Heart health Q+A -- risk factors, heart attack symptoms and more

What is heart disease?
Heart disease commonly means that the arteries supplying the heart are narrowed by calcified fatty deposits. These deposits prevent blood flow that carries sufficient oxygen to the heart. Without sufficient oxygen, the heart becomes injured and feels painful, producing symptoms of what we call angina. If the heart is chronically short of oxygen, it begins to function poorly, reducing quality of life and causing heart failure. Lack of oxygen can be so profound as to cause heart death and cardiac arrest.

How would I know if I had heart disease?
Crushing chest pain with shortness of breath, sweating and dizziness could signal a heart attack. But heart disease can also be a silent, stealthy killer. And it can be difficult for women to detect subtle symptoms of heart disease until it has become severe. Commonly, mild shortness of breath -- puffing when going upstairs or carrying a load of groceries -- is an early indication. Sometimes this feeling of being out of breath is accompanied by a slight sensation of chest pressure or aching in the lower jaw, both of which disappear quickly with a brief period of rest. Other symptoms include unusual fatigue and unexplained dizzy spells. 

The difficulty in diagnosing heart disease is that these symptoms could be the result of literally dozens of other causes. But, especially in combination, these symptoms merit a visit to a family physician, who will be able to assess a woman's heart disease risk factors and, if necessary, refer her to a specialist for more in-depth investigations of her coronary arteries.

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What can I do to keep my heart healthy?
Maintaining heart health means learning if you have a family history of heart disease and lowering heart disease risk factors: smoking, excessive weight, lack of fitness, high blood pressure and diabetes. It's a pretty daunting list. Let's find out how these factors are interrelated and which ones are manageable.

Family history. Many families have elevated cholesterol levels thanks to genes that bump up the production of cholesterol in the liver to above normal. But many women with a strong family history of heart disease discover that it may be related to their parents' poor health habits. Were they smokers? What about their weight and physical fitness? Did they drink a lot of alcohol? Did they eat high-fat, low-fibre foods? If the answers are yes, these are risk factors their daughters can choose to avoid.

Smoking. If they smoke, they can quit. Smoking is invariably linked to heart disease, but the good news is that quitting can result in diminished heart (and lung) disease risk, depending on how many cigarettes were smoked over how many years.

Excessive weight, inactivity and high blood pressure. Women who are overweight increase their risk of heart disease when they consume more daily calories than are burnt up by exercise. In North America, far too many of these calories come from fatty foods, which eventually clog arteries. Furthermore, it follows that most overweight people are inactive and unfit; so are their heart muscles, which can be stressed by the demands of sudden activity, such as going upstairs. Elevated blood pressure (hypertension) is frequently associated with obesity and lack of exercise, although some people, no matter how lean and fit, still suffer from hypertension and need drug treatment to maintain a safe level.

Diabetes. Why is diabetes a concern for heart health? Unless blood sugars are meticulously controlled, diabetes is inevitably associated with heart and blood vessel disease. Blood glucose reacts with proteins to trap cholesterol, which is deposited in blood vessel walls, leading to atherosclerosis and narrow arteries, which in turn diminishes blood flow. Reduced blood flow to the brain leads to strokes, and the narrowing of coronary arteries can cause heart attacks as well as gangrene in the legs, for which amputation is the only treatment. Management of diabetes means preventing heart and blood vessel disease. It's that simple.

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How can I tackle these risk factors? Look at the recurring themes: smoking and being overweight and unfit. Most women know that nonsmokers have a lowered risk of almost every disease on the planet. But becoming a nonsmoker can be a nightmare because, for poorly understood reasons, women find quitting smoking more difficult than men do. To make things worse, it's almost impossible to kick the habit in a household of other unrepentant smokers. So now what? Get professional help. Many physicians are skilled at helping smokers along the path to abstinence. There are resources to help people quit on websites and courses at local colleges or public health units. Women must take charge.

There are no easy solutions for weight loss. But I do have a secret weapon for successful exercising: good walking shoes. Try this. Today, go buy a pair of comfortable walking shoes. Leave them out in plain view. When they've become familiar household items, put them on and walk around the house a bit. Now you're ready for action. Walk to the corner store, around the block or up the street to visit a neighbour -- whatever works -- until daily walking has become a part of your life.

It's not about walking a marathon: 20 to 30 minutes of brisk walking a day is all it takes. Don't want to walk alone? A partner, friend or neighbour might follow your shining example and come along. Dog owners, as studies have shown, are heart healthier because they often walk more than people without dogs. Fido will love you, you will burn up calories, and if you commit to smaller portions of pasta, bread, potatoes and animal fat, slowly but surely you will lose weight. You will become more fit, have more energy, enjoy better heart health, lower blood pressure and lower blood sugars. Regular exercise reduces modestly elevated blood pressure just as effectively as medication. Ditto blood sugar in type 2 diabetes. Not a bad return on your walking-shoe investment!

What should an unfit, moderately overweight woman not do?
• Don't spend money on miracle weight-loss pills, potions and lotions. Only one person will benefit: the manufacturer.

• Don't join a gym if you hate sharing space with sweaty bodies wrestling with machines that look like instruments of torture. You won't go more than a couple of times. More money down the tube.

• Don't go on one of those silly diets that promise a 10- or 20-pound weight loss and eternal happiness by next Friday. It won't happen.

• Don't go on one of those fasting/detoxifying binges. Toxins aren't the problem, and all that water and other weird stuff you have to drink can play havoc with your body chemistry. The concoctions associated with this enterprise also cost. Big time.

• Don't waste your money on Weight Watchers (which I highly recommend for their consistent track record and their sensible eating plan) if you are not committed to changing your eating habits from the dark side of high-fat, high-sugar snack foods to the sunny side of low-fat, nutritious foods.

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