Major Risk Factors

Smoking. More than 23 million American women smoke. Cigarette smoking triples the risk for heart attack, and research now shows that women smokers seem to have a higher risk of heart attack than men who smoke.

Older women and those with other risk factors for heart disease are at greatest risk. Women who smoke and use oral contraceptives, particularly women age 35 and older, are also at higher risk.

There is nothing easy about giving up cigarettes. But as hard as quitting may be, the results are worth it. In the first year after stopping smoking, the risk of heart disease drops sharply. It then gradually returns to normal—that is, the same risk as for someone who never smoked. This means that no matter what your age, quitting will lessen your chances of developing heart disease.

Many women successfully quit smoking on their own, but you also may do well in a group setting. There are a number of free or low-cost programs available that can help you stop smoking. Additionally, ask your doctor whether you are a candidate for medication, nicotine gum, a nicotine patch, or nicotine nasal spray. These aids can help you stay smoke-free by lessening withdrawal symptoms while you get used to life without cigarettes.

Second-hand smoke is also a problem. It is estimated that each year up to 40,000 people die from heart disease caused by other people's smoke. To avoid second-hand smoke, try the following strategies:

• Ask people not to smoke in your home.
• Choose the no-smoking section in restaurants and other public places.
• Seek a smoke-free work environment, or try to change the smoking policy at your current workplace.

High blood pressure. More than one-third of women age 20 to 74 have high blood pressure. The condition is more common and more severe in African-American women than it is in white women. Four out of five black women age 45 and older have high blood pressure.

High blood pressure is sometimes called the “silent killer” because most people who have it don't feel sick. It is important to have your blood pressure checked each time you see your doctor or health professional. Although high blood pressure can rarely be cured, it can be controlled with proper treatment. If it is not too high, you may be able to control it through weight loss (if you are overweight), regular exercise, and cutting back on alcohol, table salt, and packaged foods containing sodium. If your blood pressure remains high, however, your doctor may prescribe medicine in addition to the above changes.

High blood cholesterol. Young women tend to have lower cholesterol levels than do young men. However, between the ages of 45 and 55, women's levels begin to rise, surpassing men's. After age 55, the gap between women and men becomes even wider. Today, about one-fourth of all American women have blood cholesterol levels high enough to pose a serious risk for heart disease.

All women age 20 and older should have their blood cholesterol level checked. A complete lipid/cholesterol profile will show total cholesterol level as well as the levels of “good” cholesterol (HDL), “bad” cholesterol (LDL), and triglycerides. Experts are not certain whether triglycerides are a risk factor for heart disease by themselves. However, having high triglycerides may increase the risk for women more than for men.

A desirable blood cholesterol level for adults without heart disease is less than 200. A level of 240 is considered high, but even levels between 200 to 239 boost the risk of heart disease.

For many people, cutting back on foods high in cholesterol and fat, especially saturated and trans fats, can lower cholesterol. Saturated fats, found mainly in animal products, and trans fats, which are found in margarine and commercially prepared baked goods, should be replaced with monounsaturated and polyunsaturated oils. The “monos” are found in olive and canola oils. The “polys” are found in soy and corn oils. Regular exercise also can help lower cholesterol levels, as can weight loss if you are overweight.

If these lifestyle measures do not lower cholesterol level enough, your doctor may prescribe cholesterol-lowering medications. This recommendation will depend on whether you have any other risk factors for heart disease.