By now most women surely are aware that heart disease is an equal-opportunity killer, especially in those past age 50.
Slightly more than half the deaths from heart disease in the U.S. occur among women, and this share is likely to increase as the population ages.
Women are not doing nearly enough to stem this increase, particularly those in their 50s and 60s, when their coronary death rate begins its steep climb, according to recent reports.
Women with two or more major controllable coronary risk factors-cigarette smoking, lack of physical activity, high blood cholesterol, high blood pressure, diabetes and overweight-are more the norm than the exception.
The U.S. Public Health Service estimated 61,000 American women over 35 died in 1990 from cardiovascular diseases caused by smoking. The chances of suffering a heart attack can be cut in half within a year of quitting, but only 2.5 percent of women who smoke quit each year. As of 1993, the most recent year for which data are available, 22 million women-more than one in five-smoked regularly.
According to a report last month from the Centers for Disease Control and Prevention in Atlanta, 73 percent of female smokers 12 and over told government interviewers they wanted to quit but were unsuccessful.
A major hindrance, the national survey of 7,137 women revealed, is addiction to nicotine and unpleasant withdrawal symptoms. Four out of five female smokers 12 and older reported one or more indicators of addiction: Feeling dependent on cigarettes, needing more to get the same effect, being unable to cut down and feeling sick when trying to quit.
Overall, 75 percent reported feeling dependent, and the more they smoked, the greater the dependency. In those 12 through 24, 80.6 percent who smoked six to 15 cigarettes a day felt dependent; for women over 25 it was 76.1 percent.
Among those who had tried to cut smoking the year before, 81.5 percent of younger women and 77.8 percent of those over 25 were unsuccessful. Of those who smoked six to 15 cigarettes a day, an overwhelming majority had been unable to cut back.
Even among those who smoked fewer than six cigarettes a day, more than half reported one or more symptoms of addiction. More than a third of all smokers felt “sick” when they tried to reduce smoking. Withdrawal symptoms seem a far greater deterrent to quitting than the weight women tend to gain when they stop smoking.
An estimated 87 percent of girls and women who smoke every day began smoking by age 18, often with the strong belief they could quit whenever they wanted, a misconception. The easiest way to quit is never to start.
Even moderately intense activity, such as housework, gardening and walking, has significant health benefits,including reduced risk of coronary disease, some cancers and osteoporosis.
Physical inactivity accounts for about 25 percent of all deaths from chronic disease in the U.S., mostly of the heart and blood vessels, experts say. Yet more than 70 percent of American women are sedentary or irregularly active.
The survey revealed that as women get older, they become increasingly sedentary, just when they most need the cardiovacular benefits of exercise. While a quarter of women from 18 to 34 were inactive, 42.1 percent of those 65 and older did not have the recommended level of activity.
Increasing that level among American women requires more than education and encouragement by doctors. Public health experts suggest that employers schedule exercise breaks or provide incentives for participatation in exercise programs.
Impediments to participation must be addressed, including safety and child-care questions, availability of walking and cycling trails, recreation sites and something as simple as sidewalks.
A continuing study of nearly 116,000 female nurses has revealed an unsettling fact: Women who gain weight as adults increase the risk of suffering and dying of a heart attack at any age, particularly after 50. A gain of 11 to 18 pounds after age 18 increased the heart attack risk by 25 percent, and a gain of 18 to 25 pounds increased it by 60 percent.
For those who gained more than 25 pounds as adults, the risk rose as much as 200 percent to 300 percent compared with rates among women who gained less than 11 pounds as adults. The risk was lowest among women who gained nothing or perhaps lost some.
Women can prevent such gains by eating fewer calories and/or expending more as they age. Women still have a long way to go in cutting dietary fat, about 34 percent of calories.
By replacing most fatty foods with vegetables and fruits and moderate amounts of low-fat starches, they will further improve their chances of escaping heart disease and cancer.
