Heart Attack

Heart Attack

Don't Ignore the Possibility

Every so often you hear about a woman cut down in her prime by a heart attack. So you wonder "Can it happen to me?"

Don't panic. Until menopause, most women have natural protection against heart attacks. In fact, experts say that just over one-half of 1 percent of heart attacks occur in women ages 44 and under.

But while heart attacks are uncommon among premenopausal women, that doesn't mean you shouldn't do everything you can now to make sure you don't have one.

Few things in life can age you as rapidly as a heart attack.

It can strike like lightning, though the stage may have been set with years of fatty deposits forming in your coronary arteries.

When Luck Runs Out

By definition, a heart attack is a reduction or blockage of blood flow in a coronary artery that causes potentially life-threatening damage to the heart. And although our society tends to think of heart attack as a man's problem, more than 500,000 women have heart attacks each year, often visited by the crushing chest pain, heavy sweating and shortness of breath that are signs of a sudden clot in a coronary artery and its effect on the heart. One-third of these heart attacks are fatal. Four in five heart attack deaths occur in those ages 65 and older.

When it comes to our hearts, women are much luckier than men. In our premenopausal years, the female sex hormone estrogen provides natural protection against the sinister forces of heart attack that begin striking men in large numbers in their middle years. But once we go through menopause, those natural defenses just about vanish. As we grow older, our hearts and the blood vessels that nourish them begin to show and feel their age, even without the dramatic intrusion of a heart attack. The heart gradually starts to pump a little less efficiently, and the walls of the arteries become a little stiffer and less flexible.

And then there's the heart attack itself. In just minutes or hours, it can take a devastating toll upon your body, as though you were adding 20 or 30 years to your age overnight. As the supply of blood to your heart is impaired, the heart cells can become severely injured. The longer this blood flow is interfered with, the greater the chance of irreversible damage, producing cell death and the demise of part of the heart muscle.

But there's good news, too. Most heart attacks are preventable, no matter what your age, if you adopt lifestyle habits that can slow the buildup of fatty deposits in your coronary arteries. Yes, there are exceptions to this rule. On rare occasions, stress might set off a heart attack, even in a young woman without heavily clogged blood vessels. "Coronary arteries can go into spasm in stressful situations, which can reduce the blood flow to the heart," says James Martin, M.D., a family physician with the Institute for Urban Family Health at Beth Israel Medical Center in New York City. "If the spasm lasts long enough--for about seven to ten minutes--you can have a heart attack."

But that type of scenario is extremely rare. Chances are you have a lot of control over the health and longevity of your heart.

Fight the Good Fight

So where do you begin? Here are some crucial strategies to keep in mind.

Know yourself. "It's important to know where you stand," advises Richard H. Helfant, M.D., vice chairman of medicine and director of the cardiology training program at the University of California, Irvine, Medical Center and author of Women, Take Heart. That means being aware of the risk factors that may increase your chances of having heart problems. As a woman, you have estrogen as one of your greatest allies in fighting off heart attack--but your body's production of estrogen dwindles after menopause. Also, if close relatives have had heart attacks at early ages--less than 55--you need to be extra cautious. And if you have conditions that increase your risk that you can change--high blood pressure, an elevated blood cholesterol level, diabetes or a cigarette habit--you need to attack and control them before they attack your heart. Talk to your doctor about how to do that.

Toe the line. No one is asking you to be a fanatic. You don't have to swear off red meat or work out at the gym until you can't see straight. But if you live a reasonably careful, energetic lifestyle, you can keep your heart beating with the vigor of a much younger woman, with less worry about the Big One.

Get active. If you're one of those women who feels more comfortable with a TV remote control in her hand than with a tennis racket, it's time for a change of heart. Regular exercise, such as brisk walking for just 30 to 45 minutes three times a week or some laps in the pool, can turn that pump in your chest into a mean machine.

"Exercise is beneficial for your heart in a number of ways," says Stephen Havas, M.D., associate professor of epidemiology and preventive medicine at the University of Maryland School of Medicine in Baltimore. "It can boost your HDL (high-density lipoprotein) cholesterol, which is the protective component of your blood cholesterol level. It also can modestly decrease your blood pressure and help you control your weight." It can help keep your heart fit and conditioned, too, just as it gets the other muscles in your body into shape.

Eat right. It's not a magic bullet, but proper diet can be the heart and soul of any personalized cardiac care program. According to Fredric J. Pashkow, M.D., medical director of the Cardiac Health Improvement and Rehabilitation Program at the Cleveland Clinic Foundation in Cleveland and author of The Woman's Heart Book, research shows that the best way to keep your heart out of danger is to slash the fat and cholesterol in your diet. That means when it comes to menu planning, choose fish more often than steak, skim milk more frequently than whole milk, egg whites rather than whole eggs and low-fat frozen yogurt instead of ice cream. Keep your daily dietary fat intake to 25 percent or less of total calories.

Consider hormones. Estrogen replacement therapy can cut your risk of heart attack by as much as one-half to one-third, according to Dr. Helfant.

But you must talk over your options with your doctor. "There's a potential downside to hormonal therapy," says Dr. Helfant, "such as an increased risk of endometrial cancer and perhaps breast cancer, too." If you have a family history of endometrial or breast cancer or other risk factors, you and your doctor may decide that hormonal therapy isn't for you.

After You've Been Struck

Prevention may sound good, but what if you've already endured the terrifying experience of a heart attack? Well, count your blessings that you survived it--and then make a commitment to some health habits that might keep you from going through it a second time and that might put you on the fast track to a zestful, healthful life. If you've bought into the belief that a heart attack will permanently impair your mobility, activity level, job function or sex life, it's time to dispel those myths. Despite your heart attack, your best years can still be ahead of you.

With lifestyle changes, you should be able to reduce your risk of having another heart attack, says Dr. Helfant. "These changes will also allow you to take control of your health and live a purposeful, meaningful life while protecting yourself to the maximum degree possible."

So what kind of action should you take? The recommendations may sound familiar, but here's the specific impact they can have when a heart attack is part of your medical history.

Eat healthfully. After something as major as a heart attack, you might think the damage that has been done to your heart makes simple measures such as healthier eating about as helpful as applying a Band-Aid to your chest. But when researchers at the National Heart, Lung and Blood Institute conducted an analysis of studies of heart attack survivors, they found that people could significantly decrease their chances of having another heart attack by reducing their high blood cholesterol readings. Various studies have shown that declines in blood cholesterol levels of 10 percent cut the risk of having a second heart attack by between 12 and 19 percent. A key to lowering blood cholesterol is cutting back on saturated fat (the kind found in animal products and tropical oils) and dietary cholesterol (found in most animal products).

Move it. In many programs for heart attack recovery, physical activity is the center of attention, often beginning at very modest levels even while women are still hospitalized. Most cardiac rehabilitation programs recommend exercising for 15 to 30 minutes at least three times a week.

"People who have done no exercise in the past would certainly be better off doing even a little bit now," says Peter Wood, Ph.D., professor of medicine emeritus and associate director of the Stanford University Center for Research in Disease Prevention in Palo Alto, California. By gradually increasing the amount of physical activity you do--with your doctor's guidance--your heart will reap even more benefits, Dr. Wood says.

Take aspirin. In this age of high-powered, high-priced medications, can a simple aspirin make you the picture of health? An American Heart Association team of researchers analyzed six studies in which patients were given aspirin after heart attacks. This inexpensive white pill reduced the death rate from heart disease between 5 and 42 percent and cut the rate of subsequent nonfatal heart attacks between 12 and 57 percent.

One other piece of good news: You needn't go overboard on aspirin dosages. "A baby aspirin a day is all that's necessary," says Dr. Helfant. Nevertheless, some people should probably stay away from aspirin completely, despite its potential benefits. "If you have a bleeding disorder or an ulcer, for example, taking aspirin is not a good idea," says Julie Buring, Sc.D., principal investigator of the Women's Health Study and associate professor of ambulatory care and prevention at Harvard Medical School in Boston. She suggests talking with your doctor before taking aspirin.