Women’s heart disease is the number one killer of all women.  It may present differently in a woman that a man.  Symptoms are often more difficult to detect.  Men often experience a crushing chest pain, with pressure on the chest, whereas women can have an array of symptoms, from chest discomfort, to nausea, back pain, jaw pain, fatigue, or even shortness of breath.  The arteries of women are also different, with plaque developing diffusely throughout the arteries and men often getting discrete areas of disease.  This simply makes heart disease more difficult to diagnose in women.  When stress testing is “normal”, sometimes it is important to keep looking and investigating, because these “false negatives” are tests that are really abnormal, but the testing modality might actually be the wrong one to find the problem.

Menopause and peri-menopause bring other issues to women’s health. Often times palpitations develop as a result of fluctuating hormones. Other symptoms may also develop.  Just as if we train for a marathon, sometimes it is best to “train” for menopause, and the earlier we can start, the better.

Cholesterol is a major risk factor for heart disease. In managing cholesterol, sometimes medications are not necessarily the first and only step in dealing with cholesterol. Diet and exercise play a role in the management of cholesterol. Testing genetic markers on how food is metabolized may be helpful. There are environmental factors that influence these genes’ expression, such as the amount of carbohydrates eaten or the amount of fats consumed, as being part of successful cholesterol management. Included in this analysis is incorporating foods which may be more helpful in dealing with cholesterol issues. Vitamin intake and possibly, moderate alcohol consumption (6 ozs or less per day)  become considered as part of the plan, while cholesterol is monitored. Medications are then used if the cholesterol cannot be managed through diet, or if there is evidence of plaque formation seen on screening tests. Medication is sometimes not the best answer, and steps are taken to analyze how to best manage the cholesterol issues.

Everyone needs help with a lifestyle plan, figuring out what and how is best to eat specifically for them. Exercise is not instinctive for most of us, and even though we think we are doing the best we can for ourselves, sometimes seeing the numbers on the treadmill shows us exactly what we need to do.

To put together an effective exercise plan, a treadmill test is performed. We can determine how the heart rate responds in the face of exercise, and how best it is to perform more activity to get the heart optimally working. Heart health is about the efficiency of the heart, and as your heart gets healthier, the blood pressure decreases, the heart rate decreases and weight goes down. I believe and say it often, “Exercise is the best medication!”

Diet is simply a word used to explain that we all need to eat, but diets are never recommended. Once you go on a diet, eventually you have to go off of it. A food diary is reviewed, along with genetic testing for metabolism, which can tell us the best ways to eat for each individual. Food analysis is based on the diet already present in your life, and changes are made that are not too drastic, so the diet plan is do-able and achievable. Once we see what we are doing, and become accountable for our actions, somehow the next natural step is making healthy changes. As we learn to eat and live healthier, one of the benefits seems to be weight loss, and most of us don’t seem to mind that!

Sometimes our lifestyles get a bit beyond our control, and when we have reached a point of obesity, the spiral downward becomes a difficult challenge from which to recover. We start with the basics. Sometimes, learning how to eat is the most important step in dealing with food management. The Mando Center, www.mandonyc.com , is a group devoted to teaching people not just what to eat, but how to eat, and this is sometimes the best step to take. Getting the basics of learning behavior and triggers for eating is essential in analyzing the role of food in each of our lives. Being aware, being accountable and changing eating behaviors are keys to success.

Preventing heart disease begins with understanding the individual’s risk for developing heart disease. A thorough history to understand one’s health risks, as well as family history is paramount. An analysis of who each individual is makes prevention unique to each person. An assessment of risk factors including blood pressure, cholesterol, pre-diabetes, the metabolic syndrome, diabetes, inflammation, vitamin deficiencies, smoking, overweight and obesity, lifestyle issues including stress and exercise, and family history are all part of the analysis.

Baseline studies such as electrocardiograms and echocardiograms are performed in the office. Stress testing, including echo stress testing, may also be performed to look for any heart abnormalities or to determine the best exercise prescription to begin a successful exercise program.

How we live and how we eat is a product of our environment and our culture. Many times the food that we grew up with is the comfort food of today, which is not only part of how we felt love, but part of what is unhealthy for us. Some cultures’ cuisines are riddled with fat and carbohydrates, and it becomes challenging to separate ourselves from what we grew up with. For many women of color, putting the needs of everyone else before their own, is part of the learned behavior. Hypertension is the greatest problem for women of color, including obesity, diabetes and high cholesterol. Getting down to the basics and knowing that how we are living may be leading to heart disease: steps need to be taken to break the cycle. It is known that African-American women and Hispanic women have as much as a 69% higher risk of heart disease than Caucasian women due to all these risk factors. Careful analysis of risk factors and lifestyle issues need to be taken, and knowing certain medications don’t work as well in women of color can lead to a road of success in preventing heart disease.