Heart Disease & Women
Do women need to worry about heart disease?
Heart disease is the number one killer of American women, so heart disease
is definitely a woman's concern. One in ten American women 45 to 64 years
of age has some form of heart disease, and this increases to one in five
women over 65. Coronary heart disease is a disease of the blood vessels
of the heart that causes heart attacks.
Post-reproductive age women are most at risk
Cardiovascular disease is the leading cause of death for both men and women
in the United States. The risk for women significantly increases after menopause.
- Cardiovascular diseases claim more female lives every year than the
next 16 causes of death combined, and almost twice as many as all forms
- More than 250,000 women each year die of coronary heart disease.
- This compares to 46,000 deaths from breast cancer.
- Pre-menopausal women are also at risk for cardiovascular disease if
they have cardiac risk factors such as smoking, hypertension, diabetes,
elevated cholesterol and family history of premature cardiovascular
- Cardiovascular disease increases as we age, particularly after the
How do I know if I have
heart disease? Are there medical tests to alert me?
Cardiovascular disease can be silent but usually has symptoms.
- Lack of blood flow to the heart muscle can cause symptoms of chest
discomfort, shortness of breath, fatigue and sometimes palpitations
- Talking to your doctor about your symptoms, along with good routine
follow-up care are necessary first steps to determine if any further
evaluation is necessary.
- Many cardiac risk factors can be controlled, modified or eliminated,
including hypertension, diabetes, elevated cholesterol, smoking and
I had my lipid (fat) levels
checked but I do not understand the results. What do they mean?
- A person's blood lipid analysis is determined to some degree by diet
and genetic factors.
- A routine fasting blood lipid analysis provides a measure of three
things: total cholesterol, HDL-cholesterol (good cholesterol), LDL-cholesterol
(bad cholesterol), and triglycerides.
- Increases in all but the good HDL-cholesterol have been shown to increase
the risk of heart disease. In fact, a low HDL-cholesterol level is also
a cardiac risk factor.
- The results of the blood lipid analysis will determine if it is necessary
to take a cholesterol lowering medication and follow a low fat, low
- Practice guidelines to manage cholesterol levels are set by the National
Cholesterol Education Panel (NIH). You should discuss the results of
your blood tests with your doctor to determine what it means for your
health and risk of heart disease.
I read that women show
different signs than men do prior to a heart attack. What can I do to
make sure the emergency room treats me correctly?
Nearly 90% of women with a heart attack will have chest pain the same
as men. Historically, however, chest pain has not been perceived to be
of great prognostic value in women, or a great clue that heart disease
is really present. Chest pain can have different origins and women can
experience uncharacteristic features of cardiac chest discomfort. The
likelihood of chest pain coming from the heart depends to a great extent
on the person's particular cardiac risk profile. For example, a pre-menopausal
women who smokes is as likely to have cardiac chest pain as a postmenopausal
woman with hypertension. All chest discomfort in women must be taken seriously
and evaluated for its source, whether cardiac or otherwise. One should
not wait to seek medical attention if there are symptoms of chest discomfort
with or without physical exertion. Some studies have shown that women
who tell their doctors about chest pain are not treated as aggressively
as are men. Women who are not satisfied with a physicians evaluation of
their chest discomfort should be persistent and seek another opinion.
How much difference can diet and exercise REALLY have on the health
of my heart?
Following a low fat, low cholesterol diet and exercise are excellent health
habits for all to follow.
- It helps lower one's blood lipid analysis, blood pressure and blood
sugar. These are all factors that contribute to the development of arteriosclerosis
(hardening and blockage of the blood vessels).
- Studies have shown that increasing levels of leisure-time physical
activity are associated with decreased risks of coronary heart disease.
- Physically active women have an approximate 60-75% lower risk of heart
disease than sedentary women. Physical activity includes such activities
as daily walking, climbing stairs, gardening etc.
- Unfortunately, over 50% of all women in the U.S. are physically inactive.
I have a friend who is
38 years old. She has irregular heart beats or PVCs. Her doctor said that
a woman's system changes as she enters menopause and can result in PVCs.
Are they dangerous? Can you explain PVCs and menopause?
A 38 year old woman who experiences irregular heart beats or "PVCs"
(premature ventricular contractions) may have extra beats which are relatively
harmless or it may be a sign of some form of heart disease.
- If a woman has palpitations (the sensation of fast and/or irregular
heart beat) or other symptoms such as dizziness or shortness of breath,
she should inform her doctor.
- Your doctor can take a careful history and perform a physical exam.
- In some cases, further testing of your heart may be necessary to determine
the specific heart rhythm that may be causing the sensation of palpitations.
- In some individuals, caffeine products, alcohol and stress can provoke
- Menopause alone does not predispose a woman to palpitations unless
she has other medical conditions/or cardiac risk factors that could
lead to heart disease.
- However, menopause creates an estrogen deficient state that poses
a risk to the cardiovascular system. This is because estrogens have
a number of properties that protect the blood vessels and lowers LDL-cholesterol
levels, while raising the HDL-cholesterol.
What are the biggest
factors which increase my chances for heart disease?
The three biggest risk factors for cardiovascular disease that you can
do something about are:
- Cigarette smoking
- High blood pressure
- High blood cholesterol
Other risk factors
Other risk factors, such as overweight and diabetes, also are conditions
you have some control over. Even just one risk factor will raise your
chances of having heart-related problems. But the more risk factors you
have, the more likely you are to develop cardiovascular diseases.
- Various studies show that physical inactivity is a risk factor for
heart disease. Heart disease is almost twice as likely to develop in
inactive people as in those more active.
- Excess body weight in women is linked with coronary heart disease,
stroke, congestive heart failure, and death from heart-related causes.
- The more overweight you are, the higher your risk for heart disease.
- Diabetes, or high blood sugar, is a serious disorder that raises the
risk of coronary heart disease. The risk of death from heart disease
is about three times higher in women with diabetes.
- Diabetic women also are more apt to have high blood pressure and high
- The risk of heart attack or stroke is higher for women who both smoke
and use high-dose birth control pills (oral contraceptives).
How can I reduce my risk
of heart disease?
Regular physical activity can help you reduce your risk of coronary heart
disease. Being active helps women take off extra pounds, helps to control
blood pressure, lessens a diabetic's need for insulin, and boosts the
level of "good" HDL-cholesterol.
to avoid heart disease
- Quit smoking
- Cut back on foods high in fat, saturated fat, and cholesterol
- Check blood pressure and cholesterol levels
- Get more exercise
- Lose weight if you are overweight
What are the main tests
for coronary heart disease?
Diagnostic tests are usually needed to confirm the presence and assess
the severity of coronary heart disease. Often, more than one test is needed
because different tests supply different information. Also, patients vary
in their symptoms and may need more than one test to find out the heart’s
condition. The primary tests used to diagnose heart disease are described
below. Many are not invasive procedures -- they are done outside the body,
and are painless.
These tests include:
- Electrocardiogram (ECG or EKG) makes a graphic record of the heart’s
electrical activity as it beats. This can show abnormal heartbeats,
muscle damage, blood flow problems, and heart enlargement.
- Stress test (or treadmill test or exercise ECG) records the ECG during
exercise, usually on a treadmill or exercise bicycle. Some heart problems
show up only when more effort is asked of the heart, as happens during
increased activity. So the exercise ECG may be done even if the resting
ECG is normal.
- Other exercise tests may be done with an ECG or a nuclear scan to
assess heart muscle concentration or blood flow in the heart. Older
women may not be able to exercise due to arthritis, osteoporosis or
another condition. For them, a stress test can be done without exercise
by using a medication that increases blood flow.
Note: Different standards exist for reading the EKG in women as compared
to men. Make sure your doctor knows them.
What is the connection
between hormone replacement therapy (HRT) and heart disease?
Hormone replacement therapy - a term for prescription hormone pills that
are taken daily - can be used to relieve the symptoms of menopause. Some
women are prescribed pills that contain only estrogen (oestrogen). A woman
with a uterus may take estrogen combined with a second hormone called
Estrogen pills have several important benefits. They can help you feel
more comfortable as your body adjusts to lower estrogen levels by decreasing
hot flashes, night sweats, or vaginal dryness. They also help to prevent
osteoporosis, a thinning of the bones that makes them more likely to break.
Many studies also have found that estrogen pills help protect women from
developing coronary heart disease, but more research is needed before
we will know this for sure.
Possible estrogen risks
Estrogen therapy also has risks. It may increase the chances of developing
gallbladder disease, and it may worsen migraine headaches. It may also
increase the risk of breast cancer. But by far, the biggest risk of taking
estrogen pills is cancer of the uterus, but this risk is greatly decreased
by taking progestin, another hormone. Finally, we don't yet know whether
this combination will boost the risk of breast cancer. Studies are now
under way to find answers to these important questions. There are also
some studies which show that estrogen may decrease the chance of developing
or decrease the severity of Alzheimer’s disease.
Benefits versus risks
In the meantime, a woman and her doctor must decide whether the benefits
of hormone therapy are worth the risks. If you are considering this treatment,
you will need to consider your overall health and your personal and family
history of heart disease, uterine and breast cancer, and osteoporosis.
Check ups and self-tests
If you are now on hormone therapy, check with your doctor to be sure you
are taking the lowest possible effective dose.
- At least every 6 months, you and your doctor should discuss whether
you need to continue treatment.
- Be alert for signs of trouble - abnormal bleeding, breast lumps, shortness
of breath, dizziness, severe headaches, pain in your calves or chest
- and report them immediately.
- See your doctor at least once a year for a physical examination.
Material excerpted from the National Heart, Lung, and Blood Institute’s
pamphlet, Women and Heart Disease, the NHLBI’s The Healthy
Heart Handbook for Women and the Office on Women's Health in the Department
of Health and Human Services Heart Disease and Stroke in Women: the