Women and the risk factors for heart disease

Family history

You may not to realise that if your father or mother died of a heart attack before they were 60, you are three times more likely to have a heart attack. If you are at increased risk of heart disease it is important that you get the advice, support and treatment you need. o If you think you may be at risk for heart disease, discuss this with your GP.
Smoking

Women smokers have almost twice the risk of developing heart disease than male smokers do. Heavy smoking is a particularly important risk factor for women after the menopause. Almost a quarter of women in the UK smoke cigarettes. In particular, the number of younger women who smoke has been increasing over recent years. Passive, or second-hand smoking, is also harmful and women need to know about this risk, particularly if family members smoke.

The thought of putting on weight often puts women off trying to stop smoking.

• All women should aim to give up smoking. It is never too late to stop.

Is cholesterol important?

The risk of heart disease is directly related to cholesterol levels in the blood. The target level of cholesterol in the blood is 5.0mmol/l. The average cholesterol level for women is 5.6 mmol/l. This is high when compared to women in other countries.

Before the menopause, cholesterol levels tend to be lower in women than in men. After the menopause, cholesterol levels tend to rise, peaking between the ages of 55 and 65 years. Triglyceride levels (levels of simple fats in the blood) may be more significant for women than men.

Cholesterol levels can be reduced by drugs, exercise and a healthy diet, particularly reducing the amount of saturated fat that is eaten.

• Women need to know their cholesterol levels and understand the treatment to lower it.
• All women should aim to reduce their cholesterol levels by 30%.

What about diet?

Fat intake, especially saturated fat, is too high in women. And 85% of women are not eating the recommended five portions of fruit and vegetables a day. Women are often the people who shop for food and prepare meals. So they are responsible for the health of the family as well as for their own health. It can be difficult for one family member to change their diet if others are not willing to. Success is more likely if there is support and encouragement from others.

•   A healthy diet should become a way of life.

Does diabetes increase my risk of heart disease?

Women with diabetes are over three times more likely to develop heart disease than those without. The risk is particularly high in women who smoke. Diabetic women do less well after a heart attack than those without diabetes. If you have diabetes it is important that you monitor and control your blood sugar levels while recovering from a heart attack. Diabetes is often not diagnosed. Symptoms like weight loss, thirst, needing to go to the toilet more frequently and general tiredness are symptoms that need to be investigated.

It is important that diabetes is recognised and managed correctly.

• Those who are diagnosed with diabetes need to reduce their other risk factors for heart disease.

What about high blood pressure?

In England it is estimated that over a third of women have high blood pressure. Many who are having treatment still have higher than normal blood pressure and it is important for treatment to be monitored regularly to see if it is effective. Medication needs to be taken for the long term.

• You should not stop taking your medication for high blood pressure just because you feel well. Your blood pressure needs to be monitored regularly.

Being overweight – am I too fat for my heart?

Being overweight is associated with high blood pressure, diabetes and heart disease. Weight is usually assessed by working out a person’s body mass index (BMI), which is based on a person's height and weight. If the BMI is between 25 and 30, the person is classed as overweight. If it is over 30 the person is classed as obese. It is thought that a third of women are overweight and about a further quarter are obese. Many women are pear shaped with fat around their hips. However, weight carried around the waist – known as central obesity – is thought to be more significant. Around a fifth of women have central obesity. Ideally, the waist should measure between 32 and 35 inches. Losing weight is not easy and will be more successful over the long term if you lose it gradually and with support from friends and family.

•   Healthy eating needs to become a way of life.
•   Weight loss should be steady – one or two pounds (1kg) a week. Crash diets do not work in the long term.
•   Eat smaller portions, eat less fat and exercise regularly. Ask to see a dietician if you are struggling.

Physical activity and exercise – what sort of exercise should I be doing and how often?

Physical activity lowers the risk of heart disease and helps those who have been diagnosed with heart disease. It helps reduce weight, lowers cholesterol, reduces blood pressure and reduces the risk of developing diabetes. Exercise also makes you feel better. As women tend to live longer than men, it is important that they stay fit and active.

The recommended amount of physical activity is 30 minutes a day, five times a week. Brisk walking, dancing or cycling are particularly good ways of exercising. The exercise should be hard enough to make you breathe more heavily than normal. Walking around window-shopping is not enough! More women than men are physically inactive, despite the activity involved in housework. Women-only gyms and swimming sessions can be helpful for those who are put off by mixed exercise classes. The aim is to make exercise a way of life. Making exercise enjoyable, part of a regular routine and exercising with friends makes success more likely. Starting with regular brisk walking for 20 minutes three times a week, then increasing to 30 minutes at least five days a week, is a good way of exercising.

You need to introduce a programme of increasing physical activity and exercise after a heart attack or heart surgery.

• Regular physical activity needs to become a part of everyday life

Alcohol – how much can I drink?

Drinking too much can lead to weight gain and high blood pressure, and increase the risk for heart disease. The recommended weekly limit of alcohol for women is less than for men. About 17% of women go over the limit.

Alcohol is measured in units. A unit is half a pint of normal-strength beer, lager and cider, a 125ml glass of wine or a pub measure of spirits. For women, up to two units of alcohol a day can be good for the heart. More than three units is thought to be bad for your health.

• Do not save units up for weekend binges, and have two days a week without drinking any alcohol.

Psychological well-being – does stress cause heart disease?

Stress is difficult to measure. We all need a certain amount of stress to keep our lives interesting, but too much can be harmful and is thought to increase the risk of heart disease.

Many women lead busy lives, trying to juggle the demands of work and family, and may have little time for themselves. Not having enough support from friends, family or others around them, and not having enough control over work or other aspects of life, can lead to stress, anxiety, depression and personality changes. Mood swings, losing your temper, lack of concentration, not being able to see the funny side of things, feeling listless with little energy, losing interest in your appearance, crying easily and waking up early in the mornings are all examples of how stress can affect people.

• alking to friends and family may help, although it may be difficult to admit that you are feeling that you cannot cope, particularly if you are used to feeling in control of your life and are often supporting those around you.

Why don't women take action against heart disease?

Women tend not to put their health as a top priority. They are busy looking after other people and juggling their lives. Women often feel that they are too busy to make changes to their lives, and they assume that heart disease is a men's problem. They may feel that only older women develop heart disease. If they do go to the doctor, they may feel 'fobbed off' when they talk about their symptoms.

• Women need to take heart disease seriously and have the confidence to push for advice and appropriate treatment.
• It is tempting to ignore symptoms and to put needs of the family first. It is important to get medical help early.

Recovery after a heart attack

Women who have had a heart attack or heart surgery are likely to be offered a place on a cardiac rehabilitation programme run in the hospital or in the community. Many women find they are in the minority at these classes and they may feel uncomfortable exercising or discussing their feelings in a mixed-sex group. However, after their initial doubts, many women enjoy the atmosphere of the mixed group. Some centres offer single-sex rehabilitation classes.

Women sometimes feel that the information they are offered seems to be aimed at men. Women who return to a busy home and the demands of a family also need to rest and return to their normal activities gradually over a four- to six-week period after the heart attack or surgery. Women need to be able to say 'no' without feeling guilty or a failure. You will benefit from the support of understanding family and friends at this time. Many women with heart disease live alone and become anxious about their health and symptoms.

Do women's breasts get in the way during and after surgery?

The breasts do not get in the way of surgery because the surgeons make the cut between the breasts, down the breastbone.

After surgery, the breasts can put an extra strain on the wound. After surgery you should wear a sports bra and avoid wearing underwired bras. If you have large breasts it may be best to sleep in your bra for the first month after surgery. This will make sure your breasts are supported and not pulling on the wound.