But studies show that heart disease is the number 1 threat to a woman's health -- causing nearly 1 in 3 deaths in women compared to 1 in 30 for breast cancer. Yet heart experts say that far too many women don't take the risk of heart disease seriously and are failing to take steps to prevent it.
"We need for women to start thinking about prevention now. They can't wait until menopause to take care of their hearts," says Nieca Goldberg, MD, founder of the Women's Heart Program at New York University Medical Center in New York City and author of Women Are Not Small Men: Life-Saving Strategies for Preventing and Healing Heart Disease.
The experts all agree: don't get scared; get busy. In February 2007, the American Heart Association (AHA) published new guidelines on preventing heart disease in women. They advise you to take steps for your heart health now to prevent a heart attack or stroke in the future.
To get on the right track, follow these 12 steps for a heart-healthy lifestyle.
Healthy Heart Step 1: Get real about your risk. "The first roadblock is that heart disease is thought to be a man's disease, and women do not perceive themselves to be at risk," says Thriveni Sanagala, MD, assistant professor of medicine in cardiology at Loyola University Chicago, Stritch School of Medicine in Maywood, Illinois. "Awareness equals motivation to make changes that lead to a healthy heart," she says.
Healthy Heart Step 2: Know what a heart attack feels like. What you think is heartburn or nausea could actually be signs of a heart attack. While the most common symptoms in both women and men are chest pain and discomfort, women are more likely to experience other symptoms -- shortness of breath, nausea or vomiting, back or jaw pain, and unexplained fatigue, Sangala says.
Healthy Heart Step 3: Quit smoking now. Smoking is a major risk factor for heart disease. "Quit now," Goldberg says. "Find a technique that works for you. Options can be anything from smoking support groups, nicotine replacement and medication, to acupuncture and hypnosis." If one way doesn't work, try another, and keep trying until you succeed. The bottom line for heart disease prevention? Just do it.
Healthy Heart Step 4: Start your healthy-heart checkups at age 20. "All women should be screened for heart disease starting at 20," saysGoldberg. Ask your doctor to check your cholesterol and blood pressure, and screen you for diabetes. "We have to work on risk factors early, including high blood pressure, high cholesterol, lack of exercise, smoking, and diabetes," she says. If your mom had a heart attack before age 60 or your dad had one before 45, your family history ups your risk, as well.
Healthy Heart Step 5: Whittle away your middle. Being overweight is a major risk factor for heart disease -- and where you store your fat plays a role. "Women who carry their weight around the middle, as opposed to the butt, hips, and thighs, are at highrisk for heart disease," says Marie Savard, MD, an internist in private practice in Philadelphia and author of How to Save Your Own Life. "The good news is that this may be the most dangerous fat to have, but it's the easiest fat to lose," Savard says.
How to lose that "menopot" of belly fat that can accumulate later in life and raise heart disease risk? Steer clear of devilish white carbohydrates. "When women approach menopause," says Goldberg, "they become more carb-intolerant and more sensitive to the effects of simple sugar and white carbohydrates. Decrease your intake of sugar and white-floured foods," Goldberg says. Instead of white rice, order brown rice with Chinese take-out. Ditch that Kaiser roll for whole wheat toast.
Healthy Heart Step 6: Say no to trans fats. Women who eat the most trans fats (or trans fatty acids) are 3 times more likely to develop heart disease than women who eat fewer trans fats, according to a study of nearly 33,000 women done by researchers at the Harvard School of Public Health and published in Circulation: Journal of the American Heart Association. To lower heart disease risk, scale back on trans fats by avoiding fried foods and eating fewer packaged foods like cookies, crackers, and pastries. "Women need to look at good nutrients from all food groups, including good fats like canola and olive oils, flaxseed oil, and walnuts," Goldberg says.
Healthy Heart Step 7: Get more exercise. High cholesterol is a risk factor for both sexes, but women may be harder hit than men. Women with "good" cholesterol (high-density lipoprotein, or HDL) levels lower than 50 -- and triglycerides above 150 -- may be at higher risk of heart disease then men with similar numbers. "The magnitude of these risk factors is greater in women than men," says Goldberg. To compensate, she says, "Make your life more aerobic." Aerobic exercise helps boost your "good" cholesterol and lower the blood fats known as triglycerides. Bonus: Exercise also helps reduce blood pressure and keep weight your down.
Sangala agrees. "Aim for at least 30 minutes per day on most days of the week," she says. Kick it up a notch, to 60 to 90 minutes, if you're at higher-than-average risk of heart disease or need to lose weight. And don't make it any harder than it has to be. "You don't have to do very intense exercise that will make you feel weak and achy," she says. "A brisk walk is fine."
Healthy Heart Step 8: Shake your salt habit. After 55, women are more likely to develop high blood pressure than men,says the AHA. Eating too much salt can raise your blood pressure -- which is why all heart-healthy recipes use no salt at all, or low-sodium ingredients.
Your goal? Keep your blood pressure at 120/80 mm/Hg or below. Start by tossing out your salt shaker and reading food labels to add up the sodium content, Goldberg says. "Limit your salt intake to less than 2.3 grams of salt per day," she says. The AHA agrees: most doctors advise limiting yourself to 2,300 mg of salt daily. "Restaurant food tends to be heavily salted," Goldberg says, "so ask for the sauce and salad dressings on the side."
Healthy Heart Step 9: Eat fish twice a week."Eating fish at least twice a week can lower your triglycerides and help boost your levels of HDL, or 'good,' cholesterol," says Sangala. The key is to eat fatty fish like mackerel, salmon, or sardines, which are high in omega 3 fatty acids, the protective fats good for your heart.
If you already have heart disease or high triglycerides, ask your doctor if fish oil supplements might be right for you. There are 2 forms of omega 3 fatty acids found in fish oil supplements -- EPA (eicosapentaenoic acid) and DHA (docosahexaenoic acid) -- which the AHA advises to help some women build a more healthy heart.
Healthy Heart Step 10: Limit alcohol. While an occasional glass of red wine might be heart-healthy, too much wine, beer, or liquor does more harm than good -- especially for women. "Women can have one glass of wine a day," Sangala says, "because when they begin to take more than that, it can actually raise your triglycerides, so you can lose some of the benefits."
Healthy Heart Step 11: Control stress. "Women tend to be eternal caregivers, meaning that they provide care without limits or boundaries and often get swallowed up in a hectic schedule," says Pamela M. Peeke, MD, MPH, assistant professor of medicine at the University of Maryland in Baltimore and author of Body For Life for Women. "This increases levels of the stress hormone cortisol on a chronic basis, and high levels of cortisol are known to set women up for heart disease, high blood pressure, stroke, and heart attack."
Stress also kick-starts a vicious cycle of turning to food for comfort. Your best bet? Learn to say no more often, she says. "Breathing also works like a charm when you feel yourself getting distressed," she says. "Take a deep breath and blow it out slowly."
Healthy Heart Step 12: Reduce your risk of diabetes. "Women with diabetes have 5 to 7 times the risk of heart disease or heart attack," Peeke says. She suggests measuring your girth -- the circumference around your abdomen at the belly button. "Make sure your girth is below 35 inches; if it's not, we have a big problem. You are now at huge risk for diabetes and heart disease."
If you're overweight, you can lower your risk of diabetes -- and thus heart disease -- by dropping pounds. For starters, Peeke says, "Try eating small meals every 3 or 4 hours so you don't binge. Reign in your portions and refined sugars, and watch the quality of your carbs." In other words, she says, "Opt for oatmeal, not a scone at Starbucks."