The Healthy Heart Handbook for Women

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No customer reviews. Share your thoughts with other customers. Write a customer review. Most helpful customer reviews on Amazon. August 8, - Published on Amazon. Verified Purchase. Excellent addition to our hospital's consumer health collection. November 15, - Published on Amazon. After reading this, I sent it to my mother. All women should read this to learn about heart disease. See Screening Tests on page Here is a quick quiz to find out your risk of a heart attack. If you dont know some of the answers, check with your health care provider. Dont Yes No Know.

The Healthy Heart Handbook for Women

Has your father or brother had a heart attack before age 55, OR has your mother or sister had one before age 65? Do you have a body mass index BMI score of 25 or more? To find out, see page Do you get less than a total of 30 minutes of physical activity on most days? Has a doctor told you that you have angina chest pains , OR have you had a heart attack? If you answered "yes" to any of these boxes, youre at an increased risk of having a heart attack. Read on to learn what you can do to lower your risk. As important as it is to work closely with your doctor, it is only the first step.

To make a lasting difference in your heart health, youll also need to educate yourself about heart disease and about the kinds of habits and conditions that can raise your risk. Its your heart, and youre in charge. What follows is a basic guide to the most important risk factors for heart disease and how each of them affects a womans health. Smoking Cigarette smoking has been described as the most important individual health risk in this country. Women who smoke are two to six times more likely to suffer a heart attack than nonsmoking women, and the risk increases with the number of cigarettes smoked each day.

Smoking also boosts the risk of stroke. But heart disease and stroke are not the only health risks for women who smoke. Cigarette smoking greatly increases the chances that a woman will develop lung cancer. In fact, the lung cancer death rate for women is now higher than the death rate for breast cancer. Cigarette smoking is also linked with many other types of cancer, including cancers of the mouth, urinary tract, kidney, and cervix.

The Healthy Heart Handbook

Smoking also causes most cases of chronic obstructive lung disease, which includes bronchitis and emphysema. If you live or work with others, your secondhand smoke can also cause numerous health problems in those individuals. Low-tar and low-nicotine cigarettes do not lessen the risks of heart disease or other smoking-related diseases. The only safe and healthful course is not to smoke at all. For tips on how to quit, see Kick the Smoking Habit on page High Blood Pressure High blood pressure, also known as hypertension, is another major risk factor for heart disease, kidney disease, and congestive heart failure.

High blood pressure is also the most important risk factor for stroke. Even slightly high levels increase your risk for these conditions. New research estimates that middle-aged Americans have a 90 percent chance of eventually developing high blood pressure. High blood pressure is more common and more severe in African American women than it is in white women. Your risk also goes up if you are overweight or have a family history of high blood pressure. High blood pressure is often called the silent killer because it usually doesnt cause symptoms.

As a result, many people pay little attention to their blood pressure until they become seriously ill. The good news is that you can take action to control or prevent high blood pressure, and thereby avoid many life-threatening disorders. What Is Blood Pressure? Blood pressure is the amount of force exerted by the blood against the walls of the arteries. Everyone has to have some blood pressure, so that blood can get to all of the bodys organs. The first number is the systolic blood pressure, the force when the heart beats.

The second number, or diastolic blood pressure, is the pressure that exists in the arteries between heartbeats. Because blood pressure changes often, your health care provider should check it on several different days before deciding whether your blood pressure is too high. Blood pressure is considered high when it stays above normal levels over a period of time. See below. Your blood pressure category is determined by the higher number of either your systolic or your diastolic measurement.

For example, if your systolic number is but your diastolic number is 88, your category is hypertension. High blood pressure is the 1 risk factor for congestive heart failure. Heart failure is a life-threatening condition in which the heart cannot pump enough blood to supply the bodys needs. Congestive heart failure occurs when excess fluid starts to leak into the lungs, causing tiredness, weakness, and breathing difficulties. To prevent congestive heart failure, and stroke as well, you must control your high blood pressure to below over If your blood pressure is higher than that, talk with your doctor about starting or adjusting medication, as well as making lifestyle changes.

To avoid congestive heart failure, controlling your weight is also very important. Being even moderately overweight increases your risk of developing heart failure. For example, if you have prehypertension, you are still at increased risk for a heart attack, stroke, or heart failure. Also, if your systolic blood pressure first number is or higher, you are more likely to develop cardiovascular and kidney diseases even if your diastolic blood pressure second number is not too high. Starting around age 55, women are more likely to develop high systolic blood pressure.

High systolic blood pressure is high blood pressure. If you have this condition, you will need to take steps to control it. High blood pressure can be controlled in two ways: by changing your lifestyle and by taking medication. Changing Your Lifestyle If your blood pressure is not too high, you may be able to control it entirely by losing weight if you are overweight, getting regular physical activity, cutting down on alcohol, and changing your eating habits.

A special eating plan called the DASH diet can help you lower your blood pressure. The DASH eating plan emphasizes fruits, vegetables, whole-grain foods, and lowfat dairy products. It is rich in magnesium, potassium, and calcium, as well as protein and fiber. Its low in saturated and total fat and cholesterol, and limits red meat, sweets, and sugar-containing beverages.

If you follow the DASH eating plan and also consume less sodium, you are likely to reduce your blood pressure even more. Sodium is a substance that affects blood pressure. It is the main ingredient in salt and is found in many processed foods, such as soups, convenience meals, some breads and cereals, and salted snacks. For more on the DASH eating plan and how to make other changes that can lower and prevent high blood pressure, see the Taking Control section of this handbook.

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Taking Medication If your blood pressure remains high even after you make lifestyle changes, your doctor will probably prescribe medicine. Lifestyle changes will help the medicine work more effectively. In fact, if you are successful with the changes you make in your daily habits, then you may be able to gradually reduce how much medication you take. Taking medicine to lower blood pressure can reduce your risk of stroke, heart attack, congestive heart failure, and kidney disease.

If you take a drug and notice any uncomfortable side effects, ask your doctor about changing the dosage or switching to another type of medicine. A recent study found diuretics water pills work better than newer drugs to treat hypertension and to prevent some forms of heart disease. If youre starting treatment for high blood pressure, try a diuretic first. If you need more than one drug, ask your doctor about making one a diuretic. And, if youre already on treatment, ask about switching to or adding a diuretic. Diuretics work for most people, but if you need a different drug, other medications are very effective.

So talk with your doctor about your total health needs. A reminder: It is important to take blood pressure medication exactly as your doctor has prescribed it. Before you leave your physicians office, make sure you understand the amount of medicine you are supposed to take each day, and the specific times of day you should be taking it. Stroke is a medical emergency. If you or someone you know has a stroke, it is important to recognize the symptoms so you can get to a hospital quickly.

Getting treatment within 60 minutes can prevent disability. The chief warning signs of a stroke are:. Sudden numbness or weakness of the face, arm, or leg especially on one side of the body. Sudden confusion, trouble speaking, or understanding speech. Sudden trouble seeing in one or both eyes. Sudden trouble walking, dizziness, loss of balance or coordination.

Sudden severe headache with no known cause. If you think someone might be having a stroke, call immediately. Also, be sure that family members and others close to you know the warning signs of a stroke. Give them a copy of this list. Ask them to call right away if you or someone else shows any signs of a stroke. All women should keep their cholesterol levels down to lessen the chances of developing heart disease or having a heart attack. If you already have heart disease, it is particularly important to lower an elevated blood cholesterol level in order to reduce your high risk for a heart attack.

Women with diabetes also are at especially high risk for a heart attack. If you have diabetes, you will need to take steps to keep both your cholesterol and your diabetes under control. Although young women tend to have lower cholesterol levels than young men, between the ages of 45 and 55, womens levels begin to rise higher than mens. After age 55, this cholesterol gap between women and men becomes still wider. Although at older ages, womens overall risk of heart disease continues to be somewhat lower than that of men, the higher a womans blood cholesterol level, the greater her chances of developing heart disease.

Cholesterol and Your Heart The body needs cholesterol to function normally. However, your body makes all the cholesterol it needs. Over a period of years, extra cholesterol and fat circulating in the blood build up in the walls of the arteries that supply blood to the heart. This buildup makes the arteries narrower and narrower. As a result, less blood gets to the heart. Blood carries oxygen to the heart, and if enough oxygen-rich blood cannot reach your heart, you may suffer chest pain. If the blood supply to a portion of the heart is completely cut off, the result is a heart attack. Low-density lipoprotein LDL carries most of the cholesterol in the blood.

Cholesterol packaged in LDL is often called bad cholesterol, because too much LDL in the blood can lead to cholesterol buildup and blockage in the arteries. Another type of cholesterol is high-density lipoprotein HDL , known as good cholesterol. Thats because HDL helps remove cholesterol from the blood, preventing it from building up in the arteries. Getting Tested All women age 20 and older should have their cholesterol levels checked by means of a blood test called a lipoprotein profile.

Be sure to ask for the test results, so you will know whether or not you need to lower your cholesterol. However, not every woman needs to aim for so low a level. As you can see on the next page, there are four other categories of LDL level. The higher your LDL number, the higher your risk of heart disease. Knowing your LDL number is especially important because it will determine the kind of treatment you may need. Your HDL number tells a different story. The lower your HDL level, the higher your heart disease risk. Your lipoprotein profile test will also measure levels of triglycerides, which is another fatty substance in the blood.

See What Are Triglycerides? Triglycerides are another type of fat found in the blood and in food. Triglycerides are produced in the liver. When you drink alcohol or take in excess calories, your liver produces more triglycerides.

Healthy heart tips for women

To reduce blood triglyceride levels, doctors recommend a low-saturated fat, low- cholesterol diet that also limits carbohydrates. It is also important to control your weight, get more physical activity, and avoid smoking and alcohol. Sometimes, medication is needed. The higher your risk, the lower your LDL goal level will be.

Here is how to determine your LDL goal:. Step 1: Count Your Risk Factors. Below are risk factors for heart disease that will affect your LDL goal. Family history of early heart disease your father or brother before age 55, or your mother or sister before age If you have two or more risk factors on the above list, you will need to figure out your risk score. This score will show your chances of having a heart attack in the next 10 years.

Use your number of risk factors, risk score, and medical history to find out your category of risk for heart disease or heart attack. Use the table below:. This cluster of risk factors increases your risk of heart disease, no matter what your LDL cholesterol level. But because having metabolic syndrome adds additional risk, you should make a particularly strong effort to reach and maintain your LDL goal. You should emphasize weight control and physical activity to correct the risk factors of the metabolic syndrome. The higher your risk category, the lower your LDL goal will be.

To find your personal LDL goal, see the table below:. Recent studies have added to the evidence suggesting that for LDL cholesterol, lower is better. Because these studies show a direct relationship between lower LDL cholesterol and reduced risk for heart attack, physicians have the option to consider more intensive cholesterol-lowering treatment for people in the higher risk categories for a heart attack. Depending on your risk category, the use of these. Because of the recent studies that showed the benefit of more intensive cholesterol lowering, physicians have the option to start cholesterol medicationin addition to lifestyle therapyat lower LDL levels than previously recommended for high- risk patients.

Lifestyle Changes. This treatment includes a cholesterol-lowering diet, regular physical activity, and weight management. For more on the TLC approach, see page Losing extra weight and getting regular physical activity are especially important for women who have metabolic syndrome.

If your LDL level stays too high even after making lifestyle changes, you may need to take medicine. If you need medication, be sure to use it along with the TLC approach. This will keep the dose of medicine as low as possible, and lower your risk in other ways as well. You will also need to control all of your other heart disease risk factors, including high blood pressure, diabetes, and smoking.

Following are the most commonly used medicines:. These are the drugs most often prescribed for people who need a cholesterol-lowering medicine. Of all available medications, statins lower LDL cholesterol the most, usually by 20 to 60 percent. Side effects are usually mild, although liver and muscle problems occur rarely. If muscle problems occur, you should contact your doctor promptly.

Bile Acid Sequestrants. These medications lower LDL cholesterol by about 10 to 20 percent. Bile acid sequestrants are often prescribed along with a statin to further decrease cholesterol levels. Side effects may include constipation, bloating, nausea, and gas. However, long-term use of these medicines is considered safe. Nicotinic Acid. Nicotinic acid, or niacin, lowers total cholesterol, LDL cholesterol, and triglyceride levels, while also raising HDL cholesterol.

While nicotinic acid is available without a prescription, use it under a doctors care because of possibly serious side effects. In some people, it may inflame peptic ulcers or cause liver problems, gout, or high blood sugar. These drugs can reduce triglyceride levels by 20 to 50 percent, while increasing HDL cholesterol by 10 to 15 percent.

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Theyre not very effective for lowering LDL cholesterol. While the drugs usually cause only mild side effects, they can increase the chances of developing gallstones and heighten the effects of blood-thinning drugs. This is the first in a new class of cholesterol-lowering agents that interfere with the absorption of cholesterol in the intestine. It can be used alone or in combination with a statin. Side effects may include back and joint pain. Yet about 62 percent of all American women age 20 and older are overweightabout 33 percent of them are obese extremely overweight.

The more overweight a woman is, the higher her risk for heart disease. Overweight also increases the risks for stroke, congestive heart failure, gallbladder disease, arthritis, and breathing problems, as well as breast, colon, and other cancers. If you are overweight, you are more likely to develop heart disease even if you have no other risk factors. Being overweight also appears to contribute to heart disease by increasing the chances of developing other major risk factors, such as diabetes, high blood pressure, and high blood cholesterol.

The bottom line: Maintaining a healthy weight is an extremely important part of heart disease prevention. It can help to protect your health and even save your life. Should You Choose To Lose? Do you need to lose weight to reduce your risk of heart disease? You can find out by taking three simple steps. First, take a look at the box on page Youll notice that your weight in relation to your height gives you a number called a body mass index BMI.

A BMI from A person with a BMI from 25 to Those in the overweight or obese categories have a higher risk of heart disease.


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Do not gain any weight, especially if your waist measurement is high. You need to lose weight if you have two or more risk factors for heart disease and are overweight, or have a high waist measurement. You need to lose weight. See your doctor or a nutritionist if you need help. For women, a waist measurement of over 35 inches increases the risk of heart disease as well as the risks of high blood pressure, diabetes, and other serious health conditions. To measure your waist correctly, stand and place a tape measure around your middle, just above your hipbones. Measure your waist just after you breathe out.


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  8. The final step in determining your need to lose weight is to find out your other risk factors for heart disease. It is important to know whether you have any of the following: high blood pressure, high LDL cholesterol, low HDL cholesterol, high triglycerides, high blood glucose blood sugar , a family history of early heart disease, physical inactivity, or cigarette smoking. Being age 55 or older, or having gone through menopause, also are heart disease risk factors. If you have a condition known as metabolic syndrome see page 30 , your risk of heart disease is particularly high.

    If you arent sure whether you have some of these risk factors, consult with your doctor. Once you have taken these three stepsfound out your BMI, your waist measurement, and your other heart disease risk factors you can use the information to decide if you need to take off pounds. While you should talk with your doctor about whether you should lose weight, keep these guidelines in mind:.

    If you are overweight AND have two or more other risk factors, or if you are obese, you should lose weight. If you are overweight, have a waist measurement of over 35 inches, AND have two or more other risk factors, you should lose weight. If you are overweight, but do not have a high waist measurement, and have fewer than two other risk factors, you should avoid further weight gain.

    The best way to take off pounds is to do so gradually, by getting more physical activity and eating a balanced diet that is lower in calories and fat. High-fat foods contain more calories than the same amount of other foods, so they can make it hard for you to avoid excess calories. But be carefullowfat doesnt always mean low in calories. Sometimes extra sugars are added to lowfat desserts, for example. For some women at very high risk, medication also may be necessary. To develop a weight-loss or weight-maintenance program that works best for you, consult with your doctor, registered dietitian, or qualified nutritionist.

    For ideas on how to lose weight safely and keep it off, see Aim for a Healthy Weight on page Physical Inactivity Physical inactivity raises your risk of heart diseasemore than you might think. It boosts your chances of developing heart-related problems even if you have no other risk factors. It also increases the likelihood that you will develop other heart disease risk factors, such as high blood pressure, diabetes, and overweight. Yet most women arent getting enough physical activity.

    According to the Surgeon Generals Report on Physical Activity and Health, 60 percent of women in the United States dont get the recommended amount of physical activity. More than 25 percent of women are not active at all during their free time. Physical inactivity is especially common among African American and Hispanic women. Besides raising the risk of heart disease, lack of physical activity leads to more doctor visits, hospitalizations, and use of medicines for a variety of illnesses. For women, physical inactivity also increases the risk of osteoporosis, which in turn may increase the risk of broken bones.

    This is worrisome, since women tend to become less physically active as they get older. Fortunately, research shows that as little as 30 minutes of moderate activity on most, and preferably all, days of the week helps to protect heart health. This level of activity can reduce your risk of heart disease as well as lower your chances of having a stroke, colon cancer, high blood pressure, diabetes, and other medical problems. Examples of moderate activity are taking a brisk walk, raking leaves, housecleaning, or gardening. If you prefer, you can divide your minute activity into shorter periods of at least 10 minutes each.

    To find out about easy, enjoyable ways to boost your activity level, see Learn New Moves on page Diabetes Diabetes is a major risk factor for heart disease and stroke. About 65 percent of people who have diabetes die of some type of cardiovascular disease. Diabetic women are at especially high risk for dying of heart disease and stroke. Today, 6 million women in the United States have diabetes, including an estimated 2.

    In type 2 diabetes, the pancreas makes insulin but the body cannot use it properly and gradually loses the ability to produce it. Type 2 diabetes is a serious disease. In addition to increasing the risk for heart disease, it is the 1 cause of kidney failure, blindness, and lower limb amputation in adults. Diabetes can also lead to nerve damage and difficulties in fighting infection. The risk of type 2 diabetes rises after the age of You are much more likely to develop this disease if you are overweight, especially if you have extra weight around your middle.

    Other risk factors include physical inactivity and a family history of diabetes. Women who have had diabetes during pregnancy gestational diabetes or gave birth to a baby weighing more than 9 pounds are at increased risk for type 2 diabetes later in life. Symptoms of diabetes may include fatigue, nausea, frequent urination, unusual thirst, weight loss, blurred vision, frequent infections, and slow healing of sores.

    But type 2 diabetes develops gradually and sometimes has no symptoms. Even if you have no symptoms of diabetes, if you are overweight and have any of the risk factors for type 2 diabetes, ask your health care provider about getting tested for it. If you have diabetes, controlling your blood glucose levels will help prevent complications. Because diabetes is so strongly linked with heart disease, managing diabetes must include keeping certain factors under control see The ABCs of Diabetes Control on page Recommended levels of blood pressure and blood cholesterol control are lower for people with diabetes than for the general.

    Not smoking, being physically active, and taking aspirin daily if your doctor recommends it also are important to prevent heart disease if you have diabetes. Some people do not yet have diabetes, but are at high risk for developing the disease. They have a condition known as pre-diabetes, in which blood glucose levels are higher than normal but not yet in the diabetic range. But new research shows that many people with pre-diabetes can prevent or delay the development of diabetes by making modest changes in diet and level of physical activity see Preventing Diabetes on page People who are pre-diabetic also have a 50 percent greater chance of having a heart attack or stroke than those with normal blood glucose levels.

    So they should pay close attention to preventing or controlling blood pressure, blood cholesterol, and other risk factors for heart disease. Follow these ABCs:. A is for A1C test, which is short for hemoglobin A1C. This test measures your average blood glucose blood sugar over the last 3 months. It lets you know if your blood glucose level is under control. Get this test at least twice a year. Number to aim for: Below 7. B is for blood pressure. The higher your blood pressure, the harder your heart has to work. Get your blood pressure measured at every doctors visit. C is for cholesterol. Bad cholesterol, or LDL, builds up and clogs your arteries.

    Get your LDL cholesterol tested at least once a year. Be sure to ask your health care provider: What are my ABC numbers? What should my ABC target numbers be? What actions should I take to reach my ABC target numbers? To lower your risk of heart attack and stroke, also take these steps: Get physical activity every day. Eat less salt, cholesterol, and fat, especially saturated fat. Eat more fiber. Choose whole grains, fruits, vegetables, and beans. Stay at a healthy weight. If you smoke, stop. Take medicines as prescribed. Ask your doctor about taking aspirin.

    Ask others to help you manage your diabetes. If you have pre-diabeteshigher than normal glucose levels you are more likely to develop type 2 diabetes. But you can take steps to improve your health, and delay or possibly prevent diabetes. A recent study found that many overweight, pre-diabetic people dramatically reduced the risk of developing diabetes by following a lower-fat, lower-calorie diet and getting 30 minutes of physical activity at least 5 days per week.

    Some encouraging results of the study:. Overall, people who achieved a 5 to 7 percent weight loss about 10 to 15 pounds through diet and increased physical activity usually brisk walking reduced their risk of diabetes by 58 percent over the next 3 years. For people over age 60, these lifestyle changes reduced the risk of developing diabetes by 71 percent. People taking the diabetes drug metformin Glucophage reduced their risk of developing the disease by 31 percent. These findings suggest that you can act to prevent or delay diabetes, even if you are at high risk for the disease.

    For more information on how to choose and cook lowfat foods, get more physical activity, and achieve a healthy weight, see Taking Control, starting on page M enopausal hormone therapy once seemed the answer for many of the conditions women face as they age. It was thought that hormone therapy could ward off heart disease, osteoporosis, and cancer, while improving womens quality of life. But beginning in July , findings emerged from clinical trials that showed this was not so.

    In fact, long-term use of hormone therapy poses serious risks and may increase the risk of heart attack and stroke. The findings come from the Womens Health Initiative WHI , launched in to test ways to prevent a number of medical disorders in postmenopausal women. It consists of a set of clinical studies on hormone therapy, diet modification, and calcium and vitamin D supplements; an observational study; and a community prevention study.

    The two hormone therapy clinical studies were both stopped early because of serious risks and the failure to prevent heart disease. One of the hormone studies involved 16, postmenopausal women with a uterus who took either estrogen-plus-progestin therapy or a placebo. The added progestin protects women against uterine cancer. The other study involved 10, women who had had a hysterectomy and took estrogen alone or a placebo. A placebo is a substance that looks like the real drug but has no biologic effect. The estrogen used in the WHI was conjugated equine estrogens 0.

    Briefly, the estrogen-plus-progestin therapy increased womens risk for heart attacks, stroke, blood clots, and breast cancer. It also doubled the risk of dementia and did not protect women against memory loss. However, the therapy had some benefits: It reduced the risk for colorectal cancer and fractures. Estrogen-alone therapy increased the risk for stroke and venous thrombosis blood clot, usually in one of the deep veins of the legs.

    It had no effect on heart disease and colorectal cancer, and an uncertain effect on breast cancer. Estrogen alone gave no protection against memory loss, and there were more cases of dementia in those who took the therapy than those on the placebo, although the increase was no statistically significant.

    Estrogen alone reduced the risk for fractures. Further, WHI found that estrogen plus progestin did not improve womens overall quality of life. However, the therapy did relieve menopausal symptoms such as hot flashes and night sweats in women who suffered them. The women in the studies are now in a followup phase, expected to last until The other WHI studies are still underway.

    If you are currently on or have taken menopausal hormone therapy, the findings cant help but concern you. It is important to know, however, that those results apply to a large group of women. An individual womans increased risk for disease is quite small. For example, each woman in the estrogen-plus- progestin study had an increased risk of breast cancer of less than one-tenth of 1 percent per year. Estrogen alone or with progestin should not be used to prevent heart disease. Talk with your doctor about other ways of preventing heart attack and stroke, including lifestyle changes and medicines such as cholesterol-lowering statins and blood pressure drugs.

    If you are considering using menopausal hormone therapy to prevent osteoporosis, talk with your doctor about the possible benefits weighed against your personal risks for heart attack, stroke, blood clots, and breast cancer. Ask your doctor about alternative treatments that are safe and effective in preventing osteoporosis and bone fractures. If you are considering menopausal hormone therapy to provide relief from menopausal symptoms such as hot flashes, talk with your doctor about whether this treatment is right for you.

    The WHI did not test the short-term risks and benefits of using hormone therapy for menopausal symptoms. The current U. Food and Drug Administration recommendation for menopausal hormone therapy is that it should be used at the lowest dose for the shortest period of time to reach treatment goals. And remember: Your risk for heart disease, stroke, osteoporosis, and other conditions may change as you age. So review your health regularly with your doctor. New treatments that are safe and effective may become available.

    Stay informed. The WHI had two studies of menopausal hormone therapy estrogen alone and estrogen plus progestin. Findings for the two studies should not be compared directly. Women in the studies had different traits. Women in the estrogen-alone study were followed for almost 7 years; women in the estrogen-plus- progestin study were followed for about 5 years. Findings show the average results for every 10, women per year of hormone therapy use compared with a placebo:.

    An increased risk blood clot, usually in of pulmonary embolismblood a deep vein of legs clots in the lungwas not statistically significant. During the first 2 years of use, the risk was slightly increased for estrogen alone, but it appeared to diminish over time. More Details Other Editions 4. Friend Reviews. To see what your friends thought of this book, please sign up. To ask other readers questions about Healthy Heart Handbook for Women , please sign up.

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