Cardiovascular Disease in Women

By: Monica Mukherjee, MD, MPH, FACC, FASE

Cardiovascular disease (CVD) represents a major public health crisis in the US and worldwide, and despite increasing awareness, women remain disproportionately affected. According to recent statistics from the American Heart Association (AHA), CVD remains the single largest killer of American women, with an estimated 700,000 deaths annually.^{1, 2} More women than men will die of CVD, and to put this into perspective, one out of three US women will die from CVD which calculates to one female CVD death every 80 seconds! 75% of women who die suddenly from CVD will have had no prior symptoms, and minority women such as Hispanics and African Americans tend to develop CVD earlier than their Caucasian counterparts. While these staggering statistics can be alarming, the good news is that CVD is largely preventable.

What causes cardiovascular disease?
Cardiovascular disease is usually due to atherosclerosis, a process in which where cholesterol, fatty substances, calcium and a clotting protein called “fibrin” accumulate within the inner walls of arteries and form a “plaque”. Over time, the arteries become inflamed, hardened and progressively narrow causing blockages and impaired blood flow to the tissue. Pieces of plaque can then break off and cause formation of a blood clot inside the damage vessel. When plaques break within the heart arteries, known as coronaries, this can cause a heart attack. When plaques break off within the arteries that feed the brain, known as carotid arteries, or within the brain itself, this can cause a stroke. Procedures such as angioplasty and bypass surgery aim to reopen or bypass blocked arteries to restore blood flow to the tissue, but cannot reverse the damage to heart muscle, which is typically treated with medications.

Myths and Limitations About CVD Risk Prevention in Women
One of the limitations in CVD risk prevention is what women constitute as their greatest health problems. Despite CVD being the largest killer of women in the US, in a recent survey by Mosca et al, women attributed breast cancer and other cancers to be their biggest health risk at 62%.³ In fact CVD is the leading cause of death for women, and is greater than all cancer risks combined!

According to the AHA Go Red for Women Campaign, some of the myths surrounding CVD in women include:

• Heart disease occurs mostly in men while cancer risk is greater in women
• Heart disease only occurs in older people
• Heart disease does not occur in people who are in good shape
• Heart disease is always associated with symptoms
• Heart disease occurs in my family so there is nothing I can do to prevent my risk

Some other reasons why women do not take action against heart disease:

• Women frequently do not make their own health a top priority
• As busy women with careers and families, women feel like they are too busy to make changes in their lives

But, it is so important to remember that heart disease can largely be prevented and controlled by lifestyle changes, and sometimes with medications as prescribed by a doctor. According to the AHA Go Red for Women Campaign, by eating right, being physically active, not smoking, and maintaining a healthy weight … you can lower your risk of heart disease by as much as 82%!!

 What are the Risk Factors for CVD?
Adapted from the AHA Go Red for Women Campaign, for more information, visit: goredforwomen.org

TRADITIONAL	RISK FACTORS UNIQUE TO WOMEN
High blood pressure (Hypertension)	Gestational diabetes
Smoking	Pre-eclampsia
Obesity	Subclinical atherosclerosis
High cholesterol	Inflammation
Family history of heart disease	Poor fitness
Sedentary lifestyle	Sedentary lifestyle

 Knowing Your Risk
There are several risk calculators that can help you assess your own personal risk for heart attack, stroke, or death from CVD.

My personal favorite is: cvriskcalculator.com

Using your own risk factors allows assessment of CVD risk for heart attacks, stroke and cardiac death over next 10 years:

• Age
• Smoking
• Blood pressure (hypertension)
• Cholesterol levels (total and HDL)
• Diabetes

It is important to note though that other factors are considered in these risk calculators including: family history of premature heart disease, coronary artery calcium scores, elevated blood levels of CRP.

Warning Signs of a Heart Attack

Most Common Warning Signs	Less Common Warning Signs
Uncomfortable pressure, tightness, fullness, squeezing or pain in the center of the chest that lasts more than a few minutes, or goes away and comes back	Atypical chest pains, upper stomach or abdominal pains
Chest discomfort associated with exercise	Nausea or dizziness, palpitations, cold sweats
Pain that spreads from the chest to the neck, shoulders, or arms	Shortness of breath or anxiety, unexplained weakness or fatigue
Pain that is associated with sweating, nausea, lightheadedness, or shortness of breath	Upper back pain

To Survive a Heart Attack
If you have any heart attack symptoms or think you might be having a heart attack, call 9-1-1 immediately. It is important to learn the warning signs, and do not drive yourself to the hospital! Remember that time is heart muscle, and it is important to present as soon as possible!

Decreasing Your Risk and Preventing a Heart Attack
Adapted from the AHA Go Red for Women Campaign, for more information, visit: goredforwomen.org

1. Manage your blood pressure

• Do not add salt or salt-based seasonings
• Watch for hidden salt content: bread and rolls, cold cuts and cured meats, pizza, poultry, soup, sandwiches
• Taking prescribed medicine from your physician

2. Control your cholesterol

• Taking medications as prescribed by your doctor to lower cholesterol
• Exercising for 30 minutes daily, to a goal of 150 minutes per week will help raise your good cholesterol (HDL) and decrease your bad cholesterols (LDL, triglycerides)
• Foods that can help lower cholesterol: whole- and multi-grain products, such as bran and oats, fatty fishes (salmon, mackerel and albacore tuna), foods rich in antioxidants (fruits and vegetables), foods high in omega-3 fatty acids (avocado, flax seeds, olive oil and canola oil), foods rich in plant sterols (walnuts and almonds)
• Foods to avoid: animal products high in saturated fat, fried foods, high-fat processed meats, simple sugars (found in soft drinks, candy, cakes, cookies and other baked goods), saturated oils (coconut and palm oil), shortening (partially hydrogenated margarine and lard)

3. Reduce your blood sugar

• Look for added sugar in food: brown sugar, corn sweetener, corn syrup, fruit juice concentrates, high-fructose corn syrup, honey, invert sugar, malt sugar, molasses, raw sugar, sugar molecules ending in “ose” (dextrose, fructose, glucose, lactose, maltose, sucrose), syrup
• Cut back on the amount of sugar added to things you eat or drink regularly like cereal, pancakes, coffee or tea. Try cutting the usual amount of sugar you add by half and wean down from there, or consider using an artificial sweetener
• Buy sugar-free or low-calorie beverages
• Buy fresh fruits or fruits canned in water or natural juice
• Avoid fruit canned in syrup, especially heavy syrup

4. Get moving

• The AHA recommends just 30 minutes of moderate to vigorous aerobic exercise four to five times a week. Even brisk walking will do!
• And physical activity boosts mental wellness, increases immunity, prolongs your optimal health, and decreases risk factors such a high blood pressure, coronary heart disease, stroke
• Establishes good heart-healthy habits for children and your family while also decreasing the risk of obesity, high blood pressure, poor cholesterol levels, poor lifestyle habits that lead to heart attack and stroke later in life

5. Eat Better

According to the AHA guidelines, eating heart-healthy means:

• Eat more fruits, vegetables, whole grains, low-fat dairy, poultry, fish, and nuts
• Avoid red meat, as well as sugary and processed foods
• Avoid food high in sodium

6. Lose Weight

• For overall cardiovascular health, the AHA suggests 30 minutes of aerobic activity 5 days per week and muscle-strengthening activity at least 2 days per week.
• Don’t have time? You don’t have to do all 30 minutes at once! You’ll get the same benefits if you divide your time into two or three 10- to 15-minute segments a day. Just start walking 10 minutes per day, and add time gradually. If you slip up, don’t worry! Tomorrow is always a new chance to make a fresh start.
• Keep a food diary, reduce stress, sleep more – set realistic goals that you and your family can achieve together!

7. Stop Smoking

• According to the AHA, if you quit after a heart attack, your chances of a heart attack drop by 50%, and your risk for another heart attack continues to drop each year that you remain a nonsmoker
• Automatic weight gain is a myth. The reason women gain weight after quitting is because they substitute extra food for those missing cigarettes
• It may feel like a lifetime, but nicotine cravings last only a minute, or even less
• Just after one month of quitting: You won’t be short of breath during normal physical activities, your sense of taste and smell will return to normal and the stains on your teeth and fingernails will start to fade

In Summary
I hope that this serves as an urgent wake up call that you and your health are a TOP PRIORITY! Take care of yourself so that you can be there for your family and loved ones. Healthy lifestyle changes do not take up much time, and incorporating these changes into your family’s schedule will help not only you, but the health of your loved ones. Take one step at a time, and set realistic goals. Be your own advocate for your health, starting with knowing your risk!

For more information, please visit:

AHA Go Red for Women Resources available at: https://www.goredforwomen.org

ASCVD Risk Calculator: www.cvriskcalculator.com

REFERENCES

1. Heron M. Deaths: Leading Causes for 2014. Natl Vital Stat Rep. 2016;65:1-96.
2. Yang Q, Cogswell ME, Flanders WD, Hong Y, Zhang Z, Loustalot F, Gillespie C, Merritt R and Hu FB. Trends in cardiovascular health metrics and associations with all-cause and CVD mortality among US adults. JAMA. 2012;307:1273-83.
3. Mosca L, Jones WK, King KB, Ouyang P, Redberg RF and Hill MN. Awareness, perception, and knowledge of heart disease risk and prevention among women in the United States. American Heart Association Women’s Heart Disease and Stroke Campaign Task Force. Arch Fam Med. 2000;9:506-15.

Save

Save