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Women's Heart & Vascular Health
Center for Women's Heart & Vascular Health
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Heart Disease IS a Woman's Disease!

"Ignored," is what Dr. Stephanie Coulter, calls the situation. She should know. She is a cardiologist and director of the Texas Heart Institute Center for Women's Heart & Vascular Health.  

"Too often, heart disease in women is ignored by primary care physicians, by emergency room staff, and by women themselves," says Dr. Coulter. "Partly that's because when most people think of heart disease, they think of it happening mainly to men—but nearly 40% of all women die of a cardiovascular condition, including heart attack, stroke, peripheral vascular disease, and heart failure."

Heart Disease Risk Factors and Women

Dr. Stephanie Coulter
80% of heart disease is preventable. Knowing your risks and acting to reduce them is critical. The key is regular exercise and a healthy diet.
- Dr. Stephanie Coulter

Although women tend to experience heart problems at an older age than men, and the signs and symptoms of women's heart problems tend to differ (see related article, "Straight Talk About Heart Attacks"), the risk factors for heart disease are the same for both sexes.   

Risk Factors You Can Change

Each of the factors listed below presents a significant risk, but when you have more than one, your total risk is multiplied.

  • Smoking
  • High blood pressure
  • Obesity
  • Diabetes
  • High cholesterol
  • Physical Inactivity


About 20% of all deaths from heart disease in the U.S. are directly related to cigarette smoking. No amount of smoking is ok – any smoking at all, even light or occasional smoking, damages your vessels and arteries and puts you at increased risk for heart attack, stroke, heart failure and other diseases of the heart and vascular system.  

It is never too late to quit smoking! Once you quit, the damage can begin reversing right away. After one year of no smoking, the excess risk of heart disease created by smoking is reduced by as much as 80%. After 7 years of no smoking, the excess risk of heart disease created by smoking can be eliminated.  

High Blood Pressure/Hypertension

For millions of women, hypertension is the most significant risk factor for heart disease. In fact, 60% of women with heart disease have high blood pressure, and it causes three of every five cases of heart failure in women.  

High blood pressure, also called hypertension, is the most common heart disease risk factor, with one in three adults having it. Hypertension is defined by having the systolic blood pressure - the upper number – higher than 140, and/or the diastolic blood pressure - the lower number – being more than 90. High blood pressure happens when the blood vessels are narrowed. Not only does the heart have to work harder to pump the blood, the force of the blood is high enough to damage the vessel walls.  

Because there are often no symptoms for high blood pressure, it is called the Silent Killer. Just a 12% increase in your systolic blood pressure results in a 56% increased risk for heart disease – much higher than for men. Lifestyle changes such as losing weight, exercising and quitting smoking can prevent or bring blood pressure into a normal range. Sometimes, however, medication may be required. 


Obesity is the No. 1 indicator of potential cardiovascular diseases. Excess fat can cause high blood pressure, increase bad cholesterol and contribute to developing diabetes.  

Excess belly fat in particular increases risk. It is just as great a risk factor for cardiovascular disease as having very high blood cholesterol. Belly fat has been found to be more metabolically active than other types of fat. It produces more changes in cholesterol, blood pressure and blood sugar than fat elsewhere on your body. Again, healthy diet and regular exercise can help eliminate this risk factor!


People with diabetes have more than twice the risk of having a heart attack or stroke.  In fact, two out of three people with diabetes die from some form of heart disease or stroke.  

A full 40% of women who have cardiovascular emergencies also have diabetes. We can now identify diabetes when it is forming, and it can be slowed down or prevented by early treatment. So, being screened for diabetes is an important step all women need to take in their middle years. [See related article "Straight Talk about Metabolic Syndrome/Pre-diabetes"]

High Cholesterol

Your body needs fat to function properly, and your liver makes all the fat your body needs for this purpose. Put simply, cholesterol is a measure of the amount of the different kinds of fats in your blood – some are good and some are bad.  

High cholesterol is when there is too much bad fat in your blood. Though a predisposition for high cholesterol is usually determined by genetics, it is made worse by eating saturated fat, which comes mostly from animal products like milk, cheese and red meat. When you have too much bad fat in your blood, plaque builds up on the walls of your blood vessels and can cause heart attacks and strokes when it ruptures.  

Cholesterol can be managed by eating less animal fat, exercising more and medication. Fifty percent of middle aged Americans have cholesterol levels high enough to warrant treatment with drugs.

Physical Inactivity

People who are not active have a greater risk of heart attack. In several studies, more sedentary time was associated with higher levels of triglycerides and C-reactive protein (linked to coronary heart disease), increased insulin resistance (a marker for diabetes), and lower HDL (the so-called good cholesterol) levels.  

Furthermore, exercise burns calories, helps to control cholesterol levels and diabetes, can lower blood pressure and relieve menopausal symptoms and depression. Exercise also strengthens the heart muscle and makes the blood vessels more flexible. Those who actively burn 500 to 3500 calories per week, either at work or through exercise, can expect to live longer than people who do not exercise. Even low-intensity exercise is helpful if done regularly.

Risk Factors You Can't Change

Genetics - Heart disease tends to run in families. For example, if your parents or siblings had a heart or cardiovascular problem before age 55, then you are at greater risk for heart disease. Women whose mothers have heart disease are twice as likely to have heart disease as men whose fathers have heart disease. Risk factors (including high blood pressure, diabetes, and obesity) may also be passed from one generation to another.  

Genetics also applies to race - some forms of cardiovascular disease are more common among certain racial and ethnic groups. For example, studies have shown that African-Americans have more severe high blood pressure and a greater risk of heart disease than whites. The bulk of cardiovascular research for minorities has focused on African-Americans and Hispanics, with the white population used as a comparison. Risk factors for cardiovascular disease in other minority groups are still being studied.

Age - Older age is a risk factor for heart disease. In fact, about 4 of every 5 deaths due to heart disease occur in people older than 65. Women's risk for heart disease increases 5 times at menopause – if you are not already keeping track of your numbers ( your cholesterol, blood pressure, etc.) and you have started menopause, now is the time to "know your numbers".  

GenderMore women than men die from cardiovascular disease, including heart attack, heart failure, stroke and peripheral vascular disease. Heart disease is the number one killer of women. While men's risk starts earlier in life, the difference narrows after women reach menopause, when women's risk increase 5-fold.                                            

While you can't change these risks, having them makes it especially important for you to manage your other risk factors.

Get a Move On!

It isn't easy to change habits ingrained over many years. Should a woman start by going on a diet? By exercising? By taking medication? Or all three?   

"I see the best results when women move more," declared Dr. Coulter. "If I can encourage a patient to exercise, most often by walking briskly, then very soon I'll see her feel better and get motivated to eat right and lose weight. So 'getting a move-on' is exactly how I'd suggest that a woman should start in building a strong heart. Plus, exercise is good for improving virtually all of the modifiable risk factors!"

Getting a Move-on!

The hardest part about starting a new exercise routine is just that—starting. You don't have to run a marathon. You just have to get moving.  Here are a few strategies to get you moving:

  • Be realistic.
    • Weight loss and an increase in stamina take time.
    • Don't expect to be running a marathon and losing a dress size in your first week.
  • Be intentional.
    • Set aside specific times to be physically active.
    • Plan your physical activities in advance so you know what you're going to do, when, where, and with whom.
  • Set goals.
    • Start out slow and set a realistic short-term goal, like walking 10 minutes every day for the first week and taking the stairs.
    • To increase your likelihood of staying with the routine long term, set a long-term goal as well, such as walking for 30 minutes at least 5 days a week by the end of the first month.
  • Round up support.
    • Studies show that women who involve friends and family in lifestyle changes are more likely to stick to them.
    • Have friends participate in physical activity with you, or ask your partner to hold you accountable for completing your workout schedule.
    • Having a support system around you will help you make it through those days you just don’t feel like getting off the couch.

See related article "Straight Talk Answering the Exercise Question" for more information.

Learn more about these topics in the Heart Information Center.

The Heart Truth® Celebrates A Decade of Inspiring Women to
Protect Their Hearts

In 2002, 1 in 3 women died of heart disease.
Today, 1 in 4 women dies of heart disease.

10th Anniversary of The Heart Truth Campaign

Updated January 2015
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