Heart To Heart
Why women need to be concerned about heart disease.

By Linda Knittel

Cardiovascular disease (CVD) is the No. 1 health threat to postmenopausal women. Yet, according to a recent review of nearly 600 clinical trials, women remain vastly underrepresented in the scientific research, and many physicians may still not recognize the unique symptoms that heart problems display in the female body (Journal of the American Medical Association, 2001, vol. 286, no. 6). What's more, it turns out that hormone replacement therapy (HRT)—the supposed "magic bullet" for women's health—does not appear to reduce a woman's risk of heart disease. This latest revelation has prompted thousands of women to get back at the helm of their own bodies—a good thing, since natural preventive measures, like dietary changes, exercise and heart-healthy supplements, can do far more than a single pill to preserve a woman's cardiovascular health.

Heart breaker If you are currently taking hormone replacment therapy or considering its use, be sure to spend some time with your health care practitioner to determine if this now questionable treatment is right for you. Equal Opportunity Illness
Until fairly recently, heart disease was considered something only men had to worry about. Deborah Moskowitz, ND, director of the Transitions for Health Women's Institute in Portland, Ore., explains that several years ago, women were not considered heart disease candidates, even if they complained of symptoms. Often, she says, "they would be sent away with a diagnosis of anxiety and a prescription for Valium." Although some of that gender bias still remains, the numbers now show that more women than men over 65 die of heart disease, a truth that is finally making the medical community, as well as the public, sit up and take notice.

In their younger years, women reap a good deal of heart protection from the estrogen that circulates throughout their bodies. "Estrogen allows the coronary arteries to dilate and remain flexible," says Moskowitz. "It also plays a major role in keeping cholesterol levels down." While many of the risk factors of cardiovascular disease, such as high cholesterol, plaque formation and restrictive arteries naturally increase with age in both men and women, there is evidence that during and after menopause, when estrogen levels wane, the risk of heart disease in women rises significantly. This discovery led researchers to test estrogen supplements as a heart-disease preventive in postmenopausal women.

Initial studies seemed to indicate that hormone replacement therapy, in the form of estrogen alone or estrogen plus progesterone, lowered postmenopausal women's risk of developing or dying from heart disease. Although critics pointed to serious flaws in these early observational and uncontrolled studies, the medical community quickly endorsed HRT, and it became standard issue.

More recently, several randomized, controlled trials have shown a very different side of hormone replacement therapy. For example, in 1998, the Journal of the American Medical Association published the results of the Heart and Estrogen/Progestin Replacement Study (HERS), which gave 2,763 postmenopausal women who had a history of heart disease either estrogen combined with a form of progesterone or a placebo (vol. 280, no. 7). The results showed that over an average of four years, hormone replacement therapy did not protect these at-risk women from cardiovascular disease. What's more, the study demonstrated that HRT actually increased cardiac risk during the first year of use and possibly into the second or third. (If a woman is past her second year on hormone replacement therapy, the risk remains but at a lower level.) Similar studies have also linked certain forms of HRT with an increased risk of endometrial and breast cancers.

Additional long-term studies, such as the Women's Health Initiative (WHI), are currently examining the effects of HRT on women who do not have a history of heart disease. The American Heart Association recently released a statement for health care professionals suggesting that hormone replacement therapy not be used for the prevention of cardiovascular disease by women with a history of heart disease. Likewise, the association suggests there is currently insufficient evidence to show that hormone replacement therapy is capable of preventing heart disease in healthy postmenopausal women (Circulation, 2001, vol. 104, no. 4). And the issue is further complicated by different types of HRT. Some experts believe there may be more problems with conjugated equine estrogens like Premarin than with estradiol, considered "natural" estrogen.

Proven Heart Protection
Rather than become discouraged that hormone replacement therapy is not the quick fix for heart disease that it was first thought to be, empower yourself by developing good habits. In doing so, you will help prevent the disease and give your body what it needs: relaxation, exercise, high-quality supplements and good food.

A heart-healthy diet is one that minimizes salt, sugar, caffeine and alcohol; excludes saturated and trans fats as well as cholesterol; and includes plenty of healthy fats such as omega-3s found in fish and flaxseed. A plant-based diet will lend itself nicely to this regimen and will also provide a bounty of disease-fighting antioxidants and lots of fiber. At the same time, it is crucial to exercise, maintain a healthy weight, avoid stress, quit smoking and give your body supplements that can benefit your heart and blood vessels.

To prevent the oxidation of artery-damaging cholesterol, reach for powerful antioxidants such as beta-carotene, lycopene, resveratrol and vitamins C and E. In a recent study of 87,245 nurses, those taking 100 IU of vitamin E per day for more than two years had an average 41 percent reduction in heart disease (American Journal of Clinical Nutrition, 1995, vol. 62).

Additional studies have shown that the B vitamins such as B6 and folic acid have the power to keep homocysteine levels in check. High levels of homocysteine—a byproduct of the amino acid methionine—have been linked to higher rates of heart disease and heart attack.

To improve energy production in the heart and maintain adequate blood flow to the area, be sure to get enough coenzyme Q10. Since this enzyme is found in cholesterol-rich foods, it is best for those with heart concerns to obtain this nutrient through supplementation.

Certain minerals such as magnesium also play a crucial role in keeping the entire cardiovascular system healthy. Since women appear to be especially vulnerable to magnesium deficiency, it is important to fortify the diet with a quality magnesium supplement.

The heart can also benefit from several herbs. For example, garlic lowers cholesterol and reduces blood pressure; ginger is a potent antioxidant and enhances the heart's ability to contract; hawthorn increases blood flow and mildly lowers blood pressure; and capsaicin, a substance found in chili peppers, inhibits blood clotting and lowers cholesterol. As always, it is wise to seek the help of a knowledgeable health practitioner before starting any new herb or supplement regimen.

Educate Yourself
One confusing factor of hormone replacement therapy is that it offers relief to many women suffering from menopausal symptoms such as hot flashes and vaginal dryness. However, with this new research, it is important to reevaluate the benefits and assess other options for treating such symptoms. For example, taking soy isoflavones can decrease hot flashes and, potentially, your risk for osteoporosis.

The first step in taking care of your heart is to take responsibility for your own health. "A woman should come into her physician's office with a list of questions, her family's health history, and a general understanding of her own risk factors," says Moskowitz, who outlines how to determine such information in A Woman's Health Resource (Transitions For Health Inc., 2001). Then together, the two can evaluate how to best address those issues, whether it is through diet or through hormones.

Linda Knittel is a freelance writer specializing in health, nutrition and fitness.