Are You Heart Healthy?

Heart disease isn't a gender-neutral condition. Although many of the risk factors are the same in women and men, including high cholesterol, inactivity, obesity, high blood pressure, and smoking, heart disease can develop differently in women than men, cause different symptoms, and have a different impact on long-term health.

[ WELLNESS WEDNESDAY ]

The January issue of Harvard Women's Health Watch outlines 10 things women should know about heart risks and how to manage them. Here's a sample:

Cholesterol. A low level of "good" HDL cholesterol (below 50 milligrams per deciliter) is a bigger problem for women than elevated "bad" LDL cholesterol. In fact, the total cholesterol level is less important than the ratio of total cholesterol to HDL cholesterol. For women, the optimal ratio is less than 3.2. High triglycerides (over 150 mg/dL) also pose a bigger heart risk for women than men.

Inflammation. Evidence that inflammation plays a role in the formation of artery blockages has put a spotlight on C-reactive protein (CRP), a substance the body produces in response to inflammation. Now there's a test for blood vessel inflammation called high-sensitivity CRP, or hsCRP. The Women's Health Study found that women with high hsCRP results were about twice as likely as those with high LDL cholesterol to die from a heart attack or stroke. As a result of such findings, the hsCRP test is now often used to estimate the likelihood of a heart attack.

Blood pressure. Up to age 55 or so, women are less likely to have high blood pressure than men. After that, their blood pressure typically rises more sharply than men's, and by age 70, about 80% of women have hypertension. An optimal level is less than 120/80 millimeters of mercury.

Exercise. The more physically active you are, the lower your risk of heart disease. Exercise can raise HDL levels, lower triglycerides, and ease inflammation, changes that are especially important for women. It also helps relieve mental stress-a risk factor for high blood pressure and thus heart problems.

Symptoms. Women are more likely than men to report less dramatic symptoms of heart disease and heart attack, including general discomfort, exhaustion, or shortness of breath under stress or during daily routines. Women are also more likely to complain of fatigue, nausea, back pain, dizziness, and palpitations.

Risk assessment. For many years, experts have relied on a risk-assessment tool based on data from the Framingham Heart Study. It estimates the risk of having a heart attack in the next 10 years by taking into account age, gender, smoking, cholesterol levels, and blood pressure. A new measure known as the Reynolds risk score adds hsCRP testing and family history to the risk calculation and has improved predictive ability, especially for heart attacks in women.