Coronary heart disease is the leading cause of death in the U.S. Every 34 seconds, an American life is claimed by heart disease. In 1998, nearly 1 million Americans each year die from heart disease. That's more lives than the next 7 causes of death combined.

But heart disease is not just a man's disease.

Although they largely are not aware of it, women are affected by heart disease as much as men, even though it strikes females 10 years later in life. A Gallup survey of women sponsored by the American Medical Women's Association found:

80 percent do not know that heart disease is the leading cause of death for females

70 percent believe heart attack warning signs are the same for women as they are for men (when in actuality, they can be significantly different)

Only 50 percent know that menopause increases a woman's risk for heart disease

Other information on women and heart disease revealed that:

A woman who has a heart attack is one-and-a-half times as likely as a man to die from it, and, if she survives, more likely to have a second one. Framingham Heart Study

In women, the rate of death from heart disease far exceeds that of breast cancer. One woman in 25 dies of breast cancer. One in two dies of cardiovascular disease, including a heart attack or stroke. Heart disease is the number-one killer of women. 2003 American Heart Association Heart and Stroke Statistical Update

In addition, a 1997 survey by Prevention magazine found that only 33 percent of women surveyed knew that their chance of dying from breast cancer is less than that from a heart attack. In fact, the risk is five times higher, but 58 percent thought it was lower or the same risk.

But heart disease does not just develop overnight in men or women. It is a disease that takes years to develop, according to researchers. Changes in the body that eventually lead to heart disease begin in childhood and progress slowly as people age. High blood cholesterol levels, one of the easiest risk factors to measure, clearly play a role in the development of heart disease.

Good Nutrition is Key to Prevention

Although mortality from coronary heart disease has been declining in the U.S. for years, unhealthy lifestyles including poor diet, obesity and lack of physical activity are contributing to a slowdown in the progress that has been made against this disease, according to the Centers for Disease Control and Prevention. Therefore, health professionals are stepping up efforts to encourage consumers to adopt more heart-healthy diets and to become more physically active.

Good nutrition always has been important in the prevention of heart disease. The American Heart Association (AHA) makes a point of this in recently updated dietary guidelines. These guidelines offer basic dietary advice that can help reduce the risk of coronary heart disease in healthy adults and children over the age of two. The AHA guidelines recommend that healthy individuals obtain adequate nutrients from foods eaten in variety, balance and moderation. The guidelines stress balancing food intake with physical activity and encourage selection of a diet that is:

low in total fat, saturated fat and cholesterol;
rich in fruits, vegetables, and whole grain products;
moderate in sugar, salt, sodium and alcohol.

Current Thinking About Trans Fats and Hydrogenated Oils

Trans fatty acids ("trans fats") are a type of fat that occurs naturally in beef, butter, milk and lamb. Trans fats also result from a specific process (partial hydrogenation) that makes vegetable oils more solid, and thus more practical for various food preparation applications. These solidified vegetable oils are used in many foods to replace animal fats and tropical oils that are not only solid at room temperature, but are known to contain significant amounts of saturated fat, which has been known for decades to increase risk of heart disease.

Because research addressing trans fats has been in the news about a possible link with heart disease risk, it often raises questions in consumers’ minds about the trans fat content of foods. What consumers need to realize is that foods contain many fats (fatty acids) that come together as building blocks of the fat. Any individual food that contains any "fat" will also contain numerous fatty acids, each of which has a technical name. In fact, "fats" in foods are similar to proteins that are comprised of a variety of amino acids.

Much of the research that has generated news about trans fats does not look at whole foods, but looks at the effect of a specific fatty acid (like trans fat). Researchers will tell you that people do not each specific fatty acids, rather, they eat whole foods. For example, some foods that contain a small amount of trans fats contain a much larger proportion of unsaturated fats that are known to reduce risk of heart disease.

Trans fats comprise only 2-4 percent of the total calories consumed in the average American diet. Since Americans typically consume 12-14 percent of calories from saturated fat, health experts recommend consumers reduce saturated fat intake to no more than 10 percent of calories. Health professionals continue to stress that the focus should be on the big nutrition picture a balanced diet and a reduction in total fat and saturated fat to a more healthful level than currently being consumed today. If total fat in particular is reduced, both the intake of saturated fat and trans fat will be reduced as well.

Of course, there are many factors involved with heart disease risk, with dietary factors just being one of them. For additional advice about making the appropriate changes in your diet, check with a registered dietitian or other qualified health professional.

Margarine: The Healthier Tablespread

According to an article in the January 1999 Tufts University Health & Nutrition Newsletter, "A recent study from the USDA’s Human Nutrition Research Center in Beltsville, Maryland, helps answer the question (concerning butter or margarine). Scientists there studied 46 men and women for several months, periodically varying the type of spread they ate: butter, tub margarine, or trans-free tub margarine. The result: both margarines significantly improved blood cholesterol levels over butter, helping to put to rest any doubt about whether it would be better to switch back to butter from margarine."

As stated above, people eat whole foods, not individual fatty acids. At least eight studies have demonstrated the health benefits of margarine as a food, including a recent study that showed that foods rich in vitamin E, such as margarine, significantly reduced the risk of heart disease in women.

The American Heart Association and other leading health organizations still recommend soft and liquid margarine over butter. Many of these products contain little or no trans. The industry has reduced the trans content in many margarines to meet consumer needs and preferences, just as it has reduced total fat, saturated fat and calories.

Saturated fats make up a larger portion of the fat in most diets than trans fats do, so consumers need to focus their efforts on cutting saturated fats. Trans fats comprise only 2-4 percent of total calories consumed in the average American diet, while Americans typically consume 12-14 percent of calories from saturated fat. Today’s margarine can help consumers reach the goal of reducing saturated fat in the diet.

Even when you combine the trans and saturated fat in margarine products, they still have a better nutritional profile than butter. Compared to butter, margarine products contain 33-100 percent less of these two fats and many margarine products actually have little or no trans fat. For those interested in reducing their intake of trans, some margarine products (including sticks) are completely trans-free.

From the Mayo Clinic Health Letter

Q. What’s the current thinking about trans fatty acids in margarine and the risk of heart disease?

A. Trans fatty acids don’t pose as much of a health concern as saturated fats. Trans fatty acids are formed during hydrogenation. This process changes vegetable oils into solid or semi-solid margarine or shortening.

Concern about trans fatty acids stems from research suggesting these fats raise blood cholesterol and so increase your risk of cardiovascular disease. But trans fatty acids don’t elevate blood cholesterol to the same degree as saturated fats. You also eat them in smaller quantities.

To control blood cholesterol, your goal is to limit fat. When you do add fat to food, the American Heart Association (AHA) recommends margarine instead of butter because butter is high in saturated fats and cholesterol. The more liquid the margarine, such as tub or squeeze-bottle varieties, the less hydrogenated it is and the fewer trans fatty acids it contains.