SWHR Live Online
Women and Heart Disease: The Role of Cholesterol
February 15, 2008
2:00 pm - 3:00 pm
February is American Heart Month. Therefore, in this online discussion, Nanette Wenger, M.D., a professor of medicine in the Division of Cardiology at the Emory University School of Medicine and chief of Cardiology at Grady Memorial Hospital in Atlanta, will answer questions about women and heart disease with a focus on the role of cholesterol in heart disease and current cholesterol screening guidelines. Wenger is board chair of the Society for Women’s Health Research, which conducted a survey last summer that indicates a disconnect between women understanding the risks associated with high cholesterol and taking action to monitor and control it.
Evanston, Illinois:
A recent report suggested that high levels of calcium intake might predispose women to heart attacks. Yet, physicians commonly recommend that women, especially older women, take quite high levels of calcium. Can you help women sort out this issue?
A recent report suggested that high levels of calcium intake might predispose women to heart attacks. Yet, physicians commonly recommend that women, especially older women, take quite high levels of calcium. Can you help women sort out this issue?
Nanette Wenger, M.D.:
The recent report regarding the predisposition to heart attack of women with high calcium intake is an observational association, not the result of a specific research study. Women must balance the risk of osteoporosis with this unconfirmed cardiac risk. Women with an abnormal bone mineral density should consult with their physician regarding the requisite dosage of calcium, vitamin D, and specific anti-osteoporosis therapy, often a bisphosphonate drug.
The recent report regarding the predisposition to heart attack of women with high calcium intake is an observational association, not the result of a specific research study. Women must balance the risk of osteoporosis with this unconfirmed cardiac risk. Women with an abnormal bone mineral density should consult with their physician regarding the requisite dosage of calcium, vitamin D, and specific anti-osteoporosis therapy, often a bisphosphonate drug.
Florida:
I read that there are different cholesterol guidelines for women and men. I saw that women should have higher levels of the "good" cholesterol. Why is this and what does the good cholesterol do for you?
I read that there are different cholesterol guidelines for women and men. I saw that women should have higher levels of the "good" cholesterol. Why is this and what does the good cholesterol do for you?
Nanette Wenger, M.D.:
The “good” cholesterol, or HDL cholesterol, is recommended to be greater than 40 for men and greater than 50 for women – this good or high-density lipoprotein cholesterol keeps cholesterol from being deposited in plaques throughout the body arteries.
The “good” cholesterol, or HDL cholesterol, is recommended to be greater than 40 for men and greater than 50 for women – this good or high-density lipoprotein cholesterol keeps cholesterol from being deposited in plaques throughout the body arteries.
Tennessee:
I know that cholesterol can lead to heart disease, but what exactly does it do that hurts you? I've heard that it leads to the hardening of arteries, but I don't really understand what that means. What is that and does cholesterol do anything else bad?
I know that cholesterol can lead to heart disease, but what exactly does it do that hurts you? I've heard that it leads to the hardening of arteries, but I don't really understand what that means. What is that and does cholesterol do anything else bad?
Nanette Wenger, M.D.:
There are 2 kinds of cholesterol, the “good cholesterol” HDL, or high-density lipoprotein cholesterol, that prevents cholesterol from being deposited in the arteries; and the “bad cholesterol” LDL, or low-density lipoprotein cholesterol, that leads to deposition of cholesterol in plaques or narrowings of the arteries. It is not specifically hardening of the arteries, but rather the deposition of cholesterol that can either cause narrowing of the coronary arteries (and other arteries in the body). A plaque that has a large concentration of cholesterol is more likely to rupture and cause a heart attack.
There are 2 kinds of cholesterol, the “good cholesterol” HDL, or high-density lipoprotein cholesterol, that prevents cholesterol from being deposited in the arteries; and the “bad cholesterol” LDL, or low-density lipoprotein cholesterol, that leads to deposition of cholesterol in plaques or narrowings of the arteries. It is not specifically hardening of the arteries, but rather the deposition of cholesterol that can either cause narrowing of the coronary arteries (and other arteries in the body). A plaque that has a large concentration of cholesterol is more likely to rupture and cause a heart attack.
Washington:
I've heard that high HDL is more important for women? Why is that?
I've heard that high HDL is more important for women? Why is that?
Nanette Wenger, M.D.:
All major national guidelines for the treatment of cholesterol still focus on LDL cholesterol. Nonetheless, women who have a low HDL (good) cholesterol and high triglyceride (another blood fat) level appear to be more prone to coronary disease than do men with the same unfavorable levels.
All major national guidelines for the treatment of cholesterol still focus on LDL cholesterol. Nonetheless, women who have a low HDL (good) cholesterol and high triglyceride (another blood fat) level appear to be more prone to coronary disease than do men with the same unfavorable levels.
Anonymous:
I am 73 years old. I always had high cholesterol. Diets never helped reducing my cholesterol (I have a totally normal weight and no high blood pressure). I started to take medication only a couple of years ago but until I started with Ezetrol the cholesterol has not gone down. Now I read Ezetrol and Simvastatin (combined in one pill or separate) do not do the work and should not be taken. I am confused. I did copy a small section from this link: "Patients have begun 'swamping' physician offices to ask whether they should end treatment with the cholesterol medication Vytorin, co-marketed by Merck and Schering-Plough, after a recent study found the treatment no more effective than a treatment available in generic form in the prevention of accumulation of plaque on artery walls, the Wall Street Journal reports" (Winslow, Wall Street Journal, 1/17). http://www.medicalnewstoday.com/articles/94401.php Please advise. Thanks.
I am 73 years old. I always had high cholesterol. Diets never helped reducing my cholesterol (I have a totally normal weight and no high blood pressure). I started to take medication only a couple of years ago but until I started with Ezetrol the cholesterol has not gone down. Now I read Ezetrol and Simvastatin (combined in one pill or separate) do not do the work and should not be taken. I am confused. I did copy a small section from this link: "Patients have begun 'swamping' physician offices to ask whether they should end treatment with the cholesterol medication Vytorin, co-marketed by Merck and Schering-Plough, after a recent study found the treatment no more effective than a treatment available in generic form in the prevention of accumulation of plaque on artery walls, the Wall Street Journal reports" (Winslow, Wall Street Journal, 1/17). http://www.medicalnewstoday.com/articles/94401.php Please advise. Thanks.
Nanette Wenger, M.D.:
Yours is a very good question and one commonly confronting physicians today. Diet alone may not adequately reduce cholesterol, because there are 2 sources of cholesterol – the cholesterol consumed in the diet, and the cholesterol manufactured in the liver. The basic recommendation for lowering of the bad (LDL) cholesterol is the use of a statin drug, and the goal LDL cholesterol will depend on your other risk factors, but typically is at least below 130 and preferably below 100 for all patients. The combination of a statin and ezetimibe has been used for a number of years to help lower LDL cholesterol. In the study reported in the Wall Street Journal, the patients treated were not the typical high cholesterol patients (such as you), but rather patients with very high cholesterol levels and a hereditary form of high cholesterol – and the artery walls that were studied were the carotid arteries, the arteries in the neck. The American College of Cardiology has suggested that patients consult with their personal physician regarding whether to continue the statin plus ezetimibe combination or to take solely statin therapy. This certainly should not be interpreted as saying that cholesterol lowering does not work – a multitude of research studies support the benefit of lowering cholesterol.
Yours is a very good question and one commonly confronting physicians today. Diet alone may not adequately reduce cholesterol, because there are 2 sources of cholesterol – the cholesterol consumed in the diet, and the cholesterol manufactured in the liver. The basic recommendation for lowering of the bad (LDL) cholesterol is the use of a statin drug, and the goal LDL cholesterol will depend on your other risk factors, but typically is at least below 130 and preferably below 100 for all patients. The combination of a statin and ezetimibe has been used for a number of years to help lower LDL cholesterol. In the study reported in the Wall Street Journal, the patients treated were not the typical high cholesterol patients (such as you), but rather patients with very high cholesterol levels and a hereditary form of high cholesterol – and the artery walls that were studied were the carotid arteries, the arteries in the neck. The American College of Cardiology has suggested that patients consult with their personal physician regarding whether to continue the statin plus ezetimibe combination or to take solely statin therapy. This certainly should not be interpreted as saying that cholesterol lowering does not work – a multitude of research studies support the benefit of lowering cholesterol.
Washington, D.C.:
I eat right, exercise regularly and am at the right weight for my height and age -- late 40s. I don't smoke and only drink occassionally. How often do I really have to have my cholesterol checked. It's never been a problem and I don't think I'm at great risk for heart problems.
I eat right, exercise regularly and am at the right weight for my height and age -- late 40s. I don't smoke and only drink occassionally. How often do I really have to have my cholesterol checked. It's never been a problem and I don't think I'm at great risk for heart problems.
Nanette Wenger, M.D.:
The frequency of check of cholesterol depends on your cardiovascular risk, but, particularly, on the level of cholesterol initially determined. Typically, if your cholesterol is normal and you have no other risk factors, repetition of testing once every several years is reasonable.
The frequency of check of cholesterol depends on your cardiovascular risk, but, particularly, on the level of cholesterol initially determined. Typically, if your cholesterol is normal and you have no other risk factors, repetition of testing once every several years is reasonable.
New York:
I read on this Web site that most women don't know their cholesterol number. So what? That seems like an unnecessary number to track and remember. If my doctor tests for cholesterol every year or so, isn't that enough. Won't she tell me if there's a problem? This just seems like another example of one too many things we're supposed to keep tabs on.
I read on this Web site that most women don't know their cholesterol number. So what? That seems like an unnecessary number to track and remember. If my doctor tests for cholesterol every year or so, isn't that enough. Won't she tell me if there's a problem? This just seems like another example of one too many things we're supposed to keep tabs on.
Nanette Wenger, M.D.:
Certainly, if you choose not to monitor your personal health measures, that is an individual decision. But you should know your numbers and ask that your doctor review these with you at the appropriate office encounter. I tell my women patients that they should know 3 numbers: 100, 50, and 150 – that is, their bad or LDL cholesterol should be lower than 100; their good or HDL cholesterol should be greater than 50; and their other blood fat, triglyceride, should be less than 150.
Other numbers that I recommend my women patients know is their blood sugar (to determine whether or not they are diabetic) and their blood pressure. Of course you should know your weight -– is it optimal or suboptimal? -– and your waist circumference –- it should be less than 35 inches for women.
Certainly, if you choose not to monitor your personal health measures, that is an individual decision. But you should know your numbers and ask that your doctor review these with you at the appropriate office encounter. I tell my women patients that they should know 3 numbers: 100, 50, and 150 – that is, their bad or LDL cholesterol should be lower than 100; their good or HDL cholesterol should be greater than 50; and their other blood fat, triglyceride, should be less than 150.
Other numbers that I recommend my women patients know is their blood sugar (to determine whether or not they are diabetic) and their blood pressure. Of course you should know your weight -– is it optimal or suboptimal? -– and your waist circumference –- it should be less than 35 inches for women.
TX:
How much exercise do you need to improve your heart health? How often should you exercise? For how long? And how vigorous should the exercise be? Can you get away with just walking or do you need to do more?
How much exercise do you need to improve your heart health? How often should you exercise? For how long? And how vigorous should the exercise be? Can you get away with just walking or do you need to do more?
Nanette Wenger, M.D.:
Recommendations for exercise for all women include a minimum of 30 minutes of moderate exercise, such as brisk walking, on most if not all days of the week. Walking is quite a good exercise and can be done without particular skills, facilities, or equipment –- that is its major attraction. Some studies report increased benefit with more vigorous exercise or exercise of longer duration.
Recommendations for exercise for all women include a minimum of 30 minutes of moderate exercise, such as brisk walking, on most if not all days of the week. Walking is quite a good exercise and can be done without particular skills, facilities, or equipment –- that is its major attraction. Some studies report increased benefit with more vigorous exercise or exercise of longer duration.
mass.:
Can you tell me what the recommendations are for women and aspirin now? They used to say every older adult should take it to prevent heart problems, but now the recommendations have changed. Should women take aspirin? How much, how often, at what age and what does it do for you?
Can you tell me what the recommendations are for women and aspirin now? They used to say every older adult should take it to prevent heart problems, but now the recommendations have changed. Should women take aspirin? How much, how often, at what age and what does it do for you?
Nanette Wenger, M.D.:
Recommendations differ for women and for men. Based on data from the Women’s Health Study, recently reported, women younger than 65 years of age do not have benefit from aspirin in preventing myocardial infarction (heart attack) but have stroke benefit. This benefit must be weighed against the risk of aspirin side effects and that individual woman’s risk for stroke. This is totally opposite to the research results for men, where aspirin prevented heart attack but not stroke. For women older than 65 years of age, aspirin did prevent both heart attack and stroke to a modest extent, but most of the benefit was equalized by an increased risk of gastrointestinal bleeding – therefore, the recommendation to patients and their physicians is to individualize.
Recommendations differ for women and for men. Based on data from the Women’s Health Study, recently reported, women younger than 65 years of age do not have benefit from aspirin in preventing myocardial infarction (heart attack) but have stroke benefit. This benefit must be weighed against the risk of aspirin side effects and that individual woman’s risk for stroke. This is totally opposite to the research results for men, where aspirin prevented heart attack but not stroke. For women older than 65 years of age, aspirin did prevent both heart attack and stroke to a modest extent, but most of the benefit was equalized by an increased risk of gastrointestinal bleeding – therefore, the recommendation to patients and their physicians is to individualize.
Georgia:
Hi Dr. Wenger, We Georgians are lucky to have so many great hospitals in Atlanta. Can you tell me why heart disease is such a problem for older women? I know so many women in their 70s and 80s who were pretty healthy only to have their lives slowly sapped by congestive heart failure. I don't have any numbers but this seems like a bigger problem for women than men.
Hi Dr. Wenger, We Georgians are lucky to have so many great hospitals in Atlanta. Can you tell me why heart disease is such a problem for older women? I know so many women in their 70s and 80s who were pretty healthy only to have their lives slowly sapped by congestive heart failure. I don't have any numbers but this seems like a bigger problem for women than men.
Nanette Wenger, M.D.:
Heart failure is the result of a number of heart problems, including coronary disease and heart attack, valvular heart disease, and a major contributor is high blood pressure or hypertension. Women who have hypertension are more likely than their male counterparts to develop heart failure, thus emphasizing the importance of blood pressure control across the lifespan. As I said, heart failure is not a specific diagnosis, but rather the result of a number of different causes for heart disease. Probably the increased appearance of heart failure in older women in the community may reflect some medical successes – many women who might earlier have died of coronary disease or valvular heart disease, but have had these diseases treated by medical or surgical therapies – now survive the acute illness and later in the clinical course develop congestive heart failure.
Heart failure is the result of a number of heart problems, including coronary disease and heart attack, valvular heart disease, and a major contributor is high blood pressure or hypertension. Women who have hypertension are more likely than their male counterparts to develop heart failure, thus emphasizing the importance of blood pressure control across the lifespan. As I said, heart failure is not a specific diagnosis, but rather the result of a number of different causes for heart disease. Probably the increased appearance of heart failure in older women in the community may reflect some medical successes – many women who might earlier have died of coronary disease or valvular heart disease, but have had these diseases treated by medical or surgical therapies – now survive the acute illness and later in the clinical course develop congestive heart failure.
D.C.:
I know that cholesterol can lead to plaque build up in your arteries. Is there a way to reverse that build up? Through diet and exercise can your body break down that plaque on its own and make it go away?
I know that cholesterol can lead to plaque build up in your arteries. Is there a way to reverse that build up? Through diet and exercise can your body break down that plaque on its own and make it go away?
Nanette Wenger, M.D.:
There is very limited evidence for reversal or regression of plaque in the arteries. However, the composition of these plaques may well change and the plaque that is less full of lipid or cholesterol is less likely to rupture and cause a heart attack, Diet and exercise can help control a variety of risk factors, including high cholesterol, high blood pressure, etc. – but diet and exercise alone may be inadequate and medications may be required. Consult with your physician.
There is very limited evidence for reversal or regression of plaque in the arteries. However, the composition of these plaques may well change and the plaque that is less full of lipid or cholesterol is less likely to rupture and cause a heart attack, Diet and exercise can help control a variety of risk factors, including high cholesterol, high blood pressure, etc. – but diet and exercise alone may be inadequate and medications may be required. Consult with your physician.
Alexandria, Va.:
Is there a difference between cholesterol and triglycerides?
Is there a difference between cholesterol and triglycerides?
Nanette Wenger, M.D.:
Cholesterol and triglycerides are 2 different types of blood fats. See some of the responses above.
Cholesterol and triglycerides are 2 different types of blood fats. See some of the responses above.
Cali:
I know a lot of processed foods, like Oreos, no longer use trans-fats. When I'm looking at the nutrition label on something at the store, what things should I avoid?
I know a lot of processed foods, like Oreos, no longer use trans-fats. When I'm looking at the nutrition label on something at the store, what things should I avoid?
Nanette Wenger, M.D.:
Trans fats have been eliminated from many foods, but certainly in examining the nutrition labels you should look for saturated fats. For all women, saturated fat content in the diet should be less than 10%, and for women with high cholesterol or with known heart or vascular disease or diabetes, it should be less than 7% of calorie intake.
Trans fats have been eliminated from many foods, but certainly in examining the nutrition labels you should look for saturated fats. For all women, saturated fat content in the diet should be less than 10%, and for women with high cholesterol or with known heart or vascular disease or diabetes, it should be less than 7% of calorie intake.
Wisconsin:
If cholesterol levels are considered borderline to slightly elevated and Triglycerides are slightly elevated, is there any protection expected if the lipid peroxide levels are low? Would cholesterol reducing drugs still be the recommendation in this scenario?
If cholesterol levels are considered borderline to slightly elevated and Triglycerides are slightly elevated, is there any protection expected if the lipid peroxide levels are low? Would cholesterol reducing drugs still be the recommendation in this scenario?
Nanette Wenger, M.D.:
The cholesterol levels as noted in a response above are the recommended goal levels. Depending on the degree of elevation, your physician will define whether lifestyle interventions are initially appropriate, or whether added medications are needed.
The cholesterol levels as noted in a response above are the recommended goal levels. Depending on the degree of elevation, your physician will define whether lifestyle interventions are initially appropriate, or whether added medications are needed.
Boston, Mass.:
Many or most of the studies [e.g.RCT's] address groups. But a RCT eliminates inididual differences based on genetic and other biological factors. Even more critically are there studies that study INTRA-INDIVIDUAL VARIABILITY OVER TIME? e.g. Framinham Heart study but with focus on intra-individual variability?
Many or most of the studies [e.g.RCT's] address groups. But a RCT eliminates inididual differences based on genetic and other biological factors. Even more critically are there studies that study INTRA-INDIVIDUAL VARIABILITY OVER TIME? e.g. Framinham Heart study but with focus on intra-individual variability?
Nanette Wenger, M.D.:
You are certainly correct that all the randomized trials address groups. There is currently major interest in individual genetic and other biologic factors, but currently they are not reliably measurable and therefore have not been part of any organized research study or observational study, such as Framingham. This is the promise, as yet unfulfilled, of genetic-based medicine.
You are certainly correct that all the randomized trials address groups. There is currently major interest in individual genetic and other biologic factors, but currently they are not reliably measurable and therefore have not been part of any organized research study or observational study, such as Framingham. This is the promise, as yet unfulfilled, of genetic-based medicine.
Moderator:
Note: RCT stands for "randomized controlled trial."
Note: RCT stands for "randomized controlled trial."
Worcester Senior Center:
With the latest news indicating that high cholesterol is not responsible for most heart attacks, but rather plaque build up in the arteries, what would be considered a safe level of cholesterol for seniors? Women in particular.
With the latest news indicating that high cholesterol is not responsible for most heart attacks, but rather plaque build up in the arteries, what would be considered a safe level of cholesterol for seniors? Women in particular.
Nanette Wenger, M.D.:
The level of desirable cholesterol does not vary with age – it is the same for seniors as for younger women. Increasingly, research studies have shown the benefit of cholesterol-lowering to target goals both in women and in seniors.
The level of desirable cholesterol does not vary with age – it is the same for seniors as for younger women. Increasingly, research studies have shown the benefit of cholesterol-lowering to target goals both in women and in seniors.
Washington:
I've heard horror stories of women, after complaining of chest pains, back pains, numbness, indigestion and other things, being sent home from the emergency room without receiving any serious or legitmate heart screenings only to have a heart attack a short while later. How do we get doctors to take us seriously and give us the cardiovascular care we deserve?
I've heard horror stories of women, after complaining of chest pains, back pains, numbness, indigestion and other things, being sent home from the emergency room without receiving any serious or legitmate heart screenings only to have a heart attack a short while later. How do we get doctors to take us seriously and give us the cardiovascular care we deserve?
Nanette Wenger, M.D.:
Please be your personal advocate – this is my message to all women. The female heart is vulnerable to coronary disease, and the woman with chest pain deserves precise and detailed evaluation, as does her male counterpart. A sizeable amount of both community and physician education has focused on the vulnerability of women to heart disease and the need to precisely evaluate their chest pain symptoms.
Please be your personal advocate – this is my message to all women. The female heart is vulnerable to coronary disease, and the woman with chest pain deserves precise and detailed evaluation, as does her male counterpart. A sizeable amount of both community and physician education has focused on the vulnerability of women to heart disease and the need to precisely evaluate their chest pain symptoms.
Arlington, Virginia:
Women have smaller bodies, so we have smaller hearts, smaller arteries, smaller blood vessels, etc. Does this affect heart disease? Is it easier for our arteries to become clogged because they're smaller than a man's?
Women have smaller bodies, so we have smaller hearts, smaller arteries, smaller blood vessels, etc. Does this affect heart disease? Is it easier for our arteries to become clogged because they're smaller than a man's?
Nanette Wenger, M.D.:
Although women’s arteries are somewhat smaller than men’s – as a group – the arteries of women and many smaller men are comparable in size. Certainly a fixed degree of obstruction in a smaller artery is more serious. Nonetheless, both women and men should carefully learn their risk factors for coronary heart disease and embark on a risk reduction regimen.
Although women’s arteries are somewhat smaller than men’s – as a group – the arteries of women and many smaller men are comparable in size. Certainly a fixed degree of obstruction in a smaller artery is more serious. Nonetheless, both women and men should carefully learn their risk factors for coronary heart disease and embark on a risk reduction regimen.
Florida:
I know that high blood pressure can lead to stroke, but can it lead to a heart attack?
I know that high blood pressure can lead to stroke, but can it lead to a heart attack?
Nanette Wenger, M.D.:
High blood pressure is a risk not only for stroke, but for heart attack, heart failure, and kidney failiure. The risk of high blood pressure for heart attack and heart failure is more prominent for women than for men.
High blood pressure is a risk not only for stroke, but for heart attack, heart failure, and kidney failiure. The risk of high blood pressure for heart attack and heart failure is more prominent for women than for men.
Ohio:
I have a question about research. If I have been diagnosed with heart disease and want to particpate in a research study to obtain new or experimental drugs, is there a way I can guarantee that I would actually receive drugs in the study and not a placebo?
I have a question about research. If I have been diagnosed with heart disease and want to particpate in a research study to obtain new or experimental drugs, is there a way I can guarantee that I would actually receive drugs in the study and not a placebo?
Nanette Wenger, M.D.:
The concept of a research study that investigates new or experimental drugs is that there is random assignment of the research participants either to drug or placebo. Neither the research subject nor the investigator knows whether drug or placebo is being administered. This is the only way to acquire non-prejudiced information that will guide the use of the new or experimental drug. Having said that, there are some research studies that compare 2 drugs, typically either 2 doses of the same drug, or an older and a newer drug. In these studies, all patients receive drug, but neither the subject nor the investigator knows which of the study regimens is being received.
The concept of a research study that investigates new or experimental drugs is that there is random assignment of the research participants either to drug or placebo. Neither the research subject nor the investigator knows whether drug or placebo is being administered. This is the only way to acquire non-prejudiced information that will guide the use of the new or experimental drug. Having said that, there are some research studies that compare 2 drugs, typically either 2 doses of the same drug, or an older and a newer drug. In these studies, all patients receive drug, but neither the subject nor the investigator knows which of the study regimens is being received.
Moderator:
You can learn more about medical research through the Society's public education campaign called "Some Things Only a Woman Can Do," which explains the importance of women participating in medical research and what it entails: www.womancando.org
You can learn more about medical research through the Society's public education campaign called "Some Things Only a Woman Can Do," which explains the importance of women participating in medical research and what it entails: www.womancando.org
Houston:
What is the best way to determine if you are overweight? Is it BMI, waist measurement or something else? And what is the connection between obesity and heart disease? I've heard that researchers have struggled to make a causal connection between the two.
What is the best way to determine if you are overweight? Is it BMI, waist measurement or something else? And what is the connection between obesity and heart disease? I've heard that researchers have struggled to make a causal connection between the two.
Nanette Wenger, M.D.:
There are excellent tables for optimal weight based on height and for optimal body mass index or BMI. BMI is a relationship of height and weight. Waist circumference is also a risk attribute for heart disease, with the goal waist circumference for women being less than 35 inches. Please note that this applies to Caucasian women, and lower waist circumferences are considered the norm for many Asian women. Obesity in and of itself contributes to heart disease, but often it is the associates of obesity that may be more powerful contributors – unhealthy diet, physical inactivity, high blood pressure, high blood sugar, abnormal blood cholesterol, and the like. As defined in the Women’s Preventive Guidelines from the American Heart Association, the ideal body mass index for women, is a BMI below 24.9.
There are excellent tables for optimal weight based on height and for optimal body mass index or BMI. BMI is a relationship of height and weight. Waist circumference is also a risk attribute for heart disease, with the goal waist circumference for women being less than 35 inches. Please note that this applies to Caucasian women, and lower waist circumferences are considered the norm for many Asian women. Obesity in and of itself contributes to heart disease, but often it is the associates of obesity that may be more powerful contributors – unhealthy diet, physical inactivity, high blood pressure, high blood sugar, abnormal blood cholesterol, and the like. As defined in the Women’s Preventive Guidelines from the American Heart Association, the ideal body mass index for women, is a BMI below 24.9.
N.Y.:
Is it true that there is no direct evidence cholesterol actually causes serious problems? That, in fact, it is by association only, and inflammation is thought to be more of a casual factor of heart health problems?
Is it true that there is no direct evidence cholesterol actually causes serious problems? That, in fact, it is by association only, and inflammation is thought to be more of a casual factor of heart health problems?
Nanette Wenger, M.D.:
Cholesterol (and in particular, the bad or LDL cholesterol) is one of the 3 major risk factors for cardiovascular disease. Increased levels of the LDL cholesterol relate to an increased occurrence of cardiovascular events, and control of elevated cholesterol levelsdecreases morbidity and mortality. The role of inflammation remains uncertain, although it is a major area of investigation. The American Heart Association and the American College of Cardiology have specific guidelines for cholesterol control – but control of inflammation is not currently recommended.
Cholesterol (and in particular, the bad or LDL cholesterol) is one of the 3 major risk factors for cardiovascular disease. Increased levels of the LDL cholesterol relate to an increased occurrence of cardiovascular events, and control of elevated cholesterol levelsdecreases morbidity and mortality. The role of inflammation remains uncertain, although it is a major area of investigation. The American Heart Association and the American College of Cardiology have specific guidelines for cholesterol control – but control of inflammation is not currently recommended.
Bremerton, WA:
Some of the symptoms of a heart attack in women sounds like the signs of a lupus flare. How do lupus patients determine what they are experiencing? Is is a heart attack? Is it a lupus flare?
Some of the symptoms of a heart attack in women sounds like the signs of a lupus flare. How do lupus patients determine what they are experiencing? Is is a heart attack? Is it a lupus flare?
Nanette Wenger, M.D.:
Women with lupus, as you know, are at risk of having a heart attack. The signs of a lupus flare are often more gradual and protracted – however, if you are uncertain and there is a new onset of symptoms suggestive of a heart attack, prompt presentation to an emergency department is appropriate.
Women with lupus, as you know, are at risk of having a heart attack. The signs of a lupus flare are often more gradual and protracted – however, if you are uncertain and there is a new onset of symptoms suggestive of a heart attack, prompt presentation to an emergency department is appropriate.
Washington:
I heard that depression affects women's hearts more than men's. Can you tell me more about that?
I heard that depression affects women's hearts more than men's. Can you tell me more about that?
Nanette Wenger, M.D.:
Depression puts both women and men at risk for heart attack and indeed for other medical problems. However, after a heart attack, women, and in particular younger women, are far more likely to develop depression than are men. Depression is associated with unfavorable outcomes. Therefore, the recommendations for women with heart disease and their physicians is that, particularly following an acute coronary event, women be assessed for depression and referred for treatment as appropriate.
Depression puts both women and men at risk for heart attack and indeed for other medical problems. However, after a heart attack, women, and in particular younger women, are far more likely to develop depression than are men. Depression is associated with unfavorable outcomes. Therefore, the recommendations for women with heart disease and their physicians is that, particularly following an acute coronary event, women be assessed for depression and referred for treatment as appropriate.
Iowa:
This may sound silly, but if you think you're having a heart attack, what should you do? Should a woman take an aspirin? I've heard that mentioned for men, but I've also heard conflicting reports on what aspirin does for women's hearts.
This may sound silly, but if you think you're having a heart attack, what should you do? Should a woman take an aspirin? I've heard that mentioned for men, but I've also heard conflicting reports on what aspirin does for women's hearts.
Nanette Wenger, M.D.:
If you think you are having a heart attack, chew 1 full-dose (325 mg) aspirin. The sex-specific different recommendations that you address are for the chronic use of aspirin – see several of the questions and answers above.
If you think you are having a heart attack, chew 1 full-dose (325 mg) aspirin. The sex-specific different recommendations that you address are for the chronic use of aspirin – see several of the questions and answers above.
Kansas City:
This may be too general, but are the symptoms of tiredness and fatigue more often connected to heart problems in women than men? I hear of those symptoms being a precursor to a lot of heart problems discovered in women. And since, there's talk about cholesterol in this discussion, do blocked arteries or plaque build-up contribute to fatigue?
This may be too general, but are the symptoms of tiredness and fatigue more often connected to heart problems in women than men? I hear of those symptoms being a precursor to a lot of heart problems discovered in women. And since, there's talk about cholesterol in this discussion, do blocked arteries or plaque build-up contribute to fatigue?
Nanette Wenger, M.D.:
Chronically blocked arteries or plaque buildup are unlikely to contribute to fatigue, unless there is very severe narrowing and limitation of blood flow to the heart. In examining the symptoms of women and men who present with heart attack, chest pain remains the dominant symptom for both women and men. However, other symptoms such as shortness of breath, tiredness, fatigue, neck/back/shoulder pain, or abdominal pain are more likely to be described by women than by men.
Chronically blocked arteries or plaque buildup are unlikely to contribute to fatigue, unless there is very severe narrowing and limitation of blood flow to the heart. In examining the symptoms of women and men who present with heart attack, chest pain remains the dominant symptom for both women and men. However, other symptoms such as shortness of breath, tiredness, fatigue, neck/back/shoulder pain, or abdominal pain are more likely to be described by women than by men.
texas:
Regarding family history as a risk factor, should a woman be concerned with men in her family who have had heart disease or just women?
Regarding family history as a risk factor, should a woman be concerned with men in her family who have had heart disease or just women?
Nanette Wenger, M.D.:
Remember that you inherit genes from both parents – therefore, if there is a history of premature heart disease, coronary heart disease, defined as prior to age 55 for a first degree male relative, or prior to age 65 in a first degree female relative, family history is a risk factor.
Remember that you inherit genes from both parents – therefore, if there is a history of premature heart disease, coronary heart disease, defined as prior to age 55 for a first degree male relative, or prior to age 65 in a first degree female relative, family history is a risk factor.
Moderator:
Note: first-degree relative refers to the parents, brothers, sisters, or children of an individual.
Note: first-degree relative refers to the parents, brothers, sisters, or children of an individual.
CT:
Is carotid artery stenting a more beneficial treatment than surgery for patients with carotid artery disease?
Is carotid artery stenting a more beneficial treatment than surgery for patients with carotid artery disease?
Nanette Wenger, M.D.:
Both carotid artery stenting and carotid artery surgery are effective for patients who have significant obstruction of the carotid arteries. The choice often depends on the specific characteristics of the obstruction and the expertise at the local center.
Both carotid artery stenting and carotid artery surgery are effective for patients who have significant obstruction of the carotid arteries. The choice often depends on the specific characteristics of the obstruction and the expertise at the local center.
Seattle, WA:
Dear Dr. Wenger, Cholesterol is such a safe subject. And seems to mask a physician's ability to look more expansively for causes of symptoms. I rather would like to know if you all are looking at the failure of cardiolgists to pick up underlying heart failure early. Unfortunately, I -- and others I have read on WomenHeart's Web site -- have had missed problems, told we were fine, or our heart mucsle was normal, only to later find out we were not fine. Are there studies looking at the rate of women being told their hearts were normal (false positive results) and yet are now being told they have diastolic dysfunction and there is no cure? That, in fact, the prior cardiologists encouragement to exercise indeed was the wrong medicine.
Dear Dr. Wenger, Cholesterol is such a safe subject. And seems to mask a physician's ability to look more expansively for causes of symptoms. I rather would like to know if you all are looking at the failure of cardiolgists to pick up underlying heart failure early. Unfortunately, I -- and others I have read on WomenHeart's Web site -- have had missed problems, told we were fine, or our heart mucsle was normal, only to later find out we were not fine. Are there studies looking at the rate of women being told their hearts were normal (false positive results) and yet are now being told they have diastolic dysfunction and there is no cure? That, in fact, the prior cardiologists encouragement to exercise indeed was the wrong medicine.
Nanette Wenger, M.D.:
Very good question regarding diastolic dysfunction. Among the most common causes of diastolic dysfunction is uncontrolled hypertension – thus control of blood pressures to goal levels is extremely important. Certainly not all patients who have diastolic dysfunction (which is an echocardiographic diagnosis) have clinical evidence for heart failure. If there is clinical evidence for heart failure, of course, doctors routinely do an echocardiogram to differentiate between systolic dysfunction (where there is inadequate pumping function of the heart muscle) from diastolic dysfunction (where there is inadequate relaxation of the heart muscle). Several studies show improvement of symptoms of diastolic dysfunction with exercise – although there is not yet evidence that exercise will alter the diastolic dysfunction itself.
Very good question regarding diastolic dysfunction. Among the most common causes of diastolic dysfunction is uncontrolled hypertension – thus control of blood pressures to goal levels is extremely important. Certainly not all patients who have diastolic dysfunction (which is an echocardiographic diagnosis) have clinical evidence for heart failure. If there is clinical evidence for heart failure, of course, doctors routinely do an echocardiogram to differentiate between systolic dysfunction (where there is inadequate pumping function of the heart muscle) from diastolic dysfunction (where there is inadequate relaxation of the heart muscle). Several studies show improvement of symptoms of diastolic dysfunction with exercise – although there is not yet evidence that exercise will alter the diastolic dysfunction itself.
D.C.:
I am a woman. I know family history is a risk factor for heart disease--am I more at risk if my mother or my father has heart disease?
I am a woman. I know family history is a risk factor for heart disease--am I more at risk if my mother or my father has heart disease?
Nanette Wenger, M.D.:
Certainly premature coronary heart disease – before 65 years of age for a first degree female relative or 55 years of age for a male first degree relative poses an increased risk. Several people have asked this question – a family history of disease should encourage you to carefully reduce all your coronary risk factors and to work with your physician to see that all your “numbers” are at ideal values.
Certainly premature coronary heart disease – before 65 years of age for a first degree female relative or 55 years of age for a male first degree relative poses an increased risk. Several people have asked this question – a family history of disease should encourage you to carefully reduce all your coronary risk factors and to work with your physician to see that all your “numbers” are at ideal values.
D.C.:
Can you tell me: what is the connection between gum disease and heart disease? I don't understand what my teeth have to do with my heart.
Can you tell me: what is the connection between gum disease and heart disease? I don't understand what my teeth have to do with my heart.
Nanette Wenger, M.D.:
There has been some suggestion that gum disease – and the associated inflammation – might be a risk factor for coronary heart disease. To explore this concern, a major research trial was undertaken where participants were randomly allocated to antibiotics or placebo to see if antibiotic therapy decreased coronary risk. In this trial, it did not. Therefore, based on this research study, there is no documentation of a connection. Nonetheless, gum disease is an important medical problem and should be treated by your dentist.
There has been some suggestion that gum disease – and the associated inflammation – might be a risk factor for coronary heart disease. To explore this concern, a major research trial was undertaken where participants were randomly allocated to antibiotics or placebo to see if antibiotic therapy decreased coronary risk. In this trial, it did not. Therefore, based on this research study, there is no documentation of a connection. Nonetheless, gum disease is an important medical problem and should be treated by your dentist.
Washington, DC:
I've heard that women are more susceptible to high cholesterol than men. Is that true and why?
I've heard that women are more susceptible to high cholesterol than men. Is that true and why?
Nanette Wenger, M.D.:
High cholesterol (and by this we mean high levels of the bad, or low-density lipoprotein LDL cholesterol) is a risk factor for both women and men. The goal levels for treatment, either with lifestyle or with drug therapy, are comparable for women and for men.
High cholesterol (and by this we mean high levels of the bad, or low-density lipoprotein LDL cholesterol) is a risk factor for both women and men. The goal levels for treatment, either with lifestyle or with drug therapy, are comparable for women and for men.
Maryland:
What risk do triglycerides present with respect to heart disease?
What risk do triglycerides present with respect to heart disease?
Nanette Wenger, M.D.:
There is currently considerable interest in triglycerides and a great deal of investigation in this area. The lipid risk factors for heart disease include an increased level of the bad (LDL) cholesterol, a low level of the good (HDL) cholesterol, and an elevated level of triglycerides. Current guidelines from the national cardiac societies and from the National Cholesterol Education Program recommend that initial treatment address the bad or LDL cholesterol and lower this component to goal levels. Once the LDL cholesterol is controlled, then attention should be paid to the other lipid risk factors, a low HDL or a high triglyceride. From epidemiologic studies, there is suggestion that low HDL and high triglyerides impart a greater risk for women than for men.
There is currently considerable interest in triglycerides and a great deal of investigation in this area. The lipid risk factors for heart disease include an increased level of the bad (LDL) cholesterol, a low level of the good (HDL) cholesterol, and an elevated level of triglycerides. Current guidelines from the national cardiac societies and from the National Cholesterol Education Program recommend that initial treatment address the bad or LDL cholesterol and lower this component to goal levels. Once the LDL cholesterol is controlled, then attention should be paid to the other lipid risk factors, a low HDL or a high triglyceride. From epidemiologic studies, there is suggestion that low HDL and high triglyerides impart a greater risk for women than for men.
California:
Are some races more genetically susceptible to CVD? Or are the disparities in CVD related to different lifestyles or cultures?
Are some races more genetically susceptible to CVD? Or are the disparities in CVD related to different lifestyles or cultures?
Nanette Wenger, M.D.:
There is not a defined genetic racial susceptibility to cardiovascular disease – but it is well know that outcomes with cardiovascular disease are less favorable in racial and ethnic minority populations. Particularly, black women seem to be at increased risk for adverse complications of heart attack. It has not been ascertained whether this relates to access to care, quality of care, or cultural/lifestyle features. Parodoxic is that, although black women have, in general, lower levels of the bad or LDL cholesterol, they still seem to have worse outcomes with coronary disease. The genetic/cultural/access to care/quality of care components of the recognition and outcomes of coronary heart disease remain complex and likely interrelated. In regard to hypertension, it is well known that African-American patients have more severe hypertension, often earlier onset, and less favorable outcomes, including the complications of heart failure and chronic kidney disease. The message must be prevention – prevention – prevention. First recognition of heart disease risk factors and control of these to goal levels, with the appreciation that lifestyle interventions are an important component of heart disease prevention and control.
There is not a defined genetic racial susceptibility to cardiovascular disease – but it is well know that outcomes with cardiovascular disease are less favorable in racial and ethnic minority populations. Particularly, black women seem to be at increased risk for adverse complications of heart attack. It has not been ascertained whether this relates to access to care, quality of care, or cultural/lifestyle features. Parodoxic is that, although black women have, in general, lower levels of the bad or LDL cholesterol, they still seem to have worse outcomes with coronary disease. The genetic/cultural/access to care/quality of care components of the recognition and outcomes of coronary heart disease remain complex and likely interrelated. In regard to hypertension, it is well known that African-American patients have more severe hypertension, often earlier onset, and less favorable outcomes, including the complications of heart failure and chronic kidney disease. The message must be prevention – prevention – prevention. First recognition of heart disease risk factors and control of these to goal levels, with the appreciation that lifestyle interventions are an important component of heart disease prevention and control.
Washington,DC:
What is the most important concern for women: total cholesterol, HDL or LDL? triglycerides?
What is the most important concern for women: total cholesterol, HDL or LDL? triglycerides?
Nanette Wenger, M.D.:
All of the features, total cholesterol, HDL, LDL, and triglycerides are important for women. However, as noted above, national guidelines recommend first control of LDL; once the LDL target has been reached, then interventions to optimize HDL and triglycerides are appropriate. As emphasized above, in epidemiologic and other population studies, there has been suggestion that low HDL and high triglycerides may be more important risk factors in women than in men – nonetheless, the initial recommendation is for LDL (low-density lipoprotein) control.
All of the features, total cholesterol, HDL, LDL, and triglycerides are important for women. However, as noted above, national guidelines recommend first control of LDL; once the LDL target has been reached, then interventions to optimize HDL and triglycerides are appropriate. As emphasized above, in epidemiologic and other population studies, there has been suggestion that low HDL and high triglycerides may be more important risk factors in women than in men – nonetheless, the initial recommendation is for LDL (low-density lipoprotein) control.
Oklahoma:
I attended a seminar on women's heart health and the speaker made mention of the fact that women can have higher cholesterol numbers than a man and not be at the same level of risk. Is this true, and if so, why?
I attended a seminar on women's heart health and the speaker made mention of the fact that women can have higher cholesterol numbers than a man and not be at the same level of risk. Is this true, and if so, why?
Nanette Wenger, M.D.:
Perhaps the speaker was addressing the issue of total cholesterol – and since women often have a higher HDL (good) cholesterol, if this is the contributor to the higher total cholesterol, then that is not an adverse asepct. We should initially address the LDL level – and for this, risk is comparable for women and for men.
Perhaps the speaker was addressing the issue of total cholesterol – and since women often have a higher HDL (good) cholesterol, if this is the contributor to the higher total cholesterol, then that is not an adverse asepct. We should initially address the LDL level – and for this, risk is comparable for women and for men.
Michigan:
I understand from recent studies that Zetia can increase the risk of blockages even though it helps lower total cholesterol. How is that possible?
I understand from recent studies that Zetia can increase the risk of blockages even though it helps lower total cholesterol. How is that possible?
Nanette Wenger, M.D.:
The media reports have significantly misinterpreted the results of the recent ENHANCE trial. This was not a study of patients with usual levels of the bad or LDL cholesterol – but patients with extremely high levels of LDL cholesterol that were hereditary. This was not a research study that examined clinical outcomes, but rather examined changes in the degree of narrowing of parts of the arteries, the carotid arteries, in the neck. Zetia did not increase the risk of blockages, but the degree of decrease in the existing blockages seemed greater with just a statin than with the combination of Zetia (ezetimibe) and a statin. This study does not show that ezetimibe increases the risk of blockages.
The media reports have significantly misinterpreted the results of the recent ENHANCE trial. This was not a study of patients with usual levels of the bad or LDL cholesterol – but patients with extremely high levels of LDL cholesterol that were hereditary. This was not a research study that examined clinical outcomes, but rather examined changes in the degree of narrowing of parts of the arteries, the carotid arteries, in the neck. Zetia did not increase the risk of blockages, but the degree of decrease in the existing blockages seemed greater with just a statin than with the combination of Zetia (ezetimibe) and a statin. This study does not show that ezetimibe increases the risk of blockages.
Philladelphia:
Are there support groups out there for patients with heart disease AND diabetes?
Are there support groups out there for patients with heart disease AND diabetes?
Nanette Wenger, M.D.:
There are a number of support groups for patients with heart disease and diabetes. For women with heart disease, I would most enthusiastically recommend WomenHeart (www.womenheart.org); also, consult the Web site for the American Heart Association, the National Heart, Lung, and Blood Institute, and the American Diabetes Association. Because diabetes is common in patients with heart disease and because it is one of the important risk factors, all the heart disease support groups can offer help to patients with both heart disease and diabetes.
There are a number of support groups for patients with heart disease and diabetes. For women with heart disease, I would most enthusiastically recommend WomenHeart (www.womenheart.org); also, consult the Web site for the American Heart Association, the National Heart, Lung, and Blood Institute, and the American Diabetes Association. Because diabetes is common in patients with heart disease and because it is one of the important risk factors, all the heart disease support groups can offer help to patients with both heart disease and diabetes.
Moderator:
The Web site of the National Heart, Lung, and Blood Institute is: www.nhlbi.nih.gov
The Web site of the American Heart Association is: www.heart.org
The Web site of the American Diabetes Association is: www.diabetes.org
The Web site of the National Heart, Lung, and Blood Institute is: www.nhlbi.nih.gov
The Web site of the American Heart Association is: www.heart.org
The Web site of the American Diabetes Association is: www.diabetes.org
Florida:
My doctor told me I need to start going to a cardiac rehabilitation program because of my bad stress-test results. Is that normal? Isn't "rehabilitation" for hearts that are getting better?
My doctor told me I need to start going to a cardiac rehabilitation program because of my bad stress-test results. Is that normal? Isn't "rehabilitation" for hearts that are getting better?
Nanette Wenger, M.D.:
Cardiac rehabilitation programs involve both exercise training and comprehensive coronary risk reduction. The exercise training is important in maintaining and enhancing functional status and, if you had bad stress test results, your physician may want you to begin your exercise in a supervised setting. If you had bad stress test results, it is also likely that you have a number of coronary risk factors – and the comprehensive education and counseling program within cardiac rehabilitation can aid you in coronary risk reduction. Very recent national recommendations have emphasized that cardiac rehabilitation is an underutilized resource in the community both for at-risk patients and for patients who have had cardiac or coronary events – your doctor is following national guidelines.
Cardiac rehabilitation programs involve both exercise training and comprehensive coronary risk reduction. The exercise training is important in maintaining and enhancing functional status and, if you had bad stress test results, your physician may want you to begin your exercise in a supervised setting. If you had bad stress test results, it is also likely that you have a number of coronary risk factors – and the comprehensive education and counseling program within cardiac rehabilitation can aid you in coronary risk reduction. Very recent national recommendations have emphasized that cardiac rehabilitation is an underutilized resource in the community both for at-risk patients and for patients who have had cardiac or coronary events – your doctor is following national guidelines.
Boise, Idaho:
Do you have a trick on how to remember which cholesterol is good and which is bad?
Do you have a trick on how to remember which cholesterol is good and which is bad?
Nanette Wenger, M.D.:
Simply remember LDL is bad and HDL is good, but also remember that you must address triglyceride levels after the bad (LDL) cholesterol level is controlled.
Simply remember LDL is bad and HDL is good, but also remember that you must address triglyceride levels after the bad (LDL) cholesterol level is controlled.
Moderator:
You might also remember that the "L" in LDL stands for Lousy.
You might also remember that the "L" in LDL stands for Lousy.
Michigan:
My triglycerides are always 50 or below but I still have unmedicated very elevated cholesterol levels with low HDL's. I can keep the LDL cholesterol 100 or so with medication. I exercise 60 minutes at the gym EVERY morning and still can't get those HDL's up. Is there anything more I can do to raise my HDL?
My triglycerides are always 50 or below but I still have unmedicated very elevated cholesterol levels with low HDL's. I can keep the LDL cholesterol 100 or so with medication. I exercise 60 minutes at the gym EVERY morning and still can't get those HDL's up. Is there anything more I can do to raise my HDL?
Nanette Wenger, M.D.:
Congratulations on keeping your LDL cholesterol below 100 and on your low triglycerides. Exercise is a very good intervention for raising HDL. However, since I do not know your LDL cholesterol medication, I cannot suggest whether there is a medication that might do better for raising HDL. I trust you have addressed this with your physician.
Congratulations on keeping your LDL cholesterol below 100 and on your low triglycerides. Exercise is a very good intervention for raising HDL. However, since I do not know your LDL cholesterol medication, I cannot suggest whether there is a medication that might do better for raising HDL. I trust you have addressed this with your physician.
OH:
Is Metropolol good for you if it reduces your cholesterol but has the side effect of weight gain and you gain several pounds because of it? One of the side effects of this medication is increased weight gain. If you suffer from the weight gain is there a substitute medication for this?
Is Metropolol good for you if it reduces your cholesterol but has the side effect of weight gain and you gain several pounds because of it? One of the side effects of this medication is increased weight gain. If you suffer from the weight gain is there a substitute medication for this?
Nanette Wenger, M.D.:
Metoprolol is not a cholesterol medication. It can be used for hypertension or for other medical problems – but, as I noted, is not a cholesterol-lowering medication. Please check with your physician, in that there may be some confusion with your medication regimen.
Metoprolol is not a cholesterol medication. It can be used for hypertension or for other medical problems – but, as I noted, is not a cholesterol-lowering medication. Please check with your physician, in that there may be some confusion with your medication regimen.
Washington, DC:
Both of my parents, my paternal grandfather and my maternal grandmother died of heart disease. All died before age 65 except my mother, who had a stent put in at age 63 and died at age 74 of a heart attack. Needless to say, at age 51 this is a concern for me. All of them were smokers, ate a typical American diet, and did little or no exercise. A physician (not a cardiologist) recently told my sister "What you have is a family history of smoking, not heart disease. You have nothing to worry about." Could that be true?
Both of my parents, my paternal grandfather and my maternal grandmother died of heart disease. All died before age 65 except my mother, who had a stent put in at age 63 and died at age 74 of a heart attack. Needless to say, at age 51 this is a concern for me. All of them were smokers, ate a typical American diet, and did little or no exercise. A physician (not a cardiologist) recently told my sister "What you have is a family history of smoking, not heart disease. You have nothing to worry about." Could that be true?
Nanette Wenger, M.D.:
With a strong family history of coronary heart disease, of course you appropriately have concern. Please view the American Heart Association Evidence-based Prevention Guidelines for Women these are on the American Heart Association Web site. The guidelines address, both personally and in partnership with your physician, the optimization of all your coronary risk factors. You should be eating a heart-healthy diet, of course not smoking or being exposed to secondhand smoke, exercise regularly, control your weight, and check to see if hypertension, high cholesterol, or diabetes is present and that these risk factors are controlled as optimally as possible. The Women’s Guidelines emphasize lifestyle as the first line intervention for all coronary risk factors, with medication added as needed.
With a strong family history of coronary heart disease, of course you appropriately have concern. Please view the American Heart Association Evidence-based Prevention Guidelines for Women these are on the American Heart Association Web site. The guidelines address, both personally and in partnership with your physician, the optimization of all your coronary risk factors. You should be eating a heart-healthy diet, of course not smoking or being exposed to secondhand smoke, exercise regularly, control your weight, and check to see if hypertension, high cholesterol, or diabetes is present and that these risk factors are controlled as optimally as possible. The Women’s Guidelines emphasize lifestyle as the first line intervention for all coronary risk factors, with medication added as needed.
Moderator:
The American Heart Association Evidence-Based Guidelines for Cardiovascular Disease in Women can be accessed from this link: AHA Evidence-Based Guidelines for Cardiovascular Disease
The American Heart Association Evidence-Based Guidelines for Cardiovascular Disease in Women can be accessed from this link: AHA Evidence-Based Guidelines for Cardiovascular Disease
Moderator:
This concludes our live discussion today. Thank you to everyone for participating, especially Dr. Wenger for taking time out of her busy schedule to answer questions -- and Dr. Wenger's assistant for her help in getting answers posted online.
A full archive of today's discussion will be available here on the Society’s Web site for future viewing. To learn about upcoming chats and other women’s health information, sign up for our e-newsletter.
Thank you again for joining us.
This concludes our live discussion today. Thank you to everyone for participating, especially Dr. Wenger for taking time out of her busy schedule to answer questions -- and Dr. Wenger's assistant for her help in getting answers posted online.
A full archive of today's discussion will be available here on the Society’s Web site for future viewing. To learn about upcoming chats and other women’s health information, sign up for our e-newsletter.
Thank you again for joining us.
Please Note: Guests and hosts retain editorial control over discussions and choose the most relevant questions for guests and hosts; guests and hosts can decline to answer questions. Society for Women’s Health Research is not responsible for any content posted by third parties.
