Nearly one out of every two women will die from cardiovascular disease. Yet the vast majority of women are rated "low risk" by the standard scoring system that guides treatment today. Clearly, we need better measures of what's really going on in our bodies. That's why researchers are developing new tests — and new ways to look at the results of old tests.
You've heard about: Exercise stress tests, which measure your pulse, blood pressure, and the electrical function of your heart as you walk on a treadmill.
The problem: Exercise-induced electrical changes are reliable signs of trouble in men, but not in women unless they already have symptoms.
What may reveal more: Paying more attention to (1) how strenuously you can exercise, and (2) how quickly your heart rate returns to normal after you stop. (In making their assessments, doctors take age and other factors into consideration.) Women who do poorly on both these measures have a 3.5 times higher risk of cardiovascular death, according to a study of 3,000 women at Johns Hopkins Medical Institutions.
You've heard about: Angiograms, X-rays that reveal blockages in large blood vessels feeding the heart.
The problem: Many women with chest pain get an inaccurate all-clear result because their plaque, unlike men's, is spread evenly throughout arteries, rather than clumping and causing blockages in the few large arteries viewed during this test.
What may reveal more: A two-step test that uses chemicals to expand blood vessels, then measures blood flow. The test (called — get ready — the acetylcholine endothelial function and adenosine coronary flow reserve test) is especially helpful for women whose coronary arteries are open but still show evidence of poor blood flow — based, for example, on an abnormal stress test.
Got Calcium? Need a Test?
When plaque forms in your arteries, your body tries to stabilize it by adding calcium. CT scans give you a calcium score that indicates just how much plaque you have.
- Consider a scan if... you're at least 40 and have a couple of risk factors that put you at intermediate or above-average risk of heart disease. Such factors might be high blood pressure, high cholesterol, insulin resistance, low HDL cholesterol, high triglycerides, or a strong family history. A high calcium score tips you into the high-risk category, which means you'd benefit from more intensive treatment, such as cholesterol-lowering drugs. The test costs $150 and is not generally covered by insurance.
- Don't bother if... you're already labeled high risk; your doctors should know how best to treat you without the scan. And if you're under 40 or at low risk, the benefits aren't worth the cost and radiation exposure.
Are You an Apple or a Pear?
Pear-shaped people — those who have small waists in relation to their hips — are at lower risk for heart disease. People with an apple shape, who have wider waists and more fat around the abdomen, have greater reason to be concerned. Which are you? Get out your measuring tape....
Where to measure: For your waist, check just above the hip bones, not at the thinnest part of your abdomen. That way, your pot belly will be included! Hips should be measured at the widest point.
Your scores: Your waist should be less than 35 inches. Then you need to calculate your waist/hip ratio: Divide waist size by hip size. The ratio should be less than 0.85.
The ABCs of CPR
When someone suffers cardiac arrest (no pulse, no breathing), brain cells start to die within five minutes. Immediate CPR can temporarily keep enough blood flowing to the brain to preserve cells and more than doubles the chance that the victim will survive.
Learning how: The most basic class will cover adult CPR and use of a defibrillator. To find a good class near you, go to the Website of the American Red Cross () or the American Heart Association (). The AHA also offers the Family & Friends CPR Anytime kit, for home use. The kit costs $29.95. To order, visit or call 1-877-AHA-4CPR.
Don't be afraid: Even if you're not trained, "trying to do something is always better than doing nothing," says Mary Fran Hazinski, R.N., M.S.N., a critical care nurse at Vanderbilt University. "If you leave a victim, he or she will surely die." Dispatchers at 911 can coach you. Remember to push hard to generate enough blood flow and let up all the way after each compression so the heart can refill with blood. The ideal rate is 100 compressions a minute.
A Heart-Healthy Tale of Two Cities
After the residents of Pueblo, CO, voted in a tough antismoking ordinance that mandated stiff fines for lighting up in public spaces, heart attacks fell by 27 percent over the next year and a half. Meanwhile, in neighboring Colorado Springs, where the antismoking ordinance was much more lenient, heart attack rates stayed the same.
Tough laws help in two ways. For the smokers themselves, the laws provide added incentive to quit. And nonsmoking residents benefit from less exposure to secondhand smoke, which has a rapid and damaging effect on circulation and the blood vessels feeding the heart.
To fight secondhand smoke in your town, check [link href="http://no-smoke.org/" target="_blank" link_updater_label="external"]no-smoke.org.