Heart Disease and Women

Heart disease was once considered only a man's problem. But according to the American Medical Association (AMA), cardiovascular disease is also the number one killer of women. (Read about "The Heart & Cardiovascular System")

For a long time it was thought that women were not as susceptible to heart disease as men. (Read about "Coronary Heart Disease") The initial results of an ongoing study, started in 1948 in Framingham Massachusetts, were published in the 50's and showed men more likely to have heart disease. But as time progressed, it was discovered that women were also at risk; they just developed diseases of the heart 10 to 15 years later than men. Women also seem to develop, more often than men, a condition called coronary microvascular disease (CMD). CMD is the result of narrowing of the tiny arteries that supply blood and oxygen to the heart muscle. (Read about "Coronary Microvascular Disease")

The American Heart Association (AHA) estimates that 1 in 9 women ages 45 to 64 have some sort of heart disease but the ratio jumps to 1 in 3 for women over 65. So it's essential that women as well as men, especially those with a family history (Read about "Family Health History") of heart disease, adopt a heart healthy lifestyle and maintain it, as they get older.

Risk factors

It's essential for everyone to be aware of the factors that indicate a higher risk of heart disease. (Read about "Heart Risks") According to AHA, some of the main risk factors include:

• High blood pressure - High blood pressure is also a key risk factor for stroke, (Read about "Stroke") which occurs when a blood vessel bringing oxygen to the brain (Read about "The Brain") becomes clogged or bursts. Since high blood pressure can be present without any noticeable symptoms, the only way to know if you have a problem is through medical screenings. Ask your doctor how often you need to be checked. (Read about "Hypertension: High Blood Pressure")
• High blood cholesterol - You can have elevated cholesterol levels without any noticeable symptoms, so the only way to know for sure is through medical screenings. Ask your doctor how often you need to be checked. (Read about "Cholesterol")
• Diabetes - AHA says adults with diabetes are two to four times more likely to have heart disease or suffer a stroke than adults without diabetes. (Read about "Diabetes")
• Family history - Having a family history of heart disease is another risk factor
• Age - Age increases your risk, especially for women, with older women who have a heart attack being even more likely than men of the same age to die as a result.

In addition, you can reduce your risk of cardiovascular disease through the following lifestyle changes:

• Stop smoking - The AMA says smoking is responsible for one in four cases of cardiovascular disease; if you smoke, stopping can be the most important thing you do for your heart and blood vessels. There are stop-smoking classes available through the American Lung Association and the American Cancer Society. (Read about "Quit Smoking")
• Weight control - The American Heart Association says that obesity (Read about "Obesity") increases your risk of heart disease and stroke, even if you have no other risk factors present. (Read about "Body Mass Index") Maintaining a healthy weight through a low-fat and low-cholesterol diet can reduce your risk of heart disease. (Read about "Losing Weight") Be aware of the amount of fat and saturated fat in foods, especially processed foods. Learn to read food labels (Read about "Food Labels") and ask your doctor or registered dietitian how to limit the total amount of fat in your diet to no more than 30 percent of your total calories.
• Exercise - According to the AHA, regular aerobic activity plays a significant role in preventing heart and blood vessel disease. You don't have to spend hours every day at the gym either. Even a thirty minute walk, three or four times a week, can be beneficial. (Read about "Menopause and Exercise" "Walking for Health")

Hormone replacement - HRT and ERT

For some time, scientists noted that a woman's risk of heart disease rose with age as the ovaries stopped producing estrogen at menopause. (Read about "Menopause") Hormone replacement was seen as a potential solution. When the hormone estrogen is given alone, it is usually referred to as "ERT." When the hormone progestin is combined with estrogen, it is generally called "HRT." Initial studies did link estrogen replacement with a reduced risk of heart disease. However, a large-scale study in 2001 found no such link. As a result, AHA began to advise against prescribing HRT for the sole purpose of preventing heart attacks and strokes in women who already have cardiovascular disease. In July 2002, the National Heart, Lung, and Blood Institute (NHLBI) stopped a major clinical trial (Read about "Clinical Studies") of the risks and benefits of combined estrogen and progestin in healthy menopausal women due to an increased risk of invasive breast cancer. (Read about "Breast Cancer") This study also found increases in coronary heart disease, stroke and pulmonary embolism in study participants on estrogen plus progestin compared to women taking placebo pills. (Read about "Coronary Heart Disease" "Stroke" "Pulmonary Embolism") While this study found an association between HRT and fewer cases of hip fractures (Read about "Hip Fractures") and fewer cases of colon cancer (Read about "Colorectal Cancer"), it determined that, on balance, the harm was greater than the benefit. Then, in 2004, a major estrogen only study was stopped when it was discovered there was an increased stroke risk for women.

Some more recent studies have found possible cardiovascular benefits from short-term ERT use to relieve hot flashes among younger postmenopausal women.

AHA says that for women diagnosed with cardiovascular disease, who are using HRT for other conditions such as osteoporosis, the decision to continue or stop HRT should be discussed carefully with your doctor.

Know the signs

It's also important for everyone, women as well as men, to recognize the warning signs of a heart attack, which include chest pain or tightness, a squeezing sensation, pain that radiates to the shoulders, neck or arms and/or chest pain accompanied by lightheadedness, sweating (Read about "Sweating") or shortness of breath.

Women need to be aware of something else. The Food and Drug Administration (FDA) says that women are more likely to have so-called silent or unrecognized heart attacks. That's because women often have different signs of a heart attack than men. Women are more likely to have nausea and pain high in the abdomen. They also may experience a burning in the chest that they dismiss as indigestion. (Read about "Indigestion") Women also can have atypical angina resulting in extreme fatigue instead of chest pain from physical exertion. Angina is not a heart attack but is an indication for a doctor that more investigation is needed. (Read about "Angina") It's important that women are aware of these differences because there is one more crucial one. According to the FDA, 25 percent more women then men die within a year of having a heart attack. If you suspect a heart attack in yourself or another person, seek emergency medical help right away. (Read about "Heart Attack")

Related Information:

    Cardiovascular Tests

    Vascular System

    Women and Blood Pressure

    Woman's Health Terms Glossary