Middle-aged, overweight men aren't the only ones who should be worried about heart attacks. In fact, women under 55 are equally (or more!) likely to suffer from heart disease, according to a study published in the Journal of the American College of Cardiology. Despite the risks, a recent statement issued by the American Heart Association (AHA) has revealed that women are often undertreated for this deadly condition. The reason? Most fail to recognize the silent signs of a heart attack that apply exclusively to females.
While chest pain or pressure is one of the most common signs of a heart attack, there's a more surprising symptom you should recognize. Women are more likely to experience jaw pain, too, according to Laxmi Mehta, MD, clinical director of the Women's Cardiovascular Health Program at Ohio State University's Wexner Medical Center and lead author of the AHA's statement. Other female-specific symptoms include upper back pain, arm pain, intense fatigue, heartburn, or "just not feeling right," Mehta told Prevention.
The 12 best diets for heart health
The 12 best diets for heart health
#12 The Fertility Diet
According to research from the Nurses' Health Study, on which The Fertility Diet is based, women who consume “good” fats, whole grains and plant protein improve their egg supply, while those who eat “bad” fats, refined carbohydrates and red meat may make fewer eggs and increase the risk for ovulatory infertility. Your heart may benefit from such an approach, too, suggests research finding that replacing animal protein with good carbohydrates might protect against heart attack, stroke or early death from cardiovascular disease and improve artery health and blood flow.
#8 (tie) Dr. Weil's Anti-Inflammatory Diet
The Anti-Inflammatory Diet, which is based on the heart-healthy principles of the Mediterranean diet, reflects creator Andrew Weil’s belief that certain foods cause or combat systemic inflammation. According to the American Heart Association, inflammation is not a proven cause of cardiovascular disease, but it is common among heart disease patients. Plus, the program emphasizes a steady supply of omega-3 fatty acids, which research suggests protect against heart disease.
#8 (tie) Flexitarian Diet
Flexitarian is a marriage of two words: flexible and vegetarian. The plan revolves around the idea that you don’t have to eliminate meat completely to reap the health benefits associated with vegetarianism; an occasional burger is OK. One large 2015 study of more than 450,000 Europeans found that those who ate a diet of at least 70 percent plant-based foods had a 20 percent lower risk of dying from cardiovascular disease than those who were least "pro-vegetarian." Earlier research suggests a semi-vegetarian diet also helps promote healthy blood pressure and cholesterol levels. As a bonus, it's good for the environment, one reviewer pointed out.
#8 (tie) Mayo Clinic Diet
Experts agree the Mayo Clinic Diet is a sound option for preventing or controlling heart problems. It focuses on coaching dieters to develop healthy, lasting habits around which foods they choose to eat and which to avoid. Plus, it reflects the medical community’s widely accepted definition of a heart-healthy diet: heavy on fruit, veggies and whole grains but light on saturated fat and salt.
#8 (tie) Vegetarian Diet
A vegetarian diet has the potential to decrease the risk of cardiovascular disease, according to experts, as long as vegetarians don’t load up on full-fat dairy and processed foods. As one expert reminds, "vegetarian diets can be healthy or unhealthy"; the beer-and-popcorn version is the latter. Still, if you take a well-informed approach, a vegetarian plan is a good bet for heart-conscious dieters, especially those who don’t have the heart to eat animals anyway.
#7 Engine 2 Diet
This low-fat, “plant strong” diet was created by Rip Esselstyn, a firefighter, former professional athlete and medical scion. It’s thought to prevent and often reverse diseases, like heart disease, caused by the so-called Standard American Diet and should also help keep cholesterol and blood pressure in check. If you adopt the Engine 2 Diet, you’ll load up on fruit, vegetables and whole grains and slash all animal products, processed foods and vegetable oils from your diet.
#6 Vegan Diet
Veganism earned high marks for its potential to boost cardiovascular health. It emphasizes the right foods – fruit, veggies and whole grains – while steering dieters away from meat, dairy and salty, processed choices. In a 12-year study that compared 6,000 vegetarians with 5,000 meat-eaters, for example, researchers found that the vegans in the group had a 57 percent lower risk of ischemic heart disease than the meat eaters. (The condition involves reduced heart pumping due to coronary artery disease and often leads to heart failure.) Just keep in mind that vegans may need to take supplements to make up for some heart-protective nutrients like the omega-3 fatty acids found in fish.
#5 MIND Diet
This plan is a mashup of two other expert-endorsed diets – DASH and Mediterranean – and zeroes in on the foods in each that specifically affect brain health (think green leafy vegetables, nuts, berries, beans, whole grains, fish, poultry, olive oil and wine). Turns out, the heart likes the same foods, studies show. A downfall of the MIND diet: Physical activity, proven important for heart health, is not addressed in the plan, some experts pointed out.
#4 Mediterranean Diet
What can’t this eating style do? The Mediterranean diet has been associated with a decreased risk for heart disease, and it’s also been shown to reduce blood pressure and “bad” LDL cholesterol. One 2015 study even showed that Italian vegans, vegetarians and others who followed a mostly Mediterranean diet had more short-chain fatty acids, which are linked to a lower risk of heart disease. Since the approach largely shuns saturated fat (which contributes to high cholesterol) and includes healthier mono- and polyunsaturated fats in moderation (which can reduce cholesterol), you’ll do your heart a favor by following it.
#3 TLC Diet
The Therapeutic Lifestyle Changes diet, created by the National Institutes of Health’s National Cholesterol Education Program, claims to lower “bad” LDL cholesterol by 8 to 10 percent in six weeks. Research concurs: In one Journal of Lipid Research study, participants who shifted from a typical American diet to the TLC Diet reduced their LDL cholesterol by 11 percent after 32 days. No matter your aim, the diet is "very healthy and safe for all individuals," one expert said.
#1 (tie) DASH Diet
The Dietary Approaches to Stop Hypertension program, or DASH, was created to help control high blood pressure – and it works. One expert called it "by far the best with data to back up lowering hypertension." Indeed, extensive research suggests it's one of your best bets if you want to lower your blood pressure as well as improve other markers of cardiovascular health. If you adopt the diet, you’ll emphasize the foods you’ve always been told to eat (fruits, veggies, whole grains, lean protein and low-fat dairy), while shunning those we’ve grown to love (calorie- and fat-laden sweets and red meat).
#1 (tie) The Ornish Diet
This rules-heavy plan has ranked No. 1 for heart health for seven consecutive years, although this year it shares the title with the DASH diet. Followers adhere to a strict regimen: Only 10 percent of calories can come from fat, very little of it saturated, and most foods with any cholesterol or refined carbohydrates, oils, excessive caffeine and nearly all animal products are banned. Research suggests the Ornish Diet, combined with stress-management techniques, exercise, social support and smoking cessation, could actually reverse heart disease.
If you experience any of these symptoms, visit a doctor right away. Research shows that women tend to wait longer to seek the treatment they need; however, doing so could lead to irreversible consequences. "Women tend to develop cardiogenic shock," which occurs when your heart suddenly can't pump enough blood, Mehta said. And the most aggressive treatments may no longer be effective if you wait for too long. Bottom line: It's always better to be safe than sorry. Keep an eye out for the most common heart conditions in women, as well.
Something cardiologists know but the average guy doesn't: Erectile dysfunction (ED) is one of the best early tip-offs to progressive heart disease. "Today, any patient who comes in with ED should be considered a cardiovascular patient until proven otherwise," says Goldstein. In women, reduced blood flow to the genital area can impede arousal, make it harder to reach orgasm, or make orgasms less satisfying.
Scary stat: Researchers at the Mayo clinic followed men ages 40-49 with erectile dysfunction and found they were twice as likely to develop heart disease as those with no sexual health problems. Another study looked backward and found that two out of three men being treated for cardiovascular disease had suffered from erectile dysfunction, often for years, before they were diagnosed with heart trouble.
Why it happens: Narrowing and hardening of the arteries restricts blood flow to the penis, which can give men trouble when it comes to getting or keeping an erection. And because those arteries are smaller than the ones leading to the heart, erectile dysfunction can occur before any other sign of artery stiffness. Lack of oxygen can also lead to ongoing fatigue and weakness, which can sabotage libido, so lack of desire may accompany lack of success.
What to do: If you or your partner has difficulty getting or maintaining an erection or has problems with sexual satisfaction, that's reason enough to visit your doctor to investigate cardiovascular disease as an underlying cause. Get a full workup to assess possible causes of erectile dysfunction or difficulty with orgasm. (Guys, see your GP, not just a urologist; gals, don't just see an ob/gyn.) If your doctor doesn't mention heart tests, request them.
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Snoring, sleep apnea, and other breathing problems during sleep
If you snore loudly enough to keep your sleeping partner awake or to force him or her to resort to earplugs, your heart may be at risk as well. Restricted breathing during sleep -- the underlying cause of snoring -- is linked with all types of cardiovascular disease. Sleep apnea, in which breathing briefly stops during sleep, is linked with a higher risk of both cardiovascular disease and heart attack.
Scary stat: Those with sleep apnea were found to have three times the normal risk of having a heart attack within five years.
Why it happens: Sleep-disordered breathing, which includes sleep apnea and a lesser condition known as UARS, lowers the blood oxygen that feeds the heart. Obstructive sleep apnea is thought to damage the right side of the heart, which has to pump harder to support the lungs, which are strained by trying to overcome the airway obstruction.
What to do: Any sleep-related breathing problem is a clue that something's wrong, so call the doctor. She may recommend a sleep study, but get your heart checked out too.
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Sore, swollen, or bleeding gums
Sore, swollen, or bleeding gums are symptoms not only of periodontal disease -- in which exposure to bacteria causes the gums to become inflamed and pull away from the teeth -- but also a possible early sign of underlying cardiovascular disease.
Scary stat: A 2010 study by the American Academy of Periodontology (AAP) estimated that the prevalence of periodontal disease may be underestimated by as much as 50 percent.
Why it happens: Experts believe that poor circulation due to heart disease could be an underlying cause of periodontal disease. Researchers are also studying whether a common bacteria is involved in both gum disease and plaque buildup inside coronary arteries. The link may also have something to do with the body's response to prolonged inflammation.
What to do: See a dentist to treat gum disease and prevent the presence of bacteria. Because gum disease can be a red flag for inflammation and circulatory problems, ask your doctor if ongoing gum symptoms warrant a checkup.
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Puffy or swollen legs or feet
If you notice that your feet swell enough to make your shoes tight; your ankles, wrists, or fingers are noticeably puffy; or there are deep pressure marks or indents when you take off socks or hose, you may have a problem with fluid retention. Also called edema, fluid retention can be a sign of coronary artery disease (CAD), heart failure, and other forms of cardiovascular disease.
Scary stat: More than 80 million people have one or more forms of cardiovascular disease, and approximately 900,000 people die from it each year.
Why it happens: Fluid retention occurs when the heart doesn't pump strongly enough and blood doesn't carry waste products away from tissues. Edema usually starts in the feet, ankles, fingers, hands, and legs because they're furthest from the heart, where circulation is poorer.
What to do: Report problems with edema to your doctor, who can run tests that may indicate CAD and can determine if your heart function is normal.
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Irregular heartbeat or arrhythmia
An early sign that something in the cardiovascular system is out of whack is irregular heartbeat, or arrhythmia. It may feel like your heart is skipping beats, beating too fast, or pounding too hard.
Scary stat: Coronary artery disease (CAD) is the leading cause of sudden death for both men and women because it can lead to both heart attack and stroke.
Why it happens: The most common cause of irregular heartbeat is CAD, which restricts blood flow to the heart, straining the electrical system that keeps the heartbeat regular and coordinates it with other functions. Heart failure can also cause arrhythmias because the weakened heart overcompensates by beating harder and faster.
What to do: An EKG can measure the electrical activity of your heart, including the regularity of the heartbeat. A stress test, which measures your heart rate while you walk on a treadmill, can determine if your heart is pumping properly.
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Constriction or aching in the chest or shoulder
The most common symptom of coronary artery disease (CAD) is angina, a type of chest pain. Angina (officially called angina pectoris) is different from the sharp clutching pain of a heart attack; it's likely to feel like a deep ache or a constriction or weight on the chest, and it may worsen when you draw in a breath. One of the reasons angina is often missed is that it feels different to different people; to some it's more of a heaviness, fullness, or pressure rather than pain. It can also be mistaken for indigestion or heartburn when the pain occurs lower down in the abdominal area. The tightness, constriction, or pain may also occur in the shoulder, neck, jaw, arm, or upper back, where it may be mistaken for a pulled muscle.
A tip-off to angina versus a pulled muscle or gastrointestinal problem is that you're likely to experience the problem repeatedly rather than to have one isolated or prolonged episode.
Scary stat: According to the National Heart, Lung, and Blood Institute, 17 million people are living with angina. Cases of angina are divided almost equally between men and women, with men being slightly more at risk.
Why it happens: When plaque builds up in the coronary arteries, it deprives the heart muscle of blood, making it feel squeezed. Most people with stable angina find that episodes are most often triggered by anything that puts an additional strain on the heart, such as exercise or stress.
What to do: If you're diagnosed with angina, your doctor will recommend resting when episodes occur; or she may prescribe nitroglycerin, which relaxes the coronary arteries and other blood vessels, increasing blood supply to the heart and easing its workload.
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Shortness of breath
An early sign that something is wrong with a major bodily system is shortness of breath, typically with exercise, exertion, and stress. (Typically, shortness of breath indicates either early-stage heart disease or early-stage lung disease, and it's not possible to know which it is without seeing a doctor.) It may feel like you can't catch your breath, or you may notice a feeling of compression in the chest and lungs, making it difficult to take a deep breath. Another breathing symptom of poor circulation may be labored breathing, which occurs when fluid accumulates in the lungs. If you notice that your breathing problems are worse at night or anytime you lie down, that can also indicate a heart problem.
Scary stat: In a landmark study by the National Institutes of Health (NIH) published in Circulation: Journal of the American Heart Institute, 95 percent of women who'd had heart attacks reported experiencing unusual symptoms in the weeks and months before the attack, and 40 percent reported shortness of breath.
Why it happens: When your heart isn't pumping strongly enough, less oxygen circulates in your blood. The result is shortness of breath; you might feel like you do at high altitude or when you've run for the bus, unable to draw enough oxygen into your lungs.
What to do: Shortness of breath, either with exercise and stress or all the time, is always a reason to see the doctor for a checkup, since it can be a symptom of a number of serious conditions.