Women & Cardiovascular Disease

Overview

Cardiovascular disease is NOT just a man's disease

Cardiovascular disease is the number one killer of women over age 25 in the United States, regardless of race or ethnicity. The death rate from cardiovascular diseases has decreased among men but continues to increase in women.

Unfortunately, only 1 in 3 women identify cardiovascular disease as the greatest health problem facing women today. Most women think that cancer is the leading cause of death in women. But, cardiovascular disease is the single leading cause of death for women in America and claims the lives of more women than all forms of cancer combined.

What causes cardiovascular disease?

Cardiovascular disease is a broad term that includes a variety of heart and blood vessel conditions, such as coronary artery disease, peripheral arterial disease, heart attack, stroke, high blood pressure, heart valve disease, vascular disease, aorta disease, heart failure, cardiomyopathy, abnormal heart rhythms, congenital heart disease and many other heart and blood vessel conditions.

The most common cause of cardiovascular disease is atherosclerosis. Atherosclerosis is the build-up of cholesterol and fatty deposits (called plaque) on the inner walls of the arteries that restricts blood flow to the heart (coronary artery disease).

Without adequate blood, the heart becomes starved of oxygen and the vital nutrients it needs to work properly. This is called ischemia. Ischemia causes symptoms of heart disease, such as chest pain or angina; and when one or more of the coronary arteries becomes completely blocked, a heart attack (injury to the heart muscle) can occur.

What are the symptoms of cardiovascular disease in women?

Symptoms of cardiovascular disease tend to occur about 10 years later in women than in men. While chest pain or discomfort is the most common symptom of a heart attack, women often have different symptoms of coronary artery disease than men.

Symptoms of a heart attack in women include:

  • Pain or discomfort in the chest, left arm, or back
  • Unusually rapid heartbeat
  • Shortness of breath
  • Nausea or fatigue

It is important to get help right away if any of these symptoms occur. The most common symptom of cardiovascular disease is called “angina pectoris” or “angina.” Angina is often referred to as chest pain. It is described as chest discomfort, heaviness, tightness, pressure, aching, burning, numbness, fullness or squeezing. It can be mistaken for indigestion or heartburn. Angina is usually felt in the chest, but may also be felt in the left shoulder, arms, neck, back or jaw. Other symptoms that can occur with coronary artery disease include:

  • Shortness of breath
  • Palpitations (irregular heartbeats, skipped beats or a “flip-flop” feeling in your chest)
  • A faster heartbeat
  • Dizziness
  • Nausea
  • Extreme weakness
  • Unusual fatigue
  • Sudden sweating or sweating when there is no real cause (cold, clammy feeling)

If you experience any of these symptoms, it is important to call your doctor, especially if these are new symptoms or if they have become more frequent or severe.

Diagnosis and Tests

How is cardiovascular disease diagnosed?

Your doctor will talk to you about your symptoms, medical history, and risk factors, and perform a physical exam.

Diagnostic tests, including blood tests, an electrocardiogram (ECG/EKG), echocardiogram, exercise stress test (combined with heart imaging technology such as stress echocardiography or nuclear imaging), coronary computed tomography angiogram (CTA), or cardiac catheterization can help provide a more complete and accurate picture of a woman’s heart health. These tests help your doctor evaluate the extent of your heart disease, its effect on the function of your heart and the best form of treatment for you.

Tests used to predict an increased risk for coronary artery disease include C-reactive protein (CRP), complete lipid profile, lipoprotein (a), MPO, TMAO, Plac and calcium score screening heart scan.

Management and Treatment

How is cardiovascular disease treated?

Medication. If lifestyle changes aren't enough to control your heart disease, medication(s) may be prescribed to treat certain risk factors, such as high cholesterol or high blood pressure, to help your heart work more efficiently and receive more oxygen-rich blood. The medication(s) you will be prescribed will depend on your personal needs, presence of other health conditions and your specific heart problem.

Hormone replacement therapy (HRT). For many years, preliminary observational research showed that hormone replacement therapy (HRT) could possibly reduce the risk of heart disease in women. It appears that the reason why the observational studies showed a reduced risk of heart disease was likely due to the lifestyles of women who take HRT rather than medical benefits of the therapy.

More recent large-scale studies of women, such as the Heart and Estrogen/Progestin Replacement Study (HERS) and the Women's Health Initiative (WHI) concluded that the overall health risks of HRT exceeded the benefits.

Women who participated in HERS had an increased risk of heart attack and stroke during the first year of HRT. After two years of treatment, this risk appeared to be reduced in women taking HRT compared with women who were not taking HRT. Women who participated in the WHI study had an increased risk for breast cancer, coronary heart disease (including nonfatal heart attacks), stroke, blood clots, and gallbladder disease.

Based on the results of these studies, the American Heart Association and the U.S. Food and Drug Administration developed new guidelines for the use of HRT:

  • Hormone replacement therapy should not be used for prevention of heart attack or stroke.
  • The use of HRT for other problems such as preventing osteoporosis should be carefully considered, and the risks should be weighed against the benefits. Women who have existing coronary artery disease should consider other prevention options.
  • Short-term HRT may be used to treat menopausal symptoms.
  • Long-term HRT use is discouraged because the risk of heart attack, stroke and breast cancer increases the longer HRT is used.

The bottom line, say physicians at Cleveland Clinic's Sydell and Arnold Miller Family Heart, Vascular & Thoracic Institute: Weigh the benefits of HRT against the risks, and discuss the whole subject of HRT with your physician so you can make an informed decision.

Interventional procedures. Common interventional procedures to treat coronary artery disease include balloon angioplasty (PTCA) and stent or drug-eluting stent placement. These procedures are considered nonsurgical because they are done by a cardiologist through a tube or catheter that is inserted into a blood vessel, rather than by a surgeon, through an incision. Several types of balloons and/or catheters are available to treat the plaque within the vessel wall. The physician chooses the type of procedure to perform based on individual patient needs.

Coronary artery bypass surgery. During coronary artery bypass graft surgery, one or more blocked coronary arteries are bypassed by a blood vessel graft to restore normal blood flow to the heart. These grafts usually come from the patient's own arteries and veins located in the chest, arm or leg. The graft goes around the clogged artery (or arteries) to create new pathways for oxygen-rich blood to flow to the heart.

Other options. Other procedures, such as enhanced external counterpulsation (EECP) are used when traditional therapies are not optional. Your doctor can provide more information about these procedures.

Prevention

How is cardiovascular disease associated with menopause?

After menopause, a woman’s risk of cardiovascular disease increases. In women who have undergone early menopause (before age 50) or surgical menopause, the risk of cardiovascular disease is also higher, especially when combined with other risk factors.

Estrogen helps a woman’s body protect her against cardiovascular disease. After menopause, cardiovascular disease becomes more of a risk for women because of the reduced level of estrogen in the body.

A reduced level of estrogen causes:

  • Changes in the walls of the blood vessels that may cause plaque and blood clots to form
  • Changes in the level of lipids (fats) in the blood: Levels of low density lipoproteins (LDL, the “bad” kind) increase, and levels of high density lipoproteins (HDL, the “good” kind) decrease. These changes lead to the build-up of fat and cholesterol that contributes to heart attack and stroke.
  • An increase in fibrinogen (a substance in the blood that helps the blood to clot). Increased levels of blood fibrinogen are related to cardiovascular disease and stroke.

What are the other risk factors for heart disease in women?

In addition to menopause, nonmodifiable risk factors (those that cannot be changed) include:

  • Older age. Once a woman reaches the age of 50 to 52 (about the age of natural menopause), the risk of heart disease increases dramatically.
  • Family history of cardiovascular disease. If your parents have/had cardiovascular disease (especially if they were diagnosed before age 50), you have an increased risk of developing it. Ask your doctor when it’s appropriate for you to start screenings for cardiovascular disease so it can be detected and treated early.
  • Race. African Americans have more severe high blood pressure than Caucasians, and therefore have a higher risk of cardiovascular disease. Cardiovascular disease 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 (those you can treat or control) include:

  • Cigarette smoking or exposure to tobacco smoke
  • High blood cholesterol and high triglyceride levels, especially high LDL/bad cholesterol (over 100 mg/dL) and low HDL/good cholesterol (under 40 mg/dL). Some patients who have existing heart or blood vessel disease and other patients who have a very high risk should aim for an LDL level less than 70 mg/dL. Your doctor can provide specific guidelines.
  • High blood pressure (140/90 mm Hg or higher)
  • Uncontrolled diabetes
  • Physical inactivity
  • Being overweight (body mass index [BMI] 25-29 kg/m2) or obese (BMI higher than 30 kg/m2)

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

Unique risk factors for women include high blood pressure (preeclampsia) or diabetes while pregnant (gestational diabetes), polycystic ovary disease 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?

Reducing your risk factors involves making lifestyle changes, including those listed below. Your doctor will work with you to help you make these changes.

  • If you smoke, you should quit.
  • Make changes in your diet to reduce your cholesterol, control your blood pressure and manage your blood sugar if you have diabetes. Low-fat, low-sodium and low-cholesterol foods are recommended. Limiting alcohol is also important. A registered dietitian can help you make the right dietary changes. Cleveland Clinic offers nutrition programs and classes to help you reach your goals.
  • Increase your exercise/activity level to help achieve and maintain a healthy weight and reduce stress. Moderate exercise for 30 minutes a day, on most days is recommended. Check with your doctor before starting an exercise program. Ask your doctor about participating in a cardiac rehabilitation program.

Resources

Doctors vary in quality due to differences in training and experience; hospitals differ in the number of services available. The more complex your medical problem, the greater these differences in quality become and the more they matter.

Clearly, the doctor and hospital that you choose for complex, specialized medical care will have a direct impact on how well you do. To help you make this choice, please review our Miller Family Heart, Vascular & Thoracic Institute Outcomes.

Cleveland Clinic Heart, Vascular & Thoracic Institute Cardiologists and Surgeons

Choosing a doctor to treat your coronary artery disease depends on where you are in your diagnosis and treatment.

The Miller Family Heart, Vascular & Thoracic Institute Women’s Cardiovascular Center provides a multidisciplinary team of health care providers to provide the best care possible to help women prevent and manage heart disease.

Click on the following links to learn more about Sections and Departments who also treat patients with Coronary Artery Disease:

See About Us to learn more about the Sydell and Arnold Miller Family Heart, Vascular & Thoracic Institute.

Contact

If you need more information, click here to contact us, chat online with a nurse or call the Miller Family Heart, Vascular & Thoracic Institute Resource & Information Nurse at 216.445.9288 or toll-free at 866.289.6911. We would be happy to help you.

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Last reviewed by a Cleveland Clinic medical professional on 05/29/2019.

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