Heart disease is the number one killer of women — killing one woman every 60 seconds — yet only one out of five American women actually believe it’s a dangerous threat. Heart disease is a catchall term that can include a variety of conditions, such as heart attacks, strokes, and heart failure and is often related to atherosclerosis, or the formation of plaque buildup in the arteries. Warning signs are not always the same for women as men, so understanding the symptoms and risk factors is important.
Women can actually respond to heart events differently than men. “Men are more likely to survive a heart attack than women,” says cardiologist Ramavathi Nandyala, MD of Methodist Hospital in San Antonio, Texas. And while both men and women usually experience chest pressure during a heart attack, women can have a heart attack even without that obvious pressure. Women are more likely than men to have nausea, vomiting, and shortness of breath.
Smoking and a strong family history put you at risk for heart disease, but what about your eating habits and stress levels? Here are six things that can increase your heart disease risk and easy ways to keep your ticker strong.
1. Meat-based diets
A diet rich in saturated fat and sodium increases anyone’s risk of heart disease, but one study found that a high-protein diet, especially if the protein came from meat, is associated with a higher risk of heart failure among older women, specifically women aged 29 to 50. Experts say more research is needed to understand the link between a high-protein diet and heart failure.
When it comes to eating habits, Dr. Nandyala says a balanced diet is best. “Strictly avoiding carbs or fats isn’t always the best option because our bodies are made of protein, carbohydrates, and fat.” If you do eat meat, reach for lean meats like turkey and chicken rather than sausage and bacon. Plant-based proteins like tofu and nuts are good options, too.
2. Yo-Yo dieting
Repeatedly losing and gaining weight, known as yo-yo dieting, can hurt your heart later down the road.
One observational study shows that women who have lost weight and gained it back quickly four or five times in their life are more likely to have a heart attack or die from cardiac arrests, says Nandyala.
It’s more important to adopt a healthy lifestyle overall, than to drop weight quickly by drastic dieting tactics. The American Heart Association recommends foods rich in minerals, protein, and whole grains to control your weight, as well as your cholesterol and blood pressure.
3. Birth control pills
Research shows that there may be a link between birth control pills and high blood pressure in some women. And the link may be greater for women who are overweight, have kidney disease, have a family history of high blood pressure or high blood pressure during a pregnancy.
Birth control pills are made up of estrogen and progesterone, and estrogen is thought to encourage blood clot formation in some women over the age of 35, says Nandyala. Women who smoke and take oral contraception are especially at risk.
If you’re over the age of 35, talk to your gynecologist about the birth control options right for you.
Stress, whether it be work, relationship, or parental-related stress, is the number one risk factor Nandyala sees in her female patients. “We keep adding more and more responsibility and stress on women.”
Stress releases adrenaline, which can cause arteries to go into spasms and your blood pressure to increase, she adds. Broken heart syndrome from something like a death in the family can also cause the heart to go into shock leading to a temporary type of heart failure.
Related: Can a Broken Heart Really Kill You?
Nandyala says that some stress in our lives is inevitable, but that you have to learn to cope with it. She recommends relaxing for a few minutes each day with reading, music, yoga, prayer, or any other activity that relaxes your mind. Exercise can also help you manage stress — a quick walk outside is a better alternative to stress eating, and can even put you in a good mood.
Nandyala says obesity is another huge heart disease risk factor. In fact, one out of every three women in the United States is obese.
“Females are especially affected by hormones, which can sometimes make weight easy to gain and hard to lose. Testosterone is a fat burning hormone, while estrogen tends to be a fat preserving hormone,” says Nandyala.
If you’re carrying around extra fat — a body mass index (BMI) over 30 is considered obese — you may be increasing your risk of high cholesterol, high blood pressure, diabetes, and even osteoarthritis and breathing problems. Maintaining a healthy weight allows blood to circulate through the body more efficiently, helps regulate your fluid levels, and lowers your risk of the health conditions above.
Make sure you measure your BMI at least once a year, and if you are obese, talk to your healthcare provider about weight loss programs that can help you focus on eating fewer calories and developing exercising habits.
6. Neglecting regular screenings
So many female patients come in and say “I’m totally fit, so I definitely don’t have heart disease,” says Nandyala. But unfortunately, that’s not always the case. People who have a family history of heart disease should be especially cautious.
If you do have a heart condition like high blood pressure or high cholesterol, the earlier you can get it under control, the less likely you are to have a serious heart event.
The American Heart Association recommends regular blood pressure screenings: at least every two years if your blood pressure is below 120/80 mm Hg, and if your blood pressure is higher, maybe more frequently. Every four to six years, you should have a fasting lipoprotein profile, a measurement of your cholesterol and triglyceride levels. Starting at age 45, be sure you have your blood glucose checked every three years.