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What Women Should Know About Heart Health
February 11, 2021
Women’s hearts are not the same as men’s. That’s not a Valentine’s Day message, but a fact that makes it essential for women to understand the impact that cardiac differences may have on overall health.
In recognition of American Heart Month, Tracy K. Paul, MD, an attending cardiologist at Weill Cornell Medicine who specializes in women’s cardiovascular health, outlines five ways women’s hearts differ from men’s, and five ways to maintain cardiac health.
Women’s hearts are smaller than men’s in mass.
That’s not a disadvantage, Dr. Paul says, but “Because of that, women’s hearts tend to beat slightly faster than men’s on average.”
It amounts to about four to 10 heartbeats difference per minute, depending on the individual.
Women’s hearts are adaptable.
“Our hearts are dynamic. In pregnancy, for example, women’s hearts beat faster, and the blood vessels are more dilated,” Dr. Paul explains. “Women also experience lower blood pressure overall during pregnancy,”
In the post-partum period—particularly the first two weeks following pregnancy—a woman’s heart rate and output will return to its previous function within about a year.
The nature of women’s heart attacks can differ from men’s.
Women are five times more likely than men to experience a type of heart attack called MINOCA, an acronym for myocardial infarction with non-obstructive coronary arteries. This type of heart attack is not caused by blocked arteries, but occurs in the smaller blood vessels.
Women who experience MINOCA also tend to be younger and non white.
“It’s important to looks at this from a patient care perspective,” Dr. Pauls says. “If a woman has MINOCA, she may have other conditions that need to be evaluated and optimized, such as blood pressure.”
Women are at higher risk of developing heart failure with preserved ejection fraction, also called diastolic heart failure, with age.
Diastolic heart failure causes almost half of the five million cases of heart failure in the United States each year.
“Doctors should be aware that, even if the heart-pumping function is normal, the ability to receive blood into the heart can change because it can stiffen over time,” Dr. Paul says.
Petite women, she adds, already have smaller hearts, so if their hearts stiffen and are not pumping enough blood, it can back up into the lungs and cause a shortness of breath. Symptoms of this condition also can include swelling in the belly and legs.
Broken heart syndrome is real, and women are more likely to experience it.
Also called takotsubo cardiomyopathy, this condition can appear even in a healthy patient. It’s often related to a stressful emotional reaction—bad or good—that leads to a surge of stress hormones.
Broken heart syndrome can be misdiagnosed as a heart attack because its symptoms and test results are similar but, unlike a “typical” heart attack, there’s no evidence of blocked heart arteries. The syndrome causes part of the heart to temporarily enlarge and not pump well, while the rest of the heart functions normally, or with more forceful contractions.
Dr. Paul also highlighted ways that women can maintain their heart health.
Try a plant-based diet—and keep moving.
“Whole foods, a plant-based diet, and avoiding preservatives is a great choice,” Dr. Paul advises. “But not everyone has to adopt a vegan diet. Small amounts of animal protein—leaner meats and leaner cuts, are okay, and should take up about a quarter of a round plate.”
She recommends colorful vegetables on half of the plate, along with whole grains, like bulgur and quinoa, on another quarter.
Exercise also is key to optimal heart health. To maintain weight, Dr. Paul says 150 minutes a week of exercise that boosts the heart rate is healthy. For those looking to lose weight, 300 minutes per week is a good goal.
“The main message is that we’ve got to stay active. It’s not just about 10,000 steps per day, but making sure you have sustained physical activity for 15 minutes twice a day to get the best benefit,” she explains, and adds that exercise also helps decrease blood sugar levels, and control blood pressure and cholesterol.
Get enough sleep.
The idea that sleep—ideally, six to eight hours a night—can be restorative, applies to the heart directly.
“Sleep not only allows us to function during the day, but also helps control blood pressure and gives our vasculature a chance to rest and not be highly stressed,” Dr. Paul says.
Stress can lead to behaviors—such as overeating or physical inactivity—that ultimately affect heart health. So stress reduction and management are key. There are many ways to do that, from meditation and exercise, to reaching out to loved ones.
It’s also important to allot time for yourself, Dr. Paul says.
“And depending on the person, it may be helpful to see a therapist to identify and work through stressors that are affecting you,” she adds.
Understand cholesterol levels and blood pressure.
“For most people, we’re targeting a total cholesterol of less than 200, and an LDL [“bad” cholesterol], of less than 100, and an HDL [“good” cholesterol] of 60 or greater,” Dr. Paul says.
If these numbers are high, even with a lean diet and proper exercise, women should consult a cardiologist.
Blood pressure should be lower than 120 over 80.
“Some people say their blood pressure is higher at the doctor’s office, but it can be useful to have a blood pressure cuff at home to check that,” she advises. “If it’s still high at home, that’s another conversation to have with your physician.”
Be honest about your individual and family health history.
Do you have a first-degree family member who had a heart attack around the age of 55? Were your pregnancies full-term?
“Those things give us a window into women’s cardiovascular health,” Dr. Paul says. “If you have even one of those factors, you may be at risk for possibly developing cardiovascular problems. Bring it up with your doctor.”