Good news: Heart disease is preventable if you make simple lifestyle changes. Dr. Oz is on call to teach you how.

By Norine Dworkin-McDaniel

Perhaps you already know that heart disease kills more women than breast cancer — more than all cancers combined, in fact. What you may not have heard is that the number of middle-aged women having heart attacks is on the rise. The good news: Heart disease is preventable if you make simple lifestyle changes. Dr. Oz is on call to teach you how.

What a Woman's Heart Attack Looks Like

It's not that women don't get chest pain during a heart attack. We can, although often women describe the sensation more as achiness, tightness, or pressure than as pain. But we're also more likely to experience other symptoms. While chest pain was the most common symptom for both men and women, according to a Swedish study of 225 first-time heart attack patients, women were more apt to report nausea, back pain, dizziness, and palpitations. Women were three times as likely as men to experience more than three heart attack symptoms at once. "Even doctors sometimes mistake women's symptoms for indigestion, heartburn, or the flu," says Dr. Oz.

Two Big Diet Fixes—Make 'Em Today!

Eat Less Sugar

Sugar hurts us in two ways, says Dr. Oz. First, the sugar molecule itself is like a jagged piece of glass that scrapes up the arteries as it travels through your bloodstream. That scarring catches plaque, allowing it to build up and narrow the arteries. Second, because sugar is stored as fat, it leads to weight gain, particularly around the belly. Most Americans take in about 22 teaspoons of sugar every day. Much of that comes from sodas and fruit drinks. Other sweeteners, like high fructose corn syrup, lurk in unlikely places, such as ketchup, mustard, and salad dressing. The American Heart Association now recommends that women limit added sugar consumption to 100 calories (about 6 teaspoons) a day, with no more than 450 calories a week coming from sugary drinks. That's less than half a 12-ounce can of regular soda a day. Dr. Oz's rule: "If high fructose corn syrup is one of the first five ingredients in a product or there's more than 4 grams of sugar per serving (that's 1 teaspoon), skip it."

Eat More Fatty Fish

As sources of protein go, it doesn't get much better than fish, which is low in artery-clogging saturated fat and high in omega-3 essential fats, which improve triglycerides, reduce artery plaque, and prevent irregular heartbeats that can cause sudden death. Women in the Nurses' Health Study who ate fish at least twice a week lowered their risk of dying from heart disease by 31%. Grill or bake (don't fry) salmon, shrimp, rainbow trout, pollock (the fish used to make imitation crab), or sardines. Dr. Oz also recommends taking 600 milligrams a day of the omega-3 essential fatty acid docosahexaenoic acid (DHA).

5 Tests That Can Save Your Life


How Often

Target Range

Why It Matters

Blood Pressure

Your doctor will take your blood pressure during your annual visit, but once a month check it yourself at a blood pressure station at the mall, supermarket, or drugstore.

Below 120/80 mmHg (below 115/75 mmHg if you're over 40). Above 120/80 mmHg is considered pre-hypertension; above 140/90 mmHg is full-blown hypertension.

Hypertension more than triples your risk for heart disease and stroke. High blood pressure not only makes your heart work harder to pump blood throughout your body, it also hardens arteries prematurely and causes micro-tears in artery walls that can trap plaque and cause blockages.


Every five years your doctor should check the cholesterol/triglyceride levels in your blood, more often if you already have high cholesterol or are using medication to lower it. Ask your doctor about a home test kit like CardioChek ($105 plus test strips, available at drugstores and online). 

Aim for LDL cholesterol below 100 mg/dl; HDL cholesterol above 50 mg/dl; triglycerides below 150 mg/dl.

Having high LDL cholesterol and triglycerides, along with low HDL cholesterol, leads to artery plaque. About 50% of heart attacks and 20% of strokes are linked to elevated cholesterol levels.

Fasting Blood Glucose

If you have no risk factors, get this test every three years, starting at 45. But if you're overweight and have at least one other risk factor for diabetes (family history; hypertension; elevated triglycerides, and low HDL levels; or you developed gestational diabetes or had a baby weighing more than nine pounds) ask your doctor about doing this test now.

Below 100 mg/dl is normal; 100 mg/dl to 125 mg/dl is considered pre-diabetes; over 126 mg/dl is considered diabetes.

Excess sugar in your blood damages blood vessels and leads to diabetes, which doubles women's risk for a first heart attack.

Ankle-Brachial Index

At least once a year ask your doctor to do this noninvasive test that compares the blood pressure in your feet with the one in your arms to make sure you're getting good blood flow throughout your body.

Blood pressure in your foot should be at least 90% of what it is in your arm.

If the blood pressure in your foot is much lower than in your arm, it's an indication that plaque is collecting in the arteries in your legs, a condition known as peripheral artery disease. And if there's plaque down there, it's a good bet it's in your coronary arteries as well.

Waist Circumference

At least once a month wrap a tape measure around your middle at your belly button. 

Take your height in inches, then divide by 2 to get your ideal waist measurement. If you're 5'4" (64 inches), your waist should be no bigger than 32 inches around.

Belly fat produces hormones that cause inflammation, damage organs, and promote insulin resistance. New studies show that when a woman of normal weight has a waist larger than 34.6 inches, her chance of stroke quadruples. And a wide middle coupled with elevated triglycerides nearly quadruples a woman's heart disease risk.

Be a Good Health Example for Your Kids

"We can help kids develop healthy habits by adopting them ourselves," says Dr. Oz. And you want to start early because heart disease begins in childhood. Fatty streaks (the beginnings of plaque buildup) can be found in kids as young as 2. Recently, researchers discovered that obese children are developing the kind of artery stiffness that's not usually seen until middle age. Here, Dr. Oz explains how to get your child on track.

If your kid eats too much junk food...

Dr. Oz says: Make healthier choices at the supermarket so there isn't junk food around your house. The whole family has to make an effort to make good food accessible. If Dad regularly brings home pepperoni pizza, this won't work. With younger children, use positive peer pressure. My wife, Lisa, and I have four children, and we made sure that our first one ate right and used her to influence our other children's eating habits.

If your kid spends too much time playing video games or watching TV...

Dr. Oz says: Get your teen or tween involved in team sports—try many until she settles on one she likes. When you spend time together as a family, make it active time. Instead of going to a movie, go for a walk and find ways to make it interesting. Or take up a sport like tennis that you can all play together. The more you make physical activities fun, the more in shape your kids will be.

If your kid won't drink anything but sugary soda...

Dr. Oz says: Establish a rule that soft drinks are for special occasions only and don't routinely keep them in the house. And be sure to always follow your own rules. If your child sees you drinking soda all the time, it'll be that much harder to tell him he can't drink it. Be creative with fun "mocktails"—mix sparkling water or seltzer with a splash of juice and top it with a lime or orange slice.

Solve My Health Problem, Please!

Melissa Cochran, 44, 5'2", 129 pounds, a full-time nursing student in Chula Vista, California, and mother of two girls, 18 and 16, and a boy, 21.

"Two of my children live at home, but neither drives, so every day I'm running them in different directions. My youngest has type 1 diabetes and doesn't always take her insulin, so I'm frequently checking up on her. On top of that, both my mother and my father-in-law are in poor health and need care. I'm so anxious, and my blood pressure is dangerously high (190/128). I feel like I could have a stroke or heart attack at any time."

Dr. Oz says: One way to reduce your stress and your blood pressure is to get 30 to 60 minutes of exercise every day. Put it in your calendar, the way you would a doctor's appointment. You don't need to do it all at once. Aim for three 10-minute chunks of physical activity each day—like going for a quick stroll before each meal.

Shari Smith, 40, 5'9", 196 pounds, a Mary Kay independent senior sales director in Orlando, Florida, and mother of two boys, 12 and 9.

"I don't snack on junk, and once a week, I go for a 2-mile run. I'd love to do more, but between work and driving my boys to soccer practice almost every day, that's all that I can manage. I've lost 22 pounds since our family started eating organic about a year ago. I'm proud to say I'm finally under 200 pounds, but I'd love to be 150. I feel like I'm mostly doing the right things, so why aren't I thinner?"

Dr. Oz says: I congratulate you on the 22 pounds you've already lost. Losing 10% of your body weight is a huge accomplishment and dramatically reduces your risk for cardiovascular disease and other health issues. And while slow weight loss can be very frustrating, it does make it more likely that once you've lost the weight, you'll keep it off. One thing that might help speed up the process a bit is to take a look at your portion sizes. Most people believe they're eating right because they choose good foods, but overeating healthy items can also be a big problem. Use the suggestions below to monitor your portions:

A Serving of…

Should Look Like

Whole wheat pasta or brown rice

Half a baseball

Fish, chicken, lean red meats

Deck of cards

Raw almonds

1.5 golf balls

Sissy Graham, 45, 5'3", 261 pounds, a senior business analyst in Bloomfield, Kentucky, and mom of three girls, 24, and 13-year-old twins.

"I didn't know I had high cholesterol until four years ago, when I had a heart attack. Initially, the doctor at the hospital thought it was indigestion and sent me home. But my mom, a nurse, took me back to the ER the next day and insisted they do some lab tests. It turned out three different arteries in my heart were almost totally blocked. I was (and I still am) heavy, but because I didn't feel sick and my weight wasn't preventing me from working or keeping up with my girls, I didn't think anything was wrong. I still need help getting my cholesterol down."

Dr. Oz says: Sissy, you are not alone. The misdiagnosis of women's heart attacks is a very common problem. In your case, it was probably the combination of a high BMI and high cholesterol that led to your heart attack. Both can be improved by cutting back on the cholesterol and fat you're eating. Saturated fats in meat, full-fat dairy products, and some oils raise your total cholesterol. Trans fats found in margarine, and store-bought cookies, crackers, and cakes are particularly bad because they raise the "bad" LDL cholesterol and lower the "good" HDL cholesterol. Eating more soluble fiber can reduce the absorption of cholesterol into your bloodstream. An easy way to get the recommended 10g of fiber a day is to start your morning with a bowl of oatmeal and sliced bananas.

3 Killer Habits You Need to Kick Now

There are two things you can't change about your risk for heart disease: your family history and your age. Fortunately, 80% of heart attacks and strokes result from factors you can change. And women's hearts tend to respond a lot better to lifestyle tweaks than men's do. You can break these three bad habits and add years to your life.

1. Stop smoking. Women smokers have heart attacks, on average, about 19 years earlier than non-smokers. Once you quit you slash your heart disease risk in half. Within seven years, it's as if you never lit up.

Dr. Oz says: You have a much better chance of quitting for good if you use a program, like the free Kick the Habit Challenge (, than if you go cold turkey. This challenge starts a month before your quit date with a walking plan to help prevent weight gain. And don't get discouraged if you don't make it the first time around. It usually takes five tries before you finally quit for good.

2. Tweak your diet. Women whose diets are high in carbs that quickly raise blood sugar (white bread, white rice, soda, crackers), have double the heart disease risk of women who seldom eat those foods.

Dr. Oz says: Focus on adding more produce, low-fat dairy, and lean proteins to your diet, and cutting back on processed items. When it comes to carbs, reach for breads, pastas, and cereals that are made with whole wheat or other whole grains. Instead of white rice, use brown rice. Mash up yams, squashes, or turnips instead of potatoes. Satisfy cravings for sweets with fruit. Replace at least one can of regular soda a day with a glass of water.

3. Get moving. Seventy percent of Americans aren't as physically active as they should be. For women, being sedentary and overweight is just like smoking—it doubles the risk of dying from cardiovascular disease.

Dr. Oz says: Walking briskly for 30 minutes a day lowers your risk for heart disease by 35%. And always be on the lookout for other ways to get more activity into your daily routine: Try making phone calls on your cell while you walk around your house or your neighborhood. Get a pedometer and aim for 10,000 steps every day, and don't stop moving until you reach that goal.

Originally published in the February 2011 issue of Family Circle magazine.

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