Women and Cardiovascular Disease

Cardiovascular disease is NOT just a man’s disease.
Cardiovascular disease is the number one killer of women over age 25 in the United States, regardless of race or ethnicity. The death rate from cardiovascular diseases has decreased among men, but continues to increase in women.

Unfortunately, only 13 percent of women identify cardiovascular disease as the greatest health problem facing women today. Most women think that breast cancer is the leading cause of death in women. But cardiovascular disease is the single leading cause of death for women in America and most developed countries, and claims the lives of more women than all forms of cancer combined.

Source: American Heart Association

What causes cardiovascular disease?
The most common cause of cardiovascular disease is atherosclerosis (sometimes called “hardening” or “clogging” of the arteries). Atherosclerosis is the build-up of cholesterol and fatty deposits (called plaque) on the inner walls of the arteries that restricts blood flow to the heart.

Without adequate blood, the heart becomes starved of oxygen and the vital nutrients it needs to work properly. This can cause chest pain called angina. When one or more of the coronary arteries becomes blocked, a heart attack (injury to the heart muscle) can occur.

Ischemia is a condition that occurs when the narrowed coronary artery reaches a point where it cannot supply enough oxygen-rich blood to meet the heart’s needs.

What are the symptoms of cardiovascular disease in women?
Symptoms of cardiovascular disease tend to occur about 10 years later in women than in men.

Women often have different symptoms of coronary artery disease than men. For example, symptoms of a heart attack in women include:

It is important to get help right away if any of these symptoms occur.
The most common symptom of cardiovascular disease is called “angina pectoris” or “angina.” Angina is often referred to as chest pain. It is described as chest discomfort, heaviness, tightness, pressure, aching, burning, numbness, fullness, or squeezing. It can be mistaken for indigestion or heartburn. Angina is usually felt in the chest, but may also be felt in the left shoulder, arms, neck, back, or jaw.

Other symptoms that can occur with coronary artery disease include:

If you experience any of these symptoms, it is important to call your doctor, especially if these are new symptoms or if they have become more frequent or severe.

How is cardiovascular disease diagnosed?
Your doctor will talk to you about your symptoms, medical history and risk factors, and perform a physical exam.

Diagnostic tests, including blood tests, an electrocardiogram (ECG or EKG), cardiac catheterization and others may be performed to evaluate your condition. An exercise stress test, combined with heart imaging technology such as stress echocardiography or nuclear imaging, can help provide a more complete and accurate picture of a woman’s heart health. These tests help your doctor evaluate the extent of your heart disease, its effect on the function of your heart, and the best form of treatment for you.

Research into new testing procedures, such as coronary computed tomography angiogram (CTA), may change the way coronary artery disease is diagnosed in the future.

Tests used to predict increased risk for coronary artery disease include: C-reactive protein (CRP), complete lipid profile, and calcium score screening heart scan.

How is cardiovascular disease associated with menopause?
After menopause, a woman’s risk of cardiovascular disease increases. In women who have undergone early menopause (before age 50) or surgical menopause, the risk of cardiovascular disease is also higher, especially when combined with other risk factors.

Estrogen helps a woman’s body protect her against cardiovascular disease. After menopause, cardiovascular disease becomes more of a risk for women because of the reduced level of estrogen.

A reduced level of estrogen causes:

What are the other risk factors for heart disease in women?
In addition to menopause, non-modifiable risk factors (those that cannot be changed) include:

Modifiable risk factors (those you can treat or control) include:

NOTE: How your weight is distributed also is important. Your waist measurement is one way to determine fat distribution. Your waist circumference is the measurement of your waist, just above your navel. The risk of cardiovascular disease increases with a waist measurement of over 35 inches in women and over 40 inches in men.

The more risk factors you have, the greater your overall risk.

What can be done to reduce the risk of cardiovascular disease in women?
Reducing your risk factors involves making lifestyle changes, including those listed below. Your doctor will work with you to help you make these changes.

How is cardiovascular disease treated?

Medications. If lifestyle changes aren’t enough to control your heart disease, medi¬cations may be prescribed to treat certain risk factors, such as high cho¬lesterol or high blood pressure, to help your heart work more efficiently and receive more oxygen-rich blood. The medications you will be prescribed will depend on your personal needs, presence of other health conditions, and your specific heart problem.

Hormone replacement therapy (HRT). For many years, preliminary observational research showed that hormone replacement therapy (HRT) could possibly reduce the risk of heart disease in women. It appears that the reason why the observational studies showed a reduced risk of heart disease was likely due to the lifestyles of women who take HRT rather than the medical benefits?

More recent large-scale studies of women, such as the Heart and Estrogen/Progestin Replacement Study (HERS) and the Women’s Health Initiative (WHI), concluded that the overall health risks of HRT exceeded the benefits.

Women who participated in the HERS study had an increased risk of heart attack and stroke during the first year of taking HRT. After two years of treatment, this risk appeared to be reduced in women taking HRT as compared with women who were not taking HRT.

Women who participated in the WHI study had an increased risk for breast cancer, coronary heart disease (including nonfatal heart attacks), stroke, blood clots, and gall bladder disease.

Based on the results of these studies, the American Heart Association and the U.S. Food and Drug Administration developed new guidelines for the use of HRT:

The bottom line, say physicians at the Cleveland Clinic Heart and Vascular Center: weigh the benefits of HRT against the risks and discuss the whole subject of HRT with your physician so you can make an informed decision.

Interventional procedures. Common interventional procedures to treat coronary artery disease include balloon angioplasty (PTCA) and stent or drug-eluting stent placement. These procedures are considered non-surgical because they are done by a cardiologist through a tube or catheter inserted into a blood vessel, rather than by a surgeon through an incision. Several types of balloons and/or catheters are available to treat the plaque within the vessel wall. The physician chooses the type of procedure based on individual patient needs.

Coronary artery bypass surgery. One or more blocked coronary arteries are bypassed by a blood vessel graft to restore normal blood flow to the heart. These grafts usually come from the patient’s own arteries and veins located in the chest, arm, or leg. The graft goes around the clogged artery (or arteries) to create new pathways for oxygen-rich blood to flow to the heart.

Other procedures. Other less traditional procedures and other procedures being investigated include transmyocardial laser revascularization (TMR), enhanced external counterpulsation (EECP), and angiogenesis. Your doctor can provide more information about these procedures.

FOR MORE INFORMATION For more information, visit the Women’s Cardiovascular Center section of the Cleveland Clinic Heart and Vascular website at: www.clevelandclinic.org/heart/women

You may also call the Heart and Vascular Institute Resource Nurse at 216.445.9288 or toll-free at 866.289.6911. Webmail and phone calls are answered between 8:30 am to 4:00 pm on regular business days.

To make an appointment in the Women’s Cardiovascular Center, please call 216.444.9343 or toll-free 800.223.1696.

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This information is provided by the Cleveland Clinic and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition. For additional health information, please contact the Center for Consumer Health Information at the Cleveland Clinic (216) 444-3771 or toll-free (800) 223-2273 extension 43771. If you prefer, you may visit www.clevelandclinic.org/health/ or www.clevelandclinicflorida.org. This document was last reviewed on: