Women and Heart Disease

Heart disease is no longer thought of as a man’s disease. In the past, women typically received less aggressive treatment for heart disease and were not referred for diagnostic tests as often. As a result, by the time many women were actually diagnosed with heart disease, the disease was already in advanced stages and the prognosis often grim. We now know that cardiovascular diseases affect more women than men and are responsible for more than 40% of all deaths in American women.

According to the American Heart Association, heart attacks are generally more severe in women than in men. In the first year after a heart attack, women are 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.

Women need to be aware of the risk factors for cardiovascular disease and the importance of making lifestyle changes that may reduce those risks. There are obvious factors such as race, increasing age, and a family history of heart disease that cannot be changed. However, there are many risk factors that can be changed or eliminated by making informed decisions about cardiovascular health.

Cholesterol levels are also related to a person’s risk of heart disease. Doctors look at how your levels of LDL (bad), HDL (good), 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 groundbreaking study published in the American Journal of Cardiology determined that HDL levels were the most important predictor of cardiovascular health. So, the higher a woman’s HDL level, the less likely she is to have a cardiovascular event such as heart attack or stroke. Unfortunately, after menopause, HDL levels tend to drop, increasing the risk of heart disease. Luckily, both HDL and LDL cholesterol levels can be improved by diet, exercise, and when necessary, cholesterol lowering medications such as statins.

Estrogen levels can significantly impact a woman’s risk of 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. Estrogen is associated with higher levels of HDL (good) cholesterol and lower levels of LDL (bad) cholesterol. Withdrawal of the natural estrogen that occurs in menopause leads to lower HDL and higher LDL, therefore increasing the risk of heart disease.

Smoking is a major risk factor for cardiovascular disease. Although the overall number of adult smokers in the US has decreased over the past 20 years, the number of teenaged girls who smoke has increased. Cigarette smoking combined with the use of birth control pills significantly increases the risk of heart attack or stroke. But there is good news. 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, the risk of heart disease from smoking is gone.

High blood pressure, or hypertension is a silent disease. 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.

Obesity is a strong predictor for heart disease, especially among women. A person is considered obese if her body weight exceeds the “desirable” weight for height and gender by 20 percent or more. The location where the fat accumulates on the body is also an important predictor. Women who have a lot of fat around the waist or belly fat are at greater risk than those who have fat around the hips. An astounding one third of women in the United States, qualify as obese.

There are many risk factors associated with heart disease and women. The good news is that many of them are controllable with lifestyle changes. Chief among those is diet and exercise. Making healthy choices can be the difference between life and death when it comes to heart disease and women.

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