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Women & Cardiovascular Disease

Cardiovascular Disease: Not Just a Man’s Disease

While February is known for Valentine’s Day it also marks another heart event, American Heart month. This health observance was developed by the American Heart Association (AHA) to raise funds for research and education regarding the nation’s top killers – cardiovascular disease and stroke.

You may be familiar with National Wear Red Day occurring this year on Friday, Feb 5th. As part of the Go Red Campaign, this health observance was developed by the AHA to dispel the myths and raise awareness of heart disease as the #1 killer among women.

To acknowledge these important health observances, this month we offer a three-part series to increase your understanding of heart disease. This article provides an overview of heart disease and reviews the signs and symptoms of heart attack and angina. The factors that influence your risk are also identified. In two related articles, Eating a Heart Healthy Diet and Living a Heart Healthy Lifestyle, tips are offered on how to improve your diet and lifestyle to support a strong cardiovascular system.

Heart Disease is the #1 Killer

While many women are fearful of breast cancer, each year heart disease kills a much larger number of women. This year, nearly ten times as many women will die from cardiovascular disease than from breast cancer†. More than one in three women has some form of cardiovascular disease. Because of these sobering statistics, the mission of the AHA along with the National, Heart, Lung & Blood Institute is to raise awareness among women that cardiovascular disease is not just a “man’s disease”.

What is Cardiovascular Disease?

Cardiovascular disease is caused by narrowed, blocked or stiffened blood vessels that prevent your heart, brain or other parts of the body from receiving sufficient blood. Coronary heart disease (CHD) refers to a disorder of blood vessels of the heart that can lead to a heart attack.

How do arteries become blocked? Plaque – a mixture of fat, cholesterol and other substances in the body – builds up over time inside arterial walls. Referred to as atherosclerosis, these plaques can become large enough to occlude blood flow.

A plaque can also break off causing a blood clot to form on the plaque’s surface to fill in the cracks. If the clot becomes large enough, it can stop the flow of blood in the artery. If it travels, the clot can block an artery in other areas of the body. A blood clot in the brain causes a stroke; in the lungs, a pulmonary embolism.

Normal, healthy arteries are flexible but over time they can become stiff. This disease process is referred to as arteriosclerosis or hardening of the arteries. High blood pressure that goes unchecked can contribute to this condition.

In addition to hypertension, a number of dietary and lifestyle factors including smoking, elevated cholesterol levels, obesity and diabetes can damage the lining and inner layers of the arteries and contribute to coronary heart disease. When the damage occurs, the body tries to heal itself but this may encourage the formation of plaques.

Signs & Symptoms of Heart Disease

A common symptom of coronary heart disease is angina – a chest pain or discomfort when an artery in the heart is partially blocked. A common symptom of a heart attack is chest pain or discomfort.

In women, the symptoms of angina can differ than in men. Men tend to experience angina with increased physical exercise; women are more likely to experience angina while resting or sleeping.

While the expectation is that a heart attack would be accompanied by chest pain or pressure, this is not always the case. In fact, in women the symptoms can be more diffuse such as:

- Pain or discomfort in one or both arms, back, neck, jaw or stomach

- Shortness of breath

- Nausea or have heartburn

- Feeling faint or lightheaded

- Breaking out in a cold sweat

- Feeling tired, sometimes for days or weeks

If you experience chest pain or discomfort or any one of these symptoms for more than 5 minutes, contact 911 for help.

Heart Disease Affects Women Differently

According to the AHA, women’s heart disease health risk may be due to gender difference and gender bias.

Women tend to have blockages not only in their main arteries but also in the smaller vessels that supply blood to the heart. Low levels of estrogen following menopause may pose a greater risk for women developing this so-called small vessel disease or coronary microvascular disease (MVD). Standard tests for coronary heart disease do not always detect MVD in women.

Additionally, plaque build up tends to spread more evenly in arterial walls of women whereas in men it is more irregular. This makes common treatments like angioplasty (a special dye with x-rays that shows the insides of coronary arteries) and stenting (procedures that flatten the plaque to improve blood flow) less effective for women.

Here are some additional examples of how heart disease affects women differently than men:

- Most of the research on cardiovascular disease has been conducted on men. New research is underway to discover the differences in treatment and care.

- Women wait longer to go to an emergency room, assuming their symptoms are not heart-attack related.

- Health care professionals and patients often attribute chest pains in women to non-cardiac causes.

- The most common warning sign of a heart attack in men and women is chest pain. But, women are somewhat more likely than men to experience shortness of breath, nausea and jaw/back pain.

- Women tend to have heart attacks later in life when they have other diseases which can mask heart attack symptoms. Increased age explains why women have greater mortality after a heart attack.

- Some diagnostic tests and procedures may not be accurate in women so clinicians may avoid them. This means that the disease process may not be detected until later in life when heart disease is more advanced.

- The exercise stress test may be less accurate for women.

- Men’s plaque distributes in clumps whereas women’s distributes more evenly throughout artery walls. This results in angiographic studies being misinterpreted as normal.

- After a heart attack, women are less likely to receive therapies (beta blockers, ACE inhibitors and aspirin) known to improve survival.

- Women are twice as likely as men to die within the first few weeks of suffering a heart attack. Thirty eight percent of women and 25 percent of men will die within one year of a first heart attack.

Find Out Your Risk

Certain traits, conditions and habits increase your risk of developing heart disease. For a list of factors you can control, see our companion article Living a Heart Healthy Lifestyle. The risk factors that you can’t change include increasing age, family history, race and previous heart attack.

Increasing Age. Prior to menopause, more men have heart attacks than women. However, after menopause, when women lose the protective effect of estrogen, women’s rate of heart attacks exceeds that of men.

Family History. If a close relative has a heart attack, then your risk of having one goes up. If your father or brother was diagnosed with heart disease before age 55 or your mother before age 65, then your risk of coronary heart disease risk increases.

Race. African Americans have a higher risk of having heart attack and stroke than Whites or Hispanics. This is partly due to a greater incidence of high blood pressure, obesity and diabetes. Black women have a greater risk of heart disease and stroke than white women.

Previous Heart Attack. Women who have already had a heart attack are at higher risk of having another one; 22 percent of women ages 40 to 69 who survive a first heart attack will have another one or fatal coronary heart disease within five years.

Heart Health Check-up

If you’re in your 20s or 30s, most likely heart disease is not on your health radar. But, no matter what your age, understanding your risk, making adjustments to your diet and lifestyle now such as not smoking and maintaining a healthy body weight will pay dividends years down the road.

An important first step to heart health is knowing your numbers. Along with a routine physical, your doctor can order a lipid profile, a simple blood test that provides information on total cholesterol, LDL cholesterol, HDL cholesterol and triglycerides.

Here are the numbers that are optimal:

- Total cholesterol: Less than 200 mg/dL

- LDL or “bad” cholesterol: Less than 100 mg/dL

- HDL or “good” cholesterol: 50 mg/dL or higher

- Triglycerides: <150 mg/dL

- Blood Pressure: <120/80 mmHg

- Fasting Glucose: <100 mg/dL

- Body Mass Index (BMI): <25

- Waist Circumference: <35 inches

- Exercise: Minimum of 30 minutes per day

Understand Your Risk & Take Action

Once you know your numbers and family history, visit the Know Your Risk page from the GoRed website to evaluate your heart health and determine the threats for getting heart disease in next decade. You can also download action plan reports to help you stop smoking, lose weight, reduce blood pressure, manage cholesterol levels, exercise more and control blood sugar.

†Based on national statistics, over 400,000 women die annually from cardiovascular disease and over 40,000 women die from breast cancer.

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