Go Nuts! Advice on preventing heart disease in women, from Columbia's heart surgeons
You may see a lot of women wearing red Friday, February 6th, to mark "Wear Red" Day. We support this — go ahead and wear red, even if it's not your color! Because heart disease is the number 1 killer of women. That's right — one in three women die of heart disease in our country, which is approximately one woman per minute. At least one or two women may have died since you began reading this blog.
We think it's time to do something about this grim trend. So, after you've shown off the red dress for the day, how about taking it one step further?
Heart surgeons at Columbia University's Department of Surgery, all of whom are recognized as top in their fields, shared their top nuggets of advice below. Lest you are tempted to run in the other direction at the hint of a scolding, rest assured these are small steps everyone can take — but which may just make a difference in how long — or how healthy — your life may be.
Don't be a stranger.
To your doctor, that is. If you haven't had a physical exam in more than a year, now would be a good time to break that trend. Michael Borger, MD, Director of the Aortic Surgery Program, wrote, "Women have a much higher prevalence of atypical symptoms, particularly for coronary artery disease, and therefore often present with more advanced disease. That is, their doctor often thinks they have gastrointestinal problems or 'bad nerves' before realizing (often too late) that it was angina (chest discomfort due to poor blood flow through the blood vessels in your heart). Therefore, my word of advice would be, 'Make sure your doctor listens to you.'" Echoing this thought, the advice of Henry M. Spotnitz, MD, Director of the Cardiovascular Surgery Research Lab, "Find a doctor you enjoy visiting," may sound deceptively simple — but his words underscore the importance of regularly seeing a doctor with whom you feel comfortable and who will genuinely listen. A good relationship with your doctor will make it more likely that you'll discuss your risk factors for heart disease, and that he or she will take the time to help make sure you address risk factors such as high blood pressure or others that put your heart at risk.
Eat nuts, that is, and fruits and vegetables and other unadulterated, nutritious foods. As Syed Tasnim Raza, MD, FACS, Director of the Cardiac Surgery Step-down Unit puts it, "Cook at home and go back to your grandmother's cooking." He warns us to avoid any food manufactured in a factory, which means NO processed foods, no canned foods, or boxed foods. A healthy diet that includes fruits and vegetables, grains, healthy protein, and healthy fats is one of the most important things you can do to protect your heart health.  Even when you shop for groceries and cook at home, it is important to choose foods in their natural state (with nutrients and fiber intact) in lieu of processed products that contain artificial chemicals, added sugar, and high levels of salt and saturated fats.
Go fly a kite.
Join the neighborhood gym. Or catch up on the local gossip while speed-walking with your girlfriends around the neighborhood. However you enjoy being active, make sure you work your heart and body at least three hours per week, says Craig R. Smith, MD, Chairman of the Department of Surgery. Or, as Dr. Spotnitz put it, "Don't consider your day complete without regular exercise."
Less is more —
when it comes to waist size. "Maintain a normal waist size," says Dr. Smith; indeed, research has linked higher waist circumference (above 35 inches for women, and 40 inches for men) with a higher risk of diabetes and heart disease. Although obesity increases the risk of heart disease, waist size is a more accurate predictor than weight or body mass index (BMI) of death from heart disease because abdominal (visceral) fat is linked to insulin resistance, inflammation, and unhealthy cholesterol levels.
In moderation. If you are among the third of adult women in the US who need to watch your weight or manage diabetes, there's no better place to start taking care of your health than getting your diabetes and weight under control. Diabetes increases the risk of heart disease, and two out of three people with diabetes will die from heart disease or stroke.  You can significantly minimize this risk by carefully managing your diabetes through a heart-healthy diet, regular exercise, and medical therapy.
Look on the bright side.
Negative thinking and emotions can adversely affect health. High levels of distress about family or work can damage the heart almost as much as smoking, according to a Canadian study from 2004. Numerous other studies have found that depression, cynicism, and chronic stress increase the risk of heart disease.  People who have an optimistic outlook have better cardiovascular health compared to people who are less optimistic. Not only are optimists more likely to have intermediate or ideal total heart health scores, but compared to less optimistic peers, they have better cholesterol and blood sugar levels, healthier body weight, and more rigorous physical activity levels.
Get with the 21st century.
Cigarettes were cool in those old movies with John Wayne, but that's so last century. We know better now. By damaging the heart, blood vessels, and blood cells, it increases the risk of atherosclerosis and peripheral arterial disease, heart attack, and stroke. Today smoking is directly responsible for one fifth of heart disease deaths in the U.S. and is the number one cause of preventable disease and death. So please, listen to Emile Bacha, MD, Director of Pediatric and Congenital Heart Surgery at Morgan Stanley Children's Hospital of NewYork-Presbyterian. Don't start smoking, and if you do smoke, stop. Our colleague and Nobel laureate, Eric Kandel, MD has shown that eCigarettes aren't the answer either.
Dr. Bacha advises women to limit alcohol to no more than one drink per day, with 'a drink' meaning one 12 oz. beer, 4 oz. of wine, 1.5 oz. of 80-proof spirits, or 1 oz. of 100-proof spirits. Drinking more than this can lead to high blood pressure, elevated 'bad' cholesterol, obesity, diabetes, and heart failure. Excessive and binge drinking can also cause stroke, arrhythmia, cardiomyopathy, and sudden cardiac death.
Taking time out to meditate for even a short period of time each day can have dramatic benefits in preventing heart disease. Meditation reduces stress and reduces blood pressure, atherosclerosis, and heart rate. In some cases, the benefits of meditation are significant enough that patients can stop taking blood pressure medication, and studies have found it to reduce coronary heart disease and heart failure. 
Turn it off.
The TV, the computer, the X-box, all of it. Sitting for hours contributes to heart disease, increases the likelihood of disability after age 60, and shortens our lifespan. Research is now clear that even regular exercise cannot offset the effects of a sedentary lifestyle.  
The advice from individual surgeons in the Division of Cardiac, Thoracic, and Vascular Surgery was remarkably consistent. Their feedback was perhaps best summarized by Isaac George, MD, Surgical Director of Transcatheter Therapies at Columbia's Heart Valve Center, who said the following: "Learn and understand your risk factors for heart disease. See your doctor and work to reduce this risk."
We hope you will heed their advice, starting this month, to protect your hearts now and in the decades to come. Follow us on Facebook and Twitter for continued information about your heath and visit ColumbiaHeart.org for more information.
- Central obesity and survival in subjects with coronary artery disease: a systematic review of the literature and collaborative analysis with individual subject data. Coutinho T et al. Journal of the American College of Cardiology 2011 May 10;57(19):1877-86. doi: 10.1016/j.jacc.2010.11.058.
- Psychosocial Factors and Inflammation in the Multi-Ethnic Study of Atherosclerosis. Nalini Ranjit et al. Arch Intern Med. 2007;167(2):174-181. doi:10.1001/archinte.167.2.174.
- Multi-Ethnic Study of Atherosclerosis. Am. J. Epidemiol. (2002)156 (9): 871-881.doi: 10.1093/aje/kwf113
- Effects of Physical Activity and Sedentary Time on the Risk of Heart Failure. Deborah Rohm Young, PhD et al. Circulation: Heart Failure, 2014; 7: 21-27.
- Sedentary Time in U.S. Older Adults Associated With Disability in Activities of Daily Living Independent of Physical Activity. Dorothy Dunlop et al. Journal of Physical Activity and Health, Nov. 12, 2013
- Duck-chul Lee, Russell R. Pate, Carl J. Lavie, Xuemei Sui, Timothy S. Church, Steven N. Blair. Leisure-Time Running Reduces All-Cause and Cardiovascular Mortality Risk. Journal of the American College of Cardiology, 2014; 64 (5): 472 DOI: 10.1016/j.jacc.2014.04.058