A Nagging Heartache
I should feel happy, having the morning free to chaperone my son's class trip to the nearby children's museum. Instead I'm uneasy. I can't help thinking back to the time my mother went along with my fifth-grade class to a children's museum. It was also the day she died.
I remember that after our class toured the exhibits we sat at long tables and molded animals from clay. I turned and made eye contact with Mom, a few rows behind me. She held up a rabbit, with long front teeth. She was smiling.
The half-mile walk back to school was uneventful—carefree kids, an autumn wind blowing on our faces—until pandemonium erupted. The adults hovered in an intersection, toward the back of the line. I couldn't see my mother. A boy said she'd fallen. I wanted to move, or speak, but I stood frozen and dumbstruck. The principal arrived and my classmates and I were quickly ushered back to our classroom. What is happening to my mother? I desperately wanted to know, but no one would meet my gaze. Outside, an ambulance passed, its siren wailing.
After an interminable wait that afternoon at my grandmother's, my father finally came through the kitchen door, his shoulders slumped, his face drawn. He brought my 6-year-old brother and me into the living room, dropped into a chair and pulled us close. He hesitated for what seemed like forever, before barely whispering, "Mommy's in the heavens now." I broke free and ran, ran up the stairs, threw myself on a bed and screamed.
I've been running ever since: from the memory of that painful day and from delving too deeply into the mysteries that struck down my seemingly healthy mother at 46. At 37, I'm still young, but then so was Mom. I've got her blue eyes and thin legs—as well as some of the attributes that likely put her at risk, like a predisposition to harbor excess weight in the midsection. Whether by nature or nurture, I'm carrying on her weakness for cheese and, despite having run one marathon in my life, her on-again-off-again relationship with exercise. Like her, I have two young children. I know that damage to the heart is cumulative, that the choices I make right now will better or worsen my odds for a long life with my kids (and—knock wood—their children). Yet I've been too busy, too afraid, or maybe just too lazy to calculate my own risk for heart disease, which every year kills more women than all kinds of cancers combined.
Recently my extended family gathered at my house for dinner. The subject of my mom came up. My aunt said, "I always thought, Thank God Eileen didn't have the heart attack while driving you two kids to school that morning." I looked at my son, who's 5, and my daughter, 2, running the length of the house with their cousins. That night, I sat alone in my kitchen, peered into my computer screen, made a few clicks, jotted down a number. The next morning I'd call a cardiologist.
After ignoring my fears for so long, I found myself sleepless with questions. What if my mother had some genetic risk factor, perhaps the same thing that brought on her father's fatal heart attack, at 60, that I've inherited and can't do anything to change? Do I really want to know? Or, what if it's within my control, and I've been clogging my arteries one fatty meal at a time for years, sealing my own fate?
Still, I thought, as uncomfortable as it may be to dig into the past, or face the ways in which I've been coming up short taking care of myself, isn't doing everything possible better than leaving my children without a mother, my husband without a wife?
I knew it was, of course. And in a few short weeks I'd learn a ton about what I, and women like me, could do to win the fight of our lives.
You no doubt know someone with heart disease. Eight million American women are currently living with it. Every year 435,000 women have a heart attack. And it's not just older women—and nearly a quarter of those heart-attack victims are under the age of 65. Even more troubling, women are much more likely than men to die of a first heart attack—women under 50 three times more likely. Part of the problem is that women—and doctors—may fail to recognize it's happening.
But while the very words "heart attack" give the impression of sudden onslaught, an episode is typically years in the making. "Heart disease starts early, with the earliest building blocks of a heart attack forming in your teens and early 20s," says Nieca Goldberg, MD, a cardiologist and a spokesperson for the American Heart Association.
So now I'm sitting across from Dr. Goldberg in her Manhattan office, answering her list of questions about my health history. No, I don't smoke and never have. (Mom didn't smoke either.) Yes, I try to eat healthy most of the time, but long hours on the job have me grabbing pretzels or candy on my commute home, then speed-dialing the local takeout joint for a late-night dinner, usually fried. What about exercise, Dr. Goldberg asks? I tell her I'm hitting the elliptical machine at the gym three days a week. I fess up that I dusted off my sneakers right after I made my appointment to see her, but I'm now up to 40 minutes each session. "This is great!" she says. Phew.
Weight and Diet
I'm not in the clear yet. We talk about my body mass index, the relationship of weight to height. (To calculate yours, go to familycircle.com/bmi.) A healthy BMI is between 18 and 24.9. A BMI between 25 and 29.9 means you're overweight. Obesity's defined as a BMI equal to or greater than 30 and is strongly associated with a sharp increase in heart disease. Dr. Goldberg informs me my BMI is 31. In other words, I am obese. Not merely overweight, as I'd hoped. My face grows hot. It's not like I hadn't noticed I've grown from a size 8 to a size 14 over five years and two children. But obese?
Dr. Goldberg quickly points out I'm making a smart move with the aerobic exercise, crucial to burn off the excess abdominal fat that's correlated with heart disease. "But you have to organize your diet a little better," she says. She suggests I decrease my simple-carbohydrate intake (white bread and pasta) and eat more whole grains, fish, and grilled chicken. I might not be personally satisfied until I'm in a single-digit dress size again, but even a modest weight loss would help: Dropping just 10% of body weight if you're overweight or obese significantly reduces the risk of heart disease.
As we wrap up our appointment I'm instructed to come back for blood work—and to take small steps to improve my diet, such as reducing my salt intake and planning a week's worth of meals ahead of time.
After I get my blood drawn and while I wait for my next appointment, I read more research on my own. I learn I ought to cut out the fat—but not too much. Low-fat diets are typically recommended to improve heart health, but a moderate-fat diet may be even better. In a 2004 study from the University of Buffalo, overweight or obese participants who followed a moderate-fat (33% of calories from fat) diet had healthier cholesterol numbers and lowered their cardiovascular risk by 14%, compared with people who followed a low-fat (18% of calories from fat) diet, who reduced their risk by only 9%. Of course, not all fats are created equal: Saturated fat, which raises bad cholesterol, should make up no more than 7% of anyone's diet. And trans fat should be avoided whenever possible, since it not only raises bad cholesterol but also may lower good cholesterol.
When I return to Dr. Goldberg's office, she gets right down to my lab results. We sit in front of her computer screen. My levels of thyroid-stimulating hormone (TSH) are high, which means my thyroid is underactive. We'll do more testing to determine whether I have mild hypothyroidism, which frequently goes undiagnosed in women and might help explain why I've been feeling sluggish lately. In my case it has nothing to do with my heart. Can I partly blame my weight on a poky thyroid? "It can contribute, but at your levels probably not much," says Dr. Goldberg. So much for excuses.
Next, she shows me the Framingham Heart Study online risk-assessment tool (go to americanheart.org/riskassessment). Those who know their blood pressure and cholesterol numbers can plug them in and do a quick check of how likely they are to have a heart attack within the next 10 years. Experts recommend that everyone find out her risk score by age 20, and reassess every five years after that. Dr. Goldberg plugs in my gender, age, nonsmoker status, and my blood pressure, which at 118/64 is normal. Then she gets to my cholesterol counts, which are all safe, if not optimal: My total is 195; my HDL is 59; my LDL is 118. My non-HDL cholesterol—that's the total minus the HDL—is 136 (normal is less than 160). More good news: I don't have diabetes, despite a history on my maternal grandmother's side. Diabetes raises the risk of heart disease by 20%. In seconds, the tool calculates my 10-year risk. "So here you are: less than 1%," says Dr. Goldberg. Before I get too euphoric, she adds, "But this doesn't mean it's a license to just stay the way you are." While useful, the Framingham tool has notable limitations, points out the doctor. "It doesn't include whether you exercise, or anything about your weight or weight distribution, and it doesn't account for family history."
With a few more clicks, Dr. Goldberg pulls up a newer risk-assessment tool, the Reynolds Risk Score (www.reynoldsriskscore.org), developed by researchers at Brigham and Women's Hospital in Boston. "I risk-score all of my patients on both," says Dr. Goldberg, "but then I also have to integrate other things going on with their health. If patients do these online, they should bring the results to their doctor." Unlike the Framingham online tool, the Reynolds risk assessor asks whether my mother (or father) had a heart attack before age 60. Even with the additional info, my risk in the next decade is still less than 1%.
My job now is to keep it that way. A test of my cholesterol particles reveals they're the light, fluffy kind that are associated with a lower risk of coronary disease, says Dr. Goldberg, though my HDL particles are a little tighter than they could be. To keep them from becoming the dense, artery-clogging kind, I need to do more aerobic exercise. "I wish I could tell my patients that if they dieted and exercised and did everything right, I could give them a 100% guarantee that they're going to be totally risk free," says Dr. Goldberg. "We can't, but it is a big reduction in risk."
Push a Little Further
Despite the mostly positive news, my labs turn up one black mark. I brace myself. Is this the genetic, can't-control-it factor I'd feared? Dr. Goldberg explains that my Lipoprotein(a) cholesterol "was a little out of range." Lp(a) is a blood protein that causes cholesterol to stick to the walls of arteries, and high levels are associated with an increased risk of heart attack and stroke. Since scientists are still working to understand Lp(a) as a factor in heart disease, doctors don't routinely measure it. Given my family history, Dr. Goldberg decided to check mine. "Unfortunately, there's little you can do to change that number," she says. What's more, no studies show that treating Lp(a) actually reduces risk. There is one study, though, that shows that if I lower my LDL cholesterol to less than 100, I may be able to negate the potential damage somewhat and lower my overall risk.
When I leave her office, I think about what the doctor said. It's true I may not be able to completely change my fate, but there is so much I haven't been doing—or doing enough. A few days later I'm pushing my daughter, asleep in her stroller, through a park, not far from the cemetery where my mother is buried. I'd been thinking about wrapping up our walk a little early, to get home to take care of some school paperwork and to respond to a few work-related e-mails. But as I pass the place where my mother rests, I think of the health benefits of walking just a little farther. I feel the sun on my face, push the stroller a little faster and keep going.
Know the Signs of a Heart Attack
The most common symptom of a heart attack is the same for women and men: chest pain or discomfort. But women are slightly more likely to have subtler warning signs:
- Upper-body pain, in the arms, back, neck, jaw, or stomach
- Shortness of breath
- Breaking out in a cold sweat
- Nausea or vomiting
How Much Exercise Do You Need? (Hint: Not Much)
You can't change your genes. But anyone can start moving. For a healthier heart, strive for 30 minutes or more of moderate activity—like walking, cycling, or swimming—at least five days a week. You don't need a half-hour at once—even three 10-minute brisk walks a day count. Besides helping to manage your weight, boost your mood, and get your heart working more efficiently, you'll also lower your LDL cholesterol ("bad") and pump up the heart-healthy HDL kind.
Learn Your Numbers
Starting at age 20—but it's never too late—you should get a lipid panel (a lipoprotein profile if you are at increased risk for heart disease) every five years. If you get an iffy report back, the good news is that you and your doctor can develop a plan (usually involving diet and exercise) to improve your score. Below are the numbers you're striving to attain.
Total cholesterol: People with a total cholesterol level of 240 mg/dL or more typically have twice the risk of heart disease as people whose cholesterol level is normal, according to the American Heart Association. Healthy target: less than 200 mg/dL.
LDL ("bad") cholesterol: Too much low-density lipoprotein can slowly build up and eventually form a thick plaque that narrows and hardens the arteries, also known as atherosclerosis. Healthy target: less than 100 mg/dL.
HDL ("good") cholesterol: High levels of high-density lipoprotein protect against heart attack by carrying cholesterol away from the arteries. Having low levels (less than 40 mg/dL) of HDL increases your risk of heart attack. Healthy target: above 50 mg/dL.
Triglycerides: High amounts of these fats are associated with a high cholesterol count and heart disease. Triglycerides may be elevated if you're overweight, obese, or physically inactive, or if you smoke, drink too much alcohol, or eat a diet very high in carbohydrates (60% or more of your total calories). High triglycerides also signal excess levels of glucose in diabetics. Healthy target: less than 150 mg/dL.
Blood pressure: Blood pressure that's greater than or equal to 140/90 directly increases your chances of suffering from heart disease and stroke. Healthy target: below 120/80.
Copyright © 2008. Used with permission from the February 2008 issue of Family Circle magazine.