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Did you know that 90% of heart and blood vessel disease (what doctors call atherosclerotic cardiovascular disease - ASCVD) is preventable? And did you know that only two of the risk factors for developing ACVD cannot be modified? One is your age. You can lie about your age but that doesn’t change it! The other is family history, and although you may wish you had different relatives or genes, at least today you’re more or less stuck with those you were born with. While you cannot change certain risk factors, Speaking of Women’s Health believes that the more you know about what you can do, the healthier you will be.
For women, the age at which she is considered to be at risk for ASCVD is 55 or more (it’s 45 for a man). A family history of premature heart disease is present if a female first degree relative (like a parent or a sibling) had heart disease prior to age 65, or a male first degree relative had heart disease prior to age 55.
What are the other risk factors for developing plaque in the arteries, those blood vessels that carry oxygen and nutrients to every cell of the body? The modifiable risk factors are unhealthy levels of blood fats, smoking, high blood pressure, diabetes, obesity, sedentary lifestyle and inflammation.
Cholesterol is an important blood fat that is carried in the bloodstream by special proteins called "lipoproteins." The lipoproteins are classified based on their density into VLDL (very low density lipoprotein), LDL (low density lipoprotein) and HDL (high density lipoprotein). Your total cholesterol is the sum of these three.
VLDL is the major carrier of triglycerides, blood fats which are increased in diabetes, obesity and some inherited diseases. High levels of triglycerides increase a woman’s risk of ASCVD more than they increase a man’s risk. A normal fasting level of triglyceride is under 150 mg/dl. Avoiding starchy carbohydrates and maintaining a normal body weight are important in keeping your triglyceride level normal. If that is insufficient there are medicines that treat high triglycerides.
LDL is the so-called "bad" cholesterol (think L for lousy). When LDL cholesterol is elevated the risk of ASCVD increases. However, elevations of LDL cholesterol are less risky for women than they are for men. Avoiding saturated fat (animal fat, palm oil and coconut oil) and trans fats (partially hydrogenated vegetable oils) is the first step in lowering LDL cholesterol when it is elevated. Women who have vascular disease need to get their LDL cholesterol levels as low as possible, and a class of medicines called statins has been shown to lower the risk of cardiac events in women with vascular disease (just as they lower risk in men). However, no study has shown that putting a woman who does not have vascular disease on a statin medicine lowers her risk of a cardiac event. This may be because only about three thousand women have been included in such studies. But it may also be because LDL cholesterol elevations are less of a risk factor for women than men.
HDL is the so-called "good" cholesterol (think H for healthy). HDL cholesterol actually removes cholesterol from plaque, making it less likely to rupture and cause a heart attack or stroke. The normal level of HDL cholesterol for a woman is 50 mg/dl or above. Regular exercise, avoiding smoking, maintaining normal body weight and consuming monounsaturated fats (olive oil and canola oil) all are effective in raising levels of HDL cholesterol. I tell my patients with low HDL to consume 2 to 3 tablespoons of olive oil a day
Smoking is just a socially acceptable form of suicide. The chemicals inhaled from cigarettes poison every cell in the body.
High blood pressure is known as the "silent killer"; you can walk around with scary levels of blood pressure and experience no symptoms. Get your blood pressure checked and take medicine if your doctor prescribes it. Lowering blood pressure has been shown to lower your risk of heart attack, stroke and kidney failure.
We are in the midst of a diabetes epidemic, which is being caused by the epidemic of overweight and obesity. Two-thirds of Americans are overweight or obese. We are eating more and more and exercising less and less
– a recipe for disaster. Walk briskly for 30 minutes most days of the week, avoid junk food and limit portion size if you want to lower your risk of developing diabetes.Even if you are not overweight, if you don’t exercise you have a higher risk of developing ASCVD than someone who exercises regularly. If you can’t exercise during the week, exercise on the weekends. Climb stairs rather than taking the elevator. Walk everywhere you can. Do arm curls while you watch TV (or better yet, set up a treadmill in front of the TV and walk while you watch). In bad weather, take a walk at your local mall.
Many people have read about C reactive protein (CRP), a marker in the blood for inflammation. It is a fact that elevations of CRP are associated with increased risk of vascular disease. Unfortunately we don’t know the best way to lower CRP, or if lowering CRP lowers the risk of vascular disease. We do know that smoking, having increased fat around the waist and diabetes all increase CRP. If you are leading a heart healthy lifestyle, you are probably optimizing your CRP in a way that is completely safe.
In the end, preventing ASCVD is not all that difficult. If you smoke, STOP. If your blood cholesterol, blood sugar or blood pressure is high, get it down. Eat a heart healthy diet, exercise most days and pick your parents wisely. (If you can figure out that last one I can guarantee that the Nobel Prize committee will be calling on you!)
