TAKE CHARGE OF YOUR HEALTH What Is the Bottom Line? Heart health is crucial. Men and women should understand their risk for heart disease, heart attack, and stroke, as well as for cancers and other diseases that may be preventable through diet and other strategies. This can be done by increasing self-awareness and by having honest talks with your doctor. To make the most of each doctor visit, bring along a few important questions. That’s one giant step toward taking charge of your health. The Good and Bad of Cholesterol  Cholesterol, a fat-like substance in the blood, is needed for production of hormones, among other things. Our bodies produce cholesterol naturally; many foods contain it. Excess levels of cholesterol in the blood is linked to an increased risk for heart disease and stroke. HDL-C: High levels of “good” cholesterol are a good thing because it can remove cholesterol from cells and carry it to the liver for elimination from the body. Physical activity is one way to raise HDL-C levels. LDL-C: When there is too much “bad” cholesterol in the blood, it can deposit in the coronary arteries, leading to atherosclerosis. High blood levels of LDL-C can be lowered through diet and, when recommended by a physician, drug treatment. Supported by an unrestricted educational grant from Pfizer Inc

Gender Differences in Heart Disease For both men and women, coronary heart disease (CHD) is the leading cause of death in the United States. However, CHD can affect men and women differently—differences that certainly matter when it comes to diagnosis and treatment.     Coronary arteries supply blood to the heart muscle. Reduced blood flow to the heart muscle can occur when a fat-like substance called plaque builds up in the artery wall, causing the vessel to narrow. This build-up is called atherosclerosis. In some cases, the plaque ruptures, forming a blood clot that blocks blood flow to the artery, bringing on a heart attack. How Does Heart Disease Differ in Men and Women? In women, CHD tends to occur about 10 years later than in men. Severe, unexpected events such as a heart attack or sudden death tend to happen about 20 years later for women than for men. After having a heart attack, however, women are more likely to die within a year, perhaps because they are older at the time of occurrence. The fact that CHD tends to affect women later in life has been linked to loss of estrogen (a hormone) production, since CHD rates are two to three times higher in women who have already gone through menopause (postmenopausal) than in women of the same age who have not gone through menopause (premenopausal). However, recent studies have found that the use of hormone replacement therapy (estrogen plus progestin) does not reduce the risk for CHD in postmenopausal women. Should Women Be as Concerned as Men About CHD? Each year, 41.3% of deaths among US women are caused by some form of cardiovascular disease (CVD). In 2000, CVD claimed the lives of more women than did all forms of cancer combined, and many more women died of CHD than of breast cancer or lung cancer. In that same year, however, a survey of 1,000 women found that just 34% believed heart disease to be the leading cause of death for women. Awareness among young women was even more limited. In the group between the ages of 25 and 34, only 20% thought heart disease was the major cause of death for women, and a mere 4% regarded heart disease as their greatest health threat. Overall, just 8% of the women surveyed regarded heart disease as their greatest personal health risk. Lack of awareness, coupled with the fact that atherosclerosis is often a silent disease (63% of women and 50% of men who die suddenly of CHD had no previous symptoms), may cause many people to ignore lifestyle changes that can help prevent a heart attack. What Are the Symptoms of a Heart Attack? When they occur, the symptoms of a heart attack may not be the same in men as in women. For example, women with chest symptoms may feel pressure, heaviness, or a sensation of tightness/squeezing, whereas men may experience pain in the center or left side of the chest. In addition, women are more likely than men to experience subtle symptoms that may be disguised by or mistaken for other medical problems. These include shortness of breath, nausea and/or vomiting, indigestion, palpitations, and pain in the mid-back. What Is the Role of Cholesterol? In young boys and girls, there are no significant differences in cholesterol levels. However, this begins to change at puberty, when estrogen production in women decreases their LDL-C and increases their HDL-C levels. The cholesterol levels of young men tend to remain at prepuberty levels. After menopause, women usually experience an increase in LDL-C levels and a decrease in HDL-C levels. However, if HDL-C levels remain high, a postmenopausal woman may still have a relatively low risk for heart disease, even if her levels of LDL-C and triglycerides are high.     Only a physician can determine whether your cholesterol levels are acceptable according to national guidelines for the management of cardiovascular risk. These guidelines recommend that all adults aged 20 years or older have their cholesterol levels tested every 5 years. Changes can then be regularly monitored and the risk for a heart attack reduced through diet and/or drug therapy.