The statistics are startling. Each year, every 80 seconds, cardiovascular disease and stroke take the life of one woman, according to the American Heart Association. In addition, heart disease is the leading cause of death for men in the United States. Here, Alpesh Shah, MD, a specialist in cardiology at Houston Methodist Hospital in Texas talks with Real Health about this deadly killer that’s currently among the top five leading causes of death in this country.
What are the most common types of cardiovascular disease?
Coronary artery disease, or CAD, is the most common type of heart disease and the leading cause of death in the United States in both men and women. In fact, black Americans have a one-and-a-half-times greater rate of death attributable to heart disease than white Americans. (CAD occurs when the arteries that supply blood to the heart muscle become hardened and narrowed because of cholesterol and plaque buildup on their inner walls.)
In addition, the annual rate of first heart attacks is higher for black Americans than white Americans. And the prevalence of high blood pressure in black Americans is among the highest in the world.
Recently, I worked on the first stent (a small expandable mesh tube used to open narrowed arteries) with a bioabsorbable polymer coating, called SYNERGY, that’s approved by the Food and Drug Administration for the treatment of CAD. Unlike with previously approved stents coated with drugs, the body absorbs the polymer coating on these SYNERGY stents after delivering the drug to the artery. This eliminates complications associated with the body’s long-term exposure to polymer.
Can birth control pills, a woman’s pregnancy history (including abortions and complications during pregnancy) or menopause put her at greater risk of cardiovascular disease?
Well, that’s a very complex question, and it reflects the complex hormonal issues connected with a woman’s health. For example, birth control pills have been shown to cause certain types of blood clots that do not relate to heart disease. But there are varieties of birth control pills that actually accelerate atherosclerosis, the buildup of plaque inside arteries, the blood vessels that carry oxygen-rich blood to the heart and other parts of the body. In addition, hormone replacement therapy used by elderly women is also associated with increased cardiovascular events.
This is why it’s very important for physicians and women to assess the risk and benefits of birth control pills or hormone replacement therapy. Hormonal fluctuations can actually damage or weaken a woman’s heart, especially after childbirth, which can cause a condition called cardiomyopathy.
Is there a greater risk of cardiovascular disease for people with a family history of these illnesses?
Absolutely. I think one has to understand what the risk factors are. The American Heart Association has identified the risk factors for any woman who is about age 60 as hypertension, diabetes and a family history of heart disease. In addition, if a woman eats an unhealthy diet, doesn’t exercise, carries excess weight or smokes, these risk factors can place her at a low, medium or high risk of suffering cardiac events.
Nearly half of all black American adults have some form of cardiovascular disease, and black women have a 50 percent greater risk of developing heart failure than white men and women.
What are some of the signs of cardiovascular disease that women should look for that might be not typical for men?
I think the medical community eventually realized that heart disease in women is very tricky to diagnose—especially because most women show no symptoms of this illness. This is because many women don’t like to complain about how they feel physically, or sometimes they tend to be more focused on everybody else’s health. For example, there’s a case where a husband was coming with his wife to see me for his heart disease problems, and I was seeing the couple for many, many years. Not once did the wife complain. Later, I found her in the emergency room with a heart attack. Even then, she just said, “Well, I’ve been a little short of breath; I’m a little bit tired.”
This is why it’s very important for us to understand what all the symptoms of heart disease are. As I said, a lot of women are asymptomatic, so you have to understand your risk factors; and if they are high, you have to get yourself checked.
Many women actually feel more tired and fatigued than just being short of breath. And in the case of angina, which is usually characterized by a crushing pain, heaviness or pressure that radiates across the chest and sometimes down the arm, into the neck, jaw or teeth or into the back, women don’t always have those symptoms. That’s when doctors must look for factors beyond the typical angina so we can detect heart disease earlier in women.
Is there a healthy weight range women should aim for that would help prevent cardiovascular disease?
Absolutely, and the American Heart Association has identified excess weight as a predictor of cardiac events (this is true for women and men). We have seen in several studies that folks who are not able to lose weight after having a heart attack and remain on the heavier side actually have an increased risk of subsequent and recurrent cardiovascular events, such as heart attacks or strokes. We generally recommend a body mass index (BMI)—a measure of body fat based on your weight in relation to your height—below 27. But this is also determined based upon a person’s age and height. Once we calculate an individual’s BMI, we recommend an appropriate weight.
What’s the best range for women’s blood pressure to be in for avoiding cardiovascular disease, and are there good ways to lower blood pressure without medication?
Commonly, hypertension is diagnosed when blood pressure is measured and the top number, or systolic, registers in the upper 140, and the bottom number, or diastolic, is 85 or higher. High blood pressure affects almost 20 percent of adults. We recommend that their blood pressure be below those numbers. So if there are specific numbers you want to try to remember, they’re 140 on the top and 85 on the bottom. That being said, the lower the numbers the better, as long as you don’t start to feel weak or tired or dizzy. We really do believe that the lower the number the better, so the person’s cardiovascular risk remains really low.
There are many ways we can address blood pressure issues. Obviously, it is very important that a person who develops hypertension tries to understand why. There are some secondary factors, such as too much salt intake, too much stress in life, too much coffee drinking, excess weight and sleep disturbances, such as sleep apnea and other conditions. This means individuals must modify their lifestyle to correct their blood pressure. If lifestyle modifications, such as weight loss and restricting salt intake, don’t help, then it may be time to try medical therapies, such as diuretics or beta-blockers or calcium channel blockers.
What kinds and levels of exercise have cardiovascular benefits for women?
I think we as physicians are guilty of not realizing that heart disease creeps up on women, sometimes at an earlier age, and sometimes the condition can be more fatal for them than for men.
One of the ways a woman can be more aggressive about fighting heart disease is to include exercise in her day-to-day life. We recommend at least 30 minutes of aerobic exercise five days each week, for a total of 150 minutes per week. You can do any form of exercise, but aerobic exercise, such as swimming, bicycling, jogging, fast walking on a treadmill or working out on elliptical machines—or whatever helps increase the heart rate—ought to be the core of a woman’s exercise program. These activities improve cardiovascular metabolism and can reduce subsequent cardiac events.