Although we have long recognized the essential role of the heart in physical health, we’ve probably imagined it as the epicenter of our emotions for even longer. The Valentine’s Day symbol is an ancient one, though its exact origin is a mystery. Some people claim that it comes from a vision of the 17th century saint Margaret Marie Alocoque. Others believe the Egyptians were the first to use the symbol, calling it the “heart-soul” representing one of the seven souls they believed each person possesses. Some historians trace it back even further, to the heart-shaped seed of a medicinal plant used in the African city of Cyrene in the 7th century BCE.

Confused? Probably not as confused as you are by the various explanation and heart health recommendations that you hear. What seems true one day is debunked the next. Women have the added burden of questioning whether the latest news can be applied to our half of the population, as most heart health advice is still based on research conducted primarily in men. Nevertheless, we know enough about how cardiac disease arises to confidently protect ourselves.


Common sense recommendations are those irrefutable guidelines that tell us what to do to keep our hearts healthy: Eat less fat and sugar and more fruits, vegetables and whole grains; maintain a healthy weight; and exercise most days of the week for 30 minutes or more. We should learn how to de-stress, using the methods that work best for us, such as yoga, meditation, talk therapy, journaling or dance. We should not smoke or drink more than one alcoholic beverage per day.

In addition, we should know our optimal levels for blood pressure, cholesterol and other heart-disease risk factors (See “Are You at Risk?”). We should have regular checkups and learn CPR. We should know the warning signs of heart attack or stroke and seek care immediately if these signs appear.


Controversy arises when research collides with current advice. Consider vitamin E, long touted as cardio-protective until a report in The New England Journal of Medicine debunked its value in 2002. Controversy and ongoing debate remain in a number of areas.

The idea that your personality can trigger disease dates back to the 1960s, when the concept of a type-A personality—competitive, perfectionistic and hostile—was first linked with heart disease in men. Large studies, however, have not shown a direct relationship between these traits and heart disease in men or women. Researchers are now exploring whether the the type-D(istress) personality— characterized by negative thinking and social inhibition—is a more accurate personality based risk factor.

One area of relative certainty is the relationship between depression and heart disease. Two years ago, the Archives of Internal Medicine reported that menopausal women who became depressed were 50% more likely to develop heart disease. These findings are particularly significant because depression is a treatable disease.


No arthritis sufferer will soon forget the withdrawal of Vioxx and Bextra for their implication in causing or worsening heart disease. The exit of these Cox-2 inhibitors raised doubts about their over-the-counter cousins, nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and naproxen, following the publication of British and European studies that showed an association between these medications and an increased risk of heart disease or heart attack.

The authors of a 2005 study in the British Medical Journal caution that “enough concerns may exist to warrant a reconsideration of the cardiovascular safety of all NSAIDs.” If you use these drugs more than occasionally, discuss their risks with your health care provider.


Whether gum infections lead to heart disease is a matter of ongoing debate, made all the more interesting by the link between oral infections and circulating inflammatory molecules associated with the formation of blood clots. Research to date has failed to show an association between gum and heart disease but has pointed to a potential association with stroke.

Virginia Commonwealth University researchers recently found that patients with severe gum disease also had “small dense low-density lipoprotein” in their bloodstream, which has been associated with cardiac disease and stroke.

This study was conducted in a very small sample of patients who may have had other risk factors, including smoking. Then again, even without evidence that good oral care has a positive effect on heart health, do we really need another reason to brush and floss?

No real controversy here: trans-fats—or trans-fatty acids—are bad for our hearts because they increase bad cholesterol (LDL). The debate is over how to spot them in foods. Trans-fats are created from oils that are turned solid by adding hydrogen, a process called hydrogention which extends shelf life and improves flavor stability.

Manufacturers are now required to add this information to food labels, but the language can be deceptive. Most processed snack foods and deep-fried fast foods are high in transfat.

Even seemingly healthy foods such as supplements or nutrition bars can contain trans-fats, so make sure to read labels.


Most cardiologists now agree that omega-3 fatty acids can reduce cardiac deaths by protecting against inflammation and preventing irregular heart rhythms. Omega-3s are found in sardines and cold-water, fatty fish like salmon and mackerel.

Experts suggest we eat two servings of these fish each week, although some can have high levels of toxins such as mercury or PCBs, putting pregnant women, fetuses, and young children at risk. These groups might want to get their omega-3s from leafy green vegetables, walnuts, or flaxseed and canola oil.


What researchers are curious about these days is the relationship between inflammation and heart disease. Inflammation is the body’s natural response to injury, but chronic inflammation can damage healthy tissue and is linked to an array of illnesses, including cancer, autoimmune diseases, diabetes, Alzheimer’s, and heart disease.

Inflammation is a recognized precursor to the build-up of plaque in arteries (atherosclerosis). You may have heard of the clinical test for C-reactive protein (CRP), which is one of the inflammatory proteins that increases during chronic inflammation.

A highly sensitive test for CRP called hs-CRP is now available, with a normal range for the test being less than 1.0 mg/L and a level of greater than 3.0 mg/L representing a high-risk result.

In 2003, the American Heart Association and the Centers for Disease Control published a joint recommendation for use of the hs-CRP test in limited situations but not for the general population, emphasizing that most people should focus instead on the main risk factors for heart disease, including high blood pressure, high blood cholesterol, cigarette smoking,
and diabetes.

• Is your total cholesterol more than 200 mg/dL?
• Is your LDL cholesterol low enough, given your heart disease risk? If you are at low risk for heart disease, your LDL should be less than 160 mg/dL; at medium risk, less than 130 mg/dL; and at high risk, less than 100 mg/dL.
• Is your HDL cholesterol less than 50 mg/dL?
• Are your triglycerides 150 mg/dL or more?
• Is your blood pressure 120/80 mmHg or more?
• Is your fasting blood glucose (sugar) 100 mg/dL or more?
• Is your body-mass index (BMI) 25 Kg/m or more? If you’re a woman, is your waist circumference 35 inches or more?
• Do you exercise less than 30 minutes a day, at least five days per week?

Myth: Heart attack symptoms are the same in women and men.
Fact: Women typically don’t feel the crushing chest pain men report when having a heart attack. Instead, women report feeling fatigue, nausea and other gastrointestinal symptoms, dizziness, shortness of breath, heat and sweatiness, and pain in the arm or jaw.

Myth: The risk of heart disease is similar for white women and women of color.
Fact: Heart disease is the No. 1 killer of women. But black, Hispanic, and Native American women have far higher rates of heart attacks, diabetes, strokes, and diabetic kidney disease compared with white women.

Myth: It’s safe for women to drink as much alcohol as men do.
Fact: A little alcohol can be heart-smart, but the benefits associated with drinking alcohol in women are based on a single beverage per day, not the two drinks that are the basis for advice given to men. Women should also be concerned about the added risk of breast cancer when drinking more than one drink per day.

About the Author: Risa Denenberg, BSN, MSN is a family nurse practitioner currently working as a hospice nurse in Philadelphia.