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What are the risk factors?
How can it be prevented?
How is it diagnosed?
How is it treated?
It's a slowly dying myth that heart disease is more of a man's disease. Coronary heart disease, also known as coronary artery disease, is the number one killer of American women.
Women may think of heart disease as more of a man's disease because men tend to develop it 10 years earlier than women. Once women reach menopause, however, they are as much at risk, or even greater risk, than men for heart disease. Their risk increases threefold to fivefold each decade. Today, there are 38.2 million American women living with cardiovascular disease (CVD).
Before going through menopause, women have less risk of heart disease and stroke than men of the same age who have the same risk factors. Menopause itself increases a woman's risks of coronary heart disease and stroke. If menopause is caused by surgery to remove the ovaries, the risk rises sharply. If menopause occurs naturally, the risk rises more slowly. A hormone is the culprit. Estrogen helps protect a woman against heart disease. However, as a woman goes through menopause, her ovaries produce less estrogen. Hence, her risk of heart disease rises dramatically.
Studies also show that after menopause women have higher levels of triglycerides, cholesterol and low-density lipoprotein (LDL) cholesterol. These changes are due to the effects of menopause and the loss of estrogen, as well as weight gain and aging.
What are the risk factors?
Women should be aware of risk factors that make them prone to heart disease. According to the American College of Cardiology (ACC), risk factors can be divided into three categories as follows:
High risk
- Established coronary heart disease
- Cerebrovascular disease
- Peripheral arterial disease
- Abdominal aortic aneurysm
- End-stage or chronic renal disease
- Diabetes mellitus
At risk
- Having one or more major risk factors for CVD, including:
- Cigarette smoking
- Poor diet
- Physical inactivity
- Obesity
- Family history of early CVD (under age 55 in male relative and under age 65 in female relative)
- High blood pressure
- Dyslipidemia
- Evidence of subclinical vascular disease, such as coronary calcification
- Metabolic syndrome
- Poor exercise capacity on treadmill test and/or abnormal heart rate recovery after stopping exercise
Optimal Risk: Framingham global risk under 10 percent and a healthly lifestyle, with no risk factor.
How can it be prevented?
Experts say making lifestyle changes can be critical. The following changes have been shown to reduce the risk or improve the symptoms of heart disease:
- Quitting smoking.
- Eating a healthy diet, including:
- Lots of fruits and vegetables
- Whole-grain, high-fiber foods
- Fish, especially oily fish, at least two times a week
- Limited saturated fat and consumption of trans-fatty acids as low as possible
- No more than one alcoholic drink per day
- Lest than one teaspoon of salt per day
- Maintaining a normal blood pressure.
- Keeping cholesterol levels within a normal range.
- Engaging in regular physical activity (a minimum of 30 minutes of moderate-intensity physical activity, such as brisk walking, on most, preferably all, days of the week (and a minimum of 60 to 90 minutes for women who need to lose weight or maintain weight loss.) Check with your doctor before you start.
- Maintaining as near normal body weight as possible. (Ask your doctor what weight is healthy for you)
- Keeping blood glucose levels within normal range if diabetes is present.
- Reducing stress.
- Screening for depression and treatment when indicated.
How is it diagnosed?
The diagnosis of coronary heart disease is based on patient history, physical examination, symptoms and the results of diagnostic testing. Many times heart disease produces few if any symptoms. For this reason, all adults should have regular examinations by a physician, which include blood pressure and weight measurements, blood tests and a lifestyle evaluation to identify and control your overall risk factors for heart disease.
If your physician suspects that you have coronary heart disease, the following diagnostic tests may be ordered:
Electrocardiogram (EKG) - An EKG is a recording of the electrical activity of the heart. It can detect abnormalities in heart rate and rhythm, and it can also give information about whether or not the heart muscle is receiving enough oxygen and blood.
Stress test - A stress test is done on a treadmill or exercise bicycle to evaluate the heart and blood pressure's response to exercise. During a stress test, the individual is connected to an EKG and blood pressure monitor, while the level of physical activity is slowly increased. Changes in the EKG during this exam can identify exercise-related abnormalities of the blood flow to the heart muscle that might not be evident on a resting EKG.
Nuclear scanning - A nuclear scan is sometimes used to evaluate the heart's ability to pump blood and to show damaged areas of the heart muscle. This test involves the injection of a small amount of radioactive material (usually into an arm vein). After the heart muscle has taken up the dye, a special camera is used to scan the heart and detect areas of unhealthy tissue.
Coronary angiogram - A coronary angiogram is considered the most accurate method for diagnosing the severity of coronary artery disease. This procedure involves the insertion of a long, thin catheter (usually inserted through the forearm or groin) that is directed into the heart's coronary arteries. Dye is then injected into the catheter to show the flow of blood within the coronary arteries. Narrowed areas and blockages in the arteries can be detected.
How is it treated?
The following medications often used to treat the risk factors that can cause or worsen heart disease:
- Cholesterol-lowering medications, such as the statins simvastatin, atorvastatin, pravastatin, fluvastatin, rosuvastatin, lovastatin. Other drugs (non-statins) sometimes used include ezetimibe, colestipol and cholestyramine. The triglyceride-lowering medications include genfibrozil and fenofibrate. Niacin is also used to help treat high blood pressure. Doctors may suggest taking bile acid sequestrants, plant sterols/stanols, or ezetimibe in addition to statins because they can lower LDL ("bad") cholesterol up to an additional 20 percent when combined with statins.
- Blood pressure lowering medications.
- Research found rather than protect women from heart attacks, hormone therapy increases their risk. In fact, the American Heart Association has warned women not to see hormone therapy as a means of treating or preventing heart disease.
When lifestyle modifications are not enough to treat the symptoms of heart disease, medication may be needed. Commonly prescribed medications include:
- Nitrates. By dilating the arteries that supply blood to the heart, nitrates increase the flow of blood and oxygen to the heart. Nitrates also reduce the workload of the heart by decreasing the amount of blood returning to the heart and pumped to the rest of the body.
- Beta-blockers. Atenolol and metopropal are commonly prescribed beta-blocker medications. Beta-blockers slow the heart rate and decrease the force needed to contract the heart muscle. In doing so, beta-blockers reduce the workload of the heart.
- Calcium channel blockers. Nifedipine, verapamil and diltiazem are examples of commonly prescribed calcium channel blockers. These medications open up the coronary arteries and may also decrease the heart muscle's needs for blood and oxygen.
- Aspirin. Aspirin can stop blood clots from forming within the coronary arteries.
When lifestyle modifications and medications don't treat symptoms of coronary heart disease, you may need surgery. All treatments for heart disease are aimed at relieving symptoms and reducing the risk of complications. Heart disease does not have a cure. The best management of heart disease includes lifestyle changes aimed at reducing risk factors.
This article was reviewed and updated June 2007.
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