Heart disease remains the leading killer of women, yet only half of women know this fact. Heart disease and stroke kill more women each year than all cancers combined. Ninety percent of women have at least one risk factor for heart disease.
Risk Factors
Traditional risk factors include:
- Obesity
- High blood pressure: Considered high at 130 systolic (top number) over 80 diastolic (bottom number), which is lower than the previously cited 140/90.
- Family history of heart disease
- Smoking
- Poor physical activity
- Diabetes
- High LDL cholesterol
- Low HDL cholesterol
- High triglycerides
Less commonly discussed risk factors include:
- Rheumatoid arthritis: This increases the risk of heart disease as much as diabetes.
- History of gestational diabetes
- History of high blood pressure or preeclampsia in pregnancy
- Early menopause
- Depression: This doubles the risk of ischemic heart disease.
Symptoms
Symptoms of heart disease in women can be milder than those in men and can present atypically. Common symptoms include:
- Indigestion
- Shoulder, arm, or back pain
- Shortness of breath
- Nausea
- Vomiting
- Sweating
- Fatigue
Guidelines and Treatment Recommendations
To manage and reduce the risk of heart disease:
- Know your risk factors: Including your personal and family medical history.
- Establish care with a primary clinician: For proper screening and follow-through on an action plan.
- Use tools like the American College of Cardiology’s risk calculator: This helps calculate your individual ten-year risk of coronary disease using information about your race, blood pressure, cholesterol results, medical history, and smoking status.
- Adopt a healthy lifestyle: This can involve a weight loss plan, smoking cessation, diabetes control, a low sodium (DASH) diet, and possibly starting blood pressure and/or cholesterol-reducing medications.
- Consider daily low-dose aspirin: This is recommended for some high-risk patients but should be decided by your clinician. According to 2019 American Heart Association recommendations, daily low-dose aspirin use is not for everyone.
Menopause and Heart Disease
Menopause can increase blood pressure due to lowered estrogen levels, as estrogen in younger women acts as a vasodilator (opening blood vessels). When estrogen levels drop during menopause, blood vessels can constrict, leading to higher blood pressure.
The Women’s Health Initiative study (WHI), a large, ongoing national study of over 161,000 women ages 50-79 that started in 1993, focuses on heart disease and certain cancer prevention. The 2019 findings indicate that hormone replacement therapy (HRT) can help reduce coronary heart disease in women younger than 60 years old and/or less than ten years post-menopause. This conclusion is supported by 23 large randomized controlled trials of over 191,000 women.
For women over 60 or more than ten years post-menopause, HRT is not recommended for reducing coronary heart disease risk. The timing of starting hormones significantly determines whether HRT is beneficial or harmful. For younger menopausal women without contraindications (such as a history of blood clots or breast cancer), HRT can reduce coronary heart disease. This is further discussed in the 2017 Hormone Therapy Position Statement of The North American Menopause Society. This information contrasts with many media headlines and represents a shift from recent misinformation.
Conclusion
Being proactive in your healthcare in collaboration with your clinician is the goal. Self-education using reliable resources, some of which have been cited here, can be empowering and helpful!
