Straight From the Heart-American Jewish University Lunch and Learn Summary
Straight From the Heart Summary
University of Women of American Jewish University
Dr Sherry A. Ross, OBGYN
February 16, 2017
Heart Disease is the most common cause of death among women throughout the world affecting 1 in 4 women.
Heart Disease accounts for more deaths than all forms of female cancers combined including breast, lung and ovarian cancer.
Staggering Facts about Heart Disease
- 1 in 4 women die of heart disease
- A women dies almost every minute from a heart attack or stroke
- Estimated 43 million women in US are affected by heart disease.
- 90% of women have one or more risk factor
- 80% of heart disease can be prevented
- Every minute of every day, a woman dies and more than 2/3 of them won’t feel a single symptom.
Guidelines for Screening for Heart Disease
- There are really NO set guidelines for screening women for heart disease even though 1 of 4 women die will ultimately die from it.
- What is needed between the nonexistent guidelines and the patients and is a health care provider who knows how to think…and for me it is thinking outside the box!
Who’s at Risk for Heart Disease?
LESS Traditional Risk Factors For Women
- Pregnancy Complications
- Oral Contraception
- Hormonal Infertility Therapy
- Hormone Replacement Therapy (HRT)
- Systemic Autoimmune Diseases
- Rheumatoid Arthritis, Lupus, Psoriasis
Pregnancy and Heart Disease
- Pregnancy is the first “stress test” a woman experiences.
- Pregnancy complications such as hypertension of pregnancy (Pre-eclampsia) , preterm labor, small for gestational age baby, and gestational diabetes.
- Complications uncover early predictions of cardiovascular risk.
- So once pregnancy is over, the disease of the blood vessels continues after pregnancy so these complications persists.
- A detailed pregnancy history is important in accessing your risk of cardiac disease.
- These are women at risk and need to be informed and have preventative management. We can help alter their risks.
Oral Contraception & Heart Disease
- There is no increased risk of heart disease in a healthy woman with no risk factors.
- If you use OCP and smoke cigarettes you have a 7 fold increase risk of heart disease. You should not be on OCP if you smoke.
- If you have hypertension you have a small increase risk of stroke.
- Women who take OCP and have known coronary risk factors such as cigarette smoking or hypertension should be advised accordingly by their OBGYN and other health care providers.
- Healthy birth control options are available for those who are at risk.
Hormonal Infertility Therapy & Heart Disease
- A large study (1993-2010) out of Canada showed women who had successful fertility therapy had a decrease in all-cause mortality including non-fatal heart disease, stroke, TIA, thromboembolism and heart failure. (Study details and final results are unpublished)
- Women with unsuccessful fertility therapy were at increased risk for heart disease than the general population.
- This needs to be a part of your medical history when talking to your health care providers.
Hormone Replacement Therapy (HRT) & Heart Disease
- HRT is safely recommended for women suffering from symptoms related to menopause. It’s recommended to be used at the lowest dose for the shortest amount of time for symptomatic menopausal women.
- HRT is not recommended for the prevention of cardiovascular heart disease.
Other Medical Conditions Make You At Risk
- Systemic Autoimmune Diseases
- Rheumatoid Arthritis
- Systemic Lupus
- Depression and its associated high risk behaviors (drugs, cigarette smoking) and non-compliant to medications increases risk of heart disease.
- If you have any of these medical problems you are at an increased risk of heart disease and stroke. Discuss your risks with your health care providers to set up screening and preventative management.
Traditional Risk Factors for Heart Disease
- High Blood Pressure (140/90 – either one of those numbers consistently is a risk factor)
- High Lipid panel (Cholesterol)
- Obesity Epidemic BMI>30
- Tobacco Use
- Genetic influences
- Physical Inactivity
What is a Heart Attack?
- A heart attack occurs when blood flow, which is delivering oxygen to the heart, is reduced, limited or completely restricted.
- Do you think you would know the signs of a heart attack?
- Every minute of every day, a women dies of a heart attack and more than 2/3 of them won’t feel a single symptom.
- Classic symptoms-Chest Pain, Shortness of breath, Cold Sweats, pain radiating down left arm
- Warning signs for heart disease in women are much different than in men.
- Women often present with pain, pressure or discomfort in the chest, but it may not be severe or significant. Women may also have right arm pain, nausea or vomiting, sweating, dizziness or fatigue.
- Silent Heart Attack– Affects both women and men, can present with less specific signs including flu-like symptoms, indigestion, fatigue, jaw ,upper back/body or arm pain and these types of signs are more common in women. BUT SHA are more common in men than women.
- In general, 50% of all heart attacks are mistaken for less serious problems and can increase your risk of dying from heart disease.
80% of the Causes of Heart Disease can be PREVENTED!
- Don’t smoke or use tobacco
- Eat a heart-healthy diet
- Exercise for 30 minutes on most days of the week
- Maintain a healthy weight
- Lifestyle habits including getting quality sleep and managing stress
- Get regular health screenings
The Department of Nutrition and Harvard School of Public Health made easy dietary guidelines that can help you prevent heart disease through your diet.
- Fruits 4 to 5 servings/day
- Vegetables 4 to 5 servings/day
- Whole Grains 3 or more servings/day
- Vegetable oils-Canola oil, Olive oil, safflower oil-2-6 servings/day
- Dairy Products Reduced fat or nonfat milk 2-3 servings/day
- Nuts and seeds 4-5 servings/day
- Fish and Shellfish Salmon, tuna, mackerel, trout 2 or more servings/week
- BEST Heart-Healthy Diets include DASH Diet, Ornish Diet
Foods to Avoid
- Excessive sodium- Recommended 1,500mg/day (.75 Tsp)
- Sugar-sweetened beverages, sweets, grain-based dessert and bakery foods
- Processed meats-Bacon, sausage, hot dogs, pepperoni, salami, processed deli meats
- Any food containing or made with partially hydrogenated vegetable oil-Stick margarine, Snack foods, deep-fried foods, prepared baked foods (cookies, pies, donuts)
- It’s been shown that you need to exercise 2.5 hours a week-30 minutes 5 times a week!
- A study at Cleveland Clinic showed that only 20% of Americans were aware of this benchmark.
- 40% of women are getting less exercise than they should.
- Physical inactivity greatly increases your risk of heart disease.
Avoid Obesity & Beyond
- Rise in obesity in the US by 27 % is a key factor in increasing your risk for heart disease.
- Obesity is directly associated with high blood pressure, high cholesterol and diabetes, which ALL increase risks for heart disease.
- Women with a waist circumference of more than 35 inches are at increased risk for heart disease and Type 2 Diabetes.
- Ideally!! Women want to maintain a healthy body weight with a BMI 25-30.
How to Calculate your Body Mass Index BMI
- BMI is your weight (in kilograms) over your height squared (in meters) Ex Women weighs 132lb and is 5’5” (65 inches)
- Convert your weight from pounds to kilograms (kg)
132 pounds divided by 2.2kg=60kg
- Convert your height from inches to meters
5’5” (65 inches) divided by 39.37 meter=1.65
BMI=60kg divided by (1.65meters x 1.65meters)=22.03
Other Important Lifestyle Habits
- Adequate and quality sleep –best 7-9 hours/night
- Managing stress, depression, anxiety, anger, hostility and social isolation.
- Yoga, Meditation, Guided Imagery, Deep breathing exercises and other forms of mindfulness help with relaxation responses.
- Antioxidant Vitamin Supplements-Omega 3 Fish oil, Vitamin C, E, B’s should not be used for prevention of heart disease
- Aspirin prophylaxis? Routine use of ASA in healthy women < 65y should not be used for the prevention of heart disease.
- Low to Moderate alcohol use has been shown to reduce and protect against heart disease. 1-2 drinks/day (5 oz of wine, 1 oz of hard liquor).
Get Regular Health Screenings
- Evaluation of Heart Disease Risk
- Medical history/Family history/Pregnancy Complication History
- Symptoms of Heart Disease
- Depression Screening in women
- Physical Examination including Blood Pressure, Body Mass Index and Waist Size
- Laboratory Testing including a lipid panel and glucose
Health Care Providers Awareness is Lagging
- Unfortunately, health care providers need to catch up on how to educate and screen their patients.
- The medical community needs to do more in educating younger women on ways of reducing their risk factors for future heart health protection.
- Changes in health care allow little time to spend talking about some of the most important medical concerns patients want to discuss.
- Screening women for smoking, obesity, high blood pressure, high cholesterol and diabetes should be a part of women’s annual medical assessment.
Women Need to be their Best Health Advocates!
- Women need to be educated and proactive in finding out their personal risks of developing heart disease .
- Increasing your awareness and taking preventive steps to reduce your risk has to be a priority against the #1 killer of women.