Preventing Heart Disease
Heart disease is virtually preventable. It is a disease that develops during the teen years but does not usually present until a person is in his or her 50s, 60s or 70s.
There are two keys to heart disease prevention — assessing your risk and doing what you can to reduce your risk.
Every middle-aged adult should talk to his or her physician about assessing personal risks for developing heart disease or stroke. Doctors can help patients determine this risk by examining lifestyle choices such as diet and smoking and reviewing blood pressure, height, weight and waist girth measurements.
Additionally all middle-aged adults have a fasting lipid panel (a blood test that measures HDL and LDL cholesterol and triglyceride levels in the bloodstream) and a fasting glucose test (which identifies impaired fasting glucose).
Cholesterol measurements are important because increased levels of cholesterol can increase the risk of heart disease. Glucose tests are necessary because there is a connection between diabetes and heart disease, and people with diabetes are more likely to develop cardiovascular complications. This is because high blood glucose levels damage blood vessels, and patients with diabetes tend to have higher fat levels in their blood, which clog and narrow blood vessels.
There is also a second generation of tests (for heart disease) that we are increasingly starting to use more. These include new imaging tests and new blood tests, such as the CRP test. CRP, or C-reactive protein, tests are used to detect areas of acute inflammation. Some researchers think inflammation can trigger heart attacks by affecting the walls of diseased blood vessels.
Heart disease prevention is important for both men and women. More women will die from heart disease this year, making it the number one killer. Women are more likely to be overweight, less likely to exercise and appear to be affected more adversely by stress. They are also more likely to have diabetes or smoke.
Heart disease risk factors for women are the same. However, symptoms may affect women differently. Women may experience symptoms in addition to chest pain, such as jaw pain or nausea and may not necessarily experience dramatic or severe symptoms. Heart disease symptoms in women don’t usually start appearing until their 60s, which is about 10 years after men’s first signs are detected.
These differences of symptoms can make heart disease more difficult to detect in women. Recognition of symptoms by both women and health care providers remains problematic. Women report symptoms differently and have enhanced pain perception compared with men. These differences may be due to many difficult-to-measure factors, including gender-specific prior expectations, varying estimates of personal risk and gender differences in pain threshold or communication style.
Physicians are beginning to do a better job of taking gender into effect. For example, studies have found the standard stress test may not be as accurate in women, especially pre-menopausal women. Also, some scans may not be as effective in women because breast tissue may block blood flow, making the scans difficult to interpret.
Most of what we know about heart disease comes from earlier studies in men. Although heart disease risk factors are the same for both men and women, there is a heightened need to critically review and document strategies to prevent cardiovascular disease in women. It needs to be evidence-based.