Coronary artery disease is a leading cause of death for women throughout the world. More women die from heart disease than from cancer, chronic obstructive pulmonary disease, Alzheimer's, and
But many women underestimate the threat coronary artery
disease (CAD) poses to their health. And many women do not know what they can
do to help prevent heart disease.
disease is caused by the gradual buildup of
plaque (made of fat,
cholesterol and other substances) on the inside walls
coronary arteries. These arteries supply oxygen-rich
blood to the heart. Over time, the plaque deposits grow large enough to narrow
the arteries' inside channels, decreasing blood flow to heart muscle. If the
plaque becomes unstable and ruptures, a blood clot can form at the rupture site
and block blood flow, resulting in a
heart attack. See a picture of
how plaque causes a heart attack.
Coronary artery disease seems to happen slightly differently in women compared to men. For example, plaque might build up differently in a woman's arteries so that a doctor cannot see a blockage during a cardiac catheterization test. Researchers are trying to understand these differences to help find the best ways to diagnose and treat women who have CAD.
Women have unique risk factors for heart disease. These include pregnancy-related problems as well as medicines they may be taking, such as birth control pills or hormone therapy.
Menopause. A woman's chance of getting coronary artery disease is higher after menopause. This higher chance is not completely
understood. But cholesterol,
high blood pressure, and fat around the abdomen—all
things that raise the risk for coronary artery disease—also increase around this time.
Hormone therapy (HT). If you have menopausal symptoms such as hot flashes and vaginal dryness, you might consider hormone therapy to relieve your symptoms. Because menopause and hormones are linked with the health of your blood vessels, you and your doctor will discuss your health and your risk of heart disease to make sure hormone therapy is safe for you. Risk for heart disease and other health problems varies based on when you start HT in menopause and how long you take it. Short-term use of hormone therapy in early menopause has less risk than when it is started later in menopause. Risk also depends on the type of HT used (estrogen or estrogen plus progestin).2
Birth control pills. Using birth control pills might
increase your risk if you smoke and are older than 35 or if you have a family
atherosclerosis or blood-clotting disorders. Healthy, young, nonsmoking women probably do not increase their risk of coronary artery disease (CAD) when they take low-dose birth control pills.
Pregnancy-related problems. A problem during pregnancy called preeclampsia has been linked to a higher risk of heart disease later in life. Experts are studying whether other pregnancy-related problems are linked to heart disease. Tell your doctor about any problems you had during pregnancy.
Immune diseases. Some immune-related diseases, such as lupus and rheumatoid arthritis, have been linked with a higher risk of heart disease in women.
Risk factors for coronary artery disease that are common in women and men include
smoking, diabetes, obesity, lack of exercise, and
Your doctor will calculate your risk for coronary artery
disease by assessing the number of risk factors you have. Your doctor might use this tool to calculate your risk of a heart attack:
Your doctor might find your risk for coronary artery disease using a different, but similar, method. These methods give you and your doctor a good idea about your risk. And they can help you decide if you should take steps to prevent a heart attack or stroke.
Women can use healthy lifestyle changes and medicines to help prevent
coronary artery disease. Women can also balance the risks and benefits of
hormone therapy when they decide whether or not to use it.
A healthy lifestyle can help prevent heart disease. And it can help you manage other problems that raise your risk of heart disease. These problems include high blood pressure, high cholesterol, and diabetes.
You might take medicines, along with making healthy lifestyle changes, to lower your risk of heart disease. If you already have heart disease, medicine can help you prevent a heart attack or stroke. You might take:
Knowing symptoms of a heart attack can help save lives.
So even if you're not sure that your symptoms are from a heart attack, do not
delay seeking care. Do not wait more than 5 minutes to call
911 if you think you or someone else is
having a heart attack.
Women are more likely than men to delay seeking help for a possible
heart attack. Women delay for many reasons, like not being sure it is a heart
attack or not wanting to bother others. But it is better to be safe than
Pay attention to your symptoms, know what
is typical for you, learn how to control it, and know when to call for help.
Angina (say "ANN-juh-nuh" or "ann-JY-nuh") symptoms happen when there is not enough blood flow to the heart.
Most people feel angina symptoms in their chest. The most common symptom is chest pain or pressure, or a strange feeling in the chest. But you might feel symptoms in other parts of your body. Some people feel pain, pressure, or a strange feeling in the back, neck, jaw, or upper belly, or in one or both shoulders or arms.
Other symptoms of angina include shortness of breath, nausea or vomiting, lightheadedness or sudden weakness, or a fast or irregular heartbeat.
Women are somewhat more likely than men to have other symptoms like shortness of breath, nausea, and back or jaw pain.
Some women describe their symptoms as mild. Others feel tired when they have angina.
Stable angina occurs at predictable times and may continue without much change for years.
It is relieved by rest or nitrates (nitroglycerin) and usually lasts less than
5 minutes. Unstable angina is a change in the usual pattern of angina. It means blood flow has slowed suddenly. It is an emergency. It is a warning sign that a heart attack may soon occur.
For men and women, the most common symptom is chest pain or pressure. But women are somewhat more likely than men to have other symptoms like shortness of breath, nausea, and back or jaw pain.
Heart attack symptoms include:
After you call 911, the operator may tell you to chew 1 adult-strength or 2 to 4 low-dose aspirin. Wait for an ambulance. Do not try to drive yourself.
get to the hospital, do not be afraid to speak up for what you need. Be sure
your doctors know that you think you might be having a heart attack so that you
can get the tests and care you need.
Visit the American Heart Association (AHA) website for information on
physical activity, diet, and various heart-related conditions. You can search for information on heart disease and stroke, share information with friends and family, and use tools to help you make heart-healthy goals and plans. Contact the AHA to find your
nearest local or state AHA group. The AHA provides brochures and information
about support groups and community programs, including Mended Hearts, a
nationwide organization whose members visit people with heart problems and
provide information and support.
The Women's Heart Foundation provides education for
women about preventing and treating heart disease. Information covers
caregiving, exercise, nutrition, and medical and surgical treatments. The
information focuses on the unique needs of women who have heart disease.
CitationsMosca L, et al. (2011). Effectiveness-based guidelines for the prevention of cardiovascular disease in women 2011 update: A guideline from the American Heart Association. Circulation, 123(11): 1243–1262. North American Menopause Society (2012). The 2012 hormone therapy position statement of
the North American Menopause Society. Menopause, 19(3): 257–271. Also
available online: http://www.menopause.org/PSht12.pdf.U.S. Preventive Services Task Force (2009). Aspirin for the prevention of cardiovascular disease. Available online: http://www.uspreventiveservicestaskforce.org/uspstf/uspsasmi.htm.Other Works ConsultedCharney P (2011). Women and coronary artery disease. In V Fuster et al., eds., Hurst's The Heart, 13th ed., vol. 2, pp. 2226–2240. New York: McGraw-Hill.Hsia J, Manson JE (2007). Women and heart disease. In
EJ Topol, ed., Textbook of Cardiovascular Medicine, 3rd
ed., pp. 553–560. Philadelphia: Lippincott Williams and Wilkins. Mosca L, et al. (2011). Effectiveness-based guidelines for the prevention of cardiovascular disease in women 2011 update: A guideline from the American Heart Association. Circulation, 123(11): 1243–1262. Newby LK, Douglas PS (2012). Cardiovascular disease in women. In RO Bonow et al., eds., Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine, 9th ed., vol. 2, pp. 1757–1767. Philadelphia: Saunders.North American Menopause Society (2012). The 2012 hormone therapy position statement of
the North American Menopause Society. Menopause, 19(3): 257–271. Also
available online: http://www.menopause.org/PSht12.pdf.U.S. Preventive Services Task Force (2009). Aspirin for the prevention of cardiovascular disease. Available online: http://www.uspreventiveservicestaskforce.org/uspstf/uspsasmi.htm.
January 17, 2013
Rakesh K. Pai, MD, FACC - Cardiology, Electrophysiology & Robert A. Kloner, MD, PhD - Cardiology
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Last modified on: 2 April 2014