Heart Disease in Women
and How to Prevent it

Many women believe that heart disease only affects men.  However, 50% of women in United States die from heart disease (i.e. heart attacks or the problems caused by heart attacks).   In a recent survey by the American Heart Association, only 8% of women knew that heart disease was the greatest cause of death in women (most thought that breast cancer was).  This article will focus on what the risk factors are for developing heart disease in women, how women can decrease their risk for developing heart disease and then review how heart disease presents in women.

Risk Factors for Developing Heart Disease in Women

There are six main risk factors for developing heart disease in women.  They are elevated blood pressure (hypertension), abnormal cholesterol levels, having diabetes, being obese, being physically inactive and being a smoker.  Seventy percent of women in the United States have at least one of these risk factors.

Hypertension (elevated blood pressure)

Having a blood pressure that is elevated (> 140/90) increases the risk for developing heart disease 2-3 times normal in both women and men.  This is a common problem; 51% of white women older than 45 have hypertension and this increases to 77%  once women are 75 years old.  Hypertension is even more common in black women; 79% of black women older than 45 have hypertension.

The good news is that studies in women have shown that decreasing blood pressure can help decrease the risk of developing heart disease.  Many studies with various blood pressure medications have shown a 25-45% decreased risk of developing heart disease.  These studies have included white women, black women and elderly women.

If you are 45 or older and have not had your blood pressure recently checked, make an appointment with your doctor.  There are also blood pressure machines available that are free to use in most pharmacies.

Abnormal Cholesterol Levels

Abnormal cholesterol levels can increase the risk of developing heart disease in women and men.  Twenty five percent of women in the United States have abnormal cholesterol levels.    The three main numbers that are important are total cholesterol (TC), high-density lipoprotein (HDL) and low-density lipoprotein (LDL).

Although we know that a high TC and LDL in men increases the risk of heart disease, the studies in women are conflicting.  It appears that a high LDL in younger women (<65 years old) increases the risk of developing heart disease more than it does in older women.  We do know that having a low HDL seems to increase the risk of developing heart disease in women of all ages.

Studies in women have shown that improving your cholesterol levels can decrease the risk of developing heart disease.  If you are 35 or older and have not had your cholesterol checked, make an appointment with your doctor to discuss having this done.  Levels of TC and LDL are determined partly by genetics and partly by your diet and exercise habits.  In most women, a low fat diet and increased exercise will help to lower their cholesterol.  The main way to increase your HDL is to increase your exercise.

Diabetes

Women who have diabetes are six times more likely to develop heart disease than women who do not and they are six times more likely to die from heart disease.  If a person’s diabetes is well controlled they are less likely to develop complications from their diabetes (blindness, kidney disease).  The studies have not specifically looked at whether this also decreases the risk of developing heart disease, but most physicians believe that it probably does.

If you have diabetes, get regular medical care and work with your physician to keep your diabetes as well controlled as possible.

Obesity

If you are more than 30% above your ideal body weight, you are obese.  By the time women reach menopause in United States, 50% are obese.  Studies in women have shown that being obese triples the risk of developing heart disease.

Although there are no long term studies that have shown that decreasing your weight will decrease your risk of developing heart disease, studies have shown that weight loss is associated with improved cholesterol levels, decreased blood pressure and helps to decrease the development of diabetes.  As was discussed above, these all help to decrease the development of heart disease.

Physical Inactivity

In women, being physically inactive increases their risk for developing heart disease.  Many studies have shown that women who are active have a 60-75% decreased risk of developing heart disease.  Most of the studies have shown that mild to moderate exercise (for example, walking briskly for a hour 3 times a week) is sufficient.  If you are not currently exercising, work with your physician to develop an exercise program that will be appropriate for you.

Smoking

Twenty five percent of women in the United States smoke.  Women who smoke are three times more likely to have heart disease or a heart attack.  Even if women only smoke 3-5 cigarettes a day, they still increase their risk by two and half times above normal.  Second hand smoke also increases the risk of developing heart disease in nonsmokers.  A large study showed that women who didn’t smoke and were married to smokers had a 22% increased risk of death from heart disease.

If a person stops smoking they will decrease their risk of developing heart disease.  Studies have shown that after 2 years of not smoking, the risk of developing heart disease decreases dramatically.  After 5 years of not smoking, the risk of developing heart disease is the same as if a person had never smoked!  If you are a smoker and are ready to quit, make an appointment with your physician to discuss the method that will work best for you.

Presentation of Heart Disease in Women

When women first present with heart disease, they often have angina.  Angina is a chest pain that is located in the mid-chest between the breasts and often appears with exercise (for example, going up a flight of stairs).  The sensation is described as heavy and dull and sometimes also moves into the arms or neck.  It most often goes away with rest.  However, women, more often than men, also have other symptoms with their chest pains including jaw pains, back and shoulder pains and feeling short of breath and nauseous.  Any chest pains should be evaluated by your physician.

In summary, heart disease is a very common disease in women and is the main cause of death for women in United States.  As discussed above, there are many things that women can do to help decrease their risk of developing heart disease.  If you have any of the risk factors for heart disease, see your doctor on a regular basis.  And if you ever have any chest pains, please see your doctor for an evaluation.

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