Taking the Message to Heart

Is there anything I can do to reduce risk?

For starters, don't smoke: Smoking puts women at twice the risk of heart attack that it does for men.

Next, maintain a healthy weight. Overweight (25 to 29 on the Body Mass Index scale) and obesity (over 30) are closely tied to diabetes. And women with diabetes have a 50 percent greater risk of having a heart attack than men with diabetes, according to a study presented in February at an Orlando conference on women and heart disease.

Metabolic syndrome (a pre-diabetic state indicated by large waist circumference, poor cholesterol measures, high blood pressure and a high fasting glucose) is also tied to more arterial plaque and higher heart attack risk for women.

Maintaining a healthful diet pays off, too. Holly Thacker, director of the Women's Health Center and Breast Pavilion at the Cleveland Clinic, advises increasing the good fats (from olive and peanut oil and fatty fish such as salmon) and decreasing the bad (eliminate anything partially hydrogenated). Women who eat more fiber -- especially from cereal -- have a lower risk of heart disease.

Exercise helps keep the weight off and increase HDL, or good cholesterol, which studies have shown is more predictive of cardiovascular health in women than in men.

Can't I just take a cholesterol-lowering drug, the way my husband does?

Yes, but the benefits aren't as well established for women.

It's true the National Cholesterol Education Program (NCEP) recommends a statin for anyone -- man or woman -- with an LDL ("bad" cholesterol) reading of 190 or higher. NCEP also recommends statins for people at high risk of heart disease whose LDL is over 100.

But while statins have been proven to reduce both heart disease and deaths in men, statin use in women is more controversial. Although statins clearly reduce deaths and disease in women with heart disease, for women without heart disease, they've been shown thus far to reduce heart attacks and strokes but not deaths.

Reduce bad events but not deaths? Help me out here.

This is a case where the lack of research in women could compromise women's health. Susan Bennett, director of the Women's Heart Program at George Washington University, said women generally make up only 25 to 30 percent of study trials, and the women in the studies were younger and healthier than women who typically have heart attacks. As more women are studied, she predicts, statins will be shown to reduce deaths.