By Jane Kelly, BSN, RN, Cardiac Nurse Specialist

Heart disease has been the leading cause of death for both women and men in the United States for the past 100 years. In recent statistics from the Center for Disease Control (CDC), women comprise 51% of the total heart disease deaths. According to the American Heart Association, heart disease is the number-one killer of women with more than 500,000 deaths each year (Diagram 1). In fact, one in three women die from heart disease each year. American women are six times more likely to die of heart disease than of breast cancer, and heart disease kills more women over the age of 65 than all cancers combined. Studies have shown that women can reduce their risk of heart disease by up to 82 percent by becoming aware of their risk and making lifestyle changes.

Women and Heart Attacks

Unfortunately, the first sign of heart disease can be a heart attack. It is important for women to understand that they may experience symptoms of a heart attack that are different from men. These differences may account for the reason many women do not receive proper diagnosis and, therefore, more women die from heart disease than men. Studies have shown that up to 78% of women reported experiencing unusual fatigue, problems sleeping and shortness of breathe a month prior to having a heart attack. Warning signs of a heart attack include

• Chest discomfort or high back pain. Most heart attacks involve discomfort in the center of the chest that lasts more than a few minutes, or that goes away and comes back. It usually is described as uncomfortable pressure, aching or tightness, fullness or pain.
• Discomfort in other areas of the upper body. Symptoms can include pain or discomfort in one or both arms, back, neck, jaw or stomach.
• Shortness of breath. May occur with or without chest discomfort.
• Unusual fatigue and weakness.
• Nausea, cold sweats and dizziness.

As with men, women's most common heart attack symptom is chest pain or discomfort. But women are somewhat more likely than men to experience some of the other common symptoms, particularly shortness of breath, nausea/vomiting and back or jaw pain. Recognizing these symptoms and seeking emergency medical care could save your life.

Heart Disease Prevention

Heart disease is a preventable disease. Women can decrease their risk for cardiovascular disease by knowing their risk factors and making heart healthy lifestyle changes. The more risk factors a woman has, the greater her risk for heart disease. Some risk factors cannot be changed such as increasing age and race. Women that are over the age of 55 or post menopausal are at higher risk for heart disease. After menopause, women are more likely to get heart disease, which may be related to the drop of the body’s production of estrogen. Women who have gone through early menopause are twice as likely to develop heart disease. A family history of premature coronary heart disease also can predispose women as well.
Some risk factors that can be modified are smoking, high blood pressure, elevated cholesterol, obesity, sedentary lifestyle and diabetes (high blood sugar).

1. Don’t smoke—Smoking is the greatest risk factor for heart attack. Women who smoke are two to six times more likely to have a heart attack and more likely to die after having one. Women that smoke and take birth control pills are 20 to30 times more likely to have a heart attack or stroke. When you quit smoking, your risk of heart disease drops dramatically within one to two years. It also is important to avoid secondhand smoke.
2. Be physically active—Building physical activity into your life is very important in reducing the risk of heart disease. According to a Tennessee on the Move study, only 7% of women describe themselves as very active and 60 % of Tennesseans do not spend time exercising. Heart disease can be reduced as much as 30 to 50 % by exercising at least 30 minutes a day. Ideally, it is recommended to accumulate one hour of physical activity most days. Exercise also helps with weight control and decreases your risk for developing high blood pressure, diabetes and high cholesterol. Be sure to check with your physician before starting any exercise program.
3. Eat a heart-healthy diet—It is important to eat a variety of nutritious foods from all the food groups. Most of your food consumption should come from fruits, vegetables and whole-grain foods. Be sure to select meats that are low in saturated fats such as chicken, fish or lean meats. Limit all types of fat to no more than 30% of your total calories and avoid trans-fats. Women should limit alcohol to one drink a day.
4. Maintain a healthy weight—Body Mass Index (BMI) is used to estimate an appropriate weight: a BMI less than 25 is considered healthy; BMI of 25 to 29 is overweight; and BMI greater than 30 is obesity. According to the Tennessee on the Move study, the average Tennessean is overweight and nearly obese, with an average BMI score of 29.2. Your risk for heart disease is increased with a BMI greater than 25. Excess weight contributes to an increased heart rate, blood pressure, diabetes and high cholesterol.
5. Know your Numbers—It is vital that women understand their numbers that are related to their heart health.
             a. BMI – less than 25
             b. Blood Pressure - 120/80 or less
             c. Blood Sugar less than 100 mg/dL
             d. Cholesterol
                       Total cholesterol less than 200 mg/dL
                       LDL (bad cholesterol) - < 100 optimal: 100-130 near optimal; >130 borderline high
                       HDL (good cholesterol) - greater than 50 mg/dL women
                       Triglycerides less than 150 mg/d

The University of Tennessee Medical Center strives toward educating the public and healthcare providers in the importance of women and heart disease. While we in the healthcare try to do our part in the treatment of heart disease, it is important that individuals take care of their own health particularly with this preventable disease.
Find out more about Women and Heart Disease with Go Red for Women and 4 Your Heart.