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Take It to Heart: Most Cardiovascular Risk Factors Are Manageable

Author: Patricia Nicholson

Cardiovascular disease doesn’t discriminate: anyone can be affected. But identifying risk factors and taking preventive action can help women take charge of their heart health.

‘Heart disease is the number 1 killer of men and women in Canada,’ said Faith Delos-Reyes, program co-ordinator and exercise specialist with the Women’s Cardiovascular Health Initiative at Women’s College Hospital (WCH) in Toronto.

‘Heart disease and stroke kill more than seven times as many women as breast cancer,’ Delos-Reyes said. ‘And in health care we spend about $18.4 billion on heart disease annually.’

Delos-Reyes and her colleague Debbie Childerhose, a physiotherapist and program co-ordinator with the WCH Women’s Cardiovascular Health Initiative, gave a presentation on risk factors for heart health at the Marion Powell Women’s Health Information Centre at WCH on Feb. 5. Their talk covered 10 major risk factors for heart disease:

  • age
  • family history and ethnicity
  • menopause
  • high blood pressure
  • smoking
  • diabetes
  • high cholesterol
  • overweight
  • physical activity
  • stress

Although three of those risk factors are unchangeable, the good news is that the other seven are things that women can manage or have some control over.

Fixed factors

A woman can’t change her age, genetics or menopause, and all three affect risk of heart disease.

‘As we age, our heart ages,’ Childerhose said. ‘Men over 55 and women over 65 have an increased risk of heart disease. Over 85 per cent of people who die of heart disease and stroke are 65 years and older.’

Having a close family member with heart disease also increases risk, especially if a family member had heart disease at a younger age (under 65 in women and under 55 in men).

‘If that heart attack happened at 60 in a female, that’s more significant than if someone had a heart attack at age 90,’ Childerhose said.

Heart disease risk is also higher in certain groups: people of aboriginal, African and South Asian descent have a higher incidence of risk factors such as diabetes and high blood pressure, which raises cardiovascular risks in these groups.

Menopause is a unique heart risk for women, Childerhose said. Before menopause, estrogen has protective effects on the arteries and helps prevent heart disease. Once estrogen levels fall after menopause, that protection ends. Menopause can also be associated with changes in body weight and blood cholesterol. These factors can add up to a quadrupled risk of heart disease after menopause, but Childerhose noted that a healthy lifestyle can keep those risks under control.

Flexible factors

Among the major risks that women may be able to moderate through lifestyle choices is blood pressure.

‘High blood pressure is the leading cause of stroke,’ Childerhose said. ‘Forty per cent of women over 55 have high blood pressure.’

Blood pressure over 140/90 mmHg is considered high. Optimal blood pressure is 120/80 mmHg, but the target for people with diabetes is 130/80 mmHg or below.

Strategies that can help control blood pressure include physical activity and dietary changes, including increasing consumption of fruit and vegetables, and keeping a close eye on sodium, saturated fats and alcohol consumption.

One of the most important modifiable risk factors for heart disease is smoking. It not only increases blood pressure and heart rate, but also raises the risk of blood clots, lowers the level of oxygen in the blood, has a harmful effect on blood cholesterol levels and contributes to the development of blocked arteries.

Childerhose said we need better approaches to helping smokers quit.

‘I think there have been a lot of different tactics used: a lot of shame and scare tactics, and guess what? They’re not effective,’ she said. ‘What we need to do is support people who are trying to quit smoking.’

Type 2 diabetes is a huge risk factor for heart disease. Women with diabetes have eight times the heart disease risk of those without diabetes.

‘Diabetes increases the risk of high blood pressure, heart disease and stroke, especially when the blood sugar levels aren’t controlled,’ Delos-Reyes said. ‘You can still lead a very healthy life with diabetes if you’re managing your sugars.’

Exercise helps control blood sugars, and other lifestyle choices such as eating a balanced diet and maintaining a healthy body weight can also help manage diabetes.

The right highs and lows

Our bodies use cholesterol to help regulate cell membranes, and for many other important functions, but our livers produce enough cholesterol for these functions, Delos-Reyes said. Too much cholesterol in the blood means increased plaque and fatty deposits on the walls of blood vessels, clogging or stiffening the arteries.

‘It’s called atherosclerosis,’ Delos-Reyes said. ‘So when you have an increase in cholesterol, that’s when you might be at risk of heart disease.’

When testing for blood cholesterol levels, there are several types of cholesterol that matter: total cholesterol, low-density lipoprotein (LDL) cholesterol, high-density lipoprotein (HDL) cholesterol and triglycerides.

‘A lipoprotein is basically a transporter, or a vehicle, that binds to cholesterol. The bad cholesterol – LDL – that’s the lipoprotein that kind of hangs around arteries. That helps develop plaque in your arteries,’ Delos-Reyes explained. ‘HDL, the good cholesterol, is a vehicle that actually brings the cholesterol away from the arteries. That’s why we want that to be high. Triglycerides are another type of cholesterol that acts like the bad cholesterol.’

Delos-Reyes suggested using the first letters of LDL and HDL to remember their roles: LDL is Lousy, so keep it Low. HDL is the Happy one, so keep it High.

Cholesterol ratios can be very predictive of heart disease risk in women.

‘For women who have heart disease, we see that they have low HDL and high triglycerides,’ Delos-Reyes said. Those cholesterol levels can be important values for women.

Diet is obviously a factor in managing cholesterol levels. When looking at nutritional labels, the elements that represent ‘bad’ cholesterol are saturated fats, trans fats and hydrogenated fats.

Medications can also help keep bad cholesterols under control. However, there is no medication that helps to raise levels of good cholesterol. But exercise does help boost HDL.

‘You want the good cholesterol,’ Delos-Reyes said. ‘Exercise helps increase that.’

Exercise can also help control stress, which is another risk factor for heart disease.

‘It’s not about trying to get rid of all the stress in your life,’ Delos-Reyes said. ‘It’s really about trying to manage stress.’

Stress has physical effects: it boosts blood pressure and heart rate, increases the body’s oxygen demands, can raise breathing rate, blood cholesterol and the risk of blood clots, and can alter heart rhythms. Many years of stress can be a predictor for heart disease.

Some other ways to manage stress include identifying what causes you stress, prioritizing activities, and respecting your limits by being willing to ask for help and learning to say no when you’re overloaded.

Weighty matters

Being overweight increases the likelihood of having some of the biggest risk factors for heart disease: high cholesterol, high blood pressure and diabetes. Delos-Reyes noted that half of Canadians are overweight, especially those over 45 years old.

Most people know that some of the most effective ways to maintain a healthy weight are to keep active, eat a balanced diet and manage stress. But when using those tools to try to maintain or achieve a healthy weight, people should remember to use criteria other than BMI (body mass index) and waist circumference to gauge their progress.

‘There are other measures of success. Sometimes we’re too focused on the number on the scale,’ Delos-Reyes said. ‘So we’re looking at other measures. Are you feeling better? Have you started exercising or eating better? Are your clothes fitting better? Are you able to walk up the stairs and not stop or not breathe too hard? All of those are measure of success.’

The importance of physical activity to heart health can’t be stressed enough. It has obvious physical benefits, but can also have social benefits, and is a major element in controlling other risk factors for heart disease, including weight, diabetes, cholesterol, blood pressure and stress.

‘Heart disease is more than two times as likely to develop in inactive people,’ Delos-Reyes said. ‘A lot of studies show that someone who is overweight but exercises is at a lower risk than someone who is smaller or petite or skinnier and doesn’t exercise.’

She recommends using the FITT principle for physical activity. FITT stands for frequency, intensity, time and type.

Frequency is how often you exercise. At least three days per week, and as many as seven.

Intensity is how hard you exercise. ‘You want to exercise at a moderate effort,’ Delos-Reyes said. ‘You want to notice your heart rate slowly going up. Your breathing rate increases, you’re feeling warm, you’re feeling a little bit of fatigue after you exercise.’

A brisk walk, as opposed to an easy stroll, is a good starting point to build from. To make sure you’re not overdoing it, take the talk test: you should be able to say a sentence aloud without gasping for air.

Time is how long you exercise. Thirty minutes to one hour per day, but that time can be cumulative. So doing 10 minutes three times per day equals 30 minutes of activity.

Type is the kind of exercise you do. ‘If we’re looking at improving our fitness and making our heart stronger, we’re looking at aerobic exercise,’ Delos-Reyes said. ‘That’s basically activity that uses your full body.’ Walking, swimming and cycling are great examples.

Appraising and addressing risks

Knowing your personal risk factors can help you manage your overall risk of heart disease. Many people have more than one risk, Childerhose said. Those factors can be cumulative, combining to increase the odds of cardiovascular disease. But that accumulation may not be gradual: factors such as smoking or diabetes can add up to big jumps in heart risk.

Taking control of heart risks can mean getting to know your community resources, she added. Finding a local stop-smoking program, joining a mall-walking group or consulting a registered dietitian are all positive steps.

Childerhose also stressed the positive impact of diet and exercise. Eating plenty of fruit and vegetables daily, plus regular exercise, is an excellent formula to improve your risk factor profile.


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