facts about heart disease & women

Source: National Heart, Lung, and Blood Institute

The Heart Truth is that all women can take steps to lower their risk of developing heart disease. If you're a woman ages 40-60, it's especially important that you begin right away to lower your risk. That's the time when a woman's risk of heart disease starts to rise.  Younger and older women also need to act now.  Heart disease can begin early, even in the teen years.  But it's also never too late to improve heart health—even for those who have already had a heart attack.

Whatever a woman's age, she needs to take action to protect her heart health.

What is Heart Disease?

Coronary heart disease is the main form of heart disease.  It is a disorder of the blood vessels of the heart that can lead to heart attack.  A heart attack happens when an artery becomes blocked, preventing oxygen and nutrients from getting to the heart.  Often referred to simply as heart disease, it is one of several cardiovascular diseases, which are diseases of the heart and blood vessel system.  Other cardiovascular diseases include stroke, high blood pressure, angina (chest pain), and rheumatic heart disease.  

One reason some women aren't too concerned about heart disease is that they think it can be "cured" with surgery.  This is a myth.  Heart disease is a lifelong condition—once you get it, you'll always have it.  True, procedures such as bypass surgery and angioplasty can help blood and oxygen flow to the heart more easily.  But the arteries remain damaged, which means you are more likely to have a heart attack.  What's more, the condition of your blood vessels will steadily worsen unless you make changes in your daily habits.  Many women die of complications from heart disease, or become permanently disabled.  That's why it is so vital to take action to prevent and control this disease.

Risk factors are conditions or habits that make a person more likely to develop a disease.  They can also increase the chances that an existing disease will get worse.  Important risk factors for heart disease that you can do something about are:

• High blood pressure
• High blood cholesterol
• Diabetes
• Smoking
• Being overweight
• Being physically inactive
• Having a family history of early heart disease
• Age (55 or older for women)

Some risk factors, such as age and family history of early heart disease, can't be changed.  For women, age becomes a risk factor at 55.  After menopause, women are more apt to get heart disease, in part because their body's production of estrogen drops.  Women who have gone through early menopause, either naturally or because they have had a hysterectomy, are twice as likely to develop heart disease as women of the same age who have not yet gone through menopause.  Another reason for the increasing risk is that middle age is a time when women tend to develop risk factors for heart disease.  Family history of early heart disease is another risk factor that can't be changed.  If your father or brother had a heart attack before age 55, or if your mother or sister had one before age 65, you are more likely to get heart disease yourself.

While certain risk factors cannot be changed, it is important to realize that you do have control over many others.  Regardless of your age, background, or health status, you can lower your risk of heart disease—and it doesn't have to be complicated.  Protecting your heart can be as simple as taking a brisk walk, whipping up a good vegetable soup, or getting the support you need to maintain a healthy weight.

Some women believe that doing just one healthy thing will take care of all of their heart disease risk.  For example, they may think that if they walk or swim regularly, they can still smoke and stay fairly healthy. Wrong!  To protect your heart, it is vital to make changes that address each risk factor you have.  You can make the changes gradually, one at a time.  But making them is very important.  Other women may wonder:  If I have just one risk factor for heart disease—say, I'm overweight or I have high blood cholesterol—aren't I more or less "safe"?  Absolutely not.   Each risk factor greatly increases a woman's chance of developing heart disease.  But having more than one risk factor is especially serious, because risk factors tend to "gang up" and worsen each other's effects.  So, the message is clear:  Every woman needs to take her heart disease risk seriously—and take action now to reduce that risk.

The first step toward heart health is becoming aware of your own personal risk for heart disease.  Some risks, such as smoking cigarettes, are obvious:  every woman knows whether or not she smokes.  But other risk factors, such as high blood pressure or high blood cholesterol, generally don't have obvious signs or symptoms.  So you'll need to gather some information to create your personal "heart profile."

You and Your Doctor:  A Heart Healthy Partnership
A crucial step in determining your risk is to see your doctor for a thorough checkup.  Your physician can be an important partner in helping you set and reach goals for heart health.  But don't wait for your physician to mention heart disease or its risk factors.  Many doctors don't routinely bring up the subject with women patients.  Here are some tips for establishing good, clear communication between you and your doctor:

Speak up.  Tell your doctor you want to keep your heart healthy and would like help in achieving that goal.  Ask questions about your chances of developing heart disease and how you can lower your risk.  Also ask for tests that will determine your personal risk factors.  

Keep tabs on treatment.  If you already are being treated for heart disease or heart disease risk factors, ask your doctor to review your treatment plan with you.  Ask:  Is what I'm doing in line with the latest recommendations?  Are my treatments working?  Are my risk factors under control?  If your doctor recommends a medical procedure, ask about its benefits and risks.  Find out if you will need to be hospitalized and for how long, and what to expect during the recovery period.

Be open.  When your doctor asks you questions, answer as honestly and fully as you can.  While certain topics may seem quite personal, discussing them openly can help your doctor find out your chances of developing heart disease.  It can also help your doctor work with you to reduce your risk.  If you already have heart disease, briefly describe each of your symptoms.  Include when each symptom started, how often it happens, and whether it has been getting worse.

Keep it simple.  If you don't understand something your doctor says, ask for an explanation in simple language.  Be especially sure you understand how to take any medication you are given.  If you are worried about understanding what the doctor says, or if you have trouble hearing, bring a friend or relative with you to your appointment.  You may want to ask that person to write down the doctor's instructions for you.

Menopausal Hormone Therapy and Heart Disease

Menopausal hormone therapy once seemed the answer for many of the conditions women face as they age. It was thought that hormone therapy could ward off heart disease, osteoporosis, and cancer, while improving women's quality of life.  But beginning in July 2002, findings emerged from clinical trials that showed this was not so.  In fact, long-term use of hormone therapy poses serious risks and may increase the risk of heart attack and stroke.  The findings come from the Women's Health Initiative (WHI), launched in 1991 to test ways to prevent a number of medical disorders in postmenopausal women.  It consists of a set of clinical studies on hormone therapy, diet modification, and calcium and vitamin D supplements; an observational study; and a community prevention study.

The two hormone therapy clinical studies were both stopped early because of serious risks and the failure to prevent heart disease.  Briefly, the estrogen-plus-progestin therapy increased women's risk for heart attacks, stroke, blood clots, and breast cancer.  It also doubled the risk of dementia and did not protect women against memory loss.  However, the therapy had some benefits:  It reduced the risk for colorectal cancer and bone fractures.  Estrogen-alone therapy increased the risk for stroke and venous thrombosis (blood clot, usually in one of the deep veins of the legs).  It had no effect on heart disease and colorectal cancer, and an uncertain effect on breast cancer.  Estrogen alone gave no protection against memory loss, and there were more cases of dementia in those who took the therapy than those on the placebo, although the increase was not statistically significant.  Estrogen alone reduced the risk for bone fractures.

While questions remain, the findings make possible some advice about using hormone therapy:   Estrogen alone or with progestin should not be used to prevent heart disease.  Talk with your doctor about other ways of preventing heart attack and stroke, including lifestyle changes and medicines such as cholesterol-lowering statins and blood pressure drugs.

• If you are considering using menopausal hormone therapy to prevent osteoporosis, talk with your doctor about the possible benefits weighed against your personal risks for heart attack, stroke, blood clots, and breast cancer.  Ask your doctor about alternative treatments that are safe and effective in preventing osteoporosis and bone fractures.
  
  
• Do not take menopausal hormone therapy to prevent dementia or memory loss.
  
  
• If you are considering menopausal hormone therapy to provide relief from menopausal symptoms such as hot flashes, talk with your doctor about whether this treatment is right for you.  The WHI did not test the short-term risks and benefits of using hormone therapy for menopausal symptoms.  The current U.S. Food and Drug Administration recommendation for menopausal hormone therapy is that it should be used at the lowest dose for the shortest period of time to reach treatment goals.
  
  
• And remember:  Your risk for heart disease, stroke, osteoporosis, and other conditions may change as you age.  So review your health regularly with your doctor.  New treatments that are safe and effective may become available.  Stay informed.

If You Have Heart Disease:  Menopausal hormone therapy was once thought to lower the risk of heart attack and stroke for women with heart disease.  But research now shows that women with heart disease should not take it.  Menopausal hormone therapy can involve the use of estrogen alone or estrogen plus progestin. For women with heart disease, estrogen alone will not prevent heart attacks, and estrogen plus progestin increases the risk for heart attack during the first few years of use.  Estrogen plus progestin also increases the risk for blood clots, stroke, and breast cancer.

Posted July 2008