Imagine this: complications of pregnancy can foreshadow future heart disease or stroke for women and constitute a risk right up there with flunking an exercise stress test used to diagnose heart disease. Depression can be a factor, too, but here there’s a twist: depression itself doesn’t increase the risk of heart disease, but not following medical advice because you’re depressed can pose a threat.

Listening in on a conference call discussion of the new guidelines for women from the American Heart Association (AHA) and a new campaign aimed at women by the U.S. government was an eye-opener. The pregnancy related risk isn’t exactly new, but this is the first time the AHA guidelines committee decided to focus on it. The risks in question include high blood pressure during pregnancy (called preeclampsia), diabetes during pregnancy (it goes away after the baby is born but may come back later in life unless women are vigilant about their health), have a baby that is small for its gestational age and bleeding during the third trimester. Doctors don’t yet know why these complications signal heart trouble ahead, said Lori Mosca, M.D., M.P.H., Ph.D., chair of the guidelines writing committee, just that they amount to a warning that your vascular system doesn’t function ideally. Dr. Mosca said that a history of preeclampsia alone doubles the risk of stroke, heart disease and dangerous clotting in the veins during the five to 15 years following pregnancy.

As for depression, the guidelines call upon physicians to screen women for this common problem as part of an overall all evaluation for cardiovascular risk.

The new guidelines also flagged rheumatoid arthritis and lupus as risk factors because inflammation is involved in them, as it is in heart disease. Among the other recommendations:

  • Limit salt intake to less than 1,500 milligrams per day (this is particularly important for African-American women because they tend to be more prone to high blood pressure that is salt sensitive).
  • Limit sugar intake to five servings a week (this is designed to curb obesity, which is a risk factor for heart disease).
  • Avoid hormone replacement therapy for prevention of heart attack and stroke (it doesn’t help); the guidelines also found no need for such supplements as folic acid, antioxidant vitamins and beta-carotene for prevention of cardiovascular disease.
  • Low dose aspirin can be protective for women who already have heart disease, but isn’t recommended for other women under 65.

Perhaps the most mind-blowing news I heard on the conference call came from Suzanne Haynes, Ph.D., of the Office of Women’s Health in the U.S. Department of Health and Human Services. She was describing the government’s new campaign to urge women to call 911 if they develop chest pains, the most common heart attack symptom in men and women. It turns out that a year ago, a survey found that only 53 percent of women would call 911 under those circumstances. Why not the others? The excuses ranged from, “I didn’t want to bother the ambulance crew” to “the house wasn’t clean” or “I wasn’t wearing makeup.” Oh, please! For this you risk your life?

Women can develop atypical symptoms of a heart attack including upper body pain and pain through the arms, shoulder, neck, jaw and upper stomach. Shortness of breath is another cue, as is unusual or unexpected fatigue. Suspect that those symptoms might mean a heart attack “when they’re sudden, unusual or profound, something you’ve never felt before in your life,” said Dr. Haynes.

If that happens, forget the house, the make-up and the sensitivities of the ambulance crew. Call 911.

How worried are you about your own risk of heart disease?


The government campaign to get more women to pick up the phone if they develop heart symptoms is called “Call 911. Don’t Miss a Beat.” To learn more about heart disease in women check out Women Heart and the American Heart Association. For more news on heart health, also check out our blog posts, “New Formula for Women’s Peak Heart Rates,” “Healthy Gums Could Prevent a Heart Attack,” “How the Mediterranean Diet Helps the Heart.”