Inquiring Minds: Barbara H. Roberts on women's heart health

According to the American Health Association, every year nearly half a million women in America die from cardiovascular diseases - more than from any other cause. On Feb. 1 Associate Clinical Professor Barbara H. Roberts, M.D. (left, with Mrs. Bush on the right), the director of the Women's Cardiac Center at Miriam Hospital, visited the White House to help launch Heart Health Month and to present her newly published book, "How to Keep from Breaking Your Heart: What Every Woman Needs to Know About Cardiovascular Disease" (Jones and Bartlett Publishers, 2004), to first lady Laura Bush. GSJ writer Mary Jo Curtis spoke with Roberts about women and heart disease.

What made you decide to write about women's heart health?

I decided to do this because there are so many misconceptions about heart disease, especially in women. Doctors are taught a "male" model of heart disease, and I hadn't been in practice very long when I realized that women often have different symptoms from men when they have heart disease. Also, women themselves did not realize that they were at risk of heart disease. They and their doctors tended to think of it as a male problem.

Although heart disease has traditionally been viewed as a male problem, more women actually die of heart disease than men, and it is the No. 1 cause of death for women. Are there warning signs that should alert women to see their physicians to be evaluated for possible heart disease? What are women's biggest risk factors?

The warning signs of heart disease may be different for a woman. For example, angina pectoris, the symptom that occurs when the heart is starved for oxygen because of narrowed coronary arteries (those supplying heart muscle), is classically described as a pressing, burning or heavy discomfort in the chest, brought on by exertion and relieved by rest. Women are more likely than men to have angina at rest, or with emotional stress, or awakening them from sleep - and women may not experience angina as a discomfort at all, just as a shortness of breath.

A woman having a heart attack (when heart muscle dies because its blood supply has been completely interrupted, usually by a clot forming in an artery that has a ruptured plaque) is more likely than a man to have a so-called "silent" heart attack, one without any pain, and if a woman has pain with a heart attack it's less likely than for a man to be located in the chest and more likely to be located in the back, or neck or shoulders. Some women only feel overwhelming fatigue as a symptom of heart attack.

The important thing is to know your risk factors. The major risk factors are age, smoking, diabetes, high blood pressure, high cholesterol (or low levels of the "good" HDL cholesterol) and family history. You can only know if you have diabetes, high blood pressure or high cholesterol by going to your doctor and having these checked. You can be walking around with sky-high levels of blood sugar, blood pressure and cholesterol and have no symptoms at all until it's too late. The two most dangerous risk factors for women are diabetes and smoking.

How much does the stress in a woman's life contribute to heart disease?

We don't know scientifically how much stress contributes to heart disease. We do know that if you have heart disease, stress can tip you over into an abnormal heart rhythm or heart failure. But more important than the amount of stress in your life is how you react to it. If your reaction to stress is to smoke or overeat or use drugs, you will not be healthy. If you react to stress by exercising regularly or by using proven stress reducers like meditation, you will be much healthier.

What are the most important steps women can take to prevent cardiovascular disease?

The most important steps a woman can take are to not smoke at all, exercise at a moderate level for 30 minutes most days of the week, and eat a healthy diet incorporating lots of colorful fruit and vegetables, nuts, fish and whole grains. The main source of fat in your diet should be olive oil, which in addition to raising levels of HDL "good" cholesterol has lots of cancer-fighting chemicals. We should all be avoiding saturated (animal) fats and trans fats (found in most margarines and store-bought pastries and crackers). Maintain a healthy weight and go to your doctor for regular checkups that include risk factor assessments.