Women and Coronary Artery Disease

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Women and Coronary Artery Disease

Topic Overview

Why is it important for women to learn about coronary artery disease?

Coronary artery disease is a leading cause of death of women throughout the world. More women die from heart disease than from cancer, chronic obstructive pulmonary disease, Alzheimer's, and accidents combined.1

But many women underestimate the threat coronary artery disease (CAD) poses to their health. And many women do not know what they can do to help prevent heart disease.

What is coronary artery disease?

Coronary artery disease is caused by the gradual buildup of plaque (made of fat, cholesterol and other substances) on the inside walls of the coronary arteries. These arteries supply oxygen-rich blood to the heart. Over time, the plaque deposits grow large enough to narrow the arteries' inside channels, decreasing blood flow to heart muscle. If the plaque becomes unstable and ruptures, a blood clot can form at the rupture site and block blood flow, resulting in a heart attack. See a picture of how plaque causes a heart attack.

What factors lead to coronary artery disease in women?

Women have unique risk factors for heart disease. These risk factors include hormone replacement therapy, birth control pills, and pregnancy-related problems.

Menopause. A woman's chance of getting coronary artery disease is higher after menopause. This higher chance is not completely understood. But cholesterol, high blood pressure, and fat around the abdomen—all risk factors for coronary artery disease—also increase around this time.

Hormone replacement therapy. Taking estrogen with or without progestin does not prevent coronary artery disease. In fact, if you are 10 or more years past menopause, taking hormone therapy may raise your risk of coronary artery disease.2

Birth control pills. Using birth control pills might increase your risk if you smoke and are older than 35 or if you have a family history of atherosclerosis or blood-clotting disorders.

Pregnancy-related problems. A problem during pregnancy called pre-eclampsia has been linked to a higher risk of heart disease later in life. Experts are studying whether other pregnancy-related problems are linked to heart disease. Tell your doctor about any problems you had during pregnancy.

Immune diseases. Some immune-related diseases, such as lupus and rheumatoid arthritis, have been linked with a higher risk of heart disease in women.

Heart disease risk factors for both women and men

The risk factors for coronary artery disease that are common in women and men include smoking, diabetes, obesity, lack of exercise, and family history.

How will my doctor determine my risk for coronary artery disease?

Your doctor will calculate your risk for coronary artery disease by assessing the number of risk factors you have. Risk factors include:

  • High LDL cholesterol level.
  • Low HDL cholesterol.
  • Cigarette smoking.
  • High blood pressure (140/90 mm Hg or greater) or taking medication to treat high blood pressure.
  • Family history of early coronary artery disease.
  • Being older than 65, or having gone through early menopause.

To find out your risk of a heart attack, see:

Interactive Tool: Are You at Risk for a Heart Attack?

What can women do to prevent coronary artery disease?

Women can use healthy lifestyle changes and medicines to help prevent coronary artery disease. Women can also balance the risks and benefits of hormone replacement therapy when they decide whether or not to use it.

Healthy lifestyle

A healthy lifestyle can help prevent heart disease. And it can help you manage other problems that raise your risk of heart disease. These problems include high blood pressure, high cholesterol, and diabetes.

  • Stop smoking, and avoid second-hand smoke.
  • Eat a heart-healthy diet, which focuses on adding more healthy foods to your diet and cutting back on foods that are not so good for you. Heart-healthy eating plans include the:
    American Heart Association Healthy Diet.
    Click here to view an Actionset. DASH Diet.
  • Be active. Try to do moderate to vigorous activity for at least 2½ hours a week. It's fine to be active in blocks of 10 minutes or more throughout your day and week. Do strength exercises at least 2 days a week. For more information, see the topic:
    Fitness.
  • Keep your body mass index (BMI) between 18.5 and 24.9 and your waist circumference less than 89 centimetres. To check your BMI:
    Interactive Tool: Is Your BMI Increasing Your Health Risks?.
  • If you drink alcohol, do so in moderation (an average of 2 drinks a day for women). If you do not drink, don't start.
Medicines

You might take medicines, along with making healthy lifestyle changes, to lower your risk of heart disease. If you already have heart disease, medicine can help you prevent a heart attack or stroke. You might take:

  • High blood pressure medicine.
  • High cholesterol medicine.
  • ASA. Your doctor may suggest that you take a daily, low-dose ASA if the benefits of ASA to prevent a stroke are greater than the risk of stomach bleeding from taking daily ASA. But the daily use of low-dose ASA in healthy women who are at low risk of stroke is not recommended.3
  • Anticoagulant, also called a blood-thinner, to lower your risk of stroke if you have atrial fibrillation.
  • Medicine to lower the workload on your heart. If you have been diagnosed with CAD or have had a heart attack, you will probably take heart medicines like beta-blockers, angiotensin-converting enzyme (ACE) inhibitors, or angiotensin II receptor blockers (ARBs).
Hormone therapy
  • Talk to your doctor about your risks with hormone therapy. And carefully weigh the benefits against the risks of taking it. If you need relief for symptoms of menopause, hormone therapy is one choice you can think about. But there are other types of treatment for problems like hot flashes and sleep problems. For more information, see the topic Menopause and Perimenopause.

What are symptoms of coronary artery disease and heart attack?

Knowing symptoms of a heart attack can help save lives. So even if you're not sure that your symptoms are from a heart attack, do not delay seeking care. Do not wait more than 5 minutes to call 911 if you think you or someone else is having a heart attack.

Women are more likely than men to delay seeking help for a possible heart attack. Women delay for many reasons, like not being sure it is a heart attack, or not wanting to bother others. But it is better to be safe than sorry. If you have symptoms of a possible heart attack that last for 5 minutes, call 911 right away.

Angina symptoms. Angina (say "ANN-juh-nuh" or "ann-JY-nuh") is a type of chest pain or discomfort that occurs when there is not enough blood flow to the heart.

Pay attention to your symptoms, know what is typical for you, learn how to control it, and know when to call for help.

Symptoms of angina include chest pain or pressure, or a strange feeling in the chest. Some people feel pain, pressure, or a strange feeling in the back, neck, jaw, or upper belly, or in one or both shoulders or arms.

Stable angina occurs at predictable times and may continue without much change for years. It is relieved by rest or nitrates (nitroglycerin) and usually lasts less than 5 minutes. Unstable angina is a change in the usual pattern of angina. It means blood flow has slowed suddenly. It is an emergency. It is a warning sign that a heart attack may soon occur.

Heart attack symptoms:

  • Chest pain or pressure, or a strange feeling in the chest
  • Sweating
  • Shortness of breath
  • Nausea or vomiting
  • Pain, pressure, or a strange feeling in the back, neck, jaw, or upper belly, or in one or both shoulders or arms
  • Light-headedness or sudden weakness
  • A fast or irregular heartbeat

For men and women, the most common symptom is chest pain or pressure. But women are somewhat more likely than men to have other symptoms like shortness of breath, nausea, and back or jaw pain.

After you call 911, the operator may tell you to chew 1 adult-strength or 2 to 4 low-dose ASA. Wait for an ambulance. Do not try to drive yourself.

When you get to the hospital, do not be afraid to speak up for what you need. Be sure your doctors know that you think you might be having a heart attack so that you can get the tests and care you need.

Other Places To Get Help

Organizations

Canadian Cardiovascular Society
222 Queen Street
Suite 1403
Ottawa, ON  K1P 5V9
Phone: 1-877-569-3407 toll-free
(613) 569-3407
Fax: (613) 569-6574
Web Address: www.ccs.ca
 

The Canadian Cardiovascular Society works to advance the cardiovascular health and care of Canadians through leadership, research, and advocacy.


Heart and Stroke Foundation of Canada
222 Queen Street
Suite 1402
Ottawa, ON  K1P 5V9
Phone: (613) 569-4361
Fax: (613) 569-3278
Web Address: www.heartandstroke.ca
 

The Heart and Stroke Foundation of Canada works to improve the health of Canadians by preventing and reducing disability and death from heart disease and stroke through research, health promotion, and advocacy.


HeartHub for Patients
Web Address: www.hearthub.org
 

HeartHub for Patients is a website from the American Heart Association. It provides patient-focused information, tools, and resources about heart diseases and stroke. The site helps you understand and manage your health. It includes online tools that explain your risks and treatment options. The site includes articles, the latest news in health and research, videos, interactive tools, forums and community groups, and e-newsletters.

The website includes health centers that cover heart rhythm problems, cardiac rehabilitation, caregivers, cholesterol, diabetes, heart attack, heart failure, high blood pressure, peripheral artery disease, and stroke.

HeartHub for Patients also links to Heart360.org, another American Heart Association website. Heart360 is a tool that helps you send and receive medical information with your doctor. It also helps you monitor your health at home. It gives you access to tools to manage and monitor high blood pressure, diabetes, high cholesterol, physical activity, and nutrition.


U.S. National Heart, Lung, and Blood Institute (NHLBI)
P.O. Box 30105
Bethesda, MD  20824-0105
Phone: (301) 592-8573
Fax: (240) 629-3246
TDD: (240) 629-3255
Email: nhlbiinfo@nhlbi.nih.gov
Web Address: www.nhlbi.nih.gov
 

The U.S. National Heart, Lung, and Blood Institute (NHLBI) information center offers information and publications about preventing and treating:

  • Diseases affecting the heart and circulation, such as heart attacks, high cholesterol, high blood pressure, peripheral artery disease, and heart problems present at birth (congenital heart diseases).
  • Diseases that affect the lungs, such as asthma, chronic obstructive pulmonary disease (COPD), emphysema, sleep apnea, and pneumonia.
  • Diseases that affect the blood, such as anemia, hemochromatosis, hemophilia, thalassemia, and von Willebrand disease.

Women's Heart Foundation
Phone: (609) 771-9600
Fax: (609) 771-3778
Email: bonnie@womensheart.org
Web Address: www.womensheart.org
 

The Women's Heart Foundation provides education for women about preventing and treating heart disease. Information covers caregiving, exercise, nutrition, and medical and surgical treatments. The information focuses on the unique needs of women who have heart disease.


References

Citations

  1. Roger VL, et al. (2010). Heart disease and stroke statistics 2011 update: A report from the American Heart Association. Circulation. Published online Dec 15, 2010 (doi: 10.1161/CIR0b013e3182009701).
  2. Rossouw JE, et al. (2007). Postmenopausal hormone therapy and risk of cardiovascular disease by age and years since menopause. JAMA, 297(13): 1465–1477.
  3. U.S. Preventive Services Task Force (2009). Aspirin for the Prevention of Cardiovascular Disease. Rockville, MD: Agency for Healthcare Research and Quality. Available online: http://www.ahrq.gov/clinic/uspstf/uspsasmi.htm.

Other Works Consulted

  • Charney P (2008). Women and coronary artery disease. In V Fuster et al., eds., Hurst's The Heart, 12th ed., pp. 2275–2290. New York: McGraw-Hill Medical.
  • Hsia J, Manson JE (2007). Women and heart disease. In EJ Topol, ed., Textbook of Cardiovascular Medicine, 3rd ed., pp. 553–560. Philadelphia: Lippincott Williams and Wilkins.
  • Mosca L, et al. (2007). Evidence-based guidelines for cardiovascular disease prevention in women: 2007 update. Circulation, 115(11): 1481–1501.
  • Newby LK, Douglas PS (2008). Cardiovascular disease in women. In P Libby, ed., Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine, 8th ed., vol. 2, pp. 1955–1966. Philadelphia: Saunders Elsevier.
  • U.S. Preventive Services Task Force (2009). Aspirin for the Prevention of Cardiovascular Disease. Rockville, MD: Agency for Healthcare Research and Quality. Available online: http://www.ahrq.gov/clinic/uspstf/uspsasmi.htm.

Credits

By Healthwise Staff
Primary Medical Reviewer E. Gregory Thompson, MD - Internal Medicine
Primary Medical Reviewer Brian D. O'Brien, MD - Internal Medicine
Specialist Medical Reviewer John A. McPherson, MD, FACC, FSCAI - Cardiology
Last Revised July 29, 2011

This information does not replace the advice of a doctor. Healthwise, Incorporated disclaims any warranty or liability for your use of this information.