heart month

Women and Heart Disease - What Are the Risk Factors for Heart Disease?

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Could you be at risk for heart disease?

Many risk factors play a part in heart disease.  Some of those risk factors are out of our control.  Those risk factors are:

  • Age
  • Gender
  • Family history of heart disease
  • Race
  • Previous stroke or heart attack
80% of heart disease and stroke events can be prevented

But the good news is that a whopping 80% of heart disease and stroke events can be prevented by making changes in the risk factors we can control.

Those risk factors are:

  • High blood pressure
  • Smoking
  • High blood cholesterol
  • Lack of regular activity
  • Obesity or overweight
  • Diabetes

Additional lifestyle factors that can contribute to heart disease, high blood pressure, and stroke include stress and lack of sleep.

Let's talk about each of these areas individually.

High Blood Pressure

In 2017, the American College of Cardiology and the American Heart Association released new blood pressure guidelines. 

Blood pressure categories in the new guideline are:

  • Normal: Less than 120/80 mm Hg;
  • Elevated: Systolic between 120-129 and diastolic less than 80;
  • Stage 1: Systolic between 130-139 or diastolic between 80-89;
  • Stage 2: Systolic at least 140 or diastolic at least 90 mm Hg;
  • Hypertensive crisis: Systolic over 180 and/or diastolic over 120, with patients needing prompt changes in medication if there are no other indications of problems, or immediate hospitalization if there are signs of organ damage. (Source:  American College of Cardiology)
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If you are in the elevated or Stage 1 category, your goal should be to make lifestyle changes now to control your blood pressure.  If you are in stage 2, you should discuss with your physician if you need medication to help manage your blood pressure, or if you can control your blood pressure through lifestyle changes alone.  In either category, lifestyle changes will be necessary to successfully manage your blood pressure.

Track your blood pressure


Cigarette smoking is one of the major risk factors for heart disease - in fact, smoking increases your risk of cardiovascular disease by 2 to 4 times.  Women who smoke have a 25% higher risk of heart disease than men who smoke (Source:  American Heart Association).

The chemicals in tobacco smoke damage the cells in the body, including the heart and the blood vessels.  Smoking increases the "bad" LDL cholesterol and decreases the "good" HDL cholesterol, and increases triglycerides, leading to more plaque formation in the artery walls.  Smoking raises blood pressure and heart rate.  Smoking also makes blood "sticky" and more likely to clot, blocking blood flow to the heart and brain.  And the carbon monoxide in smoke decreases the amount of oxygen in your blood that can reach your heart, brain, and body.

No wonder smoking can make you feel so out of breath and tired!

Second-hand smoke is also dangerous - even breathing second-hand smoke for a few minutes can damage the lining of your blood vessels and cause your blood to become stickier.  

If you smoke and have other risk factors for heart disease such as high cholesterol, obesity, or diabetes, your risk significantly increases.

The good news is that smoking is the most controllable risk factor of all, and quitting smoking can cut your risk of heart disease in half in just one year!

We can all make small changes in these areas that can really pay off in terms of decreasing our risk for heart disease, high blood pressure, peripheral arterial disease, and stroke.  

High Blood Cholesterol and triglycerides

Cholesterol is a waxy substance that is used to help build cells.  We actually need cholesterol in our bodies.  Cholesterol is made in the liver, and the liver makes all the cholesterol our bodies need.

There are two types of cholesterol.  We talk about these two types of cholesterol as being the "good" cholesterol and the "bad" cholesterol.  

Bad Cholesterol

Low Density Lipoprotein, or LDL for short, is the bad type of cholesterol.  This type of cholesterol builds up in the artery walls as part of plaque, contributing to hardening and thickening of the arteries, and increased risk of cardiovascular disease.  The higher the level of LDL in your bloodstream, the higher your risk of heart disease is.

Good Cholesterol

High Density Lipoprotein, or HDL for short, is the good type of cholesterol.  Think of HDL cholesterol as the cleaner in your blood.  It travels through the bloodstream scooping up LDL cholesterol and carrying it back to the liver to be broken down and eliminated from the body.  Higher levels of HDL in the body protects against cardiovascular disease.  Low levels of HDL in your bloodstream increase your risk of heart disease.


Triglycerides are another type of fat found in your blood.  When you take in more calories than your body can use, your body converts those calories into triglycerides and stores them in your fat cells.  When your body needs energy, your body releases the triglycerides into the bloodstream.  

Some foods that we eat are associated with higher levels of bad LDL cholesterol and triglycerides in our blood, especially diets high in refined carbohydrates, saturated fats, and trans fats.

Women with high cholesterol or high triglycerides do not necessarily experience symptoms so it is important to be tested for your levels.  The American Heart Association recommends that all adults over the age of 20 be tested for cholesterol and triglyceride levels every 4 to 6 years.  This test is called a "lipid profile" or a "lipoprotein profile" and is a simple blood test.

lack of regular activity

It's no secret that our society as a whole has become less active over the past fifty years.  With an increase in jobs that are sedentary and increased usage of computers for daily work, people are more likely to sit.  In fact, we sit on average 12 hours a day, but are bodies evolved to move.  When we sit for long hours, our bodies burn fewer calories, our blood glucose and triglycerides rise, and we are at increased risk for high blood pressure and heart disease, as well as other chronic conditions such as weight gain, stress, and type 2 diabetes. 

Reducing the amount of time you spend sitting and regular physical exercise such as daily walking for 30 minutes is linked to a lower risk of cardiovascular disease and heart attack.

obesity or overweight

According to the American Heart Association, nearly 70% of Americans are either overweight or obese.  Obesity and overweight relate to the amount of body fat you have based on your body mass index (BMI) measurement.  Your BMI is your weight in kilograms divided by the square of your height in meters, and the CDC provides a calculator online if you want to find out your BMI.  The BMI is not without its detractors, but it is a useful screening tool in most cases to determine if you are carrying around more body fat than you should.

If you have over 30 percent body fat, you are considered to be obese, and if your body fat percentage is higher than between 25 and 30 percent, then you are considered to be overweight.  

Obesity and overweight increases the risks for heart disease and stroke because of their association with higher cholesterol, higher blood pressure, and higher risk for type 2 diabetes.  According to the World Health Organization, obesity and overweight are associated with more deaths worldwide than underweight.  Visceral fat, deep in the abdomen, has been associated with inflammation leading to insulin resistance and diabetes.  And obesity and overweight have been linked to an enlarged left ventricle in the heart which can lead to heart failure.


Diabetes is one of the major risk factors for cardiovascular disease.  Adults with diabetes are two to four times more likely to die of heart disease than adults who do not have diabetes.  Diabetes is associated with high blood pressure, high cholesterol, and high triglycerides.  Diabetes can contribute to earlier and more severe heart disease, less successful outcomes, and higher risk of death and disability.  For people who have diabetes, the higher their blood sugar is, the higher risk they have of developing heart disease. 

As you may have gathered as you read through these controllable risk factors, they are all interlinked.  Each risk factor by itself increases your risk of cardiovascular disease; however, they rarely come by themselves.  Most often, people have two or more risk factors, greatly increasing the chance they may be affected by heart disease, stroke, and/or peripheral vascular disease. 

Overweight and obesity, diabetes, high blood pressure, high cholesterol, lack of physical activity, and smoking are all controllable risk factors, meaning we can take action to improve our odds.  In the next series of articles, we will explore what we can do to improve each risk factor.  When you improve one risk factor, you will improve all of them, and give yourself the best chance to increase your heart health.

Learn how you can  Love Your Heart

Learn how you can Love Your Heart

DASH Diet Challenge - Week 1

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Week 1 of the DASH Diet Challenge is complete and I want to share with you how it went.  Below, I will break down what I ate, results for the week, and what I learned.  If you are considering trying out the DASH Diet for weight loss, to lower your blood pressure, or for heart health, I hope this information will be helpful to you.

For this challenge, I set my daily calorie goal at 1,800 calories, based on the calorie needs chart provided by the National Heart, Lung, and Blood Institute, the creator of the DASH Diet Plan.  I wrote a previous post on the DASH Diet recommended food groups and serving sizes.

I started off the week tracking my food intake using my Fitbit app.  While this app does a good job of calculating total calories, sorting out percentages of carbs, proteins, and fats, and it is easy to enter the data, I couldn't track the sodium intake.  So, midweek, I switched over to tracking in MyFitnessPal.  The free version was adequate for my needs, but a premium version is available.  This app can track your food diary, and you can also track your water intake and exercise and generate printable reports (which is a great extra if you are keeping a food diary to share with your physician or dietician).  It has the functionality to provide nutrition information on imported recipes and help you with meal planning.  There is also a community forum, and MyFitnessPal syncs with lots of trackers, including the FitBit.

Week 1 Results:

1.  My starting weight was 219.5.  Weight on Friday was 217.8 - down a little over a pound, and that is within my goal plan for the year.

2.  Blood pressure.  I knew my blood pressure has been running high for several years.  I decided should get a reading for a baseline for this challenge.  Before I left my office Friday afternoon, I checked it, and it was a freaking scary 183/94.  I checked it 2 more times on different machines, and the results were similar.  Not good!  And here is where I have to admit that I did not do what I would tell any one of you to do:  I did not immediately take myself off to see the doctor.  I did what a lot of women do.  I waited. 

Luckily, when I went to my local pharmacy and checked my blood pressure the next morning, it was much more in line with what I expected at 144/87.  That reading is still way too high, though.  I will be putting a visit with my physician on my calendar this week for sure!

3.  Exercise.  I only exercised one morning this week.  Since the weather has remained frightfully cold, I did a walk-jog video on YouTube.  Gotta love all the workout video options on the internet.  

4.  The Diet.  Once I put everything I ate this week into the food diary, I categorized each food into the appropriate food group categories.  And here is what I found:

  • I had a really hard time eating the recommended amount of grains, and I did not achieve the recommended amount on any day of the first week.  I'm not used to eating a lot of grains, and even consciously incorporating them into my daily mail plan was hard.  They also have a relatively high calorie count for small portions and aren't very filling.
  • It was fairly easy to get in the right amount of vegetables every day.  My lunch is usually 3 cups of leafy power greens and lettuces, sprinkled with lemon juice, with a serving each of meat, cheese and fruit. 
  • I had to consciously add fruits, just as I had to consciously add grains.  I only got the recommended amount on 1 day.  I went for apples (studies have shown that women who regularly eat apples have lower blood pressure), and low sugar fruits like berries.  I did add bananas to smoothies on a couple of days, for the potassium and sweetening.
  • Dairy was easy.  Just a cup of yogurt or kefir or fat free milk and a cheese stick and this one is taken care of.
  • Lean meat, fish, poultry - This was another easy category.  I focused more on lean meats and fish like tuna and turkey, bison, and lean beef stew meat.
  • Because of my addiction to hummus, I went overboard on the nuts, seeds, legumes category this week.  Enough said.
  • Using just a bit of avocado oil was enough for the fat category - another easy category to meet, but I had to be careful of the portion so that I wouldn't exceed the allowance. 
  • I don't usually eat a lot of sweets anyway, having weaned myself off most sugar over a year ago, but I did have a Halo top ice cream pint that lasted through three days, and one night, I indulged in two cinnamon twists from Dominos.  The nice thing about this diet is that it does allow for those little indulgences once in a while.
  • Speaking of Dominos, yes, my favorite pizza place does have health(ier) options.  When the fam decided that Friday should be pizza night, I chose the plain bone-in chicken wings and the Apple Pecan Chicken Salad with the Lite Balsamic Vinaigrette Dressing.  But I should probably find another option for the hot wing sauce - it is way high in sodium.
  • Keeping the sodium levels low was also a challenge.  I admit it, I like the salt shaker.  Tracking it is making me mindful of how much is in what we eat everyday.
  • On only two days did I go over my calorie allowance, and not by much.  Most days were under the allowance, so I consider that a success.
  • Tracking my food intake made me really mindful of the portion sizes on the DASH Diet.  This is an area where I have struggled to get control and it is probably the area that has most contributed to my lack of progress in losing weight.  
  • There were a few things that I ate during the week that I have had to scratch my head about where to fit them in the plan:  the half and half in my morning coffee, a little snack bag of potato chips (are those a vegetable lol?), EAS Advantage Low Carb Shakes (to stave off a hunger attack mid-morning), a Zone Perfect Chocolate Peanut Butter Bar (does that go under "Sweets" or "Nuts"?), and chicken/vegetable broth that I used in soups.  
  • Although I did feel hunger on most days as lunch or dinner approached (hence, a shake or protein bar - and I'm not sure a little bit of hunger is necessarily a bad thing), I did not feel deprived.  There really was no food that was absolutely prohibited, and I could eat a large variety of foods.  
  • Planning meals through the week helped to keep me on track.
  • This whole challenge is not necessarily about following the diet perfectly.  It is about learning to be mindful about what I am eating and improving my eating habits and portion control.  Tracking my calories and portions right now is very helpful to me so that I can see exactly what and how much I'm eating and where I need to make adjustments.  

I've copied my chart and food diaries below to help you with your own meal planning on the DASH Diet.  I've color coded the top chart in green (met the goal) and red (did not meet goal), so I can more easily see where I can improve.  Please note that the charts show exactly what I ate in the first week of the challenge.  Obviously, from the chart below, if you wanted to follow the diet perfectly, some adjustments would need to be made to the meals.  Feel free to use this information as a starting point to create your own meal plan.

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Follow my progress on the 30-Day DASH Diet Challenge!

Learn to Love Your Heart in this series on Midlife Women and Heart Health

Women and Heart Disease - Signs of a Heart Attack

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Would you recognize the signs if you or someone you know were having a heart attack?

As you learned in Part 2 of this Women and Heart Disease series, a heart attack occurs when an artery supplying the heart muscle is blocked by plaque or a clot.  The muscle supplied by the artery begins to die from lack of oxygen.  If blood flow is not quickly restored, significant damage to the heart muscle, and even death, can occur.  A heart attack is a medical emergency.

We've all watched a television show where a guy, usually in his midlife or older, suddenly clutches his chest, cries out in pain, and collapses to the floor.  TV shows and movies usually show the most common signs and symptoms of a heart attack, so that's what we are familiar with, and that's what we look for ourselves.  If we saw someone clutching her chest, crying out, and fainting, we would immediately assume "heart attack."  And in fact, in both men and women, chest pain is the most common symptom of a heart attack.

But, in women, and especially women in midlife, the signs and symptoms of a heart attack may be different.  A woman may not even experience chest pain.  Rather, she might have one or more of a group of vague, subtle symptoms that she might not associate with heart attack at all.  These symptoms include:

Shortness of breath, with or without chest discomfort.  A woman may begin to experience shortness of breath several weeks prior to a heart attack, and it may occur at random times.  She could be sitting at her desk and suddenly experience severe difficulty breathing, or find herself short of breath while walking up a flight of stairs that usually presents no problem.  Feeling short of breath right after waking up is also a sign something could be wrong.

Chest discomfort or pressure.  The most common phrase is "like an elephant sitting on my chest," but the discomfort may be more vague than that.  It may feel like squeezing, fullness, or pain in the center of the chest.  It may even radiate to the arms, back, neck, jaw, or stomach.  The woman may experience pain in the back or the neck or the jaw, but not in the chest.  

Nausea.  A woman may experience nausea and vomiting and believe she has the flu.  Nausea may occur days or weeks before the heart attack.

Breaking out in a cold sweat.  Women in midlife may associate this symptom with perimenopausal symptoms.

Dizziness, lightheadedness or fainting.  In both women and men, this symptom can be a sign of a heart attack or cardiac arrest.  Bob Harper, a fitness trainer, experienced spells of dizziness and even fainting at the gym before he had a cardiac arrest.

Any of these symptoms should prompt a call to 9-1-1 for transport to an emergency room.  Women in particular may wait to call, thinking (hoping) it's not serious, but delay can put you in a life-threatening situation.  Making the 9-1-1 call early, as soon as you experience symptoms, can save your life.

Even More Vague Symptoms - The Silent Heart Attack

Women sometimes experience a heart attack and don't even know it has happened!  But the result is the same - heart damage has occurred.  This is the so-called "silent heart attack."  However, there are some signs.

Prolonged or Excessive Fatigue.  Either before or after a heart attack, a woman may feel excessively exhausted and unable to carry out her usual activities, as the heart muscle is deprived of blood and oxygen.

Indigestion that women may think is the flu, heartburn, an upset tummy, or gastric reflux.

And again, women may experience soreness or pain in the chest or upper back, neck, arm, or jaw that they attribute to a muscle pull.

Because the symptoms can be so vague, women (and their doctors) may think a silent heart attack is just caused by anxiety.  Studies indicate that women may experience more silent heart attacks than men, and the silent heart attack causes damage to the heart muscle that may be more dangerous because it is not detected early on.

Feeling of Doom - Many patients experience a feeling of "impending doom," that something is just not right.  If you are feeling any of these symptoms, see your physician and request a cardiac asssessment.

Learn more about Women and Heart Health in the Love Your Heart series.