According to the Heart and Stroke Foundation heart disease is the leading cause of death in Canadian women. Here's how to manage your risk.

Tests: How reliable are they – for women?
One area in which gender enters the heart disease equation is the treadmill stress test. This test helps doctors determine the presence of heart disease, but it was designed for men. During a treadmill stress test, patients are outfitted with electrocardiographic leads that record their heart rate. They walk on a treadmill or use a stationary bike, with increasing intensity, until they develop symptoms such as shortness of breath and fatigue. Some women aren't able to achieve the high heart rate needed for diagnosis, which results in treadmill tests being inaccurate for them, says Dr. Marg Blackwell, a clinical instructor of medicine and rural family practice at the University of British Columbia in Vancouver.

Other standard tests given to heart attack patients include:
• Electrocardiogram (ECG). According to Dr. Rob Myers, the author of Heart Disease (Key Porter, 2004), an ECG is a rapid and noninvasive test that provides accurate diagnostic information from a long list of cardiac problems, such as heart rhythm.

• Perfusion imaging. Prior to treadmill testing, your doctor inserts an intravenous line through which the drug thallium or hexamibi is injected and absorbed by the heart. A special machine takes pictures of the heart, which indicate in what part of the heart the drug has settled. If you have suffered a heart attack, part of your heart muscle is dead and no longer receives blood, so it also won't absorb the drug.

• Echocardiography. Also known as cardiac ultrasound, or echo, these tests are painless and safe. They provide detailed information about cardiac anatomy and function, such as weakness of the heart muscle and heart-valve abnormalities.

• Magnetic resonance imaging (MRI). Cardiac MRI provides more detailed images than echocardiography.

Page 1 of 3 – Learn the role that stress plays in heart disease on page 2
 

The stress factor
As many as one-quarter of heart attacks in women could be triggered by some stressful external event, says Dr. Paul Dorian, coauthor of A Change of Heart: Recovering from Heart Disease in Body and Mind (Random House Canada, 1999).

Our body responds to stress by producing more adrenaline, a hormone that gives us increased energy to fight or flee but also increases blood pressure, heart rate and blood-clotting potential. “All of these lead to an increased likelihood of plaques in the arteries rupturing and a subsequent heart attack,” says Dorian, who is also a professor of medicine at the University of Toronto.

This may help explain why people who suffer from chronic low-grade depression are more likely to develop heart disease as they age compared with more cheerful folk. People who stay depressed following a heart attack are also more likely to die than those who recover from any depression a heart attack is likely to engender. Dorian's own research has shown that people who require an implantable defibrillator to help maintain a regular heartbeat are more likely to die if they are depressed than if they are not.

“People react spontaneously to acute illness, but a proportion don't get over the expected low mood,” says Dorian. This will not only impair their recovery but also make them less likely to adopt heart-healthy habits, he adds.

If mild depression persists for longer than six to 12 weeks following a heart attack, you should seek medical attention.

Does Asprin work?
Aspirin really does prevent heart attacks -- and strokes -- in women. After more than 10 years of followup, the Women's Health Study showed last year that in women over age 65, taking low-dose Aspirin every other day reduces the risk of heart attack by 34 per cent and the risk of ischemic stroke (caused by a blockage in an artery leading to the brain) by 30 per cent. Ischemic stroke is caused by the same disease process that causes the majority of heart attacks and it is by far the most common type of stroke women experience.

Page 2 of 3 – Learn the risk factors and what to avoid in your daily habits on page 3.

Risk factors you can control

• Smoking. According to Health Canada smokers have a 70 per cent greater chance of dieing from coronary heart disease than non-smokers. Stopping smoking is the single most important lifestyle change you can make to prevent heart disease.

• Blood pressure. High blood pressure is a major contributor to stroke but has less influence over heart disease. Blood pressure often increases with age, so even if your blood pressure is perfect now, you need to know your numbers and have a high level treated as soon as it tips the cutoff point of 140/90 if you are otherwise healthy.

• Cholesterol. High levels of “bad” low-density lipoprotein (LDL) cholesterol and especially low levels of “good” high-density lipoprotein (HDL) cholesterol are toxic to the inside of the blood vessels and promote the build-up of cholesterol-rich deposits. Either a heart attack or a stroke can occur when these deposits rupture and form blood clots, which are released into the bloodstream and find their way into arteries, where they block blood flow.

• Excess weight. If you're going through menopause, you're prone to putting on weight around the abdomen, which could adversely affect blood pressure, “bad” LDL cholesterol, insulin and blood sugar levels. It's this constellation that significantly increases the risk of both heart disease and diabetes. Women who put weight on around the hips and thighs are still at higher risk for heart disease.

• Inactivity. Routine exercise reduces your risk of heart disease. At the minimum, Dr. Beth Abramson of St. Michael's Hospital in Toronto and a spokesperson for the Heart and Stroke Foundation tells her patients to partake in moderate exercise, such as a power walk for 20 minutes, three times a week. Ideally, people should be walking for 30 minutes most days of the week. Moderate exercise means being short of breath and sweaty, but you should still be able to walk and talk at the same time.

• Poor diet. A common-sense diet features low-fat dairy products, whole grains, plenty of fruits and vegetables and modest amounts of lean meat or meat alternatives.

• Recreational drugs. Cocaine has been associated with heart attacks in young people, and now crystal methamphetamine (meth) is taking its toll among the young as well. Crystal meth causes the arteries to constrict, closing off blood supply and possibly triggering a heart attack.

• Alcohol Intake. Excess alcohol consumption may increase blood pressure and the risk of stroke.

• Stress. Mental stress, whether on the job or at home, doubles heart attack risk.

Risk factors you can't control

• Age. Women tend to be better protected against heart disease until they reach menopause, after which they start catching up to men. Although women of all ages should concern themselves with heart disease prevention, the risk of heart disease increases with age.

• Family history. Women whose father had heart disease before the age of 55, or whose mother had heart disease before the age of 65, or even whose sibling had heart disease, are at increased risk. You can't change your genes, but knowing that you have "bad" heart genes should be a major incentive to adopt heart-healthy behaviours.

• Diabetes. If you are premenopausal, having diabetes takes away the protection against heart disease that premenopausal status tends to confer on younger women.

Read more:
• How to recognize the signs of a stroke – and to find out if you're at risk
• Foods that lower cholesterol
• 9 ways to reach your weight-loss goals

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