A heart-to-heart about improving your midlife health

For most midlife women, taking care of themselves is one more thing on a long list of daily tasks. We tell ourselves that we'll exercise or work on lowering our stress when we have more time. Unfortunately, many women don't have the time to prioritize their health until they face a chronic illness. As women get older, the chronic illness that becomes the most significant threat is heart disease.

Heart disease is the number one killer of women worldwide, and more women lose their lives to heart disease every year than all cancers combined. [1] Women have different issues with heart disease than men, and our experiences with the related risk factors are complex.

Here's what else you need to know:

• Heart disease is one of the leading causes of premature death in women
• Women who have a heart attack are more likely to die when compared to men
• Half as many women than men attend cardiac rehab
• Because women tend to get heart disease and have heart attacks later in life, their conditions can be more complex to manage (especially if dealing with another health condition)
• Nine out of every ten women have at least one risk factor for heart disease or stroke

One of the biggest reasons that midlife women are not taking action to reduce risk is that heart disease doesn't seem to appear on our radar. Women involved in a study at the Canadian Women's Heart Health Centre showed low awareness about heart disease in general, symptoms unique to women, personal risk factors, and the significant lifestyle risks.

There are certain risk factors that you can't control, like age and family history, but there are others that you can reduce or eliminate. Most women are aware that diet, physical activity, and obesity play a role in developing cardiovascular disease. However, fewer women know that smoking, diabetes, high cholesterol, and high blood pressure are the more significant risks. In fact, these risk factors alone account for over half of all female heart attacks.

The good news is that workplaces can significantly influence some heart disease risk factors and support preventative efforts. A critical paradigm shift would be to move from viewing the workplace as a barrier to good health to a facilitator for integrating healthy living practices into our daily lives.  

Workplace and chronic disease risk

We all recognize that living through the COVID-19 pandemic has created significant stressors over the past few years. This is especially true for midlife and older women who have more responsibilities than ever. Multiple role demands mean that midlife women report some of the highest stress levels of any group surveyed. Workplace stressors make up a large portion of their overall allostatic load (i.e., the cumulative burden of chronic stress and other life events) [2]. Researchers have uncovered that workplace stress can ultimately contribute to unhealthy behaviours that increase the risk of developing diabetes and heart disease. [3] As a result, they recommend that employers explore creating psychologically safe work settings. Psychologically safe workplaces support good mental health and can act as a preventive tool for chronic disease risk by reducing job strain. Those with high levels of job strain can further benefit from risk awareness and self-management skills regarding stress reduction.

Using the workplace as a setting for prevention

Most employers are aware of the cost of chronic disease on healthcare claims. Population aging means that disease-related costs will become more significant over time. The annual claims per chronic condition estimate is $1700-2000 per employee. [4] Employees who experience chronic illness also have a higher rate of both presenteeism and absenteeism.[5]

Because most women are employed, the workplace provides an important setting to promote better health and reduce the risk factors for heart disease. Here are two easy steps to consider.

Step 1: Support women to move

High stress levels at work have been shown to lead to low physical activity levels, a significant risk for developing heart disease. Being regularly physically active is one of the most powerful ways to control heart disease risk. If you're active, you're less likely to smoke, you can better control your blood pressure, you can help prevent (or better manage) diabetes, you can reduce centralized body fat (a risk), you can better manage blood lipid levels, and typically you will have a better quality diet. And this applies to all types of activity; studies confirm that aerobic exercise and resistance training both positively impact heart health.

Becoming regularly physically active can start with small amounts of movement. Although we tend to only think about the benefits of structured exercise (of which there are many), regular small amounts of movement can also profoundly impact our health. For example, we know people have been less active during the pandemic in lockdowns and because of home-based work. One of the knock-on effects of staying at home is that we've lost a lot of "incidental" activity. For example, public transit commuters take an average of an extra 2000 daily steps just getting to and from their bus or train. This may not sound like much, but that movement adds up to an extra ten-kilometre walk over a typical work week.

Employers can support their staff to be more physically active by encouraging and normalizing regular movement breaks throughout the day; even better would be to also offer dedicated workday time for structured exercise.

Step 2: Encourage screening

Hypertension (high blood pressure) is a leading cause of heart disease and the number one risk factor for stroke in women. If high blood pressure goes untreated for an extended period, it can also contribute to dementia, sexual problems, issues with vision, and kidney failure.

As part of my work in the community, I have administered hundreds of blood pressure screenings for midlife and older women. I am always surprised by the number of women with high blood pressure readings (some of whom have had dangerously high numbers). Many of those women hadn't checked their blood pressure regularly, and some hadn't had it checked in years.

Although medication remains the first line of defence against high blood pressure, regular exercise has also shown significant blood-pressure-lowering effects. In fact, a recent study of a collection of related research (called a meta-analysis) compared the impact of medication versus exercise for lowering systolic blood pressure (the top number in the reading that represents the pressure on your arteries during a contraction of the heart). The researchers found that exercise appeared to be as effective as medication in people with high systolic blood pressure.[6] To be clear, this doesn't mean that exercise should replace medication. Still, it does provide another reason to encourage your staff to be regularly active.

High blood pressure typically has no symptoms - your body won't let you know when your blood pressure is high. Therefore, regular screening is essential (this also applies to blood lipid levels). Reminders or short educational pieces about the importance of screening placed in wellness newsletters (or similar) are low-cost interventions that may save a life.

Because February is heart month, it's a great time to evaluate our risks for heart disease. And please, have a heart-to-heart with the women in your life to encourage them to remember to prioritize taking care of themselves while they're taking care of everyone else.

If you would like to learn more about how tailored wellbeing programs can more deeply engage, support, and retain your midlife and older female staff, I would love to connect! You can contact me at https://www.cardeahealthconsulting.com/site/contact/ or for easy meeting scheduling 𝗵𝘁𝘁𝗽𝘀://𝗰𝗮𝗹𝗲𝗻𝗱𝗹𝘆.𝗰𝗼𝗺/𝗺𝗶𝗹𝗻𝗲𝗸/𝗱𝗶𝘀𝗰𝗼𝘃𝗲𝗿𝘆-𝗺𝗲𝗲𝘁𝗶𝗻𝗴

References

[1] The Facts about Women and Heart Disease. www.goredforwomen.org. (n.d.). Retrieved from https://www.goredforwomen.org/en/about-heart-disease-in-women/facts

[2] Guidi, J., Lucente, M., Sonino, N., & Fava, G. A. (2021). Allostatic Load and Its Impact on Health: A Systematic Review. Psychotherapy & Psychosomatics, 90(1), 11–27. https://doi.org/10.1159/000510696

[3] Nyberg, S. T., Fransson, E. I., Heikkilä, K., Alfredsson, L., Casini, A., Clays, E., De Bacquer, D., Dragano, N., Erbel, R., Ferrie, J. E., Hamer, M., Jöckel, K.-H., Kittel, F., Knutsson, A., Ladwig, K.-H., Lunau, T., Marmot, M. G., Nordin, M., Rugulies, R., & Siegrist, J. (2013). Job Strain and Cardiovascular Disease Risk Factors: Meta-Analysis of Individual-Participant Data from 47,000 Men and Women. PLoS ONE, 8(6), 1–6. https://doi.org/10.1371/journal.pone.0067323

[4] Wilson, M. G., DeJoy, D. M., Vandenberg, R. J., Padilla, H. M., Haynes, N. J., Zuercher, H., Corso, P., Lorig, K., & Smith, M. L. (2021). Translating CDSMP to the Workplace: Results of the Live Healthy Work Healthy Program. American Journal of Health Promotion, 35(4), 491–502. https://doi.org/10.1177/0890117120968031

[5] Fouad, A. M., Waheed, A., Gamal, A., Amer, S. A., Abdellah, R. F., & Shebl, F. M. (2017). Effect of Chronic Diseases on Work Productivity. Journal of Occupational & Environmental Medicine, 59(5), 480–485. https://doi.org/10.1097/JOM.0000000000000981

[6] Naci, H., Salcher-Konrad, M., Dias, S., Blum, M. R., Sahoo, S. A., Nunan, D., & Ioannidis, J. P. A. (2019). How does exercise treatment compare with antihypertensive medications? A network meta-analysis of 391 randomised controlled trials assessing exercise and medication effects on systolic blood pressure. British Journal of Sports Medicine, 53(14), 859–869. https://doi.org/10.1136/bjsports-2018-099921