WOMEN and men share one characteristic when it comes to heart disease: it's the leading killer of both. But otherwise, much is different - and not always to women's benefit. For instance, women don't usually experience the classic chest-clutching symptoms. Their first warning sign may be pain in the jaw or neck, fatigue, shortness of breath, a stomachache or nausea, all of which could be associated with another condition. Even the classic chest pain can be misinterpreted. "A lot of women come to me saying their bras feel too tight," said Dr. Maryann McLaughlin, assistant professor of cardiology at the Mount Sinai School of Medicine in Manhattan.
Some risks for heart disease are inherited. Luckily, however, women can do a lot to mitigate the other major risk factors. The following are areas where women can address their vulnerabilities:
CIGARETTES "Never smoke. Period. End of story," said Dr. Suzanne Steinbaum, medical director of the Center for Cardiac and Pulmonary Health at Beth Israel Medical Center in Manhattan. Experts say that smoking increases the risk of heart disease more than threefold because it constricts the blood vessels and raises blood pressure.
OBESITY In itself this is a risk factor for heart disease, and it also plays a part in other conditions that can increase the danger. There is no special cardiovascular diet, just the standard nutritional advice to eat more whole grains, fresh fruits and vegetables, low-fat dairy products and lean meat and less saturated fat and refined sugar. Some physicians would add food with omega-3 fatty acids, like fish, and folic acid, found in cereal and whole-wheat bread. The other half of the regimen is to do at least 30 minutes of moderate exercise daily, which can be as undemanding as a brisk walk or even housework. Abdominal fat is particularly tied to heart disease.
DIABETES The disease is a double whammy for women. More women than men are diabetic, and diabetic women are more at risk for heart disease than diabetic men. Diabetes increases the threat of heart disease about 50 percent.
Diabetes can be delayed, and even prevented, by exercise and a low-fat, low-sugar diet. If that is not enough, women might need a drug like metformin to increase the body's responsiveness to insulin.
Women who are at the greatest risk - those who are overweight and also over 45, with high cholesterol or blood pressure or with a family history of the disease - can ask for their blood sugar levels to be tested as part of their regular checkup.
CHOLESTEROL There are three main lipids, or fats, in the blood that can be strong predictors of heart disease; all work slightly differently in women and in men.
The level of LDL, or so-called bad cholesterol, should be under 100 milligrams per deciliter of blood, while HDL, or "good" cholesterol, should be above 50. Premenopausal women naturally have a relatively low level of LDL and relatively high HDL, most likely because of estrogen effects. Even older women continue to have levels of HDL that are about 10 milligrams above men's.
Sadly, women's natural advantages do not carry over to triglycerides, the third lipid. These should be kept below 150 milligrams per deciliter. The level, however, tends to rise after menopause, and high levels are more strongly correlated with coronary heart disease in women than in men.
The cholesterol and triglyceride numbers can be monitored through a simple, fasting blood test as part of a routine physical.
A low-fat diet can do wonders to bring cholesterol to the right range. If that does not work, or if people have two or more risk factors, doctors often prescribe a statin drug like Lipitor or Zocor. There has been a lot of enthusiasm about the ability of these drugs to stave off coronary problems for both sexes, but they seem to be more effective in men.
HIGH BLOOD PRESSURE This can lead to stroke as well as heart disease. Chalk up another disadvantage for females: after age 60, they are more likely to have this condition.
Ideally, blood pressure should be no higher than 120 over 80. Dr. Elizabeth G. Nabel, director of the National Heart, Lung and Blood Institute, suggests having the doctor check the level twice during an office visit because the anxiety of the appointment can send the scores shooting up at first.
ANXIETY Stress, depression, social isolation and anxiety can be factors in heart disease. "Women should make sure they have a good support network, and doctors should be on the lookout for depression," said Dr. Lori J. Mosca, director of preventive cardiology at New York-Presbyterian Hospital.
ASPIRIN Should women take this medicine as part of a daily regimen? For more than 15 years, doctors have known that an aspirin a day helps men over 45 avoid heart attacks. But the finding was never tested on women. Finally, definitive word came in March from a study done by Brigham and Women's Hospital in Boston: aspirin does not significantly help women under 65 avoid a first attack, but it does help them avoid one type of stroke - the exact opposite of what happens with men.
That finding has not really changed standard medical practice, because women do not usually get their first heart attacks until after 65 anyway. So most physicians continue to recommend preventive low-dose (81-milligram) aspirin for women under 65 only if they have two or more coronary risk factors, and for all women over 65.
