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HEART Insight:
doi: 10.1097/01.HEARTI.0000422821.90774.18
Features: Cover Story

Three Generations of Heart Health: Three Women, Three Generations, Three Sets of Concerns about Being Healthy Now, Staying Healthy Down the Road

Muñasque, Angela

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Angela Muñasque is an editorial assistant for HEART INSIGHT

Additional reporting by Ruth Papazian.

Photographs by Beall + Thomas Photography

My grandmother, mother and I grew up in the South — Sevierville, TN, near the Great Smoky Mountains — so it's a given that we all love the outdoors, football and home cooking. And being women, it's also a given that cardiovascular disease (CVD) is our Number One health concern.

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CVD kills more women than all forms of cancer combined. The prevalence of CVD in women increases with age — but it's not just women in my grandmother's age group who need to manage their heart health proactively. Current research suggests that even women between the ages of 35 and 44 need to pay close attention to reducing their risk of heart disease.

My grandmother, Anna Faye Matthews, 63, belongs to the Grey Tigers Generation (born between 1925 and 1945). She missed WWII, but the civil rights movement began while she was a child. She listened to Porter Wagoner and Johnny Cash, and bought her clothes at a dry goods store.

My mother, Trish Matthews-Muñasque, 40, who is in Generation X (1965–1983), saw Richard Nixon's presidency end in the wake of the Watergate scandal, and the medical profession confronted with the first cases of AIDS. She rocked to Aerosmith and the Eagles and shopped at department stores.

At age 23, I am in Generation Y (1981–1995). In high school, I remember the false alarm of Y2K and the real terror of 9/11. I've been following the careers of Beyoncé Knowles and Justin Timberlake since I can remember, and buy my clothes at mega-malls or online stores.

For all three of us, heart disease is largely preventable by practicing good health habits — eating well, exercising regularly, not smoking — and being vigilant about having regular cholesterol, blood pressure and glucose tests (my mother and grandmother are not related to me; my father remarried after he and my biological mother divorced). But just like my grandmother's and mother's taste in music and clothing isn't the same as mine, our health risks and lifestyle challenges are different and require a generational approach.

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I recently graduated college, and hold both a full-time and part-time job in New York City (I've just started repaying college loans, and everything from rent to shampoo costs twice as much as it does in Tennessee). Finding the energy to do laundry, run errands and socialize is a struggle — and squeezing in time to exercise and cook healthy meals is proving nearly impossible.

Cardiologist Nieca Goldberg, M.D., a national spokesperson for the American Heart Association's “Go Red For Women” campaign says that a young woman's lifestyle may have ramifications on her health later on — smoking, for instance, or eating a high-fat diet.

Goldberg also cautions that, “If someone in her 20s has a family history of high cholesterol or type 2 diabetes, she may also have [these conditions] without knowing it.” For this reason, she would like young women to know their “baseline” CVD risks — a starting point against which changes in cholesterol, blood pressure and blood glucose can be compared over time. “Ignorance is not bliss, in this case.”

Should test results be abnormal, a woman and her doctor need to discuss whether it is a sign of an underlying health problem, or reflects some other factor. For example, “Birth control pills [that are] high in estrogen raise triglycerides; those high in progestin raise LDL [‘bad’] cholesterol,” she explains.

I don't remember the date of my last checkup, so I vow to see a doctor and find out my heart health statistics. While I am a nonsmoker and my body mass index (BMI) is in the normal range at 21.5, my diet and exercise habits clearly need improving.

Since I am too busy to exercise regularly, Goldberg suggests sneaking physical activity into my schedule: “Walk from place to place, rather than driving or riding the train as much. Take the stairs, not the elevator.” She is also a fan of working out at home with videos and DVDs in spare moments — like when the laundry is in the dryer — and of clipping a pedometer to my waistband to keep track of how much I walk throughout the day.

I should be aiming for 30 minutes of moderate physical activity — say, a brisk walk during lunch — five days a week, says Elizabeth G. Nabel, M.D., director of the National Heart, Lung, and Blood Institute (NHLBI), which runs “The Heart Truth” program. “It doesn't have to be all thirty minutes at once — take ten minutes, three times a day, and engage your body,” she adds.

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TWENTIES Get baselin...
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FORTIES Diabetes can...
FORTIES Diabetes can...
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SIXTIES  Know the si...
SIXTIES Know the si...
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Though her two oldest children are now living away from home, my mother is still raising teenagers — plus she works full-time doing administrative work at the local hospital, goes to school part-time to finish her college degree in elementary education and volunteers as a Sunday School teacher and Youth Group leader at church.

In women my mother's age, estrogen levels are starting to taper off. “As estrogen levels go down, blood vessels start to stiffen, which can cause high blood pressure. Half of all women over the age of 45 have high blood pressure,” explains Goldberg. She adds that in middle age a woman also starts carrying more of her weight around her waist, which may raise triglycerides (a blood fat that is implicated in hardening of the arteries) and increase carbohydrate intolerance, which may lead to type 2 diabetes.

My mother knows this all too well. After being diagnosed with type 2 diabetes in 2006, she lost 92 pounds by walking on a treadmill for 45 minutes, three times a week, and by watching her portion sizes. Still, her BMI is an unhealthy 34.0, and both her total cholesterol levels and blood pressure are high. With insulin, her diabetes is controlled (her fasting glucose levels fall below the recommended 100 mg/dl, but not by much).

Women in their 40s who have diabetes lose the protective cardiovascular benefit of being pre-menopausal — their risk is as high as it is for men. Other cardiovascular risk factors, such as high blood pressure and obesity, push risk even higher, so these conditions need to be treated aggressively, cautions Martin J. Abrahamson, M.D., director of the Joslin Clinic in Boston, MA.

“We can't expect everyone who is overweight to achieve a normal BMI. Any weight loss — even 10 pounds over a three month period — can improve glucose control. Start off with a realistic goal, and when you achieve it set another goal.”

Abrahamson commends my mother for losing nearly 100 pounds (“[She] has made enormous gains in improving her health. It's fantastic!”), but notes her challenge now is to stick to the diet and exercise changes she's made so she doesn't regain the weight. Goldberg adds that my mother can better control her glucose levels and boost her heart health by following “a low-salt diet that is filled with fresh fruits, vegetables and whole grains — no sugars or white flour foods — low-fat dairy and fish.”

Both doctors are concerned that my mother's high blood pressure is not being treated with medication. “Diabetics need to control all their cardiovascular risk factors — not just glucose — so it's important that her blood pressure is treated,” says Abrahamson. Goldberg cautions that exercising when you have uncontrolled hypertension can not only decrease endurance (“you get out of breath faster”), but can cause a dangerous spike in blood pressure that could cause a stroke.

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My grandmother doesn't have high cholesterol and has never been diagnosed with pre-diabetes (fasting glucose levels between 100 and 126 mg/dl) or diabetes, for which she gets checked every six months. But she has high blood pressure, which is controlled with an ACE inhibitor and a diuretic, and at 34.9, her BMI is very high.

“Heart disease symptoms begin about 10 years after menopause,” explains Goldberg. Women my grandmother's age need to pay close attention to their blood pressure and cholesterol levels, she says. Goldberg suggests that each time my grandmother sees a doctor she should make sure to discuss new symptoms or concerns that popped up since the last visit. Ideally, the doctor will also ask her to fill out a form with detailed questions about the past and present state of her health. As my grandmother frets about forgetting to tell her doctor crucial details, Goldberg suggests bringing along a family member or friend to fill in any gaps in her medical history.

When my grandmother's high blood pressure was diagnosed some 20 years ago, the doctor prescribed more physical activity so she took up water aerobics at the local community center because it looked like a “fun way to exercise.” She got hooked on physical activity, and began to walk in the park or in the mall and to lift light dumbbells as well.

A few years ago, she got sidelined by arthritis and plantar fasciitis — an inflammatory foot condition that makes it painful to walk, especially first thing in the morning — as well as by several surgeries, including one to replace worn-out cartilage in her right knee and another to correct a lumbar compression in her back. For my grandmother, non-weight-bearing chair exercises and resuming her water aerobics class will do the trick, says Nanette K. Wenger, M.D., chief of cardiology at Grady Memorial Hospital in Atlanta, GA.

And because strokes and heart attacks are the biggest CV concern for older women, Nabel stresses the importance of knowing these warning signs of heart attack and stroke:


* Uncomfortable pressure, squeezing, fullness or pain in the center of your chest. It lasts more than a few minutes, or goes away and comes back.

* Pain or discomfort in one or both arms, your back, neck, jaw or stomach.

* Shortness of breath with or without chest discomfort.

* Other signs, such as breaking out in a cold sweat, nausea or lightheadedness.


* Sudden numbness/weakness of the face, arm or leg, especially on one side of the body.

* Sudden confusion, trouble speaking/understanding.

* Sudden trouble seeing out of one or both eyes.

* Sudden trouble walking, dizziness, loss of balance/coordination.

* Sudden severe headache with no known cause.

Nabel urges women not to ignore these signs, or to dismiss them as fatigue, indigestion or a bad cold. If you suspect you — or a loved one — is having a heart attack or stroke, call 911 right away so you can get prompt medical attention.

Women of different generations, like my grandmother, mother and I, have different CV risks and lifestyle challenges, but no woman is too old or too young to take the necessary precautions to keep a potential or diagnosed problem from becoming serious enough to affect her quality of life — or worse.

© 2008 American Heart Association, Inc.