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Heart Disease Risk In Women

How Heart Disease Risk Differs From Men, And What You Can Do About It

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Updated January 14, 2014

Written or reviewed by a board-certified physician. See About.com's Medical Review Board.

If you are a woman, it is important to understand your heart disease risk - and to do something about it.

While many women (and unfortunately, many doctors) apparently still do not know it, heart disease is the number one killer of women. About a half million women die of heart disease each year in the U.S. - in fact, more women than men die from cardiovascular disease. Just as bad, women have significantly more strokes than men. So, to keep your chances of developing heart disease and stroke as low as possible, it is extremely important for you to control your risk factors.

So which heart disease and stroke risk factors do you need to be concerned about as a woman? Which can you control? Let's take a look.

Non-Controllable Risk Factors

  • You have a family history of premature coronary artery disease or stroke (occurring in male family members younger than 55, or in female family members younger than 65).
  • You are age 55 or older.
  • You are post-menopausal, or have had your ovaries removed.
  • During any pregnancies you had, you experienced pre-eclampsia (significant high blood pressure) or gestational diabetes, or you delivered a low-birth-weight baby.
A family history of premature cardiac disease, especially in a sister or brother, may be a particularly important risk factor in women. Women who have such a family history need to be particularly aggressive in managing the the cardiac risk factors that can be controlled.

Controllable Risk Factors

  • Being overweight or obese.
  • Sedentary lifestyle (little to no exercise).
  • Smoking or using tobacco products puts you at risk for a multitude of health problems, including heart disease.
  • High blood pressure.
  • High total cholesterol, and/or low HDL cholesterol.
  • A diagnosis of diabetes.
  • A diagnosis of metabolic syndrome.
  • Increased C-reactive protein (CRP) levels.
  • Using birth control pills, especially if you are also a smoker.

What Women Need to Know About These Risk Factors

Most of these controllable risk factors (except the ones dealing with your reproductive system) apply to both men and women. However, there are some special considerations you need to take into account as a woman attempting to reduce your risk of heart disease.

1. Obesity and Sedentary Lifestyle:

These two risk factors are more common in post-menopausal women than in men the same age. Women tend to be caregivers, and (research suggests) out of a sense of duty they appear to have a hard time justifying behaviors that are "just for me," such as regular exercise. As a result, older women may be particularly prone to inactivity and obesity, and both are strong risk factors for heart disease and stroke. How to eat a heart-healthy diet and why exercise is so important for your heart.

2. Smoking

Smoking is a particular problem for women, as it accounts for the vast majority of heart attacks in women under the age of 45, and is a huge multiplier of risk in women who have a family history of heart disease. And birth control pills make things even worse - the combination of smoking and birth control pills increases the risk of early heart disease by 20-fold. How to quit smoking.

3. High Blood Pressure

Hypertension is a major risk factor for heart disease and stroke. It is very common in women over 55, and is heartbreakingly undertreated. But good treatment is well worth the effort - ask anyone who has had a stroke. Take control of your blood pressure.

4. Cholesterol abnormalities

High cholesterol and other lipids greatly increase the risk of heart attack and stroke. Low HDL levels are a more important risk factor in women than in men. Evidence is mounting that achieving very low LDL levels, and/or substantially raising HDL levels, can actually halt or reverse coronary artery disease. In many women, cholesterol can be controlled with diet and exercise, but often drug therapy with statins or other medicine is also needed. How to take control of your blood lipids.

5. Diabetes

Type 2 diabetes is becoming ever more common, right along with one of its root causes - obesity. Diabetes should be thought of as a disease of blood vessels as much as a disease of sugar metabolism, as it greatly increases cardiovascular risk. The risk of heart disease in women with diabetes is increased as much as 6-fold.

6. Metabolic syndrome

Metabolic syndrome, particularly common in post-menopausal women, greatly increases the risk of heart disease and stroke. How do diabetes and metabolic syndrome contribute to heart disease?

7. C-Reactive Protein (CRP)

This is a relatively "new" risk factor that may be more important in women than in men. Increased CRP levels indicate active inflammation, and a high CRP level usually can be assumed to mean that blood vessel inflammation is present. Especially in women, inflammation is thought to be a major factor in the erosion or rupture of coronary artery plaques. Recent evidence suggests that reducing CRP levels (with statins) lowers the risk of heart attack in some patients with coronary artery disease. Do you need your CRP measured?

8. Related Problems During Pregnancy

Finally, it now appears that women who develop certain complications during pregnancy - specifically preeclampsia (significant hypertension), gestational diabetes, or delivering low-birth-weight babies - have a significantly higher risk of early cardiovascular disease and death. Women who develop these complications should begin to aggressively manage all their cardiovascular risk factors, and should do so for the rest of their lives.

In summary, controlling the risk factors for heart disease is just as important in women as in men. And if you are a woman, you have a few additional things to think about as you plan your risk reduction strategy.

Sources:

Mosca L, Benjamin EJ, Berra K, et al. Effectiveness-based guidelines for the prevention of CVD in women—2011 update. A guideline from the American Heart Association. Circulation 2011; DOI:10.1161/CIR.0b013e31820faaf8.

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