Women's Heart Advisor Ask The Doctors: April 2017
I’m a 37-year-old woman who reads Heart Advisor, because I subscribed for my mother and stepfather. I find it very educational, because I am interested in doing everything I can to lower my risk of heart disease after losing my father to a heart attack way too young. Recently I read a news clip that a first pregnancy resulting in a preterm birth increased the chances the mother would develop heart disease later in life. My first child, now age 6, was born at 35 weeks’ gestation. Does that put me at increased risk?
It does appear that giving birth early increases the risk of developing cardiovascular disease later. It’s not the only risk factor in young women: Other factors that increase risk include gestational diabetes, gestational hypertension and preeclampsia.
Recently, a study of more than 71,000 women enrolled in the Nurses’ Health Study (Circulation online Feb. 2, 2017) found that those who gave birth pre-term were more likely to be obese, smoke, and have existing hypertension or high cholesterol and a family history of heart disease. These are pre-existing risk factors for a heart attack. Other women had other risk factors that included diabetes and post-delivery development of chronic hypertension. So it’s very hard to determine the degree of risk conferred by preterm delivery in these patients.
Because of your family history of heart disease, you should be doing everything you can to maintain ideal cardiovascular health (see “Are You At Risk for Heart Disease?” on page 5). Working with your doctor to lower your risk will give you the best chance of overcoming your family history of the disease.
I just had bypass surgery and am relieved that everything went well. My doctor insists I start cardiac rehabilitation in four weeks. It’ll be a hassle to get there, since I can’t drive yet. Is it really necessary?
Yes. I would emphasize that it’s very necessary. Cardiac rehab has proven to lower the risk of death, as well as a first or second heart attack, but maybe not for the reason you think. Certainly, cardiac rehab involves appropriate, monitored exercise designed to strengthen your heart muscle. But it may be the counseling on lifestyle changes that makes the biggest difference.
A cardiac rehab program assesses patients for risk factors and educates them on nutrition, physical activity, smoking cessation, blood pressure, cholesterol and other blood lipids and diabetes. It also helps them manage psychological and social factors that can be detrimental to heart health.
Some of these risk factors played a role in your need for bypass surgery, so figuring out which ones, and what to do about them, is the way to prevent a heart attack or more heart surgery. After all, having the surgery is just the first step. The disease that caused the need for surgery will go on unchecked until you take steps to slow down its progress.