What is cardiovascular disease?
Cardiovascular disease is a broad term that includes a variety of heart and blood vessel conditions, such as:
- Coronary artery disease.
- High blood pressure (hypertension).
- Heart attack (myocardial infarction).
- Stroke.
- Heart failure.
- Cardiomyopathy.
- Abnormal heart rhythms.
- Heart valve disease.
- Vascular disease.
- Aorta disease.
- Peripheral arterial disease (PAD).
- Congenital heart problems.
- Many other heart and vascular problems.
How common is cardiovascular disease among women?
Cardiovascular disease is the number one killer of women in the United States, regardless of race or ethnicity. More women die from cardiovascular disease than from all forms of cancer combined.
Women and cardiovascular disease facts
(Source: American Heart Association; heart.org)
- One in every 3 women dies of cardiovascular disease.
- More women die from heart attacks than men do.
- 90% of women have at least one risk factor for cardiovascular disease.
- Not all women have the same symptoms, and signs of cardiovascular disease can be different in women than they are in men.
- More than 40% of African American women who are non-Hispanic have high blood pressure.
- Hispanic women tend to have cardiovascular disease 10 years earlier than non-Hispanic women.
- Taking birth control pills and smoking increases the risk of heart disease by 20% for younger women.
- Menopause increases the risk of coronary artery disease by 2 to 3 times.
- Many women (64%) who suddenly die from coronary artery disease have no prior symptoms.
What causes cardiovascular disease?
The most common cause of cardiovascular disease is atherosclerosis (sometimes called “hardening” or “clogging” of the arteries). Atherosclerosis is the build-up of cholesterol and fatty deposits (plaques) inside the artery walls. The plaques limit or stop blood flow to the heart, which can cause a heart attack. When you have narrowed or blocked coronary arteries, it is called coronary artery disease.
What are the symptoms of cardiovascular disease?
If the heart muscle can’t get enough blood, it causes ischemia. Ischemia is described as "cramping of the heart muscle". It is similar to a leg cramp after you exercise a long time. The muscles in the legs cramp up because they need oxygen and nutrients. Your heart, which is also a muscle, needs oxygen and nutrients to keep working.
Ischemia can cause angina (angina pectoris), which is the most common symptom of cardiovascular disease. Angina is often called chest pain. Your chest can also feel heavy, full, tight and you may have aching, burning, numbness or squeezing. Angina can be mistaken for heartburn. It can also affect your left shoulder, arms, back and jaw.
Other symptoms of coronary artery disease include:
- Shortness of breath.
- Heart palpitations (irregular heartbeats, skipped beats or a "flip-flop" feeling in your chest).
- Fast heartbeat.
- Dizziness.
- Nausea.
- Extreme weakness.
- Sweating.
Call your doctor if you have any of these symptoms, especially if they are new or get worse.
Symptoms can be different for women
Women tend to have symptoms of cardiovascular disease about 10 years later than men do. And, they may have different symptoms than men do.
Some women who have a heart attack have:
- Pain or discomfort in the chest, left arm or back.
- Very fast heartbeat.
- Shortness of breath.
- Nausea or fatigue.
Call 911 right away if you have any of these symptoms!
How do I know if I have cardiovascular disease?
Your doctor will examine you and ask you about your symptoms, medical history and risk factors.
You may have blood work and tests, such as an electrocardiogram (ECG/EKG), echocardiogram, stress test, nuclear imaging or a cardiac catheterization.
The test results help your doctor diagnose cardiovascular disease, see how it is affecting your heart, and create your plan of care.
Some tests, such as C-reactive protein (CRP), complete lipid profile and calcium score screening heart scan can help predict your future risk of cardiovascular disease.
What causes cardiovascular disease?
Your risk of cardiovascular disease includes factors you cannot change and those you can.
Risk factors you cannot change are called nonmodifiable risk factors. These include:
- Older age. A woman’s risk of heart disease dramatically increases around age 50 to 52 (about the age of natural menopause). Women and men have an equal risk of heart disease once they reach 70.
- Family history of cardiovascular disease. Your risk of developing cardiovascular disease is higher if your parents have/had it (especially if they were diagnosed before age 50). Ask your doctor when you should start getting tested for cardiovascular disease and risk factors so you can prevent it or get early treatment.
- Race. African Americans have more severe high blood pressure than Caucasians, which puts them at greater risk of cardiovascular disease. The risk is also higher among Mexican Americans, American Indians, native Hawaiians and some Asian Americans. This is partly due to higher rates of obesity and diabetes in these populations.
Modifiable risk factors include:
- Smoking and second-hand smoke.
- High cholesterol and triglyceride levels, especially high LDL/bad cholesterol (over 100 mg/dL) and low HDL/good cholesterol (under 40 mg/dL). Ask your doctor about goals for your cholesterol and triglyceride levels.
- High blood pressure (130/80 mm Hg or higher).
- Uncontrolled diabetes.
- Lack of exercise.
- Being overweight (body mass index [BMI] 25-29 or obese (BMI 30 or higher).
Menopause and heart disease
A woman’s risk of heart disease is higher after menopause. This includes women who go through early menopause (before age 45) or surgical menopause.
Before menopause, estrogen helps protect against cardiovascular disease. The drop in estrogen levels after menopause causes:
- Changes in the walls of the blood vessels that may cause plaque and blood clots to form.
- Changes in the lipid (fat) levels in the blood: Higher levels of low-density lipoproteins (LDL)/"bad" cholesterol. Higher levels of low-density lipoproteins (LDL)/”bad” cholesterol. Lower levels of high-density lipoproteins (HDL)/"good" cholesterol. These changes lead to the build-up of fat and cholesterol that can cause heart attack and stroke.
- Higher levels of fibrinogen in the blood. Fibrinogen helps blood clot. Too much fibrinogen can cause cardiovascular disease and stroke.
NOTE: How your weight is distributed is also important. Your waist measurement is one way to determine fat distribution. Your waist circumference is the measurement of your waist, just above your navel. The risk of cardiovascular disease is higher for women with a waist measurement over 35 inches (over 32 inches for Asian Americans) and men with a waist measurement over 40 inches (over 38 inches for Asian Americans).
- Uncontrolled stress or anger.
- Diet high in saturated fat and cholesterol.
- Drinking too much alcohol.
Other risk factors for women include high blood pressure or diabetes while pregnant, polycystic ovary disease (PCOS) and autoimmune diseases such as rheumatoid arthritis or lupus.
The more risk factors you have, the greater your overall risk.
What can I do to reduce my risk of cardiovascular disease?
Lifestyle changes
Making changes to your lifestyle can help reduce your risk of cardiovascular disease. Your doctor can help you set goals and find resources to make these changes:
- Quit.
- Eat a heart-healthy diet to manage your cholesterol, blood pressure and blood sugar/diabetes.
- Limit the amount of alcohol you drink.
- Increase your exercise/activity level to manage your weight and reduce stress. Moderate exercise for 30 minutes a day, on most days is best. Check with your doctor before you start any exercise program. Your doctor may recommend a cardiac rehab program.
Medications
In addition to lifestyle changes, your doctor may also prescribe medications to prevent or manage cardiovascular disease. These can include medications to control cholesterol levels and blood pressure and/or medications to help your heart work better and get more oxygen-rich blood. The medication(s) you need depend on your risk factors and any health problems you have.
Hormone replacement therapy (HRT). There has been much research into hormone replacement therapy (HRT) and heart disease. While early studies seemed to show that HRT reduced the risk, it turns out that the lower risk was not from the HRT, but most likely related to the lifestyles of the women involved in the studies.
Since this early research, larger studies, such as the Heart and Estrogen/Progestin Replacement Study (HERS) and the Women’s Health Initiative (WHI) have shown that HRT can cause health problems such as:
- Higher risk of heart attack and stroke in the first year of HRT. The risk was lower after 2 years of HRT compared with women not on HRT.
- Higher risk of breast cancer, coronary artery disease (including nonfatal heart attacks), stroke, blood clots and gallbladder disease.
Depending on your health problems and symptoms of menopause, the benefits of HRT may outweigh the risks. Your doctor can help you decide if HRT is a good option for you.
