Jonathan Sackner-Bernstein, MD
Biography

	If my cholesterol level is high, what do I do? What are symptoms of heart problems in women? What are heart attack symptoms in women? I am 40 with a family history. Should I be on a statin?
	Silent Risk: Women and Heart Disease

Other conditions may get the headlines, but doctors know heart disease is the No. 1 killer of women, according to the American Heart Association. What can you do to take your heart off your own list of worries? We welcomed Jonathan Sackner-Bernstein, MD, author of Before It Happens to You: A Breakthrough Program for Reversing or Preventing Heart Disease, on April 28, 2004

If you have questions about your health, you should consult your personal physician. This event is meant for informational purposes only.

SACKNER-BERNSTEIN:
As I describe in my book, Before it Happens to You , the three facts you need to know to reduce your risk from heart disease are:

• Your blood pressure
• Your cholesterol
• Your glucose level

You should start to check these by the time you're 20 and at an ongoing basis thereafter.

MEMBER QUESTION:
What should they be?

SACKNER-BERNSTEIN:
There are two ways to answer this question. One way would be to follow the standard guidelines. The problem with the standard guidelines is that they establish levels that are cost effective for society. Instead, you should follow the evidence in the scientific literature, which defines stricter guidelines in order to minimize your risk. Those goals are:

• A blood pressure of 115/75
• An LDL cholesterol (your bad cholesterol level) of less than 100
• A glucose level of less than 100

Ideally, a woman's HDL cholesterol should be above 50, but this can be difficult to achieve.

MEMBER QUESTION:
My doctor never tells me my numbers; she just says, "You're fine."

SACKNER-BERNSTEIN:
This is a very common scenario. Your goal is to be in control of your health. Without knowing your numbers you can't be in control, and you won't know whether your health is truly optimal. In my book I describe the ways to speak with a doctor like yours in order to make the relationship work for you to optimize your health.

One of the major goals in writing my book was to provide specific examples and scripts to enable you to communicate more effectively with your doctor. For example, if your doctor is resistant to measure your cholesterol, you can simply ask, "Is there any risk to having this test?" It would be unimaginable for a doctor to say yes. Then you can follow up by saying, "Since there is no down side and scientific evidence says that my risk is minimized when my bad cholesterol is under 100, wouldn't it be to my advantage to know my cholesterol levels?"

MEMBER QUESTION:
So if I get my cholesterol level and it's high, what do I do then?

SACKNER-BERNSTEIN:
The standard approach to treating any of these abnormalities is to start with a therapeutic lifestyle change. An optimal lifestyle includes adjustment of diet and exercise routine, as well as stress management. It is unusual for a person to have the ability to drastically change their lifestyle for the duration of their life. Although it would be ideal to do so, I focus on practical steps that you can achieve whether or not you are one of the few people who can change.

Therefore, the primary focus of my book, Before It Happens to You , is to utilize the scientific data that describes the safest ways to minimize your risk. As an example, control of cholesterol can be achieved in almost all patients through the use of medicines called statins. These medicines are safer than taking antioxidant vitamins that you can buy at the health food store. Ideally, you would change your lifestyle and, when necessary, take such medicines, but even if you're like most people and can't change, you can still minimize your risk of a heart attack or stroke by optimizing your cholesterol, your blood pressure, and your glucose.

"Women have to realize that heart disease is a major risk and pay attention to their own risks first and then worry about husbands, friends, and other relatives."

MEMBER QUESTION:
:Should women be taking aspirin for heart health?

SACKNER-BERNSTEIN:
Aspirin, used in low doses, is a standard recommendation for postmenopausal women and those at high risk for heart disease. If you were to examine the data supporting that recommendation, and compared it with the scientific evidence for other medicines used for the treatment for cholesterol and blood pressure, you would learn that although aspirin is very useful, its usefulness and safety are not nearly as impressive as these other medicines.

Specifically, by using blood pressure medicines, such as ACE inhibitors, beta-blockers, and sometimes diuretics, in addition to statins to optimize your cholesterol, you can cut your risk of a heart attack or stroke by about half, for a typical middle-age woman.

To give you a specific sense of what this means, we can consider the risk that a typical patient may face. I recently saw a 57-year-old woman with borderline blood pressure and cholesterol levels that were typical of a postmenopausal woman. When calculating her risk of a heart attack or dying from a heart attack, in the next year, it turns out that that risk is .4% of a heart attack or .4% of dying within a year of that heart attack. That means that this woman who would be told to change her lifestyle has a risk of dying within two years of one in 1000. No study has shown that changing her lifestyle will affect that risk very much.

In contrast, by reducing her blood pressure with an ACE inhibitor or beta-blocker and optimizing her cholesterol with a statin, her risk would drop about 80%.

The opinions expressed herein are the guests' alone and have not been reviewed by a WebMD physician.