A Guide to Preventing Heart Attacks in Women

A lot of attention is given to men and heart attacks because they’re so sudden and dramatic. The health attention given to women by the media is usually in the area of breast and cervical cancers. We want to turn up the volume on women’s heart health awareness. This is not to scare you but to show you ways to prevent heart disease so you can enjoy your golden years.

Facts You Probably Never Knew About Women and Heart Disease

  • Heart disease kills more women than men each year in the U.S.
  • Heart disease kills ten times more women per year than breast cancer in the U.S.
  • Most women don’t even realize they’re having a heart attack, the symptoms are much more subtle than men’s
  • Sadly, many medical professionals don’t properly diagnose heart attacks in women
  • Heart disease does not have to be an inevitable part of aging

As Dr. Miriam Nelson explained in our 2007 interview below, the first step is learn, then take control and then challenge medical authority when they ignore your symptoms.

“I am woman, hear me roar
In numbers too big to ignore
And I know too much to go back an’ pretend
’cause I’ve heard it all before
And I’ve been down there on the floor
No one’s ever gonna keep me down again”

— Helen Reddy

In recent years, heart disease has claimed the lives of more women than men. Yet it remain a little known fact, why? Mostly because perpetuated myths about women and heart disease still stand in the way of prompt, effective diagnosis and treatment. Sad but true.

Heart attacks are the Number 1 killer of women. 10 times as many women die of heart disease as of breast cancer.

According to Miriam Nelson, Ph.D., and Alice Lichtenstein, D.Sc., the way to change the perception that heart disease is a “man’s problem” is by empowering women to take charge of their own heart health. The two women teamed up to write Strong Women, Strong Hearts a groundbreaking guide that every woman should read.

Backed by cutting edge research, the book combines diet and exercise guidelines, stress reduction techniques, and more practical advice in a workable, effective life plan. Its proven strategies help women assess their risk for heart disease, choose foods wisely, lose weight sensibly, and nurture their emotional health.

Here is that 2007 conversation with Miriam Nelson…

FitCommerce: What’s the biggest misconception about heart disease with respect to women?

Dr. Nelson: The biggest misconception is that heart disease is mainly a man’s problem. Not true. Almost 500,000 women die from heart disease each year. Another 8 million women are living with heart disease.

FitCommerce: More women than men die from heart disease, a statistic that seems to be a well-kept secret. Why? And why has that fact stayed under wraps for so long?

Dr. Nelson:  One reason is that historically, women have been under-represented in studies. Also, a lot of the spotlight has been on breast cancer rather than heart disease, at least in part because breast cancer tends to strike women at a younger age. But 10 times as many women die of heart disease as of breast cancer. It’s not that breast cancer isn’t a devastating disease. But you can’t deny the numbers. Still, knowledge often lags behind perception. Shifting the knowledge in the culture takes a while.

For whatever reason, the media wasn’t picking up on heart disease prevalence in women, so the facts have stayed largely under wraps. Also, women’s diagnoses are often delayed, so the presence of heart disease is not always clear.

“I believe all women can be what I call ‘agents of change’ for other women.”

FitCommerce: How are women’s symptoms different from a man’s?

Dr. Nelson:  When a man is having a heart attack/it’s typically as though a Mack truck is

Women experience different heart attack symptoms then men. courtesy of the Washington Post.

running over his chest. Women’s symptoms are often much more subtle – mild indigestion-like feelings, sometimes some jaw pain, fatigue, feeling winded. Also, men often have no symptoms before the heart attack; it just strikes.

Women often feel lousy up to a month before – fatigued, indigestion, etc. That’s a silver lining. If a woman doesn’t feel great, she can get to the doctor, get intervention, and avoid the heart attack.



FitCommerce: What are the emotional factors that elevate the risk of heart disease, particularly for women?

Dr. Nelson:  While type A personality appears to be a risk factor for men, it’s women who repress anger, etc., too much that appear to be at increased risk. That is, women who bottle up their negative emotions too much might be at increased risk.

FitCommerce: What’s the most misinterpreted sign of heart disease in women? What signs should women be on the alert for?

Dr. Nelson:  Women should be on the alert for feeling more fatigued than usual in the course of their daily activities. They might also feel that tasks requiring exertion, such as carrying a suitcase or doing yard work, are more difficult than they used to be.

There can perhaps tie some jaw pain, too, along with a persistent feeling of mild indigestion. Finally, there might be a general feeling lousy, but it doesn’t go away the way a cold does. It just keeps lasting. None of these symptoms automatically mean you’re having a heart attack, but it does mean you should get to the doctor.

FitCommerce: What tests should every woman have to assess her risk?

Dr. Nelson:  Blood tests should be done to check for total cholesterol, “good” HDL-cholesterol, and “bad” LDL-cholesterol, along with testing for blood pressure and blood sugar. Body mass index (a measure of weight for height) should be determined, too, as well as waist circumference. If any of these numbers are outside the healthy range, the doctor will probably order further tests.

FitCommerce: What about a treadmill test?

Dr. Nelson:  A treadmill test is rarely called for, but still, women do not get them often enough. Ironically, recent research has found that treadmill testing is more predictive for women’s heart disease risk than men’s. It appears women’s fitness, as measured on a treadmill test, is much more a part of the equation than has been realized.

FitCommerce: It seems that every week the prevailing opinion on certain foods changes. Fish is healthy/fish is contaminated. Fat-free is best/fat-free is bad. Abstain from alcohol/drink in moderation. How can women make sense of all the conflicting nutrition information out there?

Dr. Nelson:  A woman should think more about food patterns than this or that food. There is an ever- growing body of research that gives a much clearer picture than ever of what that pattern should look like- plenty of vegetables and fruits and whole grains; low- or nonfat dairy every single day; fish at least twice a week; modest portions of other protein-rich foods like meat, poultry, beans, and soy; use of the right types of oils; sweets and other treats now and then; and of course, calorie control. Look at the big picture.

FitCommerce: What advice would you give someone who’s been sedentary for years?

Dr. Nelson:  Someone who has been sedentary for years should start out very gradually with what I call decreasing sedentary living rather than plunge into a structured exercise program. Really do take the stairs rather than the escalator, really do park away from the supermarket entrance, and really do walk two bus stops and then get on.

These little steps will acclimate you to moving your body. After a couple of weeks, you will feel ready to walk 15 minutes at a time just for exercise’s sake, etc. But before that, simply fold more activity into your life here and there wherever you can find places to tuck it in. It won’t feel so onerous then. It’ll get you started at the right pace on a step-wise, lifelong activity pattern.

“What’s best, though, is eating better and becoming physically active at the same time. They work synergistically.”

FitCommerce: Why is it important to include strength training in your program?

Dr. Nelson:  Strength training does four things to reduce heart disease risk:

  1. It increases muscle strength, which allows you to do aerobics better (a good thing because aerobics directly target the heart and the rest of the cardiovascular system to get stronger). But strength straining also has independent effects.
  2. It decreases high blood pressure.
  3. It decreases fat around the abdomen.
  4. It keeps down blood sugar.
Nutrition and cardio exercise should be supplemented with strength training for prevention of heart disease.

FitCommerce: We once thought that hormone replacement therapy protected women’s hearts. Now it seems that it increases your risk of heart attack. Would you demystify the research?

Dr. Nelson:  A very large, rigorously controlled study that came out just a couple of years ago showed that, contrary to previous research, HRT increases a woman’s risk for heart disease within the very first year of use. The risk is small but significant. It doesn’t mean that if a woman’s hot flashes are intolerable, she should not take low-dose HRT for a very short time to help her over the hump. But it does mean that no women should take HRT for the purpose of reducing heart disease risk. That thinking is over.

FitCommerce: Why isn’t diet alone is not enough to reduce your risk of heart disease?

Dr. Nelson:  There’s evidence that diet alone can reduce your risk of heart disease, and there’s evidence that being physically fit also reduces risk. What’s best, though, is eating better and becoming physically active at the same time. They work synergistically.

Dr. Nelson practices what she preaches, she is very active. Here she is running the Boston Marathon.

FitCommerce: If you could distill a heart healthy lifestyle down to 2 or 3 principles, what would you say?

Dr. Nelson:

  1. Maintain or move toward a healthy body weight.
  2. Follow a dietary pattern that’s low in saturated and trans fatty acids and high in fruits, vegetables, and whole grains.
  3. Be physically active most days of the week.
  4. Be good to yourself – take time to nurture yourself every day, even for just 15 minutes, make medical appointments even if your life feels rushed, say “no” when you need to, etc.

FitCommerce: It seems that the health care delivery system needs more training on treating women with respect to heart disease. Is there anything women can do or should do to spread the word about this important issue?

Dr. Nelson:  I believe all women can be what I call “agents of change” for other women. The more women speak up about this – take care of themselves, urge their women friends and family and colleagues to take care of THEMselves, the more the word will spread. If a woman speaks up at the doctor’s office, the hospital, and to all her healthcare providers, the more inclined those providers will to pay attention to the heart of the next woman who walks through the door.

About Miriam Nelson:

Dr. Miriam Nelson

Dr. Miriam E. Nelson is currently the University of New Hampshire deputy chief sustainability officer and director of the Sustainability Institute.

Nelson is the author of 10 books, including the New York Times bestselling “Strong Women Stay Young” and eight others in the “Strong Women” series.

In August 2001, Dr. Nelson appeared in her own PBS special entitled Strong Women Live Well, which focused on the benefits of exercise and nutrition for women’s health. She has been featured on many television and radio shows, including The Oprah Winfrey Show, The Today Show, Good Morning America, CNN, Fresh Air, and the Discovery Channel.