholesterol numbers based on other risk factors. In general, adults should also have a fasting lipoprotein profile every five years, which provides information about total cholesterol, low-density lipoprotein (LDL) or bad cholesterol, high-density lipoprotein (HDL) or good cholesterol, triglycerides (blood fats). General ranges for these tests are categorized below. Total Cholesterol Level Category Less than 200 mg/dl Desirable mg/dl Borderline high mg/dl and above High LDL Cholesterol Level Category 70 - mg/dl Desirable (with known heart disease) mg/dl Optimal mg/dl High mg/dl Very High LDL Cholesterol Level Low density lipoprotein or bad cholesterol is in part responsible for plaque build up in the vessel walls. These particles can be large or small and there are more advanced blood studies that look at that. Ideally if you have heart disease, your LDL goal is 70 mg/dl. HDL Cholesterol Level A high density lipoprotein (good cholesterol) level of less than 40 mg/dl is a major risk factor for heart disease. An HDL level of 60 mg/dl or higher is protective. Triglycerides Triglycerides, which are produced in the liver, are another type of fat found in the blood and in food. When you drink alcohol or take in excess calories, your liver produces more triglycerides. Recent research indicates that triglyceride levels that are borderline high ( mg/dl) or high (200 mg/dl or more) increase your risk of heart disease. To reduce blood triglyceride levels, doctors recommend a low-saturated-fat, low-cholesterol diet that also limits carbohydrates. It is also important to control your weight, get more physical activity, and avoid smoking and alcohol. Sometimes, medication is needed. In addition, to cholesterol and triglyceride measures, you may also wish to discuss the following test with your physician: C-Reactive Protein To predict a woman s risk of heart disease, physicians have long relied on tests for cholesterol and triglycerides. Now a test for C-reactive protein 14 ) ( 15

9 can help physicians forecast a woman s coronary risk. A C-reactive protein test is a blood test that measures the amount of this protein, which may be elevated when a severe infection or inflammatory condition is present. Combined, C-reactive protein and cholesterol tests can more accurately predict a woman s risk of having a future cardiac event than either test can alone. Keys to Survival. Know the Warning Signs If you have heart disease, you should know the symptoms of a heart attack so that you can get immediate medical help. Not all heart attacks begin with sudden, crushing pains as so often shown in the movies and on television. In fact, the most common warning signs are: 1. Chest discomfort 2. Pain or pressure spreading to the jaw, neck, shoulders, or arm 3. Shortness of breath 4. Nausea 5. Sweating 6. Indigestion or gas-like pain 7. Dizziness 8. Unexplained weakness or fatigue 9. Discomfort or pain between the shoulder blades 10. Sense of impending doom Heart attack symptoms may be severe from the start, or they may be mild at first and then gradually worsen. Talk with your physician about other symptoms of a heart attack and what steps you should take. 16 ) ( 17

10 Steps for Survival What to Do if You Might Be Having a Heart Attack. Nobody plans to have a heart attack. But just as many people have a plan to follow in case of fire, it is a good idea to have a plan to deal with a possible heart attack. Knowing what to do can save your life. What to Do Ahead of Time. 1. Discuss heart attack symptoms and what you should do in the case of a heart attack with your doctor, family and co-workers, and friends. Tell others how they can help you if you experience symptoms (for example, help you with your medication or call for you). 2. Make a list of all your medications and how often you take each one. This list would be valuable information in an emergency situation and should be kept with you. 3. Know the location of the nearest 24-hour Emergency Department. 4. Know who should be notified in case of an emergency. For More Information For more resources on preventing and controlling heart disease, visit the Women s Heart section of Meridian Health s Web site at MeridianHealth.com/WomensHeart. For a physician referral, please call. Thank you Women s Philanthropic Fund THE HEART OF MERIDIAN 18 )

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