I was surprised to learn after surviving my own heart attack that cardiac events like mine may take 20-30 years to actually show up. In other words, I didn’t have a heart attack because I ate a piece of bacon or had a stressful day at work. I had a heart attack because something – likely decades earlier – had damaged the delicate endothelial cells lining my coronary arteries. . . . .
When I tell this to the women in my Heart-Smart Women audiences, many want to know how to tell if they too might be at specific cardiac risk – so that they don’t end up with a heart attack.
My stock answer (after the standard “I’m-Not-A-Doctor” disclaimer) is that there is simply no downside to living as if we knew with 100% certainty that we’re at very high risk for cardiovascular disease. Even without having any risk factors, we already know that quitting smoking, exercising your body, eating healthier and learning to manage stress are good ways to live life.
This is an important consideration when talking about cardiac risk factors.
Remember that a known risk factor is NOT a death sentence – and we shouldn’t embrace lifestyle changes just to lower risk of a future disease that may or may not ever happen (behaviour scientists call this an avoidance goal) but because doing so makes us feel, sleep, look and function better (that’s an approach goal). See also: Why don’t patients listen to doctors’ heart-healthy advice?
Meanwhile, Harvard University experts describe how early the progress of cardiovascular disease can begin:
“Heart attacks are swift, occurring in a matter of minutes. But atherosclerosis itself is slow, developing over years — and it can often begin in childhood.”
One study, for example reported that autopsies performed on casualties of the Korean War revealed coronary artery involvement in over 77 per cent of the hearts studied, all in soldiers under the age of 30.(1)
Even pre-teens can begin to show early signs of heart disease, according to the Cleveland Clinic:
“Coronary artery disease starts when you are very young. Before your teen years, the blood vessel walls start to show streaks of fat.
“As you get older, the streaks build up, causing minor damage to your blood vessel walls. With time, other substances that move through your blood stream, such as inflammatory cells, cellular waste products, proteins and calcium, stick to the vessel walls. These things combine with the fat to form plaque.”
We know now that younger women who experience pregnancy complications – as I did with my preeclampsia diagnosis – are also at significantly higher risk for developing serious heart disease, often many years after giving birth. See also: Pregnancy complications strongly linked to heart disease
Obstetrician/researcher Dr. Graeme Smith at Queen’s University describes pregnancy as “the ultimate cardiac stress test”:
“Pregnancy is a window of opportunity to screen women for health risks to ensure health preservation and heart disease prevention.”
Dr. Smith reminds women that pregnancy complications may be some of the earliest identifiable heart disease risk indicators available. It was only in 2011 that the American Heart Association released updated guidelines for preventing cardiovascular disease in women, including for the first time new warnings that high-risk women who have experienced pregnancy complications should have those factors taken into account when their heart disease risks are evaluated.
Yet to date, no commonly used cardiac risk calculators used by physicians in daily practice ask anything about a woman’s history of pregnancy complications.
The niggling question still remains: do pregnancy complications cause cardiovascular damage, or do they reveal underlying cardiovascular disease?
These important early warning signs include:
- gestational hypertension
- gestational diabetes
- placental abruption
- excessive weight gain
- preterm birth
- intrauterine growth restriction (full term birth/low birth weight)
If you are a woman who was born with a serious heart problem (a congenital heart defect), you may have been diagnosed and treated soon after birth. But according to the Mayo Clinic:
“Congenital heart defects are often not diagnosed until later in childhood or during adulthood.”
A 2019 study published in the British Medical Journal Heart (BMJ) reported some scary stats: despite an overall reduction in cardiovascular disease mortality, the rate of coronary heart disease diagnoses and mortality is actually on the rise in younger women aged 35-54 years.(2)
One more scary stat: if you have been treated for breast cancer, you should know that some cancer treatments are linked to a subsequent heart disease diagnosis – even years later. The field of cardio-oncology is a relatively new medical specialty that focuses on preventive cardiac care for high-risk cancer patients. See also: When cancer treatment damages your heart
The American Heart Association neatly sums up this basic health advice for all young people:
“As early as childhood and adolescence, plaque can start accumulating in the arteries and later lead to clogged arteries. And not all people who have heart disease are senior citizens.”
Here’s the good news: cardiologists tell us that up to 80 per cent of heart disease risk factors are modifiable (which means that the choices we make in life can help to significantly lower many of those risks – like choosing to quit smoking, for example).
So learn as much as you can about your own personal cardiac risks – and whether or not they are modifiable. And then, as the late U.S. tennis legend Arthur Ashe once advised:
“Start where you are. Use what you have. Do what you can!”
Image: congerdesign, Pixabay
- Joseph A et al. “Manifestations of coronary atherosclerosis in young trauma victims–an autopsy study.” J Am Coll Cardiol. 1993 August (2):459-67. doi: 10.1016/0735-1097(93)90050-b. PMID: 8335815.
Q: Did you experience an earlier medical diagnosis possibly linked to your current heart disease diagnosis?
NOTE FROM CAROLYN: I wrote more on the origins of heart disease in my book, A Woman’s Guide to Living With Heart Disease (Johns Hopkins University Press), you can ask for it at your local bookshop, or order it online (paperback, hardcover or e-book) at Amazon. Or order it directly from my publisher, Johns Hopkins University Press (use their code HTWN to save 20% off the list price).
-more Heart Sisters articles about young women and heart disease