Alpha Phi Fraternity

Heart Disease
What are you doing to prevent it?

By Christine Spiegel
Copyright © 2008, Alpha Phi Quarterly

Heart disease is the number one killer of women in North America.
As Alpha Phis, we should know this. We promote cardiac care and spread the word about the importance of awareness in the prevention of heart disease. But are we doing enough for ourselves?

According to Dr. Martha Gulati (Theta Eta-Western Ontario), Winter 2008 Quarterly
Northwestern Memorial Hospital cardiologist and coauthor of
the newest guidelines on heart disease prevention in women published by the American Heart Association (AHA), preventing heart disease in women of all ages involves knowing the risk factors and being proactive about one’s own health.

“The new guidelines on heart disease prevention in women indicate nearly all women are at risk,” says Dr. Gulati.

The six risk factors for heart disease are high blood pressure, high cholesterol, diabetes, being overweight or obese, physical inactivity and smoking. Other factors, such as a family history of heart disease or any of the risk factors of heart disease, also can affect your level of risk.

In order to determine your own personal risk, Dr. Gulati recommends yearly screening, learning your numbers and being aware of changes in your numbers. (Click here for a printable "What to ask your doctor" form that includes a summary of the numbers a woman should familiarize herself with.)

Screening: what to ask your doctor
Beginning at age 20, every woman needs to be screened for heart disease, says Dr. Gulati. It should be part of your annual physical exam.

Screenings include blood work (to check cholesterol and kidney function), blood pressure check, heart exam, weight measurement and possibly waist measurement and a discussion with your physician about symptoms that may be of concern (chest pain during activity or at rest, lack of activity, etc.). Other tests such as a stress test or EKG may be recommended depending on symptoms.

Ask your physician two questions: Am I at risk? What can I do to reduce my risk? Your physician should discuss options depending on where
Click here for a printable       you fall on the risk scale (high, intermediate or low).
"What to ask your doctor"
form                                           Heart disease screenings should be considered routine under most
                                                    insurance plans (check with your plan to confirm and learn details). If you have never been screened, make an appointment with your primary care physician to do so. Women should be screened at least once a year, but an individual’s risk factors determine the regularity and number of visits to your doctor. For those at higher risk, your physician may recommend additional tests and examinations.

Know your numbers
Based on the results of your screening, you will have a set of numbers that allow you to calculate your risk for heart disease. Once you learn what is normal and not normal for you, you will know when they are not controlled. “Watch your own trends so you can cite what’s happening and have a more rational discussion with your doctor about why you’re concerned,” says Dr. Gulati. She notes one time when numbers will change, for example, is during menopause. “This is why we see an increase of heart disease in women after menopause,” she says.

Blood pressure: There are usually no symptoms of high blood pressure, so more than one-third of adults are unaware they have the condition. Normal blood pressure is 120/80 (systolic/diastolic) or lower. It is important to know where your numbers lie. If not normal, ask your doctor what you can do to keep your blood pressure under control. Suggestions to lower high blood pressure include decrease salt and fat intake, increase the amount of fruits and vegetables you eat, stop smoking and remain physically active. Menopause is a key time for women to discuss blood pressure and other numbers since it is an important time of change for their bodies, says Dr. Gulati.

Cholesterol: High cholesterol builds up plaque in your blood vessels and can cause heart attacks and strokes. Know your HDL (good) cholesterol, LDL (bad) cholesterol and triglycerides (bad) levels, and know what range is normal for you. As a general rule, a woman’s HDL should be greater than 50, LDL less than 100, and triglycerides should be less than 150. To keep cholesterol under control, it is recommended that you eat foods low in saturated fats and cholesterol, maintain a healthy weight and exercise.

Diabetes: People with diabetes have at least twice the risk of heart disease. Women with diabetes are at a greater risk of developing heart disease compared to men with diabetes. Warning signs of diabetes include frequent urination, excessive thirst or unusual weight loss. A healthy diet and exercise can help prevent and manage diabetes.

Heart-healthy habits
According to Dr. Gulati, even if your numbers fall in the low risk category, it is important to live a heart-healthy lifestyle.

“It is critical to maintain a healthy weight by eating wisely and getting daily exercise,” she says. “If you gain even two pounds per year, it adds up over several years. I am not recommending a diet or a drastic change in habits, but to start with small changes that become part of your life.”

Weight: Adults with excess body fat are more likely to develop heart disease – even if they have no other risk factors. For women, a waist circumference greater than 35 inches puts you at higher risk of developing diabetes and heart disease. Your physician can recommend a sensible nutrition and exercise program to help you reach and maintain a healthy weight.

Dr. Gulati says she reminds her patients, “Everything we put in our mouths, we should be thinking, am I going to burn off these calories?” There are 300 calories in an average chocolate bar. To burn 300 calories, one would have to walk or run three miles (one mile of exercise is equal to 100 calories burned).

Read food and drink labels. Note contents and number of servings. Pay attention to saturated fat (cut back), trans fat (eliminate completely), eat fish at least twice a week or take fish oil supplement, and eat fruits and vegetables (antioxidants help maintain heart health).

There have been many studies done on whether supplements work. The only supplement known for certain to be good for the heart, says Dr. Gulati, is fish oil. If you cannot get the recommended two servings of fish per week (best choices with Omega 3 are salmon, tuna and trout), then 500-900 mg of a fish oil supplement is recommended. For women of childbearing age and young children, supplements are recommended because of concerns over the mercury in fish.

“Portions are much larger today, and that is why it’s important to know what serving size should be,” says Dr. Gulati. “The burgers people eat today are three times the size of those from the 1950s. If you look on the label of even a small bag of chips, you’ll see it indicates a serving size of two.”

“There is an obesity epidemic and a diabetes epidemic today, and the worse it gets, the earlier we will see heart disease,” Dr. Gulati says. “We will start to see people having heart attacks in their 30s if we don’t stop this now.”

Exercise: Regular, moderate-to-vigorous physical activity improves your cardiovascular fitness and helps reduce your risk of heart disease. Exercise can help control cholesterol, diabetes, blood pressure and obesity. Physically fit women have lower rates of death from cardiac causes and also, from any cause.

The new guidelines recommend 60-90 minutes of exercise seven days per week. Dr. Gulati says the recommendation increased from 30 minutes daily because most women are trying to lose weight or achieve a more ideal weight. To maintain weight, 30 minutes of daily exercise is recommended.

Walk. Take the stairs. Make time to exercise each day. If you’re currently sedentary, check with your physician before beginning an exercise program, begin slow and work up to the recommended amount of daily exercise.

“It is important for parents to set an example for their children,” says Dr. Gulati. “If parents are sedentary, children will be too. Examine the example you are setting. Make healthy habits a family lifestyle."

Smoking: Smoking is the single most preventable cause of death in North America. It poses a greater risk to women than men. It is never too late to quit. Ask your physician for help and recommendations.

Even Alpha Phis, who are aware of the importance of cardiac care, don’t recognize heart disease in themselves, says Dr. Gulati. She says it is critical that we all take a more proactive approach to ensure our heart health by getting screened and learning our personal risk.

Resources
The following resources offer information specific to women and include everything from prevention – recommended heart-healthy recipes to ideas for getting motivated to exercise – to support after you’ve had a heart attack.

American Heart Association: www.americanheart.org
Women Heart: www.womenheart.org
U.S. Food and Drug Administration: www.fda.gov (food pyramid, healthy food ideas)

Calculate Your Risk for Heart Disease
When you know your numbers, you can calculate your risk for heart disease. If you do not know them, schedule a screening with your physician. The National Institute of Health risk calculator assesses 10-year risk for heart disease based on age, cholesterol and blood pressure levels and whether you smoke. Just plug in your numbers and learn your 10-year risk, take it to your doctor and ask what you should be doing to lower your risk. Visit http://hp2010.nhlbihin.net/atpiii/calculator.asp?usertype=prof for the calculator.

Martha Gulati Bio
Martha Gulati, MD, MS, FACC, is associate director of the Center for Women’s Cardiovascular Health at the Bluhm Cardiovascular Institute of Northwestern Memorial Hospital. She is also an assistant professor of medicine and preventive medicine at Northwestern University’s Feinberg School of Medicine. Her exceptional commitment to the study of women and cardiac disease has won her numerous awards and distinctions, including being named by Crain’s Chicago Business as one of Chicago’s “Top 40 under 40.”

Dr. Gulati is passionate about the study of women and heart disease with a specific interest in fitness and prevention. She is the primary investigator of the St. James Women Take Heart Project, a study examining cardiac risk factors in women, which set new standards for women’s fitness levels. She also is a co-investigator on the Women Ischemic Syndrome Evaluation (WISE) and previously served as a co-investigator on the Women’s Health Initiative (WHI). She is a member of numerous advisory boards and societies, including the American Heart Association and the American College of Cardiology. She has published articles in peer-reviewed publications, including The New England Journal of Medicine, Circulation and Journal of the American Medical Association (JAMA). Her research has been featured in hundreds of newspapers across the world, including The New York Times and USA Today. She has also been featured on “Oprah” and in Oprah Magazine, Fitness Magazine and on CBS National News and NBC-5 Chicago. She recently was listed on the Marquis 2007 Who’s Who in America. Dr. Gulati completed medical school at the University of Toronto, Canada, in 1995, and her internship, residency, and cardiology fellowship at the University of Chicago. She received a master of science degree from the University of Chicago and is a fellow of the American College of Cardiology. She is board certified in both internal medicine and cardiovascular disease.