Taking Wellness to Heart

Questions to Ask Your Doctor

Sometimes you have to be the one to suggest further testing. Be aggressive in taking charge by asking for help in reducing your risks. Don't wait for your doctor to talk to you if you fall into one or more of the risk categories. Make sure that he or she understands your concerns by printing out these ten questions to ask your doctor. Take these questions to your next doctor's appointment.

Ten Questions a Woman Should Ask Her Healthcare Provider

1. What are my risk factors for heart disease?

While there's no way to be sure, certain factors can increase your risk of heart disease. You can't do anything about unchangeable risk factors like age, family history, race or gender. But you can lower your risk by changing some of your habits and taking medicine if needed.

The major risk factors for coronary heart disease that you can modify, treat or control are

Tobacco smoke
High blood cholesterol
High blood pressure
Physical inactivity
Obesity or overweight
Diabetes

2. Am I at risk for stroke?

We don't know who will have a stroke, but we know several factors increase your risk. Some risk factors you can't change, others you can. The more risk factors you have, the greater your chance of having a stroke.

Risk factors you can't change:

Increasing age
Sex (gender)
Heredity (family history) and race
Prior stroke or heart attack
Risk factors you can treat and control:

High blood pressure
Tobacco use
Diabetes mellitus
Carotid or other artery disease
Atrial fibrillation
Other heart disease
Transient ischemic attacks ("mini-strokes")
Certain blood disorders
High red blood cell count
Sickle cell disease (also called sickle cell anemia)
High blood cholesterol
Physical inactivity and obesity
Excessive alcohol intake
Some illegal drugs: Intravenous drug abuse and cocaine use
Other factors that may affect your risk of stroke:

Individual response to stress
Aging and menopause (see question 4 below)
Birth control pills: Women on the Pill who smoke or have high blood pressure or other risk factors are at higher risk of stroke.
Remember the three "R's" for life: Reduce, Recognize and Respond!

Reduce

Decrease your blood pressure (if it's too high).
Reduce high levels of blood cholesterol.
Quit smoking.
Control or delay the onset of diabetes.
Reduce excess weight or maintain a healthy weight.
Moderate use of alcohol.
Recognize the warning signs of stroke. Offer information to your doctor, nurse or other healthcare provider about any new symptoms or changes in how you feel.

Respond to warning signs of a stroke. If you notice one or more of these signs, get emergency medical help immediately. New treatments that break up blood clots can reduce the damage to your brain if given within three hours of the onset of symptoms. Every minute counts!

3. What are the warning signs of heart disease and stroke?

Some heart attacks are sudden and intense, but most start slowly, with mild pain or discomfort. Here are some of the signs that can mean a heart attack is happening.

Chest discomfort. Most heart attacks involve discomfort in the center of the chest that lasts more than a few minutes, or that goes away and comes back. It can feel like uncomfortable pressure, squeezing, fullness or pain.
Discomfort in other areas of the upper body. Symptoms can include pain or discomfort in one or both arms, the back, neck, jaw or stomach.
Shortness of breath. This feeling often comes along with chest discomfort. But it can occur before the chest discomfort.
Other signs. These may include breaking out in a cold sweat, nausea or lightheadedness.
If you or someone you’re with has chest discomfort, especially with one or more of the other signs, don’t wait longer than five minutes before calling for help. Call 9-1-1. Get to a hospital right away. (Calling 9-1-1 is almost always the fastest way to get lifesaving treatment.)

If you’re the one having symptoms, and you can’t access emergency medical services (EMS), have someone drive you to the hospital right away. Don’t drive yourself, unless you have absolutely no other option.
The warning signs of stroke are

Sudden numbness or weakness of the face, arm or leg, especially on one side of the body.
Sudden confusion, trouble speaking or understanding.
Sudden trouble seeing in one or both eyes.
Sudden trouble walking, dizziness, loss of balance or coordination.
Sudden, severe headache with no known cause.
Not all the warning signs occur in every stroke. Don’t ignore signs of stroke, even if they go away! If you or someone with you has one or more stroke symptoms that last more than a few minutes, don’t delay! Immediately call 9-1-1 or the emergency medical services (EMS) number so an ambulance (ideally with advanced life support) can quickly be sent for you.

4. What should I know about the effects of menopause on my health?

Compared to men, many women before the age of menopause seem to be partly protected from coronary heart disease, heart attack and stroke. As women age, their risk of heart disease and stroke begins to rise and keeps rising. The risk appears to rise more quickly if early menopause is induced by surgical removal of the uterus and ovaries than if it occurs naturally.

The reasons for the lower incidence of coronary heart disease and stroke in younger women aren't clear. The loss of natural estrogen as women age may contribute to the higher risk of heart disease after menopause. However, in light of recent results from clinical trials, the American Heart Association does not advise women to take postmenopausal hormone therapy (PHT, formerly called hormone replacement therapy or HRT) to reduce the risk of coronary heart disease or stroke.

If you’ve gone through menopause or had your ovaries removed, you may be taking or considering taking estrogen or estrogen plus progestin. Many people have been confused and alarmed by the news about the Women's Health Initiative (WHI), which investigated one form of estrogen plus progestin. To help you understand what the results of this study mean, see Estrogen and Cardiovascular Diseases in Women. Before you make any decisions about PHT, though, it’s very important to consult your physician.

5. Do I need to lose or gain weight for my health?

Obesity is a risk factor for heart disease and stroke. It also influences blood pressure, blood cholesterol and triglyceride levels and makes diabetes more likely to develop.

You can often help lower your heart disease and stroke risk by losing 10 to 20 pounds! But beware of fad diets, programs and products that promise rapid weight loss. Work with your doctor or a registered dietitian to set up a sensible program of eating and physical activity that will help you reach and maintain a healthier weight.

The AHA follows the body mass index (BMI) guidelines of the National Heart, Lung, and Blood Institute. (See Body Composition Tests.) If underweight, you should eat a balanced diet low in saturated fat, cholesterol and sodium. You can add calories from the breads, cereals, pasta and starchy vegetables food group, and the fruits and vegetables food group, to maintain a healthy weight for your height and build.

6. What is a healthful eating plan for me?

Better food habits can help you reduce one of the major risk factors for heart attack -- high blood cholesterol. This eating plan from the American Heart Association describes the latest advice of medical and nutrition experts. The best way to help lower your blood cholesterol level is to eat less saturated fat and cholesterol and control your weight. The eating plan is based on these AHA dietary guidelines:

Eat a variety of fruits and vegetables. Choose 5 or more servings per day.
Eat a variety of grain products, including whole grains. Choose 6 or more servings per day.
Eat fish at least twice a week, particularly fatty fish such as mackerel, lake trout, herring, sardines, albacore tuna and salmon.
Include fat-free and low-fat milk products, legumes (beans), skinless poultry and lean meats.
Choose fats and oils with 2 grams or less saturated fat per tablespoon, such as liquid and tub margarines, canola, olive, corn, safflower and soybean oils.
Balance the number of calories you eat with the number you use each day to maintain your best weight. Walk or do other physical activities for at least 30 minutes on most or all days. To lose weight, do enough activity to use up more calories than you eat every day.
Limit your intake of foods high in calories or low in nutrition. This includes foods with a lot of added sugar like soft drinks and candy.
Limit foods high in saturated fat, trans fat and/or cholesterol, such as full-fat milk products, fatty meats, tropical oils and partially hydrogenated vegetable oils. Egg yolks are high in cholesterol. Instead choose foods low in saturated fat, trans fat and cholesterol from the first five points above. (Trans fat comes from adding hydrogen to vegetable oil, which partially hydrogenates it. It also exists naturally in some foods such as meat and milk. This fat type tends to increase blood cholesterol.)
Eat less than 6 grams of salt (sodium chloride) per day. That’s equal to about 1 teaspoon of salt, or a daily sodium intake of less than 2,400 mg.
If you drink alcohol, have no more than one drink per day if you’re a woman or two per day if you’re a man. (“One drink” means it has no more than 1/2 ounce of pure alcohol.)
This is an easy-to-follow guide to delicious eating -- and you don’t have to give up your favorite foods. Every meal doesn’t have to meet all the guidelines. It’s important to apply the guidelines to your overall eating pattern over a period of several days.

When selecting foods, it's important to remember the amount of total fat, saturated fat, trans fat, cholesterol and sodium these foods may add to your daily menu. Choose foods low in saturated fat, trans fat, cholesterol and sodium. Reading labels and ingredient statements to discover what is contained in a product.

Each of the basic food groups supplies a different combination of nutrients, vitamins and minerals. Let caloric needs and a healthy appetite be your guide. But remember, variety is the key to good nutrition. The basic food groups and recommended servings are these:

Lean meat, fish and skinless poultry
Up to 6 oz. (cooked) per day; at least 2 servings of baked or grilled fish (especially fatty fish) each week

Eggs
One large, whole egg has about 213 mg of cholesterol, which is 71% of the daily limit of 300 mg. If you eat a whole egg, try to avoid or limit other sources of dietary cholesterol on that day, such as meats, poultry and full-fat milk products.

Egg whites have no fat and no cholesterol.

Vegetables and fruits
5 or more per day

Fat-free milk and low-fat dairy products
2-4 per day

Breads, cereals, pasta and starchy vegetables
6 or more per day

Fats, oils, nuts and sweets
Use sparingly

More Questions

7. What kind of physical activity is right for me?

The best way to condition your heart and lungs is to do vigorous activities like brisk walking, running and swimming for at least 30 minutes, three to four times a week. Regular physical activity improves your cardiovascular fitness and helps reduce your risk of heart attack and stroke. You'll feel better and look better, too.

You don't have to be an exercise fanatic to lower your risk! New research has shown you can gain health benefits from doing low-to-moderate-intensity physical activity for 30 minutes a day on most days. This means you can add up three 10-minute or two 15-minute periods per day, doing everyday activities like walking, yard work, housework -- even dancing!

So get up and move! Find an activity you enjoy and stick with it. Ask a friend or family member to join you. Remember to check with your doctor before starting a vigorous exercise program, especially if you've been inactive for a long time or have other medical conditions (such as high blood pressure or diabetes).

8. What is my blood pressure? Is that healthy for my age?

High blood pressure usually has no symptoms. The only way to know you have it is to measure it. Your blood pressure reading is written as two numbers, such as 130/85mmHg (millimeters of mercury). The first, bigger number is the systolic pressure, the pressure when the heart beats. The second number is the diastolic pressure, a measure when the heart is between beats. High blood pressure, or hypertension, is defined as readings of 140/90 or greater that stay high for an extended time.

Blood Pressure Normal Prehypertension Hypertension
Systolic (top #) less than 120 120-139 140 or higher
Diastolic (bottom #) less than 80 80-89 90 or higher

Have your blood pressure checked often, at least every two years. If it's too high, talk with your doctor about:

How often to check your blood pressure.
How to reduce your blood pressure by limiting the sodium (salt) in your diet, losing weight if overweight, limiting your alcohol intake and/or increasing your physical activity.
Taking medication, if needed.

9. What is my cholesterol? Is that a healthy level?

Cholesterol is a soft, fat-like substance that makes up much of the plaque found in diseased arteries. There are two main types of cholesterol. LDL cholesterol deposits some of its cholesterol in artery walls, increasing the buildup of plaque. High levels of LDL (bad) cholesterol raise your risk of coronary heart disease and heart attack. HDL cholesterol seems to clear cholesterol out of your system. High levels of HDL (good) cholesterol lower your risk of coronary heart disease.

Research has shown that low levels of HDL appear to be a stronger risk factor for women than for men. It's important to have your blood levels of total and HDL cholesterol checked, especially if you or your family have a history of high cholesterol or premature heart disease.

Cholesterol levels are measured in milligrams (mg) of cholesterol per deciliter (dL) of blood.

Total Cholesterol Level Category
Less than 200 mg/dL Desirable level that puts you at lower risk for
heart disease.
200-239 mg/dL Borderline high. A cholesterol level of
200 mg/dL or higher raises your risk.
240 mg/dL and above High blood cholesterol. A person with this level has more than twice the risk of desirable level.

LDL Cholesterol Level Category
Less than 100 mg/dL Optimal
100-129 mg/dL Near or above optimal
130-159 mg/dL Borderline high
160-189 mg/dL High
190 mg/dL and above Very high

Your LDL cholesterol goal depends on how many other risk factors you have.

If you don’t have coronary heart disease or diabetes and have one or no risk factors, your LDL goal is less than 160 mg/dL.
If you don’t have coronary heart disease or diabetes and have two or more risk factors, your LDL goal is less than 130 mg/dL.
If you do have coronary heart disease or diabetes, your LDL goal is less than 100 mg/dL.
HDL Cholesterol Level Category
Less than 40 mg/dL A major risk factor for heart disease.
40-59 mg/dL The higher your HDL level, the better.
60 mg/dL and above An HDL of 60 mg/dL and above is considered protective against heart disease.

10. Based on my history and risk factors, what can I do to lower my risk of heart disease and stroke?

Take more responsibility for your health. Ask your healthcare providers questions . . . no question is stupid. If you don't understand an answer, ask again! If your questions aren't answered to your satisfaction, ask for a referral to someone who can give you a second medical opinion.

Learn more about your risk factors and have regular checkups.
Reduce the risk factors you can control. You may need to
Cut the amount and kinds of fat and cholesterol in your diet.
Stop smoking and avoid other people's tobacco smoke.
Control high blood pressure.
Be more physically active. For example, use stairs instead of elevators!
Maintain a healthy weight.
Take medicine if your doctor prescribes it.
Learn to relax and find healthful ways to deal with situations you find stressful. Unhealthy responses to stress may lead to other risk behaviors like smoking and overeating.
Get your friends and family to join you in a healthy way of life.
Make changes slowly in your family's diet and exercise habits.
Share heart-healthy cooking tips and recipes with friends.
Suggest that your church, synagogue or community group hold a blood pressure or cholesterol screening.
Find a partner to exercise with you three or four times a week.
Turn off the TV and do something active as a family.
Help friends and family who want to quit smoking.

Take action in your community and workplace:
Ask for healthier food choices in grocery stores, restaurants and your company's vending machines or cafeteria.
Insist on a nonsmoking section in restaurants and other public places.
Request that your workplace be smoke-free.
Start a fitness walking club or exercise class.

Know the warning signs of heart attack and stroke and don't delay in getting medical help if you notice any of them.