Strong Heart and Vascular Center
Women and Heart Health
The Heart Does Not Discriminate
by Thomas Rocco ]r., M.D., F.A.C.C.
Chief of Cardiology, Highland Hospital
Diseases that affect the heart and blood vessels (cardiovascular/vascular disease) do not discriminate. Contrary to popular belief, they affect men and women in nearly equal numbers.
Many people believe that men are more prone to heart attacks and heart problems, and that women are spared this disease. It is true that women are relatively protected in their younger years. In general, women begin to exhibit the symptoms and signs of heart disease about 10 years later in life than men. But even though the risk of heart disease increases with age in both men and women, this increase is far more dramatic in women.
Women are appropriately concerned about breast and uterine cancer. Though in truth, the incidence and impact of heart disease in women is much greater. The latest estimates are that one in 10 women ages 45 to 65 years has some form of heart disease, and that the ratio increases to one in four women older than age 65. In fact, cardiovascular (heart) disease is the leading cause of death and disability in women in the U.S.
The risk factors for coronary heart disease are universal, and do not differentiate between men and women. These include:
- Cigarette smoking
- Diabetes
- High blood pressure
- High levels of bad cholesterol (LDL) / low levels of good cholesterol (HDL)
- Family history of heart disease
- Physical inactivity
- Obesity
Risk factors are habits and/or traits that increase a person's risk of developing a disease. Some are inherited/genetic traits that (as yet) are not modifiable. Many, though, are able to be modified. Modifying cardiac risk factors is a means of taking control of one's health status, and decreasing the risk of cardiovascular disease, while increasing one's overall sense of well-being.
For example, it is estimated that cigarette smoking is associated with half of all coronary events in women. In a large, population-based study, the incidence of heart attacks was increased six-fold in women who smoked, compared to nonsmokers. In addition, The Nurses' Health Study supported a strong causal relationship between cigarette smoking and stroke among young and middle-aged women. Despite these, and other, ominous findings, smoking rates are declining less for women than for men in the U.S.
Diabetes also is a particularly powerful risk factor in women, increasing the risk of coronary heart disease up to seven-fold. Cardiovascular disease is a major complication, and the leading cause of premature death among people with diabetes. Obesity, and associated diabetes, is becoming epidemic in our society. Diabetics also commonly have coexisting heart disease risk factors, such as high blood pressure, high cholesterol, and physical inactivity.
In the face of this mounting evidence, what can the average person do? Part of the answer lies in the old adage "an ounce of prevention." Partner with your health care provider to assess your risk factors. This only requires a directed history, physical, and some simple blood tests. Then, based on the results, embark on a plan to modify your health behaviors, and therefore reduce your personal risk. This is especially important if you are found to be at significant risk for heart disease.
As simple a plan as increasing your activity can have a dramatic effect. A recent article in the Journal of the American Medical Association confirmed that physically active women have lower coronary heart disease rates than inactive women. The study found that even light to moderate activity-as little as one hour of walking per week-is associated with lower rates of heart disease (even in women with other heart risk factors). Strenuous activities were not necessary to attain this benefit. Other benefits associated with regular aerobic physical activity include the following:
- Decreases risk of developing diabetes and high blood pressure
- Promotes well-being by improving mood, and reducing anxiety/tension
- Helps control weight and reduce body fat. Helps maintain healthy bones, muscles, and joints
- Helps reduce blood pressure in those with high blood pressure
- Helps manage diabetes, particularly in diabetics who are overweight
This is only one example of risk-factor modification. Health care providers are continuing to partner to educate women about their risks of heart disease, and how relatively simple lifestyle changes can reduce their chances of developing heart disease. The growing field of women's health and gender-based biology will promote the health and well-being of women in the new millennium.