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Heart disease and women

Information

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.

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EARLY HEART DISEASE SIGNS

Women may have warning signs that go unnoticed for weeks or even years 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.
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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 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.

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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 health care 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 health care 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 60 years of age.
  • 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 can take a low dose aspirin daily to help prevent heart attacks. Aspirin can increase the risk for bleeding, so check with your health care 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 or keep off 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) between 18.5 and 24.9 and a waist smaller than 35 inches.
  • 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 usually loaded with unhealthy fats.

References

Goldstein LB, Bushnell CD, Adams RJ, et al. Guidelines for the primary prevention of stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2011 Feb;42(2):517-84. Epub 2010 Dec 2.

Smith SC Jr, Benjamin EJ, Bonow RO, et al. AHA/ACCF secondary prevention and risk reduction therapy for patients with coronary and other atherosclerotic vascular disease: 2011 update: a guideline from the American Heart Association and American College of Cardiology Foundation endorsed by the World Heart Federation and the Preventive Cardiovascular Nurses Association. J Am Coll Cardiol. 2011 Nov 29;58(23):2432-46. Epub 2011 Nov 3.

Gaziano JM, ridker PM, Libby P. Primary and secondary prevention of coronary heart disease. In: Bonow RO, Mann DL, Zipes DP, Libby P, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 9th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 49.

Hansson GK, Hamsten A. Atherosclerosis, thrombosis, and vascular biology. In: Goldman L, Schafer AI, eds. Cecil Medicine. 24th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 70.

Mosca L, Benjamin EJ, Berra K, Bezanson JL, Dolor RJ, Lloyd-Jones DM, et al. Effectiveness-based guidelines for the prevention of cardiovascular disease in women--2011 update: A guideline from the American Heart Association. Circulation. 2011;123(11):1243-1262.

Newby LK, Douglas PS. Cardiovascular disease in women. In: Bonow RO, Mann DL, Zipes DP, Libby P, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular MEdicine. 9th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 81.

North American Menopause Society. Estrogen and progestogen use in postmenopausal women: 2010 position statement of The North American Menopause Society. Menopause. 2010;17:242-255.

Wolff T, Miller T, Ko S. Aspirin for the primary prevention of cardiovascular events: an update of the evidence for the U.S. Preventive Services Task Force. Ann Intern Med. 2009;150(6):405-410.

Updated: 5/1/2013

Michael A. Chen, MD, PhD, Assistant Professor of Medicine, Division of Cardiology, Harborview Medical Center, University of Washington Medical School, Seattle, Washington. Also reviewed by David Zieve, MD, MHA, Bethanne Black, and the A.D.A.M. Editorial team.


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