Heart HealthHeart Attack Signs for Women – Prevent Cardiovascular Disease
Here’s another question and answer from my February interview with Dr. Cynthia Shelby-Lane regarding heart attack signs for women. Read Dr. Shelby-Lane’s answer to learn about women cardiovascular disease.
Lisa Nelson RD: For women the signs of a heart attack are more subtle. What should women watch for? If everyone responded to every arm/jaw/chest/indigestion/feeling “not quite right” symptom, they’d never leave the ER!
Dr. Shelby-Lane: The female heart often is misdiagnosed.
True or false: Every year, more women die of heart disease than men.
The answer is true, but if you didn’t know it, you’re not the only one. In a survey of 500 physicians led by preventative cardiologist Lori Mosca, M.D, Ph.D., less than 20 percent knew the answer.
When it comes to women and heart disease, ignorance can be deadly. The misconception that heart disease is a “man’s disease” is the main reason women are misdiagnosed, or receive delayed treatment, when experiencing symptoms of heart disease and even a heart attack.
Consider these findings:
In a recent study at Weill Medical College of Cornell University/New York-Presbyterian Hospital, 230 physicians were given hypothetical cases of men and women with identical symptoms of heart disease. Half of the case studies included reports that the patient recently had a stressful experience or felt anxious. When this detail was included, doctors diagnosed heart disease in 56 percent of men compared with just 18 percent of women.
They referred men to cardiologists twice as often as women, and prescribed cardiac medications to almost half of the men, versus a paltry 13 percent of the women. Researchers concluded that in the presence of stress or anxiety, symptoms such as chest pain and shortness of breath were more likely to be attributed to anxiety in women but seen as potential signs of heart disease in men.
Another study at Tufts Medical Center in Boston found that among people who called 911 complaining of cardiac symptoms, women were 52 percent more likely than men to experience delays during emergency medical service care, a potentially critical difference because treatments for a heart attack are typically most effective when given within 1 to 2 hours of the start of the attack.
“We often hear women patients say that their complaints were dismissed or that they were ‘blown off’ by their doctors when they presented with heart disease symptoms,” says Lori Mosca, M.D., Ph.D., director of preventive cardiology at New York-Presbyterian Hospital and professor of medicine at Columbia University Medical Center. “Studies show that there is a gender bias out there that women need to be aware of. Our own research has shown that physicians are likely to label a woman at lower risk for heart disease than a man who has the exact same calculated level of heart disease risk.”
So how can you protect yourself? Dr. Mosca offers these suggestions:
Know your risks for heart disease, such as your waist size, smoking and exercise habits, blood pressure, and cholesterol levels. If you smoke, quit. Talk to your doctor about diet and exercise changes you can make to lower your risks, and, if appropriate, medications that might help you. Try this quick test at home: Wrap a tape measure around your waist right at the level of your belly button (don’t suck in your stomach). If your waistline measures 35 inches or more, you are more likely to have high cholesterol, high blood pressure, pre-diabetes and an increased risk of dying of heart disease than a woman with a normal waist size.
Knowing your family’s history of heart disease is important because if you have a close relative with heart disease or diabetes, you are at higher risk for these conditions, too.
Even if you don’t have symptoms of heart disease, having a strong family history – particularly if a parent died at a young age of a heart attack – may be enough reason to be checked early to catch problems that may not yet be causing symptoms. In 40 percent of people that develop heart disease, sudden death is the first symptom.
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Learn the unique symptoms of women cardiovascular disease.
Chest pain is the most common symptom of heart problems in both men and women, but women are much more likely to also experience subtle symptoms such as headaches, nausea and upset stomach, jaw or neck pain, shortness of breath and generalized fatigue.
Get help immediately. “Research shows that women tend to call for help later than men do, possibly because they don’t recognize these atypical symptoms as signaling heart troubles, or possibly because their tolerance for pain is greater,” says Dr. Mosca. If you have symptoms and think you might be having a heart attack or stroke, don’t delay; call 911.
Have a checkup annually. Report any suspicious symptoms and don’t let your doctor dismiss your concerns. If you have two or more risk factors and you are over the age of 50, a stress test can give more clues to your heart health. If the stress test shows signs of potential heart problems, further tests can be ordered.
Get a second opinion. If you feel your doctor is not taking your concerns seriously don’t hesitate to find a new doctor.
Lisa Nelson RD: Okay, this was a fantastic answer and I appreciate the detail, but I want to clarify. Are you saying if a woman experiences chest pain and an additional symptom, such as headache, nausea, or shortness of breath they should contact their MD immediately; but if it’s just shortness of breath by itself or just neck pain, not such a concern, monitor and watch for any changes. Is that correct?
Dr. Shelby-Lane: If a woman experiences chest pain along with symptoms such as on-going headaches, nausea, fatigue, and shortness of breath, they should contact their doctor immediately and/or go to the emergency room, especially if these symptoms are of sudden onset. Symptoms such as shortness of breath, fatigue and neck pain may also be subtle indicators of heart disease and most women may dismiss these symptoms and never mention them to their doctor, thereby, missing the opportunity to diagnose an underlying heart problem.
All the best,
Lisa Nelson, RD
Heart HealthHeart Health – Are Omega 6's Good or Bad?
I and other experts so frequently discuss omega 3 fatty acids and the health benefits that you may think all other types of fat are “bad”. That’s not the case. There are many types of heart healthy fats, including omega 6 fatty acids. At least 5-10% of your daily calories should come from omega 6 fatty acids. Some sources of omega 6’s are safflower, sunflower, and soybean oils. Replacing unhealthy fats in your diet with heart healthy unsaturated fats (such as omega 6’s) can decreased coronary heart disease by 24%.
The problem comes from our diets containing too much omega 6. The typical American diet is very high in omega 6 fatty acids. This leads to problems with inflammation when the ratio of omega 3 to omega 6 intake is drastically distorted and is why you don’t hear experts recommending you increase omega 6’s in your diet. You probably have more than enough already and need to work on balancing your omega 6’s with omega 3’s to promote optimal heart health.
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All the best,
Lisa Nelson, RD
Heart HealthReduce Heart Failure with Weight Loss and Activity
The Physician’s Heart Study followed over 21,000 between the ages of 40 and 84 for over 20 years. They found a significant link between weight, activity, and heart failure I want to share with you.
Both weight and physical activity were independently linked to risk of heart failure.
Weight
Having a high BMI increased heart failure risk in both active and sedentary men. For every additional 7 pounds on a man 5 foot 10 inches tall, risk for heart failure increased 11%.
Physical Activity
Vigorous physical activity reduced heart failure risk in lean, overweight, and obese men. Men that exercised vigorously only 1-3 times a month reduced their heart failure risk 18%. The more frequent and vigorous the exercise the greater the benefit. Very active men, exercising vigorously 5-7 days per week reduced heart failure risk 36%.
The combined risk of obesity and physical activity is substantial. When compared to lean men who were vigorously active 1-3 each month risk of heart failure increased 19% for men that were lean (BMI less than 25), but inactive, 49% in overweight active men, 78% in overweight inactive men, 168% in obese active men, and 293% in obese inactive men.
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Key point I want you to take from this post:
This study shows a little activity has substantial benefits. By being vigorously active just 1-3 days each month you can cut your risk 18%.
Get moving!
All the best,
Lisa Nelson, RD
Heart HealthHeart Disease – Link between Temperament, Personality, and Heart Disease Risk
Lisa Nelson RD: What role does temperament/personality play in a person’s heart disease risk?
Dr. Shelby-Lane: Temperament and personality have a definite effect on blood pressure and on heart disease. This is a great question and it has been studied by the experts, as you will note in the following excerpts. Heart disease consists of congenital abnormalities, arrhythmias, lipid abnormalities acquired and congenital, functional and physiologic problems, risk factors such as diabetes and metabolic syndrome, structural disease and valvular problems, heart failure, acquired disease such as coronary artery disuse, and infectious diseases along with diseases related to blood vessel structure. Again, anxiety, stress, and stress related disorders can have an effect on major hormones, heart rate and heart health and heart disease. Nutritional abnormalities can also affect heart performance.
New research suggests that people who suffer from panic attacks are at increased risk of developing heart disease.
Why people who suffer from panic attacks should be at increased risk of developing heart disease is unclear. According to the study, authors put forward several theories, one being that panic disorders might trigger nervous system changes which could promote the clogging of arteries. Another theory is that people may have been misdiagnosed as having panic attacks when they actually have coronary heart disease. “Clinicians should be vigilant for this possibility when diagnosing and treating people presenting with symptoms of panic,” said Dr Walters.
Study results have shown that people with depression are at increased risk of heart attack and heart failure because they are less likely to be active.
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Scientists have known for some years that people who are depressed are at increased risk of heart attack and other cardiac events, however the reason why this should be has remained unclear. However, according to results of a study by Mary A Wooley and colleagues, the increased risk is due to behavioral factors.
The researchers analyzed data obtained from 1,017 people with heart disease, 199 of which had symptoms of depression. Results showed that 10% of depressed participants had a cardiac event (e.g. heart attack, heart failure, stroke, transient ischemic attack) during the study period, compared to just 6.7% of non-depressed participants, meaning that depressed participants were 50% more likely to have a cardiac event. However, results also showed that depressed participants were more likely to smoke, were less likely to take their medications as prescribed, and were less physically active. After the researchers factored these behaviors into their calculations the risk of a cardiac event in depressed participants was similar to that in non-depressed participants.
All the best,
Lisa Nelson, RD
Heart HealthHigh Blood Pressure and Magnesium
Magnesium is not a mineral that tops discussions very often; however, magnesium is critical to over 300 bodily functions. Magnesium maintains normal muscle and nerve function, helps regulate blood sugar levels, promotes normal blood pressure and heart rhythm, maintains bone strength, and supports a healthy immune system.
Many people consume a diet low in magnesium receiving less than two-thirds of the recommended dietary allowance. Good magnesium sources include whole grains, spinach, broccoli, squash, beans, popcorn, nuts, pork, and seeds. Fair sources of magnesium include dairy products, chocolate, and meats.
A magnesium deficiency takes a long time to develop. Magnesium deficiency symptoms include irregular heartbeat, weakness, fatigue, numbness, muscle pain, disorientation, and seizures. Conditions related to increased risk for magnesium deficiency include alcoholism, poorly controlled diabetes, intestinal disorders (Crohn’s disease), and intake of certain medications (diuretics). Sup-optimal levels of magnesium intake have been linked with diabetes, hypertension, osteoporosis, and pregnancy discomfort.
When someone has type II diabetes they are making adequate insulin levels. The problem with type II diabetes is that the cells do not recognize the insulin. When cells do not recognize insulin they do not let sugar from the blood enter the cell and blood sugar levels remain elevated. This leads to sugar spilling over into the urine, organ damage, and other complications. Magnesium is a factor in this because it’s the “key” that opens the door for insulin to get into the cell. If magnesium levels are low there are no keys to open the door and insulin is unable to do its job resulting in continued high blood sugar levels. When diabetes is poorly controlled the loss of magnesium in the urine is even greater.
Blood levels of potassium, calcium, and magnesium are closely connected and all influence blood pressure. Studies have linked low magnesium levels with elevated blood pressure. As an aside, if you have ever been told to eat a banana by your doctor, you should also increase your magnesium intake. FYI – Bananas are not the best source of potassium – potatoes are!
Magnesium is a major component of the matrix (middle) of bones. Low magnesium levels cause fragile bones that are less flexible and have a slower recovery rate if injured.
Adequate levels of magnesium are related to decreased leg cramps during pregnancy. A magnesium deficiency is also a risk factor for gestational diabetes.
Recommended Dietary Allowances (RDA) for Magnesium:
Men 350 mg per day
Women 280 mg
Pregnancy 300 mg
Lactation 355 mg first 6 months; 340 mg next 6 months
You do NOT want to take megadoses of magnesium – more is not better in this case. You just want enough to meet the RDA. If you feel your intake of magnesium from foods is low, taking a basic multivitamin is a simple way to ensure you meet your needs. Read the multivitamin label carefully because not all multivitamins include magnesium. Always check with your doctor before altering your medications or supplements.
Magnesium may not be an exciting mineral, but it is critical. Ensure you are eating adequate sources of magnesium rich foods and/or consider a supplement to promote optimum health.
Get guidance to lower cholesterol and blood pressure with Heart Health Made Easy.
Heart HealthBlood Pressure and Cholesterol – The Affect of Personality and Panic Attacks
Lisa Nelson RD: What role does personality play in a person’s heart disease risk? Does temperament have a direct affect on cholesterol levels or blood pressure?
Dr. Shelby-Lane: Temperament and personality have a definite effect on blood pressure and on heart disease. This is a great question and it has been studied by the experts, as you will note in the following excerpts. Heart disease consists of congenital abnormalities, arrhythmias, lipid abnormalities acquired and congenital, functional and physiologic problems, risk factors such as diabetes and metabolic syndrome, structural disease and valvular problems, heart failure, acquired disease such as coronary artery disuse, and infectious diseases along with diseases related to blood vessel structure. Again, anxiety, stress, and stress related disorders can have an effect on major hormones, heart rate and heart health and heart disease. Nutritional abnormalities can also affect heart performance.
New research suggests that people who suffer from panic attacks are at increased risk of developing heart disease.
Dr Kate Walters and colleagues at University College London examined medical records of more than 400,000 people, including 57,615 who had been diagnosed with panic attacks. Results showed that people who were younger than 50 when they were first diagnosed with panic attack were 38% more likely to have a heart attack and 44% more likely to develop heart disease than those without the condition. Those who were older than 50 at the time of diagnosis did not have an increased risk of heart attack, but were 11% more likely to develop heart disease than those without the condition.
Intriguingly, the results also showed that while panic attack sufferers were at increased risk of developing heart disease, they were seemingly less likely to die from it.
Why people who suffer from panic attacks should be at increased risk of developing heart disease is unclear. According to the study, authors put forward several theories, one being that panic disorders might trigger nervous system changes which could promote the clogging of arteries. Another theory is that people may have been misdiagnosed as having panic attacks when they actually have coronary heart disease. “Clinicians should be vigilant for this possibility when diagnosing and treating people presenting with symptoms of panic,” said Dr Walters.
Walters K, Rait G, Petersen I, Williams R, Nazareth I. Panic disorder and risk of new onset coronary heart disease, acute myocardial infarction, and cardiac mortality: cohort study using the general practice research database. European Heart Journal. 2008;29:2981-2988. doi:10.1093/eurheartj/ehn477.
News release: Panic attacks linked to higher risk of heart attacks and heart disease, especially in younger people. European Society of Cardiology. December 10th 2008.
Tired of changes that don't last?
Study results have shown that people with depression are at increased risk of heart attack and heart failure because they are less likely to be active.
Scientists have known for some years that people who are depressed are at increased risk of heart attack and other cardiac events, however the reason why this should be has remained unclear. However, according to results of a study by Mary A Wooley and colleagues, the increased risk is due to behavioral factors.
The researchers analyzed data obtained from 1,017 people with heart disease, 199 of which had symptoms of depression. Results showed that 10% of depressed participants had a cardiac event (e.g. heart attack, heart failure, stroke, transient ischemic attack) during the study period, compared to just 6.7% of non-depressed participants, meaning that depressed participants were 50% more likely to have a cardiac event. However, results also showed that depressed participants were more likely to smoke, were less likely to take their medications as prescribed, and were less physically active. After the researchers factored these behaviors into their calculations the risk of a cardiac event in depressed participants was similar to that in non-depressed participants.
The researchers concluded: “These findings raise the hypothesis that the increased risk of cardiovascular events associated with depression could potentially be preventable with behavior modification, especially exercise.” Adding: “Exercise training can improve both depressive symptoms and markers for cardiovascular risk.”
Whooley MA, de Jonge P, Vittinghoff E, et al. Depressive symptoms, health behaviors, and risk of cardiovascular events in patients with coronary heart disease. JAMA 2008;300:2379-2388.
All the best,
Lisa Nelson, RD