Whole Life Times: Heartstrong Women

October 2005 | Whole Health

Heartstrong Women

Heart Disease: Not Just a Man’s Problem

Interview With Miriam E. Nelson, PhD

When women have heart pain, we’re much more likely to attribute it to disappointment in love than to a heart attack. Heart attacks, we think, are the province of men. In fact, eight million women are living with heart disease, and nearly half a million of them die from it each year—more, even, than men.

A shattered love affair may be painful, but it’s usually not fatal to a woman—at least not if she expresses her anger at her former partner. But since women are less likely than men to express unpleasant emotions, when they do have heart attacks, they are far less likely than men to survive. As Miriam E. Nelson, PhD, and Alice H. Lichtenstein, DSc tell us in their book, Strong Women, Strong Hearts (G. P. Putnam’s Sons, 2005), “stress, anger and impatience apparently do [women] in.”

Even well-intentioned health professionals have been slow to attribute a woman’s malaise to heart problems, so it’s doubly important that women preserve this vital aspect of their health and learn to recognize symptoms of malfunction that may arise.

Miriam Nelson is an associate professor of Nutrition Science, researcher and author of six previous health books. Alice Lichtenstein is a professor of nutrition science and policy who has done extensive research on nutrition and cardiovascular disease. Dr. Nelson shared some of the highlights of their findings.

Why is it so unrecognized that more women than men die from heart disease?
One reason is that historically, women have been under-represented in studies. Also, a lot of the spotlight has been on breast cancer rather than heart disease, at least in part because breast cancer tends to strike women at a younger age. For whatever reason, the media wasn’t picking up on heart disease prevalence in women, so the facts have stayed largely under wraps. Also, women’s diagnoses are often delayed, so the presence of heart disease is not always clear.

How do heart disease and breast cancer statistics compare?
Ten times as many women die of heart disease as of breast cancer. It’s not that breast cancer isn’t a devastating disease. But you can’t deny the numbers.

How are women’s heart attack symptoms different from a man’s?
When a man is having a heart attack, it’s typically as though a Mack truck is running over his chest. Women’s symptoms are often much more subtle—mild indigestion-like feelings, sometimes some jaw pain, fatigue, feeling winded. Also, men often have no symptoms before the heart attack; it just strikes. Women often feel lousy up to a month before—fatigue, indigestion and so on. That’s a silver lining. If a woman doesn’t feel great, she can get to the doctor, get intervention and avoid the heart attack.

What are the emotional factors that elevate the risk of heart disease, particularly for women?
While Type A personality appears to be a risk factor for men, it’s women who repress anger—bottle up their negative emotions—who might be at increased risk.

What indicators should signal concern for women?
Women should be on the alert for feeling more fatigued than usual in the course of their daily activities. They might also feel that tasks requiring exertion, such as carrying a suitcase or doing yard work, are more difficult than they used to be. There can perhaps be some jaw pain, along with a persistent feeling of mild indigestion. Finally, there might be a general feeling lousy, but it doesn’t go away the way a cold does—it just keeps lasting. None of these symptoms automatically mean you’re having a heart attack, but it does mean you should get to the doctor.

What tests should women have to assess risk?
Blood tests should be done to check for total cholesterol, “good” HDL-cholesterol, and “bad” LDL-cholesterol, along with testing for blood pressure and blood sugar. Body mass index should be determined, too, as well as waist circumference.

What about a treadmill test?
A treadmill test is rarely called for, but still, women do not get them often enough. Ironically, recent research has found that treadmill testing is more predictive for women’s heart disease risk than men’s.

The prevailing opinion on certain foods is often contradictory. Fish is healthy/fish is contaminated. Fat-free is best/fat-free is bad. Abstain from alcohol/drink in moderation. How can we make sense of all this conflicting information?
A woman should think more about food patterns than this or that food. There is an ever-growing body of research that gives a much clearer picture of what that pattern should look like—plenty of vegetables, fruits and whole grains; low- or nonfat dairy; fish at least twice a week; modest portions of other protein-rich foods like meat, poultry, beans and soy; use of the right types of oils; sweets and other treats now and then; and of course, calorie control. Look at the big picture.

Why do some weight-loss strategies work where others fail?
We looked at all the evidence on weight-loss strategies for long-term weight-control. Those consistently coming through as ones that work are a combination of behavioral strategies as well as wise food choices. Most importantly, however, they’re do-able. They become lifelong habits. This is not a diet that you go on and then off. It’s lifestyle rules rather than diet rules.

What advice would you give someone who’s been sedentary for years?
Start out very gradually with what I call decreasing sedentary living rather than plunging into a structured exercise program. Really do take the stairs rather than the escalator, really do park away from the supermarket entrance, and really do walk two bus stops and then get on. These little steps will acclimate you to moving your body. After a couple of weeks, you will feel ready to walk 15 minutes at a time just for exercise’s sake. But before that, simply fold more activity into your life here and there wherever you can. It’ll get you started on a lifelong activity pattern.

Why is it important to include strength training in your program?
Strength training does four things to reduce heart disease risk: It increases muscle strength, which allows you to do aerobics better (a good thing because aerobics directly target the heart and the rest of the cardiovascular system to get stronger). But strength straining also has independent effects.

It [also] decreases high blood pressure, decreases fat around the abdomen and keeps down blood sugar.

If you could distill a heart healthy lifestyle down to two or three principles, what would you say?
Maintain or move toward a healthy body weight. Follow a dietary pattern that’s low in saturated and trans fatty acids and high in fruits, vegetables, and whole grains. Be physically active most days of the week. Be good to yourself—take time to nurture yourself every day, even for just 15 minutes. Make medical appointments even if your life feels rushed and say “no” when you need to.

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