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Heart disease and women

People often DO NOT consider heart disease a woman's disease. Yet cardiovascular disease is the leading killer of women over age 25. It kills nearly twice as many women in the United States as all types of cancer.

Men have a greater risk for heart disease earlier in life than women. Women's risk increases after menopause.

EARLY HEART DISEASE SIGNS

Women may have warning signs that go unnoticed for weeks or even years before a heart attack occurs.

  • Men most often have the "classic" heart attack signs: tightness in the chest, arm pain, and shortness of breath.
  • Women's symptoms can resemble those of men.
  • Women may also complain of other symptoms, such as nausea, fatigue, indigestion, anxiety, and dizziness.

ACT IN TIME

Recognizing and treating a heart attack right away improves your chance for survival. On average, a person having a heart attack will wait for 2 hours before calling for help.

Know the warning signs and always call 911 or the local emergency number within 5 minutes of when symptoms begin. By acting quickly, you can limit damage to your heart.

MANAGE YOUR RISK FACTORS

A risk factor is something that increases your chance of getting a disease or having a certain health condition. You can change some risk factors for heart disease. Other risk factors you cannot change.

Women should work with their health care provider to address risk factors they can change.

  • Use lifestyle measures to keep your blood cholesterol levels in the right range. Targets for cholesterol levels vary, depending on your risk factors. Ask your provider which targets are best for you.
  • Keep your blood pressure in a healthy range. Your ideal blood pressure level will depend on your risk factors. Discuss your target blood pressure with your provider.

Estrogen is no longer used to prevent heart disease in women of any age. Estrogen may increase the risk of heart disease for older women. However, it may still be used for some women to treat hot flashes or other medical problems.

  • Estrogen use is probably safest for women under age 60.
  • It should be used for the shortest possible period of time.
  • Only women who have a low risk for stroke, heart disease, blood clots, or breast cancer should take estrogen.

Some women (especially those with heart disease) can take a low-dose aspirin daily to help prevent heart attacks. Some women will be advised to take low-dose aspirin to prevent stroke. Aspirin can increase the risk for bleeding, so check with your provider before beginning daily aspirin treatment.

LIVE A HEALTHY LIFESTYLE

Some of the risk factors for heart disease that you CAN change are:

  • DO NOT smoke or use tobacco.
  • Get plenty of exercise. Women who need to lose weight or maintain their weight should get at least 60 to 90 minutes of moderate-intensity exercise on most days. To maintain your health, get at least 30 minutes of exercise a day, preferably at least 5 days a week.
  • Maintain a healthy weight. Women should strive for a body mass index (BMI) of between 18.5 and 24.9 and a waist smaller than 35 inches (90 cm).
  • Get checked and treated for depression, if necessary.
  • Women with high cholesterol or triglyceride levels may benefit from omega-3 fatty acid supplements.

If you drink alcohol, limit yourself to no more than one drink per day. DO NOT drink just for the purpose of protecting your heart.

Good nutrition is important to your heart health, and it will help control some of your heart disease risk factors.

Healthy diet
  • Eat a diet that is rich in fruits, vegetables, and whole grains.
  • Choose lean proteins, such as chicken, fish, beans, and legumes.
  • Eat low-fat dairy products, such as skim milk and low-fat yogurt.
  • Avoid sodium (salt) and fats found in fried foods, processed foods, and baked goods.
  • Eat fewer animal products that contain cheese, cream, or eggs.
  • Read labels, and stay away from "saturated fat" and anything that contains "partially-hydrogenated" or "hydrogenated" fats. These products are most often high in unhealthy fats.

Alternative Names

CAD - women; Coronary artery disease - women

References

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Chandrasekhar J, Mehran R. Heart disease in women. In: Levine GN, ed. Cardiology Secrets. 5th ed. Philadelphia, PA: Elsevier; 2018:chap 52.

Gulati M, Bairey Merz CN. Cardiovascular disease in women. In: Zipes DP, Libby P, Bonow RO, Mann DL, Tomaselli GF, Braunwald E, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 11th ed. Philadelphia, PA: Elsevier; 2019:chap 89.

Hodis HN, Mack WJ, Henderson VW, et al; ELITE Research Group. Vascular effects of early versus late postmenopausal treatment with estradiol. N Engl J Med. 2016;374(13):1221-1231. PMID: 27028912 www.ncbi.nlm.nih.gov/pubmed/27028912.

Mehta LS, Beckie TM, DeVon HA, et al. Acute myocardial infarction in women: a scientific statement from the American Heart Association. Circulation. 2016;133(9):916-947 PMID: 26811316 www.ncbi.nlm.nih.gov/pubmed/26811316.

NAMS Hormone Therapy Position Statement Advisory Panel, The. 2017 hormone therapy position statement of The North American Menopause Society. Menopause. 2017;24(7):728-753. PMID: 28650869 www.ncbi.nlm.nih.gov/pubmed/28650869.

Ridker PM, Libby P, Buring JE. Risk markers and the primary prevention of cardiovascular disease. In: Zipes DP, Libby P, Bonow RO, Mann DL, Tomaselli GF, Braunwald E, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 11th ed. Philadelphia, PA: Elsevier; 2019:chap 45. 

Review Date 6/18/2018

Updated by: Michael A. Chen, MD, PhD, Associate Professor of Medicine, Division of Cardiology, Harborview Medical Center, University of Washington Medical School, Seattle, WA. Internal review and update on 10/18/2019 by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.