Dr. Manshadi
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What you need
to know about heart health

Did you know that heart disease is the No. 1 killer of women in the United States? It can strike at any time and often comes on without symptoms. Since none of us want to be caught by surprise, we turned to cardiologist Dr. Ramin Manshadi, author of The Wisdom of Heart Health: Attaining a Healthy and Robust Heart in Today's Modern World, to answer our most pressing questions about women and heart disease. Here are 10 things about heart health that may surprise you.

Meet the expert:

Dr. Ramin Manshadi is a board-certified physician with the American Board of Interventional Cardiology, American Board of Cardiology, American Board of Internal Medicine and is board-eligible with the American Board of Nuclear Cardiology. He is an associate clinical professor in the Department of Cardiology at UC Davis Medical Center. Dr. Manshadi is an award-winning physician, considered a "2011 Top Cardiologist" by U.S. News & World Report and voted "America's Top Interventional Cardiologist, 2007" by Castle Connelly, Ltd. to name a few. He is also the author of The Wisdom of Heart Health: Attaining a Healthy and Robust Heart in Today's Modern World, and has generously pledged proceeds from the book to help purchase automated external defibrillators (AEDs) for placement in schools throughout California.

SheKnows: We've heard that pregnancy and miscarriages can affect heart health. Can you shed more light on this?

Dr. Ramin Manshadi: Try to maintain excellent health while pregnant and carry through with your pregnancy. A recent study showed that women who have experienced a stillbirth or repeated miscarriages have a greater chance of having heart attacks later in their lives. The risk of heart attack for a woman who had at least one stillbirth was 3.5 times higher than for women who'd had none. A deficient prenatal nutrition can potentially cause a weak heart and vascular system since the nutrients are diverted to the fetus's brain rather than the heart.

SheKnows: Is stress really that unhealthy for the heart?

Dr. Ramin Manshadi: Yes. A recent 10 year Harvard study found that women with high stress jobs had a 40 percent higher risk of having some kind of heart disease, along with an 88 percent higher likelihood of experiencing a heart attack.

SheKnows: What are the signs of a heart attack in women?

Dr. Ramin Manshadi: Women should pay attention to feeling tired, short of breath, or having diffuse sweating. Women do not have the classic tell-tale symptoms of blockages that men have. The classic signs of angina or heart attack in men are chest pressure with walking, radiating to the left arm, with nausea. In women, instead, the symptoms can be pain in the upper back, fatigue, shortness of breath, or peruse sweating. If women have these symptoms, then they need to visit a cardiologist ASAP.

SheKnows: Should we be concerned if we have high cholesterol?

Dr. Ramin Manshadi: Treat your cholesterol aggressively. Women tend to have higher cholesterol than men. Within the cholesterol, women also tend to have lower HDL (the good cholesterol). Additionally, high triglycerides (the high fat content cholesterol) tend to more negatively affect women in terms of causing blockages and heart attacks.

SheKnows: How can women best assess their heart disease risk?

Dr. Ramin Manshadi: Use Reynolds Risk Score (RRS) to asses risk for heart attack rather than Framingham Risk Assessment (FRA). This is another reason why women do not get diagnosed as early with heart issues as men. FRA undercuts some of the bio markers particular to women. This is especially significant, since if the score comes out relatively low, some doctors may not perform further screening tests. RRS is more gender specific and considers more variables.

SheKnows: Should we worry about our weight?

Dr. Ramin Manshadi: Maintain an ideal body weight. Another heart disease factor more emphasized in women is weight. The obesity epidemic in this country appears to be striking women more than men. Two third of women population fall into the obese category. One of the main reasons for developing diabetes is obesity. Diabetics have an equivalent risk of heart attack as someone who already had a heart attack.

SheKnows: Vitamin D is linked to many areas of health, from immune system functioning to bone health. Is there a link between vitamin D and heart health, too?

Dr. Ramin Manshadi: Have your vitamin D checked. Vitamin D deficiency in younger women can possibly elevate the risk of developing high blood pressure in mid-life. High blood pressure is a risk factor for heart attack.

SheKnows: Can our mind affect our heart?

Dr. Ramin Manshadi: I recommend that you keep good thoughts. A recent study showed that women who were optimistic had a lower level of developing heart disease and dying than pessimistic women. Optimistic were nine percent less likely to develop heart disease than pessimistic, with a 14 percent lower likelihood of dying.

SheKnows: How does exercise specifically help women reduce their risk of heart disease?

Dr. Ramin Manshadi: Moderation in exercise is recommended. Women tend to have significant micro vascular disease, which is when tiny arteries have dysfunctional endothelium (the inner lining of the artery) and can lead to plaque build up. Exercise in moderation can help improve endothelial function.

SheKnows: What is a top lifestyle change women can make to protect their heart?

Dr. Ramin Manshadi: Quit smoking. Once again, besides all of the known negative effects of smoking on our bodies, smoking can severely damage endothelial function and accelerate heart disease and heart attack.

For more tips on heart health, visit Shape.com.

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