Q&A with Dr. James Rippe: Women's Heart Health
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Q&A with Dr. James Rippe: Women's Heart Health

Leading cardiologist Dr. James Rippe answers key questions.

Heart Disease in Women

Dr. Rippe
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Dr. James Rippe

With more than 450,000 women dying from it each year, heart disease is the leading cause of death for women in the United States. More women die of heart disease than men. The lifetime risk of heart disease in women is six times greater than the risk of dying of breast cancer. After menopause, the risk of dying of heart disease increases tenfold.

Healthy lifestyles, which include increased physical activity and increased fiber consumption, have been shown to significantly reduce the risk of heart disease in women. A recent Nurses Health Study article showed that positive health-promoting behaviors can prevent 80 percent of all heart disease in women.

Here, Dr. James Rippe, renowned cardiologist and leader in modern linkages between health and lifestyle, answers key questions about your heart health. Dr. Rippe is coauthor of Fitness Walking for Women, Heart Disease for Dummies, and The Healthy Heart Cookbook for Dummies, and editor of Irwin and Rippe's Intensive Care Medicine. He is also the director and founder of the Rippe Health Assessment at Celebration Health and the Rippe Lifestyle Institute in Shrewsbury, Massachusetts.

Heart Health Basics

Q: When should a woman first start thinking about her heart health? Why then?A: The origins of heart disease are thought to be in childhood. Women should be concerned about heart disease early on and throughout their lives. They should be concerned about cardiovascular health for their children, also.

Q: Compared to her worries about breast cancer, how concerned should a woman be about the health of her heart? Why?A: Heart disease is the leading cause of death in women. Most of the risk factors for heart disease are under a woman's control and it is critically important that every woman be informed about the risk of heart disease and that she take steps to lower risk factors.

Q: What are the risk factors for heart disease?A: To be considered a significant risk factor for heart disease, the risk factor has to at least double the risk of heart disease. There are five lifestyle related risk factors for heart disease: high blood pressure, elevated cholesterol (or other lipid problems), cigarette smoking, an inactive lifestyle, and obesity.

Heart Health & Heredity

Q: How important is heredity to a woman's heart health?A: Family history of premature atherosclerosis (hardening of the arteries) is a significant risk factor for heart disease. If a woman has any first-degree relative (brother, sister, mother, or father) who has suffered symptomatic heart disease before the age of 60, she has a significantly increased risk of heart disease.

Q: What is symptomatic heart disease? A: Symptomatic heart disease is simply when an individual has chest discomfort or shortness of breath caused by underlying cardiac problems.

More Heart Basics

Q: How are things changing or improving to help women live longer, heart-healthier lives?A: Prior to 10 years ago, most of the information from research trials did not include women. Now it is federally mandated that research studies include women. Important new information has emerged on the reduction of cardiovascular risk factors in both men and women. Specifically for women, data is available on weight management, lowering cholesterol and blood pressure, and enhancing physical activity.

Q: What is the latest thinking on the relationship between drinking wine and having a healthy heart? Which is better for women? Red wine or white wine? Why?A: Multiple studies have shown that moderate alcohol consumption lowers the risk of heart disease. We never recommend that an individual who doesn't drink alcohol start consuming it. It is important for women to understand that moderate consumption of alcohol for women is lower than for men. For women, we recommend the consumption of no more than one glass of wine per day or one beer or one shot of distilled spirits.

Red wine is thought to contain more health benefits than white wine. This is possibly because some of the natural chemicals contained in the grapes' skins and stems are left in the wine-making process longer in making red wine than in making white wine. These chemicals are thought to yield additional cardiovascular benefits over and above the alcohol in wine. Incidentally, these chemicals are also present in grape juice, although consumption of a larger quantity of grape juice is thought to be necessary in order to get the cardiovascular benefits.

Heart Health in Your 30s & 40s

Q: What are some realistic things women can do to improve their heart health in their 30s?A: A woman should be establishing a heart-healthy lifestyle including regular physical activity, such as moderate- intensity walking, proper weight management, and proper nutrition, including increased consumption of both fiber and calcium. In addition, regular medical care should be established. Every woman should know her blood pressure and lipid profile. No woman of any age should smoke cigarettes.

Q: What are some realistic things women can do to improve their heart health in their 40s?A: All of the recommendations for women in their 30s also apply to women in their 40s. Particular emphasis should be placed on regular physical activity, including a fully monitored exercise treadmill test, and weight management. During an annual physical examination, blood pressure, cholesterol determinations, and a high speed CT scan of her coronary arteries should be taken. A blood pressure of less than 120/80 mm Hg is now considered normal for both men and women.

Heart Health in Your 50s & 60s

Q: What are some realistic things women can do to improve their heart health in their 50s?A: By their 50s, most women will have gone through menopause or at least be in the midst of it. This is a particularly important time from a cardiovascular risk standpoint. By the end of her 50s, a woman has at least the same risk of heart disease as a man does. All of those lifestyle issues already discussed for women in their 30s and 40s become even more important for women in their 50s.The issue of whether or not to use supplemental estrogen is now quite controversial. We believe that supplemental estrogen should only be used in the short term to control symptoms of menopause where necessary.

Q: What are some realistic things women can do to improve their heart health in their 60s?A: It is important to remember that a woman who reaches the age of 65 has greater than an 80 percent chance of reaching the age of 80. Thus, all of the risk factor reduction issues that we have discussed become all the more important. Blood pressure control is also particularly important.Since there is an age-related increase in the prevalence of heart disease, women in their 60s need to be particularly concerned about any symptoms that might suggest heart disease. Symptoms such as shortness of breath or any evidence of chest discomfort should be taken very seriously. Many studies have shown that women tend to underestimate their own symptoms and that the medical profession also underestimates women's symptoms of heart disease.

Too Late to Improve Heart Health?

Q: Is there a point of no return, when a woman simply can't improve her likelihood of having a healthy heart?A: A woman can lower her risk of heart disease at any age! Even women in their 60s, who may have heart disease, can still lower their risk of heart disease-related problems by adopting a heart-healthy lifestyle. At my clinic, we recommend that women over the age of 50 not only have a regular treadmill test at our clinic but also have regular high speed CT scans of their coronary arteries. Even if a woman does not have symptoms, we feel this is an important way of monitoring whether or not any early evidence of chronic atherosclerosis is present and whether or not it is progressing.

Q: What are acute coronary syndromes?A: Acute coronary syndromes represent sudden onsets of discomfort or excessive shortness of breath caused by narrowing or complete closure of one or more coronary arteries. These are acute in the sense that they happen suddenly. They typically present either with chest pain (angina) or in some instances a heart attack (myocardial infarction).

Treatment Options

Q: If a woman is informed she has heart disease, what are her treatment options today?A: There are many wonderful treatment options available today for women who have heart disease. Significant advances in the areas of both noninvasive testing and invasive procedures have occurred. Recent research trials have established more effective procedures for clot busting for acute coronary syndromes, and a more sophisticated understanding of angioplasty and stents is now available.

Q: What is angioplasty? A: Angioplasty is a procedure where a long tube (catheter) is inserted into a coronary artery. This catheter has a balloon near the tip of it. The balloon is then inflated to press the narrowing of a coronary artery up against the wall. Angioplasties are extremely common procedures in the cardiac catherization laboratory.

Q: What is a stent?A: A stent is a mechanical device (typically a fine mesh wire tube) that is inserted inside a coronary artery to serve as kind of a scaffolding to keep the artery open. Recently, newer stents have been developed that actually also have drugs contained in them that decrease the likelihood of the coronary artery closing up again (re-stenosing). Stents are typically put in place following an angioplasty to provide a structure inside the wall to prevent the significant problem of the artery closing down again.

Q: Does the treatment depend on the age of the woman?A: Women of all ages should be aware of the significant lifelong risk of heart disease and take proactive steps to lower their risk. With the new information on women and heart disease available in the last five to 10 years, heart disease therapies can now be geared specifically to women.

 
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