But I’m a Woman, I Can’t be Having a Heart Attack

One evening…Mary and her husband Tom were about to leave to go over to some friends house to play cards. Mary suddenly told Tom, “Ewe, I don’t feel well, I’m not sure I should go”.

“Really, what’s wrong”, asked Tom.

“I don’t know, I suddenly feel weak, and my jaw aches, and I’m having trouble breathing…It’s nothing”.

She was so coherent, Tom didn’t suspect a stroke, but could it possibly be a mild heart attack?

“Trouble breathing, really! Do you have chest pains”, he asked.

“No not really, I think I just put my new bra on too tight and it’s restricting my breathing”.

“C’mon let’s not take any chances, let’s take you to the medical center and get it checked out just to be on the safe side”.

A very wise decision. Although there were none of the classic symptoms of a heart attack that we were all brought up to recognize: chest pain, sweating, and weakness. Mary had the subtle symptoms that many women experience that are different than what typically men experience.  Luckily, the medical staff was able to treat her in time.

It turns out, that in heart attack cases, up to a third of people will have more uncommon symptoms or no symptoms at all. Women, older adults, and diabetics are the most likely to have symptoms that aren’t commonly associated with heart attacks.

Women and Heart Disease – Little Known Facts

CDC statistics on heart attacks
Sobering statistics on heart attacks in the U.S.

Did you know? According to the CDC, heart disease is the leading cause of death for women in the U.S., killing just shy of 300,000 women as recently as 2017.  That’s roughly 20% of all deaths to women.

About 6% of women over the age of 20, have some form of coronary heart disease. It didn’t matter if they were white, African American, or Hispanic. Luckily Asian American rates were roughly half.

Heart Attacks in Women Are as Serious as for Men, if Not More So

In her book, “Strong Women, Strong Hearts, author Miriam Nelson citied 25% of men die within one year of their first heart attack. But that number rose to 38% for women.

She went on to say that 18% of men experience a second heart attack within 6 years, and again that number rose to 35% for women.

With these staggering numbers, why is so little know about women and heart attacks in the American public?

An Interview with Dr. Miriam Nelson on Women’s Strength, Nutrition and Successful Aging

Take a Page from Breast Cancer Awareness

The organizers and fund raisers for breast cancer have done a fabulous job. The American awareness level is very high as a result of those efforts. And, more and more women are doing self-tests and getting their mammograms as a result.

We need an equal amount of awareness for women’s heart disease. Seven times more women die of heart disease than of breast cancer. It’s a wakeup call.

Heart Attack Symptoms are Different for Women

As with Mary, don’t expect your female loved one to suddenly keel over and complain of an elephant sitting on her chest. Again, women’s symptoms are oftentimes different. She may experience the following:

  • Pain in the jaw, back, neck, stomach, or arm

    Woman heart attack
    Symptoms of a heart attack in women are different than those of men
  • Sudden, unexplained fatigue
  • Confusion
  • Shortness of breath during activities that didn’t previously cause breathing difficulty
  • Vague chest pain that may feel more like indigestion
  • A squeezing or tightness in the chest (could be mistaken as “bra tightness” in women), rather than the typical sudden, sharp pain

Is it Really a Heart Attack? Know Your Risk Factors

These symptoms are not one size fits all. For example, pain that feels like indigestion in a person who’s completely healthy could very well be indigestion.

In contrast, someone who has a lot of risk factors for heart disease could very well be having a heart attack and not simple indigestion.

If you have certain risk factors you may be in the high risk category for a potential heart attack.

People with a history of heart disease are most likely to have a heart attack. Smoking, not getting enough exercise, having high blood pressure or diabetes, and being overweight can all increase a person’s risk for heart disease.

Know Your Numbers

There’s an old adage, “You get what you measure”. If you truly want good health, know your critical numbers, especially when it comes to preventing heart disease.  Work with your primary care physician, know your numbers and know the target range you should be in, and take corrective action where need be.

Lipid Panel

The lipid panel is a series of measurements taken from a blood sample. It generally measured in milligrams per decilitre, abbreviated as mg/dL. This is a serious biomarker and you definitely want to stay in the healthy range.

Total Cholesterol

The aggregate number is your total cholesterol. Here are the ranges:

  • Desirable: <200 mg/dL
  • Borderline: 200-240 mg/dL
  • High Risk: >240 mg/dL
LDL Cholesterol

You probably heard there is “good” cholesterol and “bad” cholesterol, LDL is your bad cholesterol. This is the stuff that builds up along the inner walls of your arteries and can cause a blockage and a heart attack. There are dietary changes that can help bring down the number to the optimal range, otherwise your doctor may need to put you on a statin drug.

Here are the ranges:

  • Optimal: <100 mg/dL
  • Near/Above Optimal: 100-129 mg/dL
  • Borderline High: 130-159 mg/dL
  • High: 160-189 mg/dL
  • Very High: >190 mg/dL
HDL Cholesterol

This is the good cholesterol that actually mops up the bad. Exercise is the best way to increase this number. In fact, some health experts feel that a high number can offset a high LDL number and not require medication.

Undesirable: <40

Desirable: > 60

Triglycerides

Triglycerides are a type of fat found in your blood, it’s what your body uses for fuel. But when the levels get too high it can lead to heart disease. Here are the ranges:

Normal: <150 mg/dL

Borderline High: 150-199 mg/dL

High: 200-499 mg/dL

Very High: >500 mg/dL

Natural Ways to Lower Your Cholesterol part 1

Blood Pressure

Blood pressure is more critical than cholesterol and should be monitored

blood pressure monitor
For heart health, it’s best to know your numbers like your blood pressure.

often, especially as you age.

Blood pressure readings are made up of two values:

Systolic blood pressure is the pressure when the heart beats – while the heart muscle is contracting (squeezing) and pumping oxygen-rich blood into the blood vessels.

Diastolic blood pressure is the pressure on the blood vessels when the heart muscle relaxes. The diastolic pressure is always lower than the systolic pressure.

Blood pressure is measured in units of millimeters of mercury (mmHg). The readings are always given in pairs, with the upper (systolic) value first, and followed by the lower (diastolic) value.

The desirable blood pressure level is less than 120/80 mmHg.

If you are above this level you will want to reduce it. Exercise will definitely help in this end. But if your levels persist, your primary care physician may want to put you on any of the many drug alternatives there are.

 Body Mass Index (BMI)

Being heavy on a bathroom scale is not the best method of whether you’re overweight. It also depends on you height. That’s why a BMI measurement should be monitored. It factors in the proper weight to height ratio. Strive to stay in the Healthy weight range.

Underweight <18.5
Healthy weight = 18.5–24.9
Overweight = 25–29.9
Obesity > 30

Here’s a free online tool to measure your BMI:

https://www.nhlbi.nih.gov/health/educational/lose_wt/BMI/bmicalc.htm

Get an Electrocardiogram

An electrocardiogram (EKG) measures electrical pulses in your heart and can reveal a lot to your primary care physician. The test is quick, easy and affordable. Most doctors’ offices have them and perform them during your annual physical. If your doctor doesn’t routinely perform one for you, request it. It’s an ounce of prevention.

Prevention is the Best Strategy

The image of having a heart attack can be quite scary. But you don’t have to passively stand by and merely hope that you never have one.  You can act today to make diet and lifestyle changes to reduce your odds.

 Stress Control

One highly effective means to reduce the risk of heart disease is to manage

Woman Meditation
Managing stress goes a long ways to prevent heart disease. Meditation is a great stress reliever.

your stress. We often cannot eliminate stress in our lives but we can control our reactions to stressors.

Meditation

Meditation in the mother lode of stress relief. Daily meditation can go a long ways in how you respond to stressors. Suddenly molehills are no longer mountains. Practice meditation daily.

Gratitude

If you can wake up each morning and be grateful for all the things and people that you are blessed with, it’ll put you in a positive state for the rest of the day and do wonders for your health and wellbeing.

 Exercise

Woman exercising with dumbbells
Adding strength training to your aerobics will further aid in a healthy heart.

Exercise will do wonders in mitigating heart disease. It will lower blood pressure reduce cholesterol, lose weight and offer a host of other positive health factors.

Ideally you want a blend of aerobic and strength training exercise in your week. If you don’t want to join a gym because of coronavirus, there’s a plethora of YouTube videos on exercises you can do right in your home.  If you can, invest in a set of dumbbells for some strength training sessions.

Similarly there are YouTube videos for aerobics, but at a minimum go out for a walk. Better yet use your smart watch to measure your steps and shoot for that 10,000 steps per day.

Keep Moving

Good heart health and good overall health means don’t be sedentary, get out and just move. Play tennis, garden, walk, whatever you enjoy most.

HGH — A Natural Cure for Boomer Belly and Reversal of Somatopause

 Nutrition

Good nutrition is key to preventing heart disease. Stay away from “fad diets”.

Whole food plant based
Nutrition based on plant based whole foods is great for your heart

It’s not rocket science, adopt a holistic approach to primarily plant based whole foods. Minimize high glycemic heavy carbs, processed foods, and saturated fats. Smaller portions of protein have been linked to longevity, substitute fish for red meat.

According to Mariam Nelson, the data on fish is fascinating. Women eating 2-3 fish meals per week, broiled or baked (not fried), greatly reduces the progression of heart disease.

Tips from Dr. Joel Fuhrman are to merely eat a large salad everyday inhibit atherosclerosis and reduces buildup of plaque in your arteries.

Eat at least 1 oz. of raw nuts per day. No, not the ones cooed in oil and highly salted. According to the physicians health study it can reduce your chances of sudden cardiac death by 60%.

Finally substitute beans for meat protein. They’re low in calories and glycemic scale but high in Inositol pentakisphosphate a carbohydrate that offers protection against heart disease.

For more on a healthy diet to prevent heart disease refer to the tried and true The National Heart, Lung, and Blood Institute developed DASH diet:

Lower Your Blood Pressure Naturally with the Simple DASH Diet

 Live Like You’re in a Blue Zone

You may have heard of blue zones where there’s a high preponderance of centenarians. Although you may not to necessarily live to be 100, you probably want a long and robust life without chronic illness.

People in blue zones eat very little meat, eat fermented foods and get plenty of fiber.

How to get more fiber in your diet:

You’re Really Not Healthy Unless You Also Have a Healthy Gut — Here’s How

And by the way they get out and move every day and wake up to a total sense of purpose. Worth a try.

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.