8 Steps to a Healthy Heart

Step 7: Get prenatal care.

Around 135,000 women every year get gestational diabetes, high blood sugar that's likely a result of pregnancy hormones blocking adequate insulin production. Doctors used to think it came and went with pregnancy. But research now shows that gestational diabetes gives you a 50 percent chance of developing diabetes later in life, which in turn makes you three to seven times more prone to heart disease. That puts you in line with the 54 million other Americans who have prediabetes. Diabetes, especially type 2, is often attributed to obesity, though many cases result from genetics and/or environment.

Cardiologists consider diabetics heart patients as well: Even if they've never had an attack, they tend to have high blood pressure and high cholesterol. "Having diabetes is equivalent to having heart disease," says Paula Johnson, M.D., chief of the division of women's health at Brigham and Women's Hospital in Boston. She treats diabetics and heart patients with the same regimen of aspirin and statins. "The best thing is to protect yourself with diet, weight control, and exercise so you never develop diabetes, even if you had it when pregnant."

Step 8: Understand how women differ from men.

Cindy DeMarco knew something was wrong when she awoke one morning in 2000 with nausea, dizziness, heaviness in her chest, and pain in her upper back. But the 30-year-old Virginia marathoner figured whatever it was would pass. She didn't realize that she was exhibiting classic signs of a heart attack—in women. While some do experience chest—clutching pain, many others have subtler symptoms. In fact, a recent survey of women recovering from heart attacks found that many had worsening symptoms for weeks leading up to an episode but mistook them for indigestion, fatigue, or muscle strain. Dr. Goldberg says two-thirds of women who die of heart attacks never even make it to the hospital—by the time they recognize what's happening, it's already too late.

Symptoms aren't the only way men and women differ when it comes to heart problems. Only in the last decade have scientists started to explore how heart disease manifests in each sex, and they still don't have a lot of answers. They do know that it's about more than the size of our hearts.

Research from the National Institutes of Health shows that doctors may have missed heart disease in some 3 million women who have diffuse plaque, where plaque spreads evenly through the arteries instead of building up to create major blockage. On angiograms (x-rays of the blood vessels) these arteries look clear. The NIH research also looked at women with microvascular disease, in which small vessels don't dilate properly during exertion. Their angiograms were often clear too.

While they're not headed for immediate heart attack, women with diffuse plaque and microvascular disease do need to be treated with either lifestyle changes or medication or both. "Doctors should diagnose intuitively," Dr. Johnson says. "If a woman comes in with symptoms"—shortness of breath, positive cardiac stress test, high cholesterol—"we can assume she needs to be treated even if her angiogram is clear. We can't just send her home and do nothing."

As DeMarco learned, you may need to be your own strongest advocate where your heart's concerned. When she finally went to the emergency room several hours into her day, an internist told her she'd strained a muscle and tried to send her home with muscle relaxants. But DeMarco refused to leave until she'd had more tests. Good thing: An EKG showed that she'd had a heart attack, the result of a spasm in one of her arteries. "I learned that you have to be adamant about your treatment," she says. "I know my own body best and know when something's wrong. You have to insist they find out what it is."

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