By Laurie Tarkan for Health magazine
You’re under 50. You’re pretty fit. You can’t have a heart attack, right? Truth is, starting at the age of 35, heart disease is the leading killer of women. About 35,000 women younger than 50 die of heart attacks annually -- but only 20 percent of women believe they’re at risk for heart disease.
“We really need to bust the myth that this is just a disease of men and older women,” says Nieca Goldberg, M.D., medical director of the New York University Women’s Heart Program. Sixty-four percent of women die suddenly with their first heart attack without any warning signs at all, and 90 percent of those women had at least one risk factor that could have been addressed.
“That’s why it’s critical to figure out your risks and do prevention early on,” Dr. Goldberg says. And that’s what the women we’re featuring here did. Using a variety of strategies, they tackled a range of risk factors, including scary family histories, high blood pressure and obesity. We asked Dr. Goldberg to assess how well they did -- and to help us all learn how to lower our own risks.
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Loraine Morgan, 34
Risk factor: Family history
When Loraine Morgan’s dad was told he had high cholesterol, he took a pill and ignored it. Ditto with high blood pressure, and again with diabetes. “He took medications, but didn’t make any major life changes,” says Morgan, 34, a mother of two with another baby on the way. But then, when her father was 63, one of his toes turned black -- a complication of diabetes -- and his whole foot had to be amputated. “That was a turning point for everyone,” she says. “The doctor said that 90 percent of his coronary arteries were clogged.”
The next day Morgan started running, made an appointment to get a physical and looked in the mirror. She was 15 pounds overweight and decided to ditch those extra pounds. She also did some digging on her family history. Her father went on to have five amputations and died at 68. Her mom has high blood pressure and high cholesterol. Her maternal grandmother has had a stroke. Her paternal grandfather died of a heart attack. And most of her aunts and uncles have some risks for heart disease or diabetes. She realized that dealing with illness would be her destiny if she didn’t make changes.
Morgan now runs about 40 minutes a day, five days a week, and lifts weights twice a week. “I was the first of my three sisters to change my lifestyle, and they all followed suit,” she says. She no longer eats the nightly steak-and-potatoes diet her parents followed. Instead, her meals are well-balanced and varied, with plenty of fiber, a lot of lean protein (she eats fish at least twice a week) and vegetables. She also eats every two hours to keep her metabolism up and blood sugar stable. “Every food decision I make now is because it has the best nutrients for my body,” Morgan says.
Dr. Goldberg’s take:
“Morgan’s family has serious risks for diabetes and high cholesterol, so she was at risk, too. But with the lifestyle she’s now leading, she’s going to prevent it. Her numbers -- BMI, 20; waist, 23 inches; LDL, 96; HDL, 78 -- are all very good. I’d give her an A+ for heart health. Her running is a very big part of her program, and studies show that people at risk for Type 2 diabetes who exercise regularly are able to fight it off. She’s also created a balanced diet, one she can live with. Now that she’s pregnant, Morgan needs to get good nutrients for the baby without returning to the higher-fat foods of her youth.”
Barbara Lesperance, 70
Risk factor: Age
Once women hit menopause and their estrogen levels drop, risks of problems like high cholesterol and high blood pressure go up. But Barbara Lesperance hasn’t let menopause or her age affect her heart health. In fact, “I think I’m healthier now than I’ve ever been,” says the mother of four, grandmother of 10 and retired nurse.
She does a sweat-inducing 35-minute strength-training circuit at Curves three days a week and plays golf -- she walks the front nine holes -- three times a week. On her non-golfing days, Lesperance and her husband walk two miles after dinner. She eats healthy foods like chicken, salmon and lots of fruits and vegetables and salads. For her efforts, she has lost seven pounds since she retired seven years ago, her LDL (bad) cholesterol is at an all-time low of 102, and she feels that she’s got more stamina now than she has had in a long time.
Dr. Goldberg’s take:
“Lesperance’s only risk factor is her age. I think the best thing she is doing for herself, after years of taking care of others, is that she’s now taking care of her own health. Her active lifestyle has taken years off her risk. Her exercise regimen is excellent and well-rounded with strength training, walking and golf. And her healthy HDL level (66) is seen in people who exercise. Plus, her BMI of 22 and 29-inch waist show that she eats right. I’d give her an A.”
Jennifer Griola, 34
Risk factors: Overweight; had borderline gestational diabetes while pregnant
Jennifer Griola, a blogger and mother of two, busts the myth that you have to be thin to be heart-healthy -- her BMI is 30 and her waist is 35 inches. Griola does a high-intensity workout six days a week for 90 minutes, alternating between an interval workout with a trainer and a cardio boot camp class.
She eats lots of vegetables, prepares her food rather than relying on frozen meals; rarely eats red meat, opting instead for ground turkey, chicken and lots of lentils, beans, soy and nuts in moderation. Not only has Griola lost about 90 pounds in five years, but her HDL has gone from 47 (in the unhealthy range) to 56, her LDL has dropped from 109 to 94 and her triglycerides (a fat associated with heart disease) have plummeted from 130 to a very healthy 56.
When she was pregnant with her first child -- before her weight loss -- Griola had borderline gestational diabetes and high blood pressure. (New evidence suggests that women who had high blood pressure while pregnant, especially those who had preeclampsia, have a higher risk of heart disease.) While nursing her baby, she started thinking about her lifestyle and being a better role model for her daughter. That’s when she launched her exercise-and-diet program, which she blogs about on Lost100.com.
“Because I’d been an athlete, I never thought of myself as obese or at risk of a heart attack, but I probably was,” Griola says. By her second pregnancy, after she’d lost weight, she had neither high blood pressure nor borderline gestational diabetes.
Dr. Goldberg’s Take:
“I’d give Griola an A–. She’s doing all the right stuff, and she has obviously found success doing it. Some people don’t ever start an exercise program because they say it will never work, but she’s proof that the scientific data is right: The dramatic change in her triglycerides and her better cholesterol stats came from losing the weight. She needs to reduce her waist size a bit more, which she can do by doing more muscle-strengthening exercise to lower her percentage of body fat.”
Alissa Gardenhire-Crooks, 39
Risk Factors: Family history; high blood pressure
Since grad school, Alissa Gardenhire-Crooks, a social-policy researcher, has had high blood pressure -- a not-uncommon condition in African-Americans. In fact, both of her parents have hypertension, and her father had a mini-stroke in his mid-50s and a full-blown one in his late-60s. But Gardenhire-Crooks’ heart stats look great, thanks to her efforts to get back in shape (she had been sedentary since college) and her change in diet. (She’s also on blood pressure medicine.)
During college, grad school and her first years on the job, Gardenhire-Crooks had lost and gained 50 pounds several times and had become so frustrated with her weight that she saw a surgeon for bariatric surgery. “I was sad about being so heavy and not feeling good about myself,” she says. She also had a toddler who was very active. “I was really exhausted physically and worn out emotionally with the up-and-down dieting,” she says. (Yo-yo dieting is also very hard on the heart and arteries, studies show.)
While awaiting insurance approval for the surgery, Gardenhire-Crooks started a fitness plan, inspired by a personal trainer she met at a bodybuilding gym; he also gave her an education in nutrition. She lost 69 pounds, went from a size 20 to 8 (a transformation she blogs about at Size10Chronicles.com), and ditched the surgery idea. Gardenhire-Crooks currently lifts weights three times a week and does cardio six times a week. She’s also a Buddhist, and she meditates 20 to 30 minutes several times a week.
Though she wasn’t a junk-food eater, carbs were her downfall. “I was addicted to bread, potatoes and rice,” she admits. Now she does carb cycling, in which she eats no starches three days in a row. Her BMI is 27.5, HDL (good) cholesterol is 62 and LDL (bad) cholesterol is a low 92.
Dr. Goldberg’s take:
“African-American women are at higher risk for heart disease and diabetes, but I don’t think Gardenhire-Crooks will become a statistic. This woman has a plan that earns her an A–. If she keeps it up, she’ll lower her risks for heart disease and Type 2 diabetes. The only thing she has to keep an eye on is her blood pressure, which is in the prehypertensive range at 128/70. Her meditation is a great way to keep blood pressure down, but she should also reduce the salt in her diet.”
Debbie Ann Schneider, 46
Risk factors: Heart attack at 42; had been a smoker
Four years ago, after Debbie Ann Schneider had logged nearly an hour-and-a-half on the treadmill (she was absorbed in a TV show), she felt a touch of asthma and noticed that her heart rate kept going up even though she was slowing down. As she started to lie down she thought of a TV show she’d seen three weeks earlier about how heart attack symptoms differ in women and men. Then her dog uncharacteristically put his head on her heart. That was it. Schneider went to her computer to look up symptoms of a heart attack and recognized a few in herself -- chest discomfort, trouble breathing, nausea and a general unwell feeling. She got up and drove herself to the hospital.
While being triaged (ever so slowly because she appeared to be a healthy young woman), her blood pressure kept dropping. Schneider had had a heart attack caused by a coronary artery spasm, in which a contraction of the artery stops blood flow to the heart. “If I hadn’t seen that TV show, I’d probably be dead,” she says.
Schneider’s only obvious risk factor was that she had been a smoker (though she had quit five years earlier). She’d always been fighting those last 10 to 15 pounds, but she had been a vegetarian since 1991 and had always exercised. “I was perfectly healthy and fine, and had no idea I had any flaw or heart disease,” she says.
Now Schneider is considered at higher risk for a second heart attack, and she takes medication to prevent another spasm. But her healthy lifestyle is helping to keep her risks low. She exercises a couple of times a week and is trying to eat a Mediterranean diet. She takes omega-3 supplements and plant flavonoids, which may help lower her cholesterol. And she avoids stress. “I actually get chest pains when anything is too stressful,” she says. This built-in barometer has helped her kick stress out of her life.
Dr. Goldberg’s Take:
“Smoking is a major risk factor in heart disease, so it’s great that Schneider quit. She didn’t have a heart attack because of plaque buildup, but it’s important for her to keep exercising and eating right to lower her risks of another heart attack, which go up after a person has one. She has done a great job controlling her cholesterol -- her LDL of 94 is great -- but there’s room for improvement, so I’d give her a B+. Schneider needs to reduce her waist size (36) and boost her HDL (53) with exercise and diet. The stress reduction is great. Plus, she has two dogs, which can help reduce heart attack risk.”