Beauty and the Beat

Maintaining cardiac health

Illustration by Stephen Sauer

If you haven't heard, 2013 is the year of the snake, according to the Chinese zodiac. That means anyone born this year is expected to possess certain characteristics, including alertness and awareness, which are presumably snake-like qualities. (No offense to snakes, but thankfully, we wouldn't really know many snake-like qualities if they bit us - the qualities, that is, not the snakes.)

In honor of the year of the snake, let us all do our part to honestly assess and acknowledge threats to our health. For women, what do you suppose tops the list? Many women would rank cancer pretty high, and rightfully so. But when it comes to mortality, the average woman should fear heart disease the most. It is the number-one killer of U.S. women, striking down one in three women each year, according to the American Heart Association.

Despite attempts to raise public awareness, such as the American Heart Association's "Go Red" campaign, misconceptions about women's cardiac risk continue to exist. In particular, the myth that heart disease is a man's problem continues to stubbornly persist. For instance, when was the last time you saw a movie or television episode that depicted a woman clutching her chest and collapsing from a heart attack? More typically, it's a man. And yet, researchers say that heart disease kills about the same number of women as men in the United States each year, leading to nearly 300,000 deaths annually.

Many doctors caution that the notion that heart disease is a "man's disease" is not borne out by statistics. For example, this year, more women than men will die of heart disease and stroke combined, says Richard Boss, MD, a cardiologist at Concord Hospital Cardiac Associates. But the idea lingers - even among some healthcare providers - that women are not at high risk of heart disease, Boss says. "I think the perception is that women die more commonly of diseases like breast cancer, which is certainly a very worthy cause, but one in 26 women die of breast cancer, [while] one in two die from heart attack or stroke," he says.

The term "heart disease" refers to an array of conditions and diseases that affect the heart, including coronary artery disease, heart rhythm aberrations and physical defects. Women and men who make unwise lifestyle decisions - choosing to smoke, eat unhealthful foods and forgo exercise, for example - raise their likelihood of developing heart disease. And fallout from those risk factors is as significant for women as it is for men, making denial of heart disease in women dangerous.

Clearly, women need to be aware of their risk and live their lives accordingly, experts say. "There needs to be a shift in the way that we as women look at our health needs," says Kristine Ziemba, MSN, APRN, CLS, a cardiology nurse practitioner who is clinical director of the Women's Cardiac Center and associate clinical director of the Cholesterol Management Center at the New England Heart Institute of the Catholic Medical Center. Even women whose personal medical past includes cardiac trouble sometimes try to explain away new symptoms, Ziemba says, chalking them up to a variety of causes that have nothing to do with their heart.

Improved awareness and open-mindedness regarding women's chances of cardiac trouble are crucial, especially given that women's symptoms tend to be somewhat unpredictable, making clear warning signs hard to come by. Women's cardiac symptoms often don't follow the well-known pattern that men typically experience. "Men more commonly present with typical chest discomfort - tightness in the chest, pressure," Boss says. "While women can do the same thing, they more often present with some atypical chest discomfort or shortness of breath, which raises a lot of other concerns. If you add that to the bias that this is not really a disease of women" you can see how trouble develops, he says.

Genetics can also complicate matters, sometimes sealing people's fate despite the best of intentions and a lifetime of healthful choices. Risk of cardiac trouble climbs if a family history of heart disease exists, Ziemba says. "The more family members you have that have been afflicted with vascular disease, strokes, heart attacks and so on, and the younger they are when they develop their events," the higher your risk as an individual. "As an aging woman, specifically a post-menopausal aging woman, [heart disease] is your number-one health risk," Ziemba says. "You can do everything right sometimes and still have to deal with this. Your genetic tendency, your family history, is a very potent contributor."

There is a bright spot: women's age-associated risk of cardiac woes typically lags men's by about 10 years, probably due to estrogen's protective effect on blood vessels and cholesterol, experts say. Once menopause hits, however, women's risk of cardiac trouble mirrors that of men, Boss says. So the prudent course for all to follow is prevention, which can go a long way toward mitigating risk and can help reduce the chance of developing future cardiac problems in individuals who have already experienced a heart attack or other heart-related trouble.

First, Prevention

Lower your risk for heart disease

Nearly two-thirds of women whose heart disease results in sudden death experience no symptoms beforehand, according to the Centers for Disease Control and Prevention, which is all the more reason to do what you can to lower your risk. Don't put yourself in harm's way to begin with - many varieties of heart disease are preventable.

What can you do? Make smart lifestyle choices that focus on the well-known linchpins of health:

  • Keep your blood pressure and cholesterol under control.
  • Don't smoke.
  • Maintain a healthy weight and diet.
  • Avoid a sedentary lifestyle.
  • Steer clear of excessive alcohol use.

For more information, visit

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