No matter how heart smart you think you are, it’s tough to keep up with the latest science. And that lapse could mean that your heart-disease risk is greater than you realize. Here, the most common mistakes midlife women make — and how to avoid them.
1. You sweat silently through hot flashes
Those flashes could be linked to high blood pressure. A preliminary study found that women who reported being bothered by hot flashes during a two-week span had significantly higher blood pressure than those who were untroubled. The link could be due to an increase in norepinephrine, a hormone that can increase heart rate, blood pressure, and blood-sugar levels, according to study author Linda M. Gerber, PhD, of Weill Medical College of Cornell University, in New York City. Be sure to have your blood pressure checked regularly, and if you have a lot of hot flashes, tell your doctor about them. While the study did not specify the exact number of hot flashes, experts consider more than eight to 10 episodes a day above normal.
2. You exercise for 20 minutes a day
Bump it up. The new American Heart Association guidelines recommend 60 to 90 minutes of exercise most days for women who want to maintain or lose weight. Extra weight taxes the heart by elevating blood pressure, raising levels of LDL cholesterol and triglycerides, and lowering HDL cholesterol. Hitting this exercise mark is even more important after 40, because hormonal shifts make weight loss more difficult just when staying lean becomes crucial for heart protection. Regular workouts will also improve circulation and overall heart function, as well as help stave off depression, a key risk factor for cardiovascular disease.
3. You stopped taking hormone therapy to spare your heart
Not so fast. While the 2002 findings from the Women's Health Initiative showed that HT increased the risk of heart attacks, recent research suggests the reverse may be true if it's used at the right time. Results from a substudy by the WHI released this summer found that younger postmenopausal women (50 to 59) on estrogen-only therapy had 40 to 60 percent lower levels of calcium deposits in their arteries than women who weren't taking any hormones. Calcium is one of the components of plaque and is a marker for future heart attack risk.
"These findings do provide reassurance for recently menopausal women who are considering hormone therapy for the short-term treatment of menopausal symptoms," says lead author JoAnn Manson, MD, chief of preventive medicine at Brigham and Women's Hospital, in Boston. "The evidence is mounting that a woman's age and length of time since menopause influences the effects of estrogen on health, particularly the risk of heart disease." Talk with your doctor to see if you should consider it.
4. You worry only about "bad" cholesterol
Take a look at your other blood fats too. New research shows that when it comes to reducing plaque in arteries, raising HDL ("good") cholesterol is as crucial as lowering LDL ("bad") cholesterol. "Low HDL may be a more important risk factor in women," says Nieca Goldberg, MD, of the Women's Heart Program at New York University. Each one-point increase in HDL lowers heart disease risk by three percent; that same increase lowers a man's risk by only one percent. Talk with your doctor about reaching your numbers (LDL below 100, HDL above 50) without drugs. You may be able to raise your HDL by exercising, quitting smoking, losing weight, and eliminating trans fats.
And don't neglect triglycerides, which can also clog arteries. While experts don't understand exactly why, high levels pose a greater danger to women than to men; they recommend keeping your number below 150 through diet, exercise and, if needed, medication. A reading of more than 200 doubles your risk of heart disease. Be sure your triglycerides are evaluated along with your cholesterol.
5. You take aspirin daily for heart insurance
Under 65? Aspirin isn't helpful for your heart yet. Aspirin thins the blood, lowering the risk of clots, but "there isn't any evidence aspirin will prevent heart attacks in women under 65," says Christine Lawless, MD, of Ohio State University Medical Center, in Columbus. Aspirin can cause potentially life-threatening gastrointestinal bleeding in women under 65. However, some doctors do prescribe it to younger women if they are at increased risk due to a strong family or personal history of heart attack. Even then, you should take no more than 325 milligrams a day. Take other pain relievers judiciously too. Ibuprofen and acetaminophen have been linked to high blood pressure. According to a recent study, women who took an average of 400 milligrams of ibuprofen a day (the amount found in a single dose) were 60 percent more likely to develop high blood pressure than women who didn't take any.
6. You think a side of fries every now and then is okay
Keep an eye on those treats. Australian researchers found that eating just one high-fat meal inhibits your HDL cholesterol's plaque-fighting abilities. Just three hours after healthy volunteers ate a fatty meal, their arteries were significantly less able to expand to pump enough blood to maintain organs and tissues. Another study found that women who consume an average of 3.6 grams of trans fats (the approximate amount in a serving of french fries) a day have triple the risk of heart disease compared with those who consume an average of 2.5 grams (roughly the amount in a serving of crackers) a day. All this is in line with new advice from the AHA, which recommends that saturated fat make up less than seven percent of total daily calories (previous guidelines allowed 10 percent) and that trans fat intake be less than one percent of total calories. If you're taking in 2,000 calories a day, that's 14 grams of saturated fat and about one gram of trans fat.
7. You never nap
Catnaps may be the new secret to a healthy ticker. Researchers from the Harvard School of Public Health recently found that midday siestas reduced coronary death by about one-third in women. The subjects of the study were people ages 20 to 86 who napped for 30 minutes, on average, at least three times a week. The study authors speculated that afternoon siestas may decrease some of the stress that can wreak havoc on your heart.
8. You take your vitamins in pill form
Instead, eat five to nine servings of fruits and vegetables a day. Supplements -- including vitamins C and E and folic acid -- are not proven to help prevent heart disease. While folic acid does decrease homocysteine, an amino acid once believed to raise your risk of heart disease, scientists have recently questioned even that benefit. "Animal studies with vitamins were very promising, but when we use the supplements in human beings, it doesn't pan out," Lawless says. Experts still believe that omega-3 fatty acids offer some protection against heart disease, though; high-risk women should continue to eat oily fish, such as salmon, at least twice a week rather than swallow pills. Recent research showed that women who eat fish two to four times a week had a 31 percent lower heart disease risk than those who don't eat any.
9. You think nature is more important than nurture
Even if you have no heart disease in your family, you can't discount the threat from your environment. A recent analysis, part of the Women's Health Initiative, found that postmenopausal women who live in areas of high air pollution have a significantly greater risk of having a heart attack or stroke and dying from it. The greater the amount of fine particulate matter in the air, the greater the danger: Each unit increase was associated with a 24 percent rise in the risk of heart attack or stroke and a 76 percent increase in the risk of dying from heart disease. (Fine particulate matter is made up of tiny particles of soot or dust -- mostly from car and truck exhaust, and also from emissions of power plants and coal burning.) Go to airnow.gov to check daily pollution levels in your area. If they're high, stay away from busy roads when exercising outdoors and focus on lowering the cardiovascular risks that you can control: Work out often, and eat a heart-healthy diet.
10. You passed your angiogram
This imaging test, which uses x-rays to examine blood vessels, is better suited to men, notes Suzanne Steinbaum, DO, of the Heart and Vascular Institute at Lenox Hill Hospital, in New York. Women have narrower arteries and "tend to have plaque throughout the arteries, but men tend to develop plaque in one location, which is easier to detect in an x-ray," Steinbaum says. A study at the National Institutes of Health estimated that as many as three million women whose angiograms indicated they had healthy arteries could have hidden problems.
11. You still reach for the salt shaker
A study in the British Medical Journal found that lowering salt intake by 25 to 30 percent reduced the risk of heart disease by 25 percent. Women with "high normal" blood pressure (130 to 139/85 to 89) reduced their risk of death by 20 percent just by watching their sodium intake. Keep your intake to less than 2.3 grams (one teaspoon of table salt) a day. And limit the number of commercially prepared or processed foods in your diet; they are hidden salt mines.
12. You downplay your health problems
Stoicism isn't good for your heart. A University of Michigan survey of 490 heart attack survivors or those who had experienced severe chest pain found that women consistently rated the severity of their disease the same as men's -- even when the disease was worse. This attitude can lead to less aggressive care. What's more, new research has found that unlike men with so-called "hostile" personalities, women of a similar type aren't at increased risk for heart disease. So go ahead and tell your doctor how you really feel.
13. You think your doctor is looking out for your heart
Don't take it for granted that your doctor understands your risk of heart disease; most underestimate it. According to an American Heart Association study, only eight percent of primary care physicians and 17 percent of cardiologists knew that heart disease kills more women than men every year. Another survey found that while 42 percent of women knew this basic fact, a whopping 82 percent of them thought their doctor knew it as well. Talk with your physician, and if he or she isn't attuned to your heart disease risk, switch doctors.
14. You think you can quit smoking without help
Fewer than seven percent of smokers quit unaided. That's why the new guidelines recommend that smokers use medication, counseling, nicotine replacement, or other cessation programs. Drugs that can help you break the habit: Zyban (bupropion), an antidepressant, and Chantix (varenicline), which binds to nicotine receptors in the brain. Another medication, the opiate blocker naltrexone, was shown to be helpful when combined with nicotine patches; it also reduced weight gain. Talk to your doctor if you think you may need medication. And to figure out which method for quitting would be best for you, go to quitnet.com.
15. Your body mass index is "normal"
BMI doesn't distinguish between fat, muscle, and bone, so it's not a good heart health indicator on its own. Pay attention to your waistline too. "Excess fat in the abdomen tends to be closely linked to higher CRP [a marker of inflammation]," says Samia Mora, MD, of Brigham and Women's Hospital, in Boston. A large waist or an apple-shaped body can spell particular trouble. "If your waist circumference is over 35 inches and you have triglycerides levels above 150, you are at nearly fives times greater risk of dying from heart disease," says Donnica Moore, MD, president of Women's Health Group, in Far Hills, New Jersey.
Ethnicity is also an often overlooked factor. Hispanics and some Asians, for example, may need different BMI cutoffs. What might be normal for a Caucasian may be unhealthy for someone of another racial or ethnic group. Calculate your BMI at our sister site, FitnessMagazine.com.
16. You ignore the arthritis in your knees
Severe leg pain may be a sign of peripheral artery disease (PAD), blockages in the blood vessels of the leg that can indicate coexisting coronary artery trouble. "Because of osteoporosis or arthritis, some postmenopausal women get discomfort that causes them to change their gait, giving them problems in the leg," explains vascular surgeon James C. Stanley, MD, a director of the University of Michigan's Cardiovascular Center, in Ann Arbor. "It may be hard for patients to differentiate that kind of pain from PAD." But it's important to be able to know the difference. PAD gradually worsens as activity increases during the day, as opposed to arthritis, which gets better after some movement.
And be wary of tightness in the calf muscle when you walk or exercise. This charley horse sensation could mean PAD is preventing blood from reaching the muscles. "If you have leg pains, get a good physical examination," Stanley advises. "And if there's any question about adequate circulation in the lower leg, request a Doppler ultrasound test, which measures blood flow and pressure."
Amanda Gardner is a senior reporter for Healthday news service. Her last feature for MORE was "Gaining Ground on Breast Cancer" in October 2006.
More on Heart Disease
Originally published in MORE magazine, September 2007.