Women's Heart Advisor January 2011 Issue

Ask The Doctors: January 2011 Women's Edition

Q. I am a 65-year-old woman with a total cholesterol level of 233 mg/dL. My HDL is 78 mg/dL and my LDL is 137 mg/dL. My doctor says I have hypercholesterolemia. What do I need to do?

We would advise you to follow a low-fat diet, get regular exercise and take a cholesterol-lowering statin. Itís not a sexy solution, but it makes sense. If you eat less and burn more calories, you will lose weight, and your cholesterol will drop. Add a statin, and it will drop further. Your cholesterol goal will depend on whether you have been diagnosed with coronary artery disease or have had a coronary event (secondary prevention) or are simply hoping to prevent one (primary prevention). If you have had an event, your LDL ("bad cholesterol") is far too high.

For secondary prevention patients, we recommend an LDL less than 70 mg/dLóalthough guidelines recommend a level under 100 mg/dL. For primary prevention, an LDL under 130 mg/dL is recommended UNLESS you have a CAD equivalent, such as diabetes, kidney disease or peripheral vascular disease. In these cases, we recommend an LDL under 100 mg/dL. HDL ("good cholesterol") levels should be over 40 mg/dL, so yours are excellent.

Q.I heard that women with heart failure live longer than men with heart failure. If this is true, can you tell me why?

There is a difference, but it is slight. No matter who has heart failure, it is a bad disease. Women with heart failure do tend to live slightly longer than men, but they also have more symptoms such as breathlessness and depression and require more frequent hospitalizations.

There are two types of heart failure: diastolic and systolic. Women tend to have diastolic heart failure, and in fact, 90 percent of patients with diastolic heart failure are women. In this form of heart failure, the heart muscle pumps well, but its walls become so thick and stiff that the heart cannot fill properly. As a result, the heart loses its flexibility and cannot pump effectively. Hypertension is the primary cause of diastolic heart failure, so treatment requires aggressive blood pressure control.

Systolic heart failure is the most common form in men and is often the result of damage from heart attack. In systolic heart failure, the left ventricle enlarges and cannot pump blood efficiently into the body

Q. I am at high risk for heart attack and would like to try non-medical ways to lower my risk. What is meant by "aggressive lifestyle modification?"

When I say "aggressive lifestyle modification," I mean exercising 30 minutes most days of the week, using an aerobic form of exercise that is aggressive enough that you cannot carry on a conversation of more than two or three words at a time.

You need a diet that is low in fat ( less than 30 grams/day), high in vegetable protein, high in fiber and low in sodium, such as the Mediterranean diet, Lyon diet or DASH diet. Of course, you should not smoke. If you have diabetes, you should practice aggressive glucose control.

Many people who have never exercised are intimidated byóand, frankly, turned off byóthe idea of beginning an exercise program. You donít have to run a marathon. You do have to start somewhere, and we suggest starting by doing whatever you can. If you are only comfortable walking five minutes a day, do it. Then gradually increase the length of time you walk or your speed.

Little things make a difference. Thereís a field we are calling "non exercise-related motion." Itís the activity of daily life that burns calories. Park farther away from the store and walk those extra steps. Donít take elevators when stairs are nearby. Fidget. Pace. Move your body however you can. It can make a big impact.

Q. I read that common over-the-counter pain medications increase the risk of heart attack and stroke. What can I take for my aching hands? I think I have arthritis, but itís not bad enough to see a rheumatologist yet.

You are thinking of non-steroidal anti-inflammatories (NSIADS), such as Advil, Aleve and Motrin, which are commonly used to treat arthritis pain. They are great pain relievers, but they can dramatically increase blood pressure. Thatís why if you have heart disease or high blood pressure, we donít like to give NSAIDs. The American Heart Association does not recommend taking NSAIDs after a heart attack. Tylenol is the safest drug for heart patients. Low-dose (81 mg) aspirin would be a second choice. If these donít do a good job at relieving your pain, ask your family doctor for advice.