Hear Me Roar, Time For Change -- Understanding Women's Heart Disease page 2

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5. What's the most misinterpreted sign of heart disease in women? What signs should women be on the alert for?

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.

6. What tests should every woman have to assess her risk?

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.

7. What about a treadmill test?

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.

8. 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?

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.

9. You offer ten strategies for weight loss. Why do your strategies work where others fail?

We looked at all the evidence on weight-loss strategies for long-term weight-control. These were the 10 that were consistently coming through as the ones that work. They're a combination of behavioral strategies as well as wise food choices.

Most importantly, however, is that they're do-able. They become lifelong habits. This is not a diet that you go on and then off. In fact, it's really lifestyle rules rather than diet rules. Note that they're rigorous - this takes some getting used to. But they can be made to work within any woman's lifestyle.

10. What advice would you give someone who's been sedentary for years?

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.

11. Why is it important to include strength training in your program?

Strength training does four things to reduce heart disease risk:

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.
It decreases high blood pressure.
It decreases fat around the abdomen.
It keeps down blood sugar.

12. 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?

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.

13. In the book you assert that diet alone is not enough to reduce your risk of heart disease. Why not?

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.

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