The Threat and Signs of Heart Disease in Women

An American Heart Association survey taken several years revealed that women tend to underestimate their risk of heart disease and mistakenly believe that they are are greater risk of dying from other disease, such as breast cancer (click here to read about the survey). However, it is important to note coronary artery disease is the number one cause of death in the United States among both men and women.

Over 500,000 (one-half million) American women die of cardiovascular disease each year. This is twice the number of deaths from all cancer combined; lung cancer, the leading cause of cancer deaths, claims approximately 65,000 deaths per year, and breast cancer kills around 40,000 women. Other statistics from the American Heart Association:

• One in five women have some form of heart or blood vessel disease.
• 38% of women who have heart attacks die within the first year compared to 25% of men.
• 35% of women have a second heart attack within six years of the first attack compared to 18% of men.
• Over 60,000 women die of stroke each year; approximately 60% of stroke deaths occur in women.

Men have a greater risk of heart attack than women and are more likely to have heart attacks earlier in life than women. However, women are also at risk for heart disease. As a woman ages, her risk of heart disease increases: 9,000 American women under age 45 have heart attacks each year versus 250,000 women over age 65. Medical experts are unsure why the risk of heart disease increases in older women but some believe it may be related to the depletion of the female hormone estrogen at menopause.

As men age and their arteries become blocked, the body develops new arteries to serve as back-up blood routes; these back-up routes are called collateral blood supplies. However, women do not develop these collateral blood supplies as they age since, with estrogen, their blood vessels can expand to accommodate blockage. Thus, the thought is that when a woman's estrogen production decreases significantly at menopause, her arteries tend to lose their flexibility and her risk of heart disease increases significantly since no collateral blood supply is developed. This may also explain why more women are likely to die within a year of a heart attack than men.

Many of the risk factors for heart disease are the same for women and men. These risk factors include: high blood pressure, high cholesterol, diabetes, high fat diet, excessive weight, lack of physical activity, smoking, and a family history of heart disease. However, other risk factors for women include menopause (specifically, loss of estrogen at this time) and the use of oral contraceptives among smokers or those with high blood pressure.

Women also tend to have different heart attack symptoms than men. The following chart summarizes these differences:

Preventing Cardiovascular Disease

While no preventive measure can eliminate the chances of developing heart disease, the U.S. government has issued guidelines in an effort to aggressively treat and prevent heart disease in millions of Americans. In addition to more emphasis on low-fat diets and exercise, the guidelines call an estimated 36 million to take cholesterol-lowering drugs.

The guidelines include:

• Treating patients with at least a 20% risk of having a heart attack in 10 years as aggressively as those who already have heart disease.
• Treating high cholesterol more aggressively in people with diabetes.
• Using a lipoprotein profile as the first test for high cholesterol.
• Modifying the current HDL ("good") cholesterol level guideline to 40 mg/dL.
• Emphasizing the need for nutrition, exercise, and weight control in treating high cholesterol.
• Identifying people with "metabolic syndrome" and treating them aggressively to prevent heart attacks (a condition characterized by abdominal obesity, high triglycerides, high blood pressure, high blood-sugar levels, and low HDL ("good") cholesterol)
• Treating people with high triglyceride levels more aggressively.
• Advising to take cholesterol-lowering drugs to lower cholesterol instead of hormone replacement therapy (the American Heart Association recently endorsed this recommendation too).

 Click here learn more about these guidelines.

Additional Resources and References

• The American Heart Association provides information on heart disease in women at http://www.americanheart.org/

Updated: March 16, 2008