Q: How do I know whether statins are right for me?

A: In general you should probably be on a statin—a cholesterol-lowering drug that can prevent heart attack and stroke—if you suffer from coronary artery disease; have a combination of its risk factors, such as high blood pressure or a family history of high cholesterol or cardiovascular disease; or if you're diabetic, obese, or over the age of 65 (for women). If you have high cholesterol but only a few of these factors, you may not benefit from statins. In most cases, before writing a prescription, your doctor will give you six months to lower your cholesterol through lifestyle changes such as diet and exercise. Keep in mind that statins have side effects, including muscle and joint aches and diarrhea, and that you have to take them indefinitely in order to retain their benefit.

Q: What are the signs of heart attack in women?

A: Women are less likely than men to experience chest discomfort during a heart attack, and more likely to have shortness of breath, weakness or fatigue, nausea or vomiting, indigestion, dizziness, or pain in the back, neck, or jaw. In addition, women often exhibit warning signs—such as unusual tiredness and sleep disturbances—weeks to months before having a heart attack, but don't seek treatment because they don't associate these symptoms with an oncoming cardiac event. (Doctors can—and do—make the same mistake, attributing such symptoms to noncardiac causes such as anxiety or heartburn.) Protect yourself by being proactive: As soon as you suspect you're having a heart attack, call 911 and chew an aspirin, which can reduce damage to the heart muscle. At the hospital, insist that your complaints be taken seriously; you should be given an electrocardiogram or enzyme blood test.

Q: Do hormone therapies or birth control pills increase heart attack risk?

A: The answer seems to depend on your age. If you begin hormone therapy (HT) less than 10 years after the onset of menopause, or between the ages of 50 and 59, you're probably not in harm's way. Some data even suggest estrogen can protect the heart when taken early in your menopausal years. But women who wait more than 10 years after menopause to start HT, or who are over 60, are at increased risk. The general recommendation is to start HT as soon as possible after menopause begins, and to take the lowest effective dose for the shortest amount of time needed to treat symptoms (you shouldn't be on HT for more than five years, as this significantly increases your risk of breast cancer). As for birth control pills, they're generally safe for healthy women under the age of 35 who don't smoke and don't have any other risk factors for heart disease.

Next: How the heart works...and what happens when it doesn't

As a reminder, always consult your doctor for medical advice and treatment before starting any program.


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