Heart Disease

Overview

Listen to Your Heart

Many women do not acknowledge the warning signs of coronary cardiopathy (CHD) till their health—and their lives—are in risk. According to the yank Heart Association (AHA), coronary cardiopathy is that the single leading reason for death for yank ladies. In fact, nearly twice as many women die from heart attack, stroke and other coronary heart diseases than of all forms of cancer combined, includingbreast cancer. And in every year since 1984, a lot of ladies have died of vessel diseases than men.

Coronary heart disease, also known as coronary artery disease (CAD) and ischemic heart disease, is a disease of the heart’s blood vessels that, if untreated, can cause heart attacks. Like any muscle, the center desires a continuing provide of element and nutrients that square measure carried to that by the blood within the coronary arteries. When the coronary arteries become narrowed or clogged and can’t provide enough blood to the center, the result’s CHD.

Heart attack and stroke are common results of conditions that restrict or stop the blood flow to the heart or brain. At any given age, men have a larger risk of attack than ladies, but women are only half as likely as men to survive a heart attack and more likely to have a second attack.

In addition, about 60 percent of stroke deaths occur in women. According to the AHA, each year, about 55,000 a lot of ladies than men have strokes.

African-American women are more likely to die of CHD than Caucasian women, perhaps because they are more likely to have more risk factors, including high blood pressure (hypertension), diabetes, obesity and smoking, and square measure a lot of probably to receive poorer health care than Caucasian ladies. For example, in 2005, the overall CHD death rate (per 100,000 women) was 298.2 for black women compared to 215.5 for white women. Heart disease risk is additionally higher among Mexican Americans, Native Americans and native Hawaiians. This may be part thanks to higher rates of blubber and polygenic disorder in these teams.

Characteristics of Heart Disease

Decreased Blood Flow
Coronary heart disease, also known as coronary artery disease (CAD) and ischemic heart disease, is a disease of the heart’s blood vessels that, if untreated, can cause heart attacks. Like any muscle, the center desires a continuing provide of element and nutrients that square measure carried to that by the blood within the coronary arteries. When the coronary arteries become narrowed or clogged and can’t provide enough blood to the center, the result’s CHD.

Symptoms of Heart Disease
When blood flows a lot of slowly at the positioning of narrowing, it can become “sticky” and eventually form a clot. This blood will slim the gap of the artery even additional, which can reduce blood flow to the heart, leading to chest pain, or angina. If blood flow is almost or fully blocked, a heart attack can occur, leading to the death of muscle cells in the heart. Because the cells can’t be replaced, the result is permanent heart damage. Each year, up to 0.5 1,000,000 yank ladies suffer heart attacks, associate degree all-too-frequent outcome of CHD

Heart Disease in Women

Hormone-Related Risk Factors

Your risk of developing heart disease increases as you grow older; however, a woman’s risk of heart disease develops over her entire lifetime.

Prior to climacteric, estrogen is thought to provide some protection to women against heart disease. (Premenopausal ladies United Nations agency have polygenic disorder or United Nations agency smoke don’t seem to be adequately protected by sex hormone as a result of polygenic disorder and smoking ar major risk factors for cardiovascular disease.)

Scientists are still learning about the actions of estrogen on the body. In terms of the cardiovascular system, estrogen works to keep a woman’s arteries free from atherosclerotic plaque (the buildup of fatty substances, cholesterol, cellular waste and other material) partly by improving the ratio of LDL (low-density lipoprotein) and HDL (high-density lipoprotein) cholesterol. Estrogen increases the amount of HDL cholesterol, which helps clear LDL cholesterol from the bloodstream, the type of cholesterol that contributes to plaque buildup in the arteries. LDL cholesterol could be a major explanation for CHD, according to the National Cholesterol Education Program (NCEP) of the National Heart, Lung, and Blood Institute (NHLBI).

Yet, research in women who started on hormone therapy an average of 10 years after menopause showed a slight increase in risk of heart attack and stroke. However, it is uncertain if taking supplemental estrogen early on after menopause can reduce your risk of cardiovascular events, and ongoing studies continue to evaluate the effect of hormone therapy on CHD.

Risk Factors of Heart Disease
Over the last two decades, researchers have unearthed many risk factors for developing cardiovascular diseases. These include:

• SmokingSmoking accelerates the development of atherosclerosis by constricting blood vessels, accelerating the formation of blood clots and restricting the amount of oxygen the blood supplies. Smokers who have heart attacks and strokes are more likely to die from them.
• High cholesterol levels. According to the National Cholesterol Education Program (NCEP), elevated LDL cholesterol is a major cause of coronary heart disease. That’s why the NCEP panel recommends aggressive treatment. Treatment may include lifestyle changes, such as exercising more and reducing the amount ofsaturated fat in your diet, and medication. A combination of approaches is typically recommended.Optimal cholesterol levels for healthy women are:
  • Total cholesterol: less than 200 mg/dL
  • HDL cholesterol: above 60 mg/dL. This range is considered to be protective against heart disease, while levels less than 50 mg/dL for women or 40 mg/dL for men are considered a major risk factor for developing heart disease.
  • LDL cholesterol: less than 100 mg/dL
  • Triglycerides: less than 150 mg/dL
• High blood pressure (hypertension). When the heart works too hard to pump blood through the body, the intensity can damage the walls of the arteries of the heart and body.How is Blood Pressure MeasuredWhen the heart works too hard to pump blood through the body, the intensity can damage the walls of the arteries of the heart and body.How is Blood Pressure Measured?A blood pressure reading records a systolic blood pressure, the highest pressure measured when the heart contracts with each beat, and a diastolic blood pressure, This designation means you have a significant risk of developing hypertension. Hypertension—high blood pressure—is defined as systolic pressure of 140 mm Hg or higher and/or diastolic pressure of 90 mm Hg or higher. It is any classified as stage one cardiovascular disease, from 140 to 159 systolic and/or 90 to 99 diastolic, and stage 2 hypertension, 160 or more systolic and 100 or more diastolic. For people with diabetes, high blood pressure is defined as systolic pressure of 130 or higher and/or diastolic pressure of 80 or higher.Experts now know that the systolic number is the most significant once it involves following pressure level when age fifty. Although each numbers increase with age, the pulsation variety tends to change surface or maybe fall when age fifty.
• Diabetes.People with polygenic disease have death rates from cardiovascular disease that ar 2 to a few times those of adults while not polygenic disease. In fact, cardiovascular disease is the leading cause of diabetes-related deaths. People with polygenic disease United Nations agency haven’t nonetheless had a coronary failure have a similar risk of future coronary failure as somebody with far-famed coronary cardiovascular disease. Because their risk of coronary failure is thus high, NHLBI recommends that folks with polygenic disease be treated sharply with LDL-cholesterol lowering medication and punctiliously manage their blood glucose to reduce their cardiovascular risk.
• Age.Generally, ladies over age fifty five and men over age forty five ar at greatest risk for developing arteriosclerosis. The risk of cardiovascular events increases with age.
• Family historyFamily history is one in every of the largest risk factors overall for arteriosclerosis. Your risk is greater if your father or brother was diagnosed before age 55, if your mother or sister was diagnosed before age 65 or if you have a sibling with early coronary disease.
• Obesity. Overweight ladies ar far more seemingly to develop heart-related issues, although they need no alternative risk factors. Excess weight in ladies is coupled with coronary cardiovascular disease, stroke, symptom failure and death from heart-related causes.
• InactivityNot exertion contributes on to heart-related issues and will increase the probability that you’re going to develop alternative risk factors, like high vital sign and polygenic disease.
• Metabolic syndrome. Having three components of this deadly quintet of abdominal obesity, high blood pressure, glucose intolerance (or prediabetes), high triglycerides and low good (HDL) cholesterol is associated with a markedly increased risk of cardiovascular disease.
• Homocysteine.a high blood level of CRP, a sign of inflammation, may mean that the walls of the arteries in your heart are inflamed, which may raise your heart disease risk.
• C-Reactive Protein (CRP), a high blood level of CRP, a sign of inflammation, may mean that the walls of the arteries in your heart are inflamed, which may raise your heart disease risk.
• Pregnancy complications. The updated 2011 AHA Guidelines for the Prevention of Cardiovascular Disease in Women added pregnancy complications such aspreeclampsia, gestational diabetes and pregnancy-induced hypertension as risk factors for cardiovascular disease in women.
• Systemic autoimmune diseases.The 2011 Guidelines also added systemic autoimmune diseases such as lupus and rheumatoid arthritis as risk factors for heart disease.

A biopsy known as the high sensitivity CRP biopsy (hs-CRP) is currently wide obtainable. Most studies show that in healthy individuals, the upper the hs-CRP levels, the higher the risk of developing a future heart attack. In fact, scientific studies have found that the danger for coronary failure in individuals within the higher third of hs-CRP levels is double that of these with hs-CRP levels in the lower third. Recent studies additionally found a link between hs-CRP, sudden cardiac death and peripheral arterial disease.

According to the yank Heart Association, varied studies have examined whether or not hs-CRP will predict perennial upset and stroke and death in numerous settings. High levels of hs-CRP consistently predict new coronary events in people with unstable angina and acute myocardial infarction (heart attack). Higher hs-CRP levels are related to lower survival rate in these individuals. Many studies steered that when adjusting for alternative prognostic factors, hs-CRP was still useful as a risk predictor.

It is not nonetheless far-famed whether or not specific interventions can profit people who have high hs-CRP, however aspirin therapy and cholesterol-lowering drugs might be helpful in these individuals.

Current guidelines from the American Heart Association and the U.S. Centers for Disease Control and Prevention recommend limiting the use of the CRP test as a discretionary tool for the evaluation of people at moderate risk and not as a means of screening the entire adult population because insufficient scientific evidence supports widespread use at this time.

Stress. though stress has been concerned within the development of arteriosclerosis, its exact relationship to heart disease has not been determined. Regular exercise will scale back stress and improve your mood.

Postmenopausal status.Your risk of developing atherosclerosis and heart disease increases once you reach menopause. Prior to biological time, women are mainly protected from heart disease by estrogen, the reproductive hormone produced by theovaries. Among its many roles, estrogen helps keep arteries free from plaque by improving the ratio of LDL (low-density lipoprotein) and HDL (high-density lipoprotein) cholesterol. It also increases the amount of HDL cholesterol, which helps clear arteries of LDL cholesterol—the kind that most contributes to plaque build up.

Heart Problems Commonly Experienced by Women

The following are common heart problems in women. If you expertise any of the symptoms delineated below, contact your health care skilled for AN evaluation:

• Angina. If clogged arteries forestall enough oxygen-carrying blood from reaching your heart, the center might respond with pain referred to as cardiopathy. Episodes of angina occur once the center’s want for chemical element will increase on the far side the chemical element obtainable from the blood alimental the heart. Silent angina occurs when the same inadequate blood supply causes no symptoms. Microvascular angina happens once the tiny vessels feeding the center muscle don’t seem to be functioning properly, most frequently because of fluctuations in vessel wall narrowing, in the absence of significant blockages within the major heart arteries.Physical exertion is that the commonest trigger for angina. Other triggers will be emotional stress, extreme cold or heat, heavy meals, alcohol and cigarette smoking. The pain is a pressing or squeezing pain, usually felt in the chest or sometimes in the shoulders, arms, neck, jaws or back.Angina suggests that coronary heart disease exists. People with angina have an increased risk of heart attack compared with those who have no symptoms. When the pattern of angina changes—if episodes become additional frequent, last longer or occur while not exercise—your risk of coronary failure in succeeding days or weeks is far higher, and you should see your health care professional immediately.If you have angina, learn its pattern—what causes an angina attack, what it feels like, how long episodes usually last and whether medication relieves the attack. Angina is usually relieved in a few minutes by resting or taking prescribed angina medicine, such as nitroglycerin.Isolated episodes of angina seldom cause permanent damage to heart muscle; however, prolonged angina (more than 30 minutes) can signal a heart attack is occurring.Heart attack pain may be similar to angina, but the symptoms of angina quickly disappear with rest. Heart attack pain, however, typically persists despite resting or taking glyceryl trinitrate and will be evaluated straight off. Like angina, heart attack pain can be a pressure or tightness in chest, arms, back or neck. Often symptoms include shortness of breath, sweating, nausea, vomiting or dizziness. A heart attack is an emergency. A delay in treatment might mean additional of the center muscle tissue is for good broken. If you think that you are having a coronary failure, call 911. The dispatcher may tell you to chew aspirin at home, or you may receive aspirin therapy at the hospital.
• Silent ischemia. Sometimes atherosclerosis causes no symptoms. Silent ischaemia may be a condition caused by arteriosclerosis, but isn’t associated with the chest pain or other symptoms common to other types of heart conditions. This condition happens once arteries with arteriosclerosis cannot deliver enough blood to the center. An electrocardiogram (EKG or ECG), a measurement of electrical impulses produced by the heart, may indicate silent ischemia. However, without a heart checkup, a woman may never know that she has ischemia. This is why regular screening and checkups, particularly among women with heart disease risk factors such as diabetes, hypertension or a family history, are so important. People with polygenic disease square measure particularly in danger for this condition as a result of polygenic disease will cause nerve endings or “pain sensors” to be less sensitive, resulting in ischemia without accompanying pain.
• Heart attack.When the blood supply to the heart is cut off completely, the result is a heart attack. It can cause permanent damage to the heart muscle if blood flow is not restored as fast as possible. Typically, chest pain caused by a heart attack may be accompanied by discomfort in other areas of the upper body, indigestion, nausea, weakness and sweating. However, coronary failure symptoms vary and should be gentle. According to the yank Heart Association, women are somewhat more likely than men to experience some of the symptoms other than chest pain, particularly shortness of breath, nausea/vomiting and back or jaw pain.Symptoms that indicate your heart is in danger may be present for months or years before a heart attack occurs. Persistent unusual symptoms—shortness of breath, nausea, great fatigue, angina/chest pain, fainting spells and gas-like discomfort—may be red flags for heart disease. Discuss such symptoms together with your health care skilled, even if the symptoms come and go.If you are at high risk for a heart attack, it is a good idea to develop associate degree action set up together with your health care skilled just in case one happens. This might include:
  
  • Keeping with you a listing of all medications and the way usually you’re taking every one. Also give a copy to a friend or family member who might be involved with your care if you’re taken to the hospital. This list provides valuable information to the emergency department staff.
  • Keeping a small-sized copy of your most recent EKG in your wallet.
  • Knowing who should be notified in case of an emergency.
• Microvascular disease. Also called viscus syndrome X or little vessel sickness, this is often a sickness of the finer blood vessels and is characterised by hurting or anemia while not proof of blockage in the large coronary arteries. Women are at higher risk than men for this condition. Microvascular sickness could also be caused once the little blood vessels within the heart do not expand enough thanks to abnormalities within the operate of the epithelium (the layer of cells lining blood vessels). Postmenopausal girls and ladies United Nations agency have had surgical change of life square measure in danger for experiencing symptoms of microvascular sickness as a result of their declining steroid levels might have an effect on the little blood vessels in their hearts.Because this condition is a small vessel disease, it can’t be seen on an angiogram(an X-ray with dye that identifies blockages in the larger blood vessels). Special imaging tests, such as PET scanning or MRI, may help with the diagnosis in the future. Today, however, microvascular sickness is usually a designation of exclusion—meaning you’ll be diagnosed with this condition once tests offer no alternative cause for the hurting. The same tests done to diagnose CAD, such as an EKG,echocardiogram or coronary angiogram, are usually used to diagnose microvascular disease. In addition, special chemical tests of the coronary blood vessels can be done at the time of the angiogram. Most women with microvascular sickness have a minimum of one risk issue for CHD, but it can occur in women who are otherwise healthy.Medications commonly used to treat CHD conditions may help to relieve pain caused by microvascular disease. Symptoms is draining and new knowledge suggests that if left untreated, women with microvascular disease do not have as favorable a prognosis as previously believed. Their risk factors should be managed as aggressively as someone who has CHD..
• Cardiac arrhythmias.The traditional regular recurrence is named “sinus rhythm” and also the normal vital sign is sixty to a hundred beats per minute. An arrhythmia occurs when the heart beats irregularly or abnormally slow (bradycardia) or fast (tachycardia). While many arrhythmias don’t cause symptoms, some cause chest pain, dizziness, fainting and shortness of breath. Atherosclerosis, angina, valvular heart disease, weakened heart muscle (i.e., cardiomyopathy), blood clots, thyroid abnormalities or heart attack can cause this condition.Medications can help stabilize heart rhythms. Abstaining from caffeine, alcohol and cigarette smoking can also help. Pacemakers square measure typically counseled to correct a slow rhythm.

Assessing Your Own Risk of Heart Disease

Because heart disease and its risk factors can be silent for so long, often with few symptoms until the disease is well under way, it’s important to know your personal risk factors. That includes knowing your family health history and your cholesterol and blood pressure levels. Two major studies printed in 2003 found that just about everybody United Nations agency dies of cardiovascular disease, including heart attacks, had at least one or more of the conventional heart disease risk factors: smoking, diabetes, high blood pressure and high cholesterol.

A simple heart disease risk assessment tool based on the Framingham Risk Model can be found online at It estimates your 10-year risk of having a heart attack or dying of coronary cardiovascular disease supported your answers to questions about your personal risk factors. Your risk, whether very high, high, moderate or low, determines what steps you should take to reduce that risk, including whether or not you should be put on medication.

No matter what your age, if you suspect you have heart disease or are at risk of heart disease, talk to your health care professional about diagnostic stress testing, which is done using the EKG and may also involve echocardiography or nuclear imaging of the heart.

Diagnosis

Be sure to debate your risks for cardiovascular disease along with your health care skilled throughout regular checkups. If you are experiencing any unusual symptoms, tell your health care professional about them all—when each started, how often it happens and if it has been getting worse. Also note any stresses in your life, such as taking care of a sick parent or partner.

Standard viscus screening isn’t as correct at diagnosis women’s heart conditions because it has been for evaluating convenience symptoms. A treadmill or stress test, also known as an exercise ECG (electrocardiogram), records the heart’s electrical impulses under exertion. There square measure limitations, however, to the accuracy of these tests, including that they may report a blockage where none exists, particularly in young women. Older girls might not be able to reach the exercise intensity necessary on the treadmill to observe any restricted blood flow.

All testing ought to be personalized and also the best approach could also be a mix of tests to guage symptoms. For example, in a thallium or sestamibi scan, radioactive substances that can assess blood flow may be used with the treadmill test to improve accuracy. An echocardiogram, which can assess the heart’s pumping function, can also provide a complete profile. Drug alternatives that mimic the stress of exercise may be given to women who aren’t physically able to take a stress test.

An examination for cardiovascular disease might embody the subsequent tests:

• An ECG (or EKG)is a graphic record of the electrical activity of the guts because it contracts and rests. To record the electrocardiogram, a technician positions variety of tiny contacts on your arms, legs associate degreed chest to attach them to an electrocardiogram machine. An ECG can detect arrhythmias and heart damage, inadequate blood flow and heart enlargement.For many women with angina, the ECG at rest is normal. This is not shocking as a result of the symptoms of angina occur throughout stress. Therefore, the functioning of the guts could also be tested beneath stress, typically exercise. In the simplest assay, the ECG is taken before, during and after exercise to look for stress-related abnormalities. Blood pressure and pulse ar|are} measured throughout the strain take a look at and symptoms are noted.
• An echocardiogram uses ultrasound to guage the form, structure and strength of the heart muscle and detect any areas of weakness that occur during stress (treadmill exercise or drug stress). This test is noninvasive and can be performed during rest and exertion.
• Nuclear scanning is usually wont to show broken areas of the guts and expose issues with the heart’s pumping action. A small amount of a radioactive substance is injected into a vein, usually in the arm. A scanning camera records the nuclear material that’s obsessed by the guts muscle (healthy areas) or not obsessed (damaged areas). An initial test is recorded while resting; a second test while you perform near maximum intensity on the treadmill. After exercise, a scan is taken of the guts muscle, showing areas of decreased blood supply.
• Coronary angiography ) is injected through a fine tube (catheter) place into associate degree artery of associate degree arm or leg and passed into the heart. The heart and blood vessels are then filmed while the heart pumps. The picture that results, called an angiogram or arteriogram, shows problems such as a blockage caused by atherosclerosis. This is the most accurate way to assess the presence and severity of coronary disease.
• High sensitivity C-reactive protein (CRP) blood test. This blood test detects a protein that becomes elevated in response to inflammation, called high-sensitivity (hs) C-reactive protein (CRP). Inflammation is associated with an increased risk of atherosclerosis although it is not clear if it actually causes the disease. Current guidelines from the American Heart Association and the U.S. Centers for Disease Control and Prevention recommend limiting the use of the hs-CRP test as a discretionary tool for evaluating people of moderate risk, and not using it as a means of screening the entire adult population because there is insufficient scientific evidence supporting widespread use at this time.

Diagnosing a Heart Attack

Heart attack symptoms might not be unexpected or dramatic like within the movies, therefore do not wait till symptoms area unit severe or intolerable. The warning signs of a heart attack are:

• Discomfort that spreads from the chest to the shoulders, neck and arms
• Pressure or squeezing pain in the chest that may spread into the neck, shoulders and arms
• Nausea, breathlessness, sweating or fainting with pain in the arms, chest or neck
• Feelings of impending doom
• Significant fatigue
• Indigestion
• Weakness in the arms

If you have got heart condition, you ought to grasp the symptoms of a attack thus you’ll be able to get immediate medical facilitate if symptoms occur. Not all heart attacks begin with sharp, crushing hurting, particularly for ladies, for whom attack symptoms usually square measure milder and fewer specific.

If a heart attack is suspected, doctors will order a blood test and an electrocardiogram (ECG) to test for changes in certain enzymes in the bloodstream and any disruption to the heart’s electrical impulses. One such blood test detects changed levels of troponin, a protein that leaks from the heart muscle when it is damaged. Health care professionals may also check levels of enzymes called creatine kinase to determine if you have had a heart attack or if other muscles in your body have been damaged. Creatine kinase almost always rises in people who have had a heart attack, but levels of the enzyme can also be elevated for other reasons. Your health care skilled can possibly perform different tests to exclude different medical conditions.

Treatment

Coronary heart condition (CHD) is treated in an exceedingly range of how, depending on its severity. For many ladies, CHD is managed with lifestyle changes and medications. Others may have a lot of invasive procedures, perhaps even surgery, and medication. In any case, once CHD develops, it requires lifelong management.

Although nice advances are created in treating CHD, changing your lifestyle habits remains the single most effective way to stop the disease from progressing.

1. Smoking. Smoking is the number one preventable cause of CHD. Quitting smoking dramatically and directly lowers the chance of a attack and conjointly reduces the chance of a second attack in folks that have already had one.
2. Diet. If you do not smoke, changing your dietary habits is the best way to stop atherosclerosis from progressing to coronary heart disease. Changing your diet to one low in saturated fat, trans fat and cholesterol reduces blood cholesterol, a primary cause of atherosclerosis. Eating less fat ought to conjointly assist you turn. The DASH (Dietary Approaches to Stop Hypertension) diet, endorsed by the major heart organizations, is one strategy for lowering high blood pressure. It is rich in lower-calorie foods such as fruits and vegetables,whole grains and low-fat dairy products, as well as being low in sodium.The “Therapeutic Lifestyle Changes (TLC) Diet” plan, developed by the NHLBI, calls for less than seven percent of your calories to come from saturated fat and for less than 200 mg of dietary cholesterol. Twenty-five to 35 percent or fewer of total daily calories can come from fat, provided most of these calories are from unsaturated fat, which doesn’t raise cholesterol. Sodium intake should be limited to no more than 2,400 mg per day. In addition, the guidelines encourage the use of certain foods rich in soluble fiber to boost the diet’s LDL-lowering power.In addition to these low-fat dietary approaches, some large studies also purpose to the Mediterranean-style diet as another pattern of uptake to cut back your risk of heart condition. Like the low-fat diets, the Mediterranean eating pattern focuses on fruits, vegetables, whole grains, nuts and seeds, but it also includes olive oil as a significant source of monounsaturated fat and wine in low to moderate amounts. The major macromolecule sources square measure dairy farm, fish and poultry, with minimal red meat.The Mediterranean eating style allows a higher percentage of calories from fat than the low-fat diets typically endorsed by health organizations, but several recent major studies have shown that the diet can lower risk for heart attacks and diabetes and is an alternative to low-fat diets.
3. Exercise. You also can benefit from exercise. Recent analysis finds that even moderate amounts of physical activity square measure related to lower death rates from coronary heart condition. The 2011 AHA pointers suggest a minimum of a hundred and fifty minutes per week of moderate exercise or seventy five minutes per week of vigorous exercise or constant combination of moderate- and vigorous-intensity aerobic activity. If you need to lose weight or maintain weight loss, the recommendation rises to 60 to 90 minutes of moderate exercise on most, preferably all, days of the week. However, if you have got severe CHD you will need to prohibit your exercise somewhat, so check with your health care professional to find out what kinds and amounts of exercise are best for you.
4. Weight loss. If you’re overweight, losing weight can help lower blood cholesterol levels. It is conjointly the foremost effective fashion modification to cut back high pressure level and polygenic disorder, which are all risk factors for atherosclerosis and heart disease. The best way to lose weight is through a combination of diet and exercise, emphasizing healthy food choices, portion control and an active lifestyle.

Medications for CHD

In addition to lifestyle changes, medications are prescribed according to the type of CHD you have, how serious it is and other health conditions you may have. The symptoms of angina can generally be controlled by beta blocker drugs that decrease the workload on the heart, by nitrates (including nitroglycerin) that dilate the arteries, by calcium channel blockers (CCBs) that relax the arteries and by other classes of drugs.

The tendency to form clots can be reduced by taking aspirin or by other drugs called platelet inhibitory and anticoagulant drugs. Beta blockers and angiotensin converting enzyme inhibitors (ACE), and statins, have also been shown to reduce the risk of recurrent heart attack.

Medications Prescribed for Heart Disease

The most common medications prescribed for those with heart disease are:

• Angiotensin converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARB). These medicine stop production of a chemical that produces blood vessels slim.
  They are primarily wont to scale back pressure level and facilitate the guts heal once it’s been broken. There is proof they will additionally scale back the chance of getting a second heart failure. Research finds that exploitation ACE inhibitors throughout gestation, particularly when the primary 3 months, will cause low pressure level, severe nephrosis, too much potassium or even death in the newborn. Therefore, it is important that you check with your doctor immediately if you are taking these drugs and think you may be pregnant.
• Aspirin.Aspirin. Low-dose aspirin—up to 325 mg per day—helps prevent heart attacks when taken daily upon the recommendation of a health careprofessional. Today, the American Heart Association and the U.S. Preventive Services Task Force recommend that people at high risk for heart attack or stroke discuss taking a daily, low-dose aspirin with their health care professionals.However, a study presented at the 2005 yank faculty of medical specialty meeting and revealed within the geographical area Journal of drugs in March 2005 found that low-dose Bayer didn’t seem to forestall 1st heart attacks in healthy women younger than 65, although it did significantly reduce their risk of ischemic stroke.So it’s very important that you check with your health care provider about whether or not Bayer medical care is true for you. If you already are taking low-dose aspirin therapy, check with your health care professional before stopping it if you have questions about the study.For women who should be on aspirin therapy, it doesn’t take much to get the benefits. Studies notice that between seventy five and one hundred milligrams, called “low-dose Bayer medical care,” is enough to reduce the risk for heart attack or angina. Most aspirin brands come in low-dose formulations of 81 mg. The upper dosage for aspirin in women at a high risk for heart disease is 325 milligrams.Aspirin’s cardioprotective benefits stem from its unique ability to interfere with the blood cells that are responsible for forming sticky clots. Aspirin also soothes inflammation in the arteries, which can help protect blockages from developing.Aspirin has a downside, however. Because it acts on the system that affects injury, aspirin increases the risk of gastrointestinal bleeding, either from an ulcer or gastritis, and the risk of a rare but dangerous variety of stroke caused not by a grume, but by bleeding in the brain. This fact, and the lack of strong enough evidence to support a change in labeling, led the U.S. Food and Drug Administration panel in Gregorian calendar month 2003 to vote against as well as “primary hindrance of heart attack” within the indications to be used of Bayer on the medication’s label.
• Anticoagulants (warfarin, dabigatran).Anticoagulants (warfarin, dabigatran). These medicine, known by brand names including Coumadin, Jantoven and a new drug called Pradaxa, protect against stroke due to atrial fibrillation (abnormal heart rhythm) by reducing the risk of blood clots. It is additionally used for a few girls with different styles of cardiopathy or stroke.
• Beta blockersThese medicine scale back the heart’s work and square measure used for prime pressure level and pain and to forestall a repeat heart failure.
• Blood cholesterol-lowering agents.Cholesterol-lowering medications that may be recommended include:
  • Statins. Numerous statin drugs are available in the United States including atorvastatin (Lipitor), fluvastatin (Lescol), lovastatin (Mevacor, Altoprev), pravastatin (Pravachol), simvastatin (Zocor), rosuvastatin (Crestor) and pitavastatin (Livalo). In addition, statins are found in the combination medications lovastatin plus niacin (Advicor), atorvastatin plus amlodipine (Caduet) and simvastatin plus ezetimibe (Vytorin).These highly effective drugs typically produce a 20 to 60 percent reduction in LDL cholesterol levels. They also provide the added benefits of some increase in HDL cholesterol, some reduction in triglyceride levels and a decrease in the inflammation in the blood vessel linings that can lead to CHD. Make sure you talk about any potential side effects from statins with your health care provider. If you start to experience any side effects such as muscle aches or dark urine, stop taking the drug immediately and call your health care professional.
    • Nicotinic acid.

• Lower your blood cholesterol level. Today, nearly half of women age 20 and older need to lower their blood cholesterol and nearly one in five American women have blood cholesterol levels high enough to pose a serious risk for CHD. Cholesterol management guidelines issued by the National Cholesterol Education Program (NCEP), a division of the National Heart, Lung, and Blood Institute (NHLBI), specifically zero in on reducing LDL cholesterol levels in adults. Elevated low-density lipoprotein (LDL) cholesterol is a major cause of coronary heart disease.Starting at age 20, all women should have their blood cholesterol tested, with repeat testing every five years, according to the most recent NHLBI guidelines. If you have a health condition or are considered at risk for developing heart disease, your health care professional may recommend cholesterol testing more frequently.Cholesterol testing is recommended for children age two or older if their parents or grandparents had heart disease or vascular disease before age 55 or if at least one of their parents has a cholesterol level of 240 mg/dL or higher.For most people, cutting back on foods high in saturated and trans fat and cholesterol will lower both total and LDL cholesterol.Both the AHA and the National Cholesterol Education Program offer specially designed cholesterol-lowering diets. Ask your health care professional for more information or visit their Web sites: www.heart.org and www.nhlbi.nih.gov.Regular physical activity and weight loss for overweight persons also will lower blood cholesterol levels. Losing extra weight, quitting smoking and becoming more physically active may help boost your HDL cholesterol levels.
• Lose weight. Overweight women are much more likely to develop heart-related problems, even if they have no other risk factors. Excess body weight in women is linked with coronary heart disease, stroke, congestive heart failure and death from heart-related causes. The more overweight you are, the higher your risk for heart disease. Being overweight contributes not only to cardiovascular diseases, but also to other risk factors, including high blood pressure, high blood cholesterol and diabetes. Fortunately, these conditions often can be controlled with weight loss and regular physical activity.Body shape as well as weight may affect heart health. “Apple-shaped” individuals with extra fat at the waistline may have a higher risk than “pear-shaped” people with heavy hips and thighs. If your waist is nearly as large as, or larger than, the size of your hips, you may have a higher risk for coronary heart disease.Ideally, the AHA preventive guidelines for women recommend women maintain/achieve a body mass index (BMI) between 18.5 and 24.9 and a waist circumference of less than 35 inches. Your BMI, a measurement that considers height as well as weight.For lasting weight loss, engage in regular, brisk physical activity and eat foods that are low in calories and fat. For physical activity, the current recommendations for women who need to lose weight and maintain weight loss are for 60 to 90 minutes of moderate exercise (such as brisk walking) most, preferably all, days of the week. Do not try to lose more than one half to one pound a week.Adjust your diet to include a wide variety of low-calorie, nutritious foods in moderate amounts from the basic food groups. Include pasta, rice, bread and other whole-grain foods, as well as fruits and vegetables, and keep other foods low in fat, since fat is the richest source of calories. But keep in mind that while many low–saturated-fat food products are now available, many of them are still loaded with sugar and therefore high in calories.
• Increase physical activity. Physical inactivity increases the risk of heart disease. It contributes directly to heart-related problems and increases the chances of developing other risk factors, such as high blood pressure and diabetes.Fortunately, it doesn’t take a lot of effort to become physically active. As little as 30 minutes of moderate activity at least five, and preferably all, days of the week helps protect the heart and is recommended by the AHA. However, the recommendations rise to 60 to 90 minutes of moderate activity most, and preferably all, days of the week in women who need to lose or maintain weight. Examples of moderate activity are brisk walking, bicycling, raking leaves and gardening. Vigorous exercise includes running, jogging, swimming laps and cross-country skiing.If you prefer, you can divide the 30 to 90 minutes of moderate activity into shorter periods of at least 10 minutes each. If you already engage in this level of activity, you can get added benefits by doing more.If you have heart disease, regular, moderate physical activity lowers the risk of death from heart-related causes. However, if you have heart disease, check with your doctor first to find out what kinds of activities are best for you.Once you get started, keep these guidelines in mind:
  • Go slow. Before each session, take five minutes for stretching and slow movement to warm up, and at the end of the session, take five minutes to cool down with a slower pace.
  • Listen to your body. Some stiffness is normal at first, but if you hurt a joint or pull a muscle or tendon, stop the activity for several days to avoid more serious injury.
  • Pay attention to warning signals. While physical activity can strengthen your heart, some types of activity may worsen existing heart problems. Warning signals include sudden dizziness, cold sweat, paleness, fainting or pain or pressure in your upper body during or after engaging in physical activity. If you notice any of these signs, call your health care professional or 911 immediately.
  • Keep at it. Unless you have to stop your exercise program for health reasons, stick with it. If you feel like giving up because you think you’re not going as fast or as far as you should, set smaller, short-term goals. If you’re getting bored, try engaging in an activity with a friend or switch to another activity.
• Be aware of diabetes.Diabetes, or high blood sugar, is a serious metabolic disorder that raises the risk of coronary heart disease. According to NHLBI, diabetes poses as great a risk for having a heart attack in 10 years as heart disease itself.

  Women with diabetes are also more apt to have high blood pressure and high blood cholesterol. About seventy five % of these with polygenic disorder die of some form of upset. Of the calculable seventeen.2 million Americans with diagnosed polygenic disorder, about 9.3 million ar ladies. In 2006, polygenic disorder killed thirty six,443 women, representing 1/2 the deaths from the sickness.People with polygenic disorder typically have accelerated coronary-artery disease, or a buildup of plaque in their arteries, meaning they develop the condition quicker than those while not polygenic disorder UN agency produce other similar risk factors.Women with polygenic disorder typically are not responsive to their considerably hyperbolic risk for cardiopathy. In fact, associate degree yank polygenic disorder Association survey found that sixty eight % of these with polygenic disorder weren’t responsive to their hyperbolic risk for cardiopathy and stroke, and 60 percent didn’t know they were at risk for high blood pressure and cholesterol, both of which increase their overall risk of heart disease and stroke.While there is no cure for diabetes, it can be controlled. The most vital beginning is obtaining the correct diagnosing. If you have diabetes, you should be treated as intensively as people with heart disease in terms of medication and lifestyle changes, according to NHLBI.In addition, the American Diabetes Association recommends that folks UN agency have polygenic disorder plus established upset take a lipid-lowering medication daily. They also recommend statins for any person with diabetes over 40 years old who has one or more risk factors for cardiovascular disease, such as high blood pressure.This recommendation is supported by results of a 2008 study revealed within the Lancet. Researchers looked at 14 previous randomized studies conducted on 19,000 people with diabetes and found that statins cut fatal cardiovascular events such as stroke, heart attack or coronary revascularization by a third for people with diabetes. More specifically, according to the study, statins reduce the risk of a major cardiovascular event by 20 percent for every 40 mg/dL they lower cholesterol.

  Additionally, tight control of your diabetes is important. The AHA preventive tips for girls advocate that manner and medicine be accustomed succeed close to traditional HbA1C levels (less than seven percent). HbA1C is a blood test that provides a picture of blood sugar levels over time.
  And people with diabetes should work with their health care professionals to get their blood pressure under 130/80.

  Finally, if you take birth control pills and have diabetes or insulin resistance, you should have regular blood sugar tests because contraceptive hormones can alter glucose levels.

• Decrease stress.In recent years, we have heard a lot about the connection between stress and heart disease. Some common ways that of dealing with stress, such as overeating, heavy drinking and smoking, are clearly bad for your heart. Studies continue to investigate the direct effects of stress on your heart.The good news is that sensible health habits can have a protective effect. Regular physical activity not solely relieves stress, but also can directly lower your risk of heart disease. Also, participating in a stress management program following a heart attack lowers the chances of further heart-related problems.
• Follow a heart healthy dietFollow a heart healthy diet. Avoiding or limiting saturated fat and cholesterol from the foods you eat can help lower cholesterol and reduce the calories contributed to your diet by fat. The “Therapeutic Lifestyle Changes (TLC) Diet” plan, developed by the NHLBI, calls for less than seven percent of your calories to come from saturated fat and for less than 200 mg of dietary cholesterol.Twenty-five to 35 percent or fewer of total daily calories can come from fat, provided most of these calories are from unsaturated fat, which doesn’t raise cholesterol.Also limit your sodium intake to no more than 2,400 mg per day.The guidelines encourage the use of certain foods rich in soluble fiber to boost the diet’s LDL-lowering power. In addition, the AHA recommends women limit their intake of trans fatty acids overall.Because some women have trouble following a low-fat diet, many experts now give their patients a choice of a low-fat diet or the Mediterranean-style diet, which also emphasizes eating fruits, vegetables and whole grains, but includes a higher percentage of unsaturated fats, primarily from the monounsaturated fat found in olive oil. Saturated fats are low in the Mediterranean-style diet.Saturated fat is found mainly in food that comes from animals. Whole milk dairy farm product like butter, cheese, milk, cream and ice cream all contain high amounts of saturated fat. The fat in meat and poultry skin is additionally loaded with saturated fat. A few vegetable fats—coconut oil, cocoa butter, palm kernel oil and palm oil—are also high in saturated fat. These fats are sometimes found in cookies, crackers, coffee creamers, whipped toppings and snack foods. Remember: Saturated fat boosts your blood sterol level quite anything in your diet.
  

• Eat a balanced diet with fish two to three times a week, if possible.
• Choose lean cuts of meat, and remove fats from meats and skin from chicken before cooking. Eat up to six ounces per day.
• Broil, bake, roast or poach foods rather than fry them.
• Cut down on sausage, bacon and processed high-fat cold cuts.
• Limit organ meats such as liver, kidney or brains.
• Eat two servings of fatty fish, such as mackerel, tuna or salmon, per week.
• Instead of whole milk or cream, drink skim or one percent milk. Try nonfat or low-fat yogurt in place of sour cream. Use nonfat or low-fat cheeses. Substitute sherbet and nonfat or low-fat frozen yogurt for ice cream.
• Instead of butter, use olive oil or liquid vegetable oils high in poly- or monounsaturated fats. All fats and oils should be used sparingly.
• Eat egg yolks only in moderation. Egg whites contain no fat or cholesterol and can be eaten often. In most recipes, substitute two egg whites for one whole egg.
• Eat plenty of fruits and vegetables as well as cereals, breads, rice and pasta made from whole grains (for example, rye bread, whole wheat spaghetti and bran cereal). These foods are good sources of starch and fiber, and usually contain no cholesterol and little or no saturated fat.
• Liquid vegetable oils are a good choice for sautéing vegetables, browning potatoes, popping corn and making baked goods, pancakes and waffles. Use small amounts or try a vegetable oil cooking spray.
• Eat plant stanol and sterol margarines. Plant sterols (also called stanol esters), work by blocking absorption of cholesterol in the digestive tract. Recent studies have shown that plant sterols effectively lower cholesterol even in people already on statin medications. Although name brands aren’t specifically mentioned, the American Association of Clinical Endocrinologists (AACE) lipid guidelines recognize plant stanol esters, like those found in Benecol and Take Control spreads, as effective dietary agents for lowering LDL or bad cholesterol by more than 10 percent. To get this effect, however, you have to “take” the full amount daily (at least 2 grams a day, equivalent to 2 to 4 tablespoons), not just once in a while.

Heart Disease Prevention for Women with Cardiovascular Disease

The AHA preventive guidelines make several recommendations for women who have been diagnosed with cardiovascular disease, including:

• • Cardiac rehabilitation. Women United Nations agency have recently had a coronary failure, or a coronary intervention such as angioplasty or bypass surgery, should participate in some form of cardiac rehabilitation. Cardiac rehabilitation could be a medically supervised program to assist heart patients recover quickly and improve their overall physical and mental functioning. The goal is to scale back the chance of Associate in Nursingother internal organ event or to stay an already gift cardiovascular disease from obtaining worse. Programs include counseling, exercise, help with identifying and modifying risk factors and returning to work, as well as lending emotional support.However, several studies find that women are underrepresented in such programs and do not get referred as often as men, even though the results are just as good for women as for men.
  • Evaluation for depression. Women with disorder ought to be evaluated for depression and referred for medical care once necessary. Studies notice that depression along side disorder will increase the chance of complications and death.

Other Approaches to Heart Disease Prevention

• • Alcohol use. If you drink, do so in moderation. This means one drink per day and for men, two drinks per day. One drink equals 12 ounces of beer, five ounces of wine, or one and one-half ounces of 80-proof liquor.If you are a nondrinker, this is not a recommendation to start using alcohol. And certainly, if you are pregnant or have another health condition that could make alcohol use harmful, you should not drink.Remember, moderation is the key. More than 2 drinks per day will raise pressure level, and binge drinking can lead to stroke. People who drink heavily on a daily basis have higher rates of cardiovascular disease than either moderate drinkers or nondrinkers.
  • Aspirin. The research on aspirin is promising. Aspirin may help to both prevent heart attacks in older healthy women and treat heart attacks in women who have already had them.Aspirin also reduces the chances that women who have already had a heart attack or stroke will have, or die from, another one. If taken quickly, aspirin may also increase the chances of survival after a heart attack. The AHA guidelines for women recommend that women who are at high risk of coronary heart disease take a daily aspirin (or clopidogrel, brand name Plavix, if they can’t take aspirin). Discuss this option with your doctor. In addition, the AHA 2011 updated guidelines for women state that routine low-dose aspirin therapy may be considered in women age 65 or older, regardless of their risk of cardiovascular disease, if blood pressure is controlled and the benefit for ischemic stroke and heart attack prevention is likely to outweigh the risk of gastrointestinal bleeding or hemorrhagic stroke.Keep in mind, however, that analgesic could be a powerful drug with several facet effects. It can increase your chances of getting ulcers, kidney disease, liver disease and a stroke from a hemorrhage. Because of these serious risks, you should not take aspirin to either prevent or treat a heart attack without first discussing it with your health care professional.

• Omega-3 fatty acids. More and more research suggests that consuming fish and fish oil supplements (omega-3 fatty acids) can lower the risk of CHD and death from CHD. In fact, the AHA recommends that women with high cholesterol and/or high triglycerides supplement their diet with omega-3 fatty acids. Women can get omega-3 fatty acids by eating two servings of fatty fish, such as tuna, mackerel or salmon, per week, as well as taking fish oil supplements. Women with documented heart disease should consume about 1 gram of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) per day, preferably from oily fish. However, EPA and DHA supplements may be considered after they have cleared them with their health care professionals. Women with elevated triglycerides may need 2 to 4 grams of EPA and DHA per day provided in supplements under the care of a health care professional.Despite past warnings about seafood and mercury content, a report released by the Institute of Medicine (IOM) showed that the heart benefits of seafood outweigh the risks in infants as well as in adults. As a result, they recommend that women eat at least two servings of fatty fish per week. Pregnant women, however, should avoid eating fish with the potential for the highest levels of mercury, including shark, swordfish, king mackerel and tile fish.
• Omega-6 fatty acids. A 2009 advisory from the American Heart Association recommends getting at least 5 to 10 percent of daily caloric intake from omega-6 fatty acids as part of a low-saturated-fat, low-cholesterol diet. An analysis of recent research shows that such consumption slightly reduces the risk of coronary heart disease risk. Omega-6 fatty acids come primarily from vegetable oils, nuts and seeds. The average American typically gets about 6 percent of daily calories from omega-6 fatty acids from such things as nuts, cooking oils and salad dressings, according to the AHA report. To find foods containing omega-6, look for polyunsaturated fat on a product’s nutrition label. Recommended daily servings of omega-6 depend on physical activity level, age and gender, but range from 12 to 22 grams per day.

Facts to Know

1. According to the American Heart Association, every year nearly 500,000 American women die of cardiovascular disease, making it the number one killer of American women.
2. The AHA reports that 23 percent of women age 40 and older will die within a year of a heart attack, compared with only 18 percent of men.
3. African-American women are more likely to die of CHD than Caucasian women. African-American women have greater incidence of high blood pressure and diabetes, both of which increase the risk of heart disease. They are more likely to die from stroke and heart attacks than Caucasian women. Heart disease risk is also higher among Mexican Americans, Native Americans and native Hawaiians. This is partly due to higher rates of obesity and diabetes in these ethnic groups.
4. Coronary heart disease is a disease of the heart’s blood vessels that, if untreated, can cause heart attacks. Like any muscle, the heart needs a constant supply of oxygen and nutrients, which are carried to it by the blood in the coronary arteries. When the coronary arteries become narrowed or clogged and cannot supply enough blood to the heart, CHD results.
5. Menopausal hormone therapy—also known as hormone replacement therapy—once was prescribed for preventing heart disease in addition to treating menopausal symptoms such as hot flashes. But, findings from the Women’s Health Initiative suggest that some forms of menopausal hormone therapy increase a woman’s risk of cardiovascular disease, especially if started long after the menopause has onset, rather than prevent it. Currently, health experts recommend against prescribing hormone therapy for prevention of heart disease. However, there does not appear to be any increased risk for developing CHD, if hormone therapy is started early on in menopause for very bothersome menopausal symptoms, such as hot flashes.
6. Smoking is one of the four major risk factors for coronary artery disease. Women who smoke are two to six times more likely to suffer a heart attack than nonsmoking women, and the risk increases with the number of cigarettes smoked per day. Smokers who have a heart attack are more likely to die and die suddenly (within an hour) than are nonsmokers. Cigarette smoking also acts with other risk factors to greatly increase the risk for coronary heart disease, such as atherosclerosis (“hardening of the arteries”).
7. Even slightly elevated blood pressure increases your risk for coronary heart disease. High blood pressure also increases your chance of stroke, congestive heart failure and kidney disease. According to the AHA, one in three Americans age 20 and older have hypertension, and nearly half are women. High blood pressure is more common and more severe in African-American women.
8. Today, nearly half of women age 20 and older need to lower their blood cholesterol, and nearly one in five American women have blood cholesterol levels high enough to pose a serious risk for CHD.
9. If you drink alcohol, do so in moderation. This means no more than one drink per day for women and no more than two drinks a day for men. One drink equals 12 ounces of beer, or 5 ounces of wine, or 1 1/2 ounces of 80-proof liquor. Drinking more than this increases your risk for high blood pressure, obesity, stroke, breast cancer, suicide, accidents and alcoholism.
10. Overweight women are much more likely to develop heart-related problems than women who aren’t. Obesity is linked with coronary heart disease, stroke, congestive heart failure and death from heart-related causes. The more overweight you are, the higher your risk for heart disease.

Key Q&A