In case you missed it, February was Women’s Heart Health Month, perfectly fitting with Valentine’s Day in the middle of the month. It isn’t too late to wear a red dress to support awareness of heart disease in women.

The pink ribbon of breast cancer awareness is easily recognized and well known, but the red dress of heart disease is not. Yet, roughly 10 times more women die from heart disease annually as do from breast cancer. Since the mid 1980s, more women have been dying annually of heart disease than men. 

Part of the problem here is focus and part is history. Breast cancer is enormously emotional, frightening, and potentially disfiguring. The good news is that it is more and more curable with good screening, early detection, treatment and follow-up. Also, many of the same lifestyle choices to reduce breast cancer risk also reduce heart disease risk.

 An important issue is that heart disease symptoms in women are often subtle and less obvious than in men. The common triad of chest pain brought on by exercise and relieved by rest, which is a common, presenting sign of heart problems is not always so clear-cut in women. Because women’s heart disease tends to occur in smaller vessels and is more diffuse symptoms can present more generically. These include fatigue, shortness of breath, indigestion, nausea, faintness, upper back, neck or shoulder pain. 

Let me give you the example of Lila, a lovely woman in my practice now in her mid 60s, who is now on the transplant list for a new heart. She seemed to be at low risk for heart disease. She was a nonsmoker, thin, active, with well-controlled blood pressure, blood sugars and cholesterol. She had also breast-fed her several children lowering her risk of breast cancer.

Nonetheless, in her early 40s and 50s she suffered a series of silent or nearly silent heart attacks that progressively damaged her heart muscle. When her husband, Jerry, died of complications of surgery a few years ago, her heart was broken with grief and her cardiac function worsened further. Even now, with a weakened heart, she rarely if ever has chest pain but suffers the symptoms of heart failure: fatigue, shortness of breath, sleep problems, digestive problems and general exhaustion. 

For many years, we have thought women’s hormones, which clearly affect their breast cancer risk, protected them from heart disease. Though being female does in many cases delay the onset of heart disease, it remains highly prevalent. Women also tend to live several years longer than men allowing more time for heart conditions to develop. 

What are some things to do to avoid Lila’s fate and reduce your heart risk? 

• Be aware of family history of heart disease, especially heart attacks occurring in younger family members.

• Maintain a healthy weight with a body mass index optimally under 25.

• Don’t smoke.

• Get your cholesterol, triglycerides, and blood sugar checked regularly along with blood pressure.

• Avoid saturated fats in your diet by eating more fruits, vegetables, low fat proteins, nuts and beans.

• Try new ways to manage the high levels of stress women endure while juggling children, care of their parents or other relatives, a husband and often a job or two. If this sounds impossible, know it isn’t. I regularly recommend Martha Davis’ “The Relaxation and Stress Reduction Workbook” for some easy, short methods to manage stress in the midst of life’s “full catastrophe.”

• Consider dietary supplementation with B vitamins, vitamin D, fish oil, calcium and magnesium for heart health as well as for bone and other organs.

• Discuss with your doctor the risks and benefits of regular aspirin. Usually, one or two baby aspirins daily is about right unless you have bleeding risks.

• Exercise regularly 30-60 minutes a day. Breaking this up into 10-15 minute segments to accumulate your daily recommended minutes is sometimes easier, and try to get at least 150 minutes total weekly.

• Get breast cancer and other gynecological screenings on schedule but keep them in the context of the much higher rate of heart disease in women than these malignancies.

• Remember that heart symptoms in women can be subtle and not be the typical exertion related, crushing chest pain radiating to the left arm.

• Remember the dark chocolate. 

And wear a red dress from time to time to help remind you and others of the importance of your heart’s health all year round. 

Dr. Victor S. Sierpina is the W.D. and Laura Nell Nicholson Family Professor of Integrative Medicine and Professor of Family Medicine at UTMB.

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