Women and Heart Disease
Heart disease is no longer considered a disease that affects just men.
Heart disease is no longer considered a disease that affects just men. In the past, women usually received less aggressive treatment for heart disease and were not referred for diagnostic tests as often. As a result, when many women were finally diagnosed with heart disease, they usually had more advanced disease and their prognosis was poorer. We now know that cardiovascular diseases affect more women than men and are responsible for more than 40% of all deaths in American women.
Women and Heart Attacks
Heart attack symptoms in women may be different from those experienced by men. Many women who have a heart attack do not know it. Women tend to feel a burning sensation in their upper abdomen and may experience lightheadedness, an upset stomach, and sweating. Because they may not feel the typical pain in the left half of their chest, many women may ignore symptoms that indicate they are having a heart attack.
Heart attacks are generally more severe in women than in men. In the first year after a heart attack, women are more than 50% more likely to die than men are. In the first 6 years after a heart attack, women are almost twice as likely to have a second heart attack.
Estrogen and Heart Disease
Studies have shown that after menopause, women experience an increased risk of heart disease. Researchers have connected this pattern to decreasing levels of the female hormone estrogen during menopause—a process that begins around age 50. Estrogen is associated with higher levels of high-density lipoprotein (HDL or “good cholesterol”) and lower levels of low-density lipoprotein (LDL or “bad cholesterol”). Withdrawal of the natural estrogen that occurs in menopause leads to lower “good cholesterol” and higher “bad cholesterol” thus increasing the risk of heart disease. Because the life expectancy for women in the United States is 79 years, women can expect to live a large part of their lives with an increased risk of heart disease. In fact, 1 out of 4 women older than 65 has some form of identified heart disease.
Researchers have looked at how hormone replacement therapy (HRT) may affect women who already have heart disease and those who don’t. After several years of study and numerous clinical trials with differing results, the AHA still does not advise women to take HRT to reduce the risk of coronary heart disease or stroke. Women should weigh the risks of HRT and discuss them with their doctor. For the symptoms of menopause, including bone loss, effective non-hormonal treatments are available.
Modifiable Risk Factors for Women
Women need to be aware of the risk factors for cardiovascular disease and the importance of making lifestyle changes that may reduce those risks. Factors such as race, increasing age, and a family history of heart disease cannot be changed. Other risk factors, however, can be changed or eliminated by making informed decisions about cardiovascular health.
Smoking is a major risk factor for cardiovascular disease. Although the overall number of adult smokers has decreased in this country during the last 20 years, the number of teenaged girls who smoke has increased. Cigarette smoking combined with the use of birth control pills greatly increases the risk of heart attack or stroke. The good news is that no matter how long or how much someone has smoked, smokers can immediately reduce their risk of heart attack by quitting. After 1 year of not smoking, the excess risk of heart disease created by smoking is reduced 80%; after 7 years of not smoking, all the risk from smoking is gone. It is never too late to stop smoking.
High blood pressure, or hypertension is a silent disease. If left untreated, it makes the heart work harder, speeds up hardening of the arteries (atherosclerosis), and increases the risk of heart attack, stroke, and kidney failure. Women who have a history of high blood pressure, black women with high blood pressure, and overweight women with high blood pressure are also at greater risk. Although high blood pressure cannot be cured, it can be controlled with diet, exercise, and, if necessary, medicines. High blood pressure is a lifelong risk and requires effective long-term management, including regular blood pressure checks and the appropriate medicines.
Pregnancy may trigger high blood pressure, especially during the third trimester, but high blood pressure caused by pregnancy usually goes away after childbirth. This is called pregnancy-induced hypertension. Another form of high blood pressure that can occur during pregnancy is called preeclampsia, and it is usually accompanied by swelling and increased protein in the urine. Women with a history of preeclampsia face double the risk of stroke, heart disease and dangerous clotting in their veins during the 5 to 15 years after pregnancy.
Cholesterol levels are also related to a person’s risk of heart disease. Doctors look at how your levels of LDL, HDL, and fats called triglycerides relate to each other and to your total cholesterol level. Before menopause, women in general have higher cholesterol levels than men because estrogen increases HDL levels in the blood. A study reported in the American Journal of Cardiology found that HDL levels were the most important predictor of cardiovascular health. That is, the higher a woman’s HDL level, the less likely she is to have a cardiovascular event such as heart attack or stroke. But after menopause, HDL levels tend to drop, increasing the risk of heart disease. HDL and LDL cholesterol levels can be improved by diet, exercise, and, in serious cases, statins or other cholesterol-lowering medicines.
Obesity is a strong predictor for heart disease, especially among women. A person is considered obese if body weight exceeds the “desirable” weight for height and gender by 20 percent or more. Where fat settles on the body is also an important predictor. Women who have a lot of fat around the waist are at greater risk than those who have fat around the hips. In the United States, about one third of women are classified as obese. A plan of diet and exercise approved by your doctor is the best way to safely lose weight.
Diabetes is more common in overweight, less active women and poses a greater risk because it cancels the protective effects of estrogen in premenopausal women. Results of one study showed that women with diabetes have a higher risk of death from cardiovascular disease than men with diabetes have. The increased risk may also be explained by the fact that most diabetic patients tend to be overweight and physically inactive, have high cholesterol levels, and are more likely to have high blood pressure. Proper management of diabetes is important for cardiovascular health.
Other diseases and conditions, such as lupus and rheumatoid arthritis, can also increase a woman’s risk of heart disease. According to new guidelines released by the AHA, illnesses linked to a higher risk of cardiovascular disease should now be incorporated into a woman’s overall risk factor evaluation.
Physical inactivity is a significant risk factor for heart disease, yet millions of Americans still don’t exercise at all. Many studies have shown that exercise reduces the risk of heart attack and stroke, increases HDL cholesterol levels, regulates glucose, lowers blood pressure, and increases the flexibility of arteries. Exercise has also been shown to reduce mental stress as well. You can benefit from exercising even it is only for 30 minutes a day, at least three times a week, but more will reap better benefits.
Oral contraceptives (birth control pills) may pose an increased cardiovascular risk for women, especially those with other risk factors such as smoking. Researchers believe that birth control pills raise blood pressure and blood sugar levels in some women, as well as increase the risk of blood clots. The risks associated with birth control pills increase as women get older. Women should tell their doctors about any other cardiovascular risk factors they have before they begin taking birth control pills.
Excessive alcohol intake can contribute to obesity, raise triglyceride and blood pressure levels, cause heart failure, and lead to stroke. Although studies have shown that the risk of heart disease in people who drink moderate amounts of alcohol is lower than in nondrinkers, this does not mean that nondrinkers should start drinking alcohol or that those who do drink should increase the amount they drink. For women, a moderate amount of alcohol is an average of one drink per day.
Stress is considered a contributing risk factor for both sexes, especially as it leads to other risk factors such as smoking and overeating.
Depression can affect how women deal with their health issues or follow their doctor’s advice. According to American Heart Association guidelines, depression screening should now be part of an overall evaluation of women for cardiovascular risk.
Many risk factors that contribute to heart disease can be controlled. Quitting smoking, losing weight, exercising, lowering cholesterol and blood pressure, controlling diabetes, and reducing stress are within every woman’s grasp.