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How to foil the biggest killer ... heart disease

Coronary problems are mostly associated with men, but they can be an even more fatal for women, explains Dr. Judith Reichman

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Dr. Judith Reichman
'Today' show contributor

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By Dr. Judith Reichman
'Today' show contributor
updated 10:55 p.m. ET June 14, 2004

Q. My father died of heart attack when he was 49. I’m 45. Am I at risk, and what can I do about it?

A: Yes, you are at risk, but so are most of us.

It’s scary that so many women barely acknowledge that their hearts can physically “break.” But heart disease is the leading cause of death for American women, accounting for 30 percent of all deaths. (Cancer is second and stroke is third.)

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We dismiss this disease because men have heart attacks 7 to 10 years earlier then women. They and their doctors know what to do, so they are more likely to get timely, lifesaving diagnosis and therapy.

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But more than 400,000 American women will have a heart attack this year, and a third of these will not even be recognized. (Many women write their symptoms off as indigestion or fatigue.) Of the women who are diagnosed, 42 percent will die within a year -- double the rate for men.

The younger we are when we get heart attacks, the worse the outcome. Women under age 65 are half again as likely to die of a heart attack as men in the same age group.

When a man has a heart attack, it often occurs after a slow formation of plaque, which closes off the arteries. When a woman does, it often occurs suddenly -- after a spasm of a coronary vessel, with the formation of a clot or the shearing-off of plaque. These bits travel through the blood stream and block a smaller vessel.

There are nearly 300 risk factors for heart disease, but an important one, as you suggest, is a family history of early heart attacks — before age 55 in men and 65 in women. This alone increases your risk two- to three-fold.

Other major factors that raise your risk:

  • Smoking.
  • Diabetes.
  • Obesity.
  • Untreated hypertension.
  • A sedentary lifestyle.
  • Abnormal lipids (a fatty substance in the blood), especially elevated triglycerides (body chemicals that transport fats) or high LDL cholesterol (the “bad” cholesterol).
  • An elevation in the inflammatory factor C-reactive protein.

If you have both genetic risk and another factor, you should have a coronary assessment. This can include a stress electrocardiogram; however, this test is often falsely positive in women, so most cardiologists prefer a cardiac ultrasound during exercise.

Your doctor may also test your blood for C-reactive protein, homocysteine (an amino acid, too much of which is related to heart disease), fasting lipid levels and fasting blood-sugar levels.

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Dr. Judith Reichman addresses your questions about women's health.

You should make efforts on your own to lower your risk. If your smoke, stop. Get at least 30 minutes of walking or other aerobic exercise daily.

If your lipid levels are high, talk to your doctor about taking statins to lower them. Your blood pressure should not be higher than 120/80. If it is, aggressive treatment with medication will make a big difference.

If you are more than 55, talk to your doctor about taking a low-dose (81 mg) aspirin daily.

Dr. Reichman’s Bottom Line: Although you may not want to admit you are at risk for heart disease, it’s to your advantage to know for sure. There is much you can do about it, including adopting a healthy lifestyle.

Dr. Judith Reichman, the “Today” show's medical contributor on women's health, has practiced obstetrics and gynecology for more than 20 years. You willl find many answers to your questions in her latest book, "Slow Your Clock Down: The Complete Guide to a Healthy, Younger You," published by William Morrow, a division of HarperCollins.

PLEASE NOTE: The information in this column should not be construed as providing specific medical advice, but rather to offer readers information to better understand their lives and health. It is not intended to provide an alternative to professional treatment or to replace the services of a physician.


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