Women and Heart Disease

Heart disease is the leading killer of women in America. Each year, heart disease and related risk factors are missed in women. Symptoms of coronary artery disease and heart attack, for example, can be different in women than in men. Women are also less likely to receive optimal treatment for certain heart conditions.

If you’re like most women, you’re probably so busy taking care of everyone else, your own well-being and health tends to fall last. But you need to make your heart’s health a priority and encourage other women to do the same.

Even though heart disease tends to strike later in life, it can happen at any age. There are things about being a woman that can make you more prone to heart problems (for example, menopause and hormones).

Learn about your risk for heart disease and what makes it more likely. You can help protect your heart by adopting heart-healthy habits—for example, by exercising, eating right, getting enough rest, not smoking and paying attention to your health in general.

If you already have heart disease, you’re in good company—millions of women are living with some form of heart disease, and they can provide a wealth of advice, tips and information to help on your journey. Remember that prevention, early and accurate diagnosis, and treatment are critical.

Use this condition center to learn more about coronary artery disease in women, keep up with the latest research, and get tips to help you feel your best.

Questions to Ask Your Doctor

Talk with your health care team beyond the traditional cardiovascular risk factors. For example, if you developed diabetes or preeclampsia during any pregnancy, if you have an autoimmune disease or poor sleep patterns. You should take stock of your risk of heart disease at every age, and especially around the time of menopause.

Here are some other questions you can ask to learn more about CAD and what you can do.

What is my risk for heart disease? (Your provider can use a formula to assess your chance of developing heart disease.)
What are my blood pressure and cholesterol numbers? Have they changed over time? What do they mean for my heart health?
Do I need to lose weight?
Am I at risk for diabetes?
What tests are best for detecting blockages in women? To what extent are my arteries blocked or narrowed?
What treatments would you recommend for me?
Will I need a procedure or surgery to address my coronary artery blockages?
How often should I have an assessment of my risk of CAD or related issues?
How will we know if my condition is getting worse or progressing?
How much exercise should I get each week to protect my heart?
What is a heart-healthy eating plan for me?
What symptoms should I pay attention to and report?
How can I tell if I'm having a heart attack or chest pain (angina)?
What are the best medications for reducing my risk of heart disease?
Are there any supplements I should be taking to reduce my risk of heart disease?
Should I take an aspirin to lower my risk for heart disease or stroke?
Was I given the recommended medications that prevent another heart attack after my first heart attack?
Will I need to take all the medicine I was given after my heart attack for the rest of my life?

If you're a woman diagnosed with coronary artery disease, there are several key questions that you should ask your cardiologist during your next visit. These questions will ensure that you and your doctor have discussed your major risk factors so that you can become or stay as healthy as possible.

How common is coronary artery disease in women?
What are the risk factors for coronary artery disease in women?
What is atypical chest pain?
How can I distinguish cardiac chest pain from chest pain of a different source?
When should I seek medical attention if I think I have atypical chest pain?
How can women be screened for coronary artery disease?
Are there support groups and resources specifically for women?
How do I find a cardiologist who specializes in women's cardiovascular health?
What can I do to stop or reverse coronary artery disease?

Overview

When it comes to heart disease, men and women are not created equal. In whatever way you look at heart disease—the way it is best diagnosed, the symptoms, the risk factors that contribute to its progression, as well as treatments or their application—clear differences emerge based on whether you are a woman or a man. While efforts are underway to better understand sex differences in heart disease, today's research is just a start.

So, if you are a woman or care for one, listen up. Arming yourself with knowledge about your risk is important. Coronary heart disease is not just a "man's disease," and its effect on women tends to be riddled with misunderstandings. While deaths related to coronary artery disease—known as CAD for short—are declining overall, rates are increasing in young women. To put it into context, more women have died from heart disease than all cancers combined. All told, heart disease claims the lives of 1 out of 3 women in the U.S. each year. Yet, half of American women are still unaware that heart disease is their No. 1 killer.

So what is CAD, and how can you protect yourself and the women in your life? Read on, and share these tips.

What is Coronary Artery Disease?

Coronary artery disease is the most common type of heart disease. It develops when your coronary arteries, which act like fuel lines to supply blood and oxygen to the heart, become damaged or diseased. This often results when a waxy substance called plaque or atherosclerosis builds up in the walls of the arteries.

When your coronary arteries become narrowed or blocked, it means there is less blood flow to the heart; in some cases, plaque can rupture and blood flow is abruptly and completely blocked. CAD can lead to:

Chest pain (angina)
Heart attack
Heart failure
Heart rhythm problems

In women more often than men, these things can occur even without evidence of any obstructive coronary artery disease, which makes the diagnosis and treatment in women challenging.

Women are just as likely as men to develop CAD. In women, CAD usually develops seven to 10 years later in life compared with men. Menopause seems to kick off a host of risk factors including:

Weight gain, especially carrying excess fat around your waist or midsection
Diabetes, which is the strongest risk factor in women; in fact, studies suggest diabetes more than triples the risk of CAD in women, compared with doubling the risk for men
High blood pressure
Change in cholesterol profile (rise in LDL and triglycerides, fall in HDL)

Women tend to:

Have different and more subtle symptoms
Have no overt signs of blockages in the three major coronary arteries on tests, although blood flow to the heart muscle is reduced
Have blockages or dysfunction in smaller arteries (men are more likely to have plaque buildup in the large arteries around the heart)
Be treated less aggressively than men
Be less likely to dial 911

What Increases Your Risk

Most women—9 out of 10—have at least one risk factor for heart disease or stroke. The good news is 80% of heart disease and stroke can be prevented through lifestyle change.

Cardiologists say one of the best things you can do for your heart health is to understand your personal risk of developing heart disease. That means you should know:

What increases your risk for heart disease.
What you can do to lower your risk.

For women, it's especially important to talk with your health care provider about traditional risk factors linked to heart disease, as well as those that are specific to being a woman.

The usual suspects for heart disease include:

Smoking
Having high blood pressure, cholesterol or diabetes
Not exercising or sitting for long periods of time
Eating a diet high in salt, saturated fats, cholesterol and added sugars
Being overweight or obese
Family history of early heart disease
Older age

Diabetes, mental stress/depression, obesity and smoking tend to play a bigger role in the development of CAD in women compared with men.

Also, be certain to discuss risk factors that are unique to women. These conditions are known to up the likelihood of heart disease. For example:

Menopause — Heart disease can happen at any age, but it tends to increase in women around or after menopause.
Having started menstruating before 10 or after 17 years of age.
Gestational hypertension/preeclampsia — Any elevation in blood pressure increases the risk for heart disease in women.
Gestational diabetes during any pregnancy.
Preterm delivery (before 37 weeks of gestation).
Polycystic ovarian syndrome.

Women are also more likely to have less common conditions linked to CAD. These include:

Heart disease that affects the smaller arteries supplying the heart (microvascular): These are typically due to dysfunction of the arteries and not complete blockages. Standard tests aren't designed to diagnose microvascular endothelial dysfunction.
Spontaneous coronary artery dissection (SCAD).
Autoimmune diseases, such as lupus (SLE) or rheumatoid arthritis (RA).
Broken heart syndrome, also called Takotsubo Syndrome or stress cardiomyopathy: Despite the name, it can occur with good or bad emotional excitement.
Breast cancer: Although not exclusive to women, it certainly occurs more often in women. The chemotherapy and radiation for breast cancer can damage the heart, both acutely and in the future. Knowing your risk for heart disease and controlling risk factors is important after breast cancer. It is now more likely you will die from heart disease than breast cancer because the treatment for breast cancer has gotten so good. Having breast cancer should be considered as a risk factor for heart disease.Most women—9 out of 10—have at least one risk factor for heart disease or stroke. The good news is 80% of heart disease and stroke can be prevented through lifestyle change.

Signs and Symptoms

Heart disease often looks and feels very different in men and women.

Although many women will have the classic crushing chest pain, which is often thought of as the hallmark sign of a heart attack, at least one-third of women will have atypical symptoms or no symptoms at all. Tragically, heart attack or sudden cardiac death can be the first symptom of CAD in younger women.

This underscores the importance of always knowing your risk factors for heart disease—you won't know if you don't get checked. High blood pressure, for example, is often called a "silent killer" because it has no symptoms. In other words, the only way to know if your blood pressure is high—or becoming too high—is to check your blood pressure readings over time. Uncontrolled high blood pressure is a leading cause of heart attack and stroke.

What a Heart Attack Feels Like

Typical Symptoms	Women Often Feel
Chest pain or discomfort (fewer women than men feel this) Shortness of breath Arm, neck, jaw or back pain Cold sweat	Unusual or extreme tiredness Feeling dizzy or lightheaded Nausea or vomiting Upper body discomfort or indigestion (back pain, jaw pain without any chest pain or pressure) Palpitations Trouble sleeping Sudden anxiety or confusion

There are many ways CAD can be diagnosed.

Listen to Your Body

Every 90 seconds in the United States, a woman suffers a heart attack. Keep in mind that that sudden, crushing chest pain, or pressure or tightness aren't the only signs of a heart attack.

If you have a nagging feeling something is wrong, play it safe and call 911 right away. Let the health experts decide if you are having a heart attack. Treatment is most effective if it's given within one hour of a heart attack starting.

Preventing CAD

The choices you make every day play a large role in determining your risk for CAD and how quickly it might progress. Positive lifestyle changes are very important and can help to prevent CAD and delay its progression.

Treatment

There are a number of treatment options for CAD, including lifestyle changes, medications, surgery and/or medical procedures.

Lifestyle changes are the mainstay of therapy. Commit to putting your health first:

Make healthy food choices to eat more plant-based and less processed foods.
Lose weight if needed.
Quit smoking or don't start.
Reduce stress.
Get enough sleep.
Limit alcohol intake to one drink a day or less.
Know your blood pressure, cholesterol levels and find out if you have or are at risk for diabetes.

Women often are the ones juggling and taking care of everyone else first. By making these heart-healthy choices every day, you can help protect your heart and help those around you live healthier, too.

In addition to lifestyle changes, you many need:

Medicine. People who have or are at high risk for CAD are often advised to take one or more medications. Medicine can help the heart work better, lower blood pressure and cholesterol, manage symptoms including chest pain (angina) and/or prevent blood clots.
Coronary angioplasty and stenting (also called percutaneous coronary intervention). This procedure opens narrowed or blocked blood vessels that supply blood to the heart. A stent is a small, metal mesh tube that expands inside a coronary artery to keep it propped open. Angioplasty is a balloon procedure to open blocked arteries. Your doctor will decide which procedure is right for you based on your test results.
Heart surgery or coronary bypass grafting (CABG). Surgeons will open the chest to place grafts that restore blood flow to blocked or damaged arteries that supply the heart.
Cardiac rehabilitation. Cardiac rehab is a 12-week program that includes a mix of supervised exercise, nutrition counseling, stress management, assistance to quit smoking and education about the disease process, including how you can better take control of your health and improve outcomes. Studies show that people who attend cardiac rehab have fewer returns to the hospital and better quality of life.

Historically, treatments have been based on clinical studies that included mostly men. In fact, less than 25% of participants in heart-related studies have been women. The good news is that as research continues to evolve and include more women of all races and ethnicities, researchers are beginning to find diagnostic approaches and therapies that are better matched to women with CAD.

Make sure you are getting the best possible treatment.

If you have CAD or are at high risk for developing it, take the time to talk with your doctor about whether you are getting the guideline-indicated therapies. Women are less likely to get them. This includes aspirin and referrals to cardiologists as well as cardiac rehab.

Living With Heart Disease

Women are natural caretakers—whether it's as a mother, sister, daughter and/or partner. More often than not, women are so busy caring for everyone else that their own health and well-being slips to the bottom of the list. Sound familiar? If so, for your loved ones and your heart, commit to making you and your health a priority.

Take time to understand how likely you are to develop heart disease and what you can do to prevent it. This way, you'll be taking steps to be here and healthy for the people who mean the most to you.

"My advice to women is to do one good thing for your heart every day. Protect your heart by making healthy choices that are right for you." —Martha Gulati, MD, FACC

Tips for Staying Healthy

Take stock of your heart disease risk at every age. We change as we age, and so do our risk factors! If you are approaching menopause or have had a pregnancy with a preterm delivery, gestational hypertension/preeclampsia or gestational diabetes, ask how these events can affect your chance of having heart problems in the future.
Schedule routine health checkups and mark the dates on your calendar. Important numbers are measured at these visits: your weight, body mass index (BMI), waist measurement, blood pressure, blood sugar and cholesterol levels.
Know and keep tabs on your numbers. Keep a notepad or use an app to track your numbers over time. For example, do you know your blood sugar, blood pressure, blood cholesterol levels and weight? Are they under control or within a healthy range?
Start or step up your exercise program. Aim to get 30-45 minutes of exercise most days. Pick activities that get your heart pumping and that you enjoy. Walking, riding a bike, swimming—even gardening or heavy housework—count. Talk with your health care provider about what exercise routine is best for you.
Maintain a healthy weight. Ask your provider what that number is, and pay attention to the fat around your waist. Women with more of an apple-shaped body and too much fat around their waists appear to be at higher risk of serious heart issues. Know your BMI and waist circumference.
Eat a healthy diet. Make healthy food choices every day. Learn which foods have hidden fats, empty calories and added sugars. The Mediterranean and the DASH diets are two examples of heart-healthy plans.
Quit or don't start smoking. Ask your doctor for information to help you quit smoking.
Reduce your stress. Too much stress can affect your health, so it's important to figure out ways to cope with stress. Find time for yourself and to connect with what's important to you. Listen to your favorite music, meditate, try out a fun exercise or yoga class, or go for a walk with a friend. If you feel overwhelmed at work or home, ask for help and only say "yes" to what you can handle.
Get enough sleep. Insufficient sleep is bad for the heart—not to mention for your overall health. Not getting enough quality shuteye is linked to a higher risk of high blood pressure. A good rule of thumb for adults is to clock at least seven hours of restful sleep a night. Talk with your health care provider about sleep habits, especially if you often wake up feeling unrested.
Limit alcohol to one drink a day or less. Too much alcohol can lead to weight gain, raise your blood pressure and disrupt how your heart beats.
Listen to your body. If you have a feeling that something is wrong, get it checked out. If you think you are having a heart attack, call 911. Early diagnosis and treatment are critical, and may even save your life!

Pregnancy Complications May Signal Future Heart Troubles

In many ways, pregnancy can be seen as nature's stress test on the heart. Why? As soon as a woman becomes pregnant, a cascade of changes begins in the body, including a dramatic rise in blood flow and extra workload on the heart. These are all healthy and normal parts of helping to nourish the growing baby, and most moms-to-be won't have any heart troubles during pregnancy.

But for a growing number of women, pregnancy may bring about new, often temporary spikes in blood pressure (gestational hypertension or preeclampsia ) or blood sugar levels (gestational diabetes). These conditions typically go away soon after childbirth. But having them at all has been linked to a greater risk of developing heart disease later in life.

For example, having had preeclampsia doubles the risk of having a future heart attack or stroke and quadruples the risk of high blood pressure, according to experts. In addition, it seems preterm birth (having a baby before 37 weeks of pregnancy) regardless of the reason may also be a red flag for future heart issues and stroke.

Take Charge of Your Health

If you've had high blood pressure—including gestational hypertension or preeclampsia—gestational diabetes, or delivered a baby earlier than 37 weeks, listen up. Although these conditions often disappear after having a baby, simply experiencing them puts you at much greater risk of heart disease or stroke in the next 10 years.

Make sure your health and heart are protected.
Let your health care providers know if you developed any of these conditions during pregnancy, and encourage other women to do so, too.
Learn about your risk of heart disease and stroke now and in the future.

In this article, we will briefly review each of these conditions and what you can do, including questions to ask your health care team.

Why Does the Heart Work Harder During Pregnancy?

A host of changes occur when you are pregnant. For example:

The amount or volume of blood in your body increases about 50%.
Your heart begins to pump a lot more blood out to the body each minute (increased cardiac output).
Your heart rate quickens—usually by 10-15 beats per minute.
Your blood pressure drops a bit due to changes in hormones.

Because of all these changes—and a growing baby—you may tire more easily or feel short of breath or lightheaded when doing things that require physical effort or when talking.

In addition, hormonal and metabolic changes affect how blood sugar levels are regulated. Changes in how your body forms clots needed to prevent excessive bleeding after delivery make pregnant women more prone to develop blood clots in the legs (called deep vein thrombosis).

Red Flags for Future Heart Problems

For some women, pregnancy can lead to (mostly temporary) complications that may make heart disease or stroke more likely down the line. These conditions are sometimes called "adverse pregnancy outcomes."

Researchers don't yet know whether pregnancy causes these issues or if a woman's predisposition to heart problems first shows itself during pregnancy. But more awareness and action is needed to better meet the health needs of women with these conditions. Many experts suggest these women should be screened for cardiovascular disease over time and given tips on heart-healthy living.

"Because these conditions disappear after pregnancy, they can be quickly forgotten. Often no one talks about or follows up on a woman's increased and ongoing cardiovascular risk." — Martha Gulati, MD, FACC

High Blood Pressure and Preeclampsia

What it is: Preeclampsia occurs when a pregnant woman develops high blood pressure and protein in the urine after the 20th week of pregnancy. A urine sample is taken at most obstetrician visits to check for this condition. It affects up to 8% of all pregnancies and usually occurs in mid-to-late pregnancy and up to six weeks after delivery.

Some women get high blood pressure for the first time during pregnancy without protein in the urine (also called gestational hypertension), which alone is concerning and can complicate pregnancy. It also can lead to preeclampsia.

In particular, preeclampsia may be characterized by:

Blood pressure of 140 mmHg/90 mmHg or greater
Protein in the urine
Swollen feet, legs, fingers and hands

Symptoms of severe preeclampsia may include headache, changes in vision, stomach pain, nausea or vomiting.

Why the concern: Preeclampsia can be very dangerous—and sometimes even life-threatening—for mom and her unborn baby. It can lead to seizures (eclampsia), damage to the liver and blood cells (HELLP syndrome), stroke and early birth. If you have preeclampsia, your health care team will monitor you closely and will induce labor at 37 weeks to prevent further problems.

But even after preeclampsia goes away—often within weeks to a few months after having a baby—women who've had it are more likely to develop heart and vascular problems, including:

Risk factors such as high blood pressure and diabetes
Heart disease
Stroke

And this risk remains over time. One study showed that compared with women with normal blood pressure readings during pregnancy, those who developed preeclampsia had a higher risk of high blood pressure over the next four decades.

What you can do:

If you had high blood pressure or preeclampsia during pregnancy, make sure this information is added to your health records for follow-up.
Also, tell all your doctors that this problem occurred.
Talk with your provider about your risk for heart disease.
Advocate for yourself and commit to a heart-healthy lifestyle.
Remember: You are more likely to develop preeclampsia again with future pregnancies, so talk with your doctor.

Half of women who had preeclampsia did not receive any additional information or follow-up after three months of delivering a baby.

Gestational Diabetes

What it is: A form of diabetes in which the body doesn't produce enough insulin to control blood sugar during pregnancy. As a result, women have higher than normal blood sugar (glucose) levels.

Gestational diabetes, which affects 7%-9 % of pregnancies, usually starts around the 24th week of pregnancy, which is why a blood sugar test is often done between 24 and 28 weeks of pregnancy. If you develop diabetes during pregnancy, careful blood sugar monitoring, diet, exercise and taking insulin, if needed, are important.

Why the concern: In most cases, this type of diabetes goes away soon after childbirth. But having it heightens your risk for type 2 diabetes later. In fact, half of all women who had pregnancy-related diabetes will develop type 2 diabetes, according to the Centers for Disease Control and Prevention.

Diabetes at any age makes heart disease more likely. Experts say that even if you don't develop diabetes at some point after your delivery, a history of gestational diabetes still puts you at risk of heart disease. It can also damage some organs (for example, your heart, kidneys, nerves or eyes) by causing changes to the blood vessels that supply them. Yet most women are not followed for this condition after pregnancy.

What you can do:

Make sure all your doctors know that you had diabetes during pregnancy and that it is noted in your health history.
The American Diabetes Association recommends testing again for diabetes at 6-12 weeks postpartum; if your blood sugar level is normal, remind your doctor to check your blood sugar every one to three years to ensure it is detected early.
Talk with your care team about ways to prevent or delay the onset of type 2 diabetes through exercise, eating a healthy diet and taking medications, if needed.
Ask about other heart disease risk factors and how to prevent or manage them.

Only 1 in 5 women who had gestational diabetes were tested again within six months of pregnancy to find out if they had diabetes, according to a study. Ask to have your blood sugar level re-checked.

Preterm Birth

What it is: When a baby is born too early, before 37 weeks of pregnancy (about three weeks before a baby's expected due date). Preterm births affect about 1 out of 10 pregnancies in the U.S.

Why the concern: Research has linked early deliveries to a higher risk of cardiovascular disease, cardiac events and related hospitalizations in moms. In fact, a recent review of existing studies found that preterm birth is associated with up to a 2-fold higher chance of developing or dying from heart disease or stroke later in life. The risk of heart and vascular diseases appears to be even greater among women who:

Deliver before 32 weeks of pregnancy
Have had more than one preterm birth
Have a preterm birth due to a medical cause (not an early delivery that happens on its own)

What you can do:

Tell your primary care doctor and other health care providers that you had a preterm birth. This information should be part of your ongoing health history long after the baby arrives.
Ask about doing a formal heart disease risk assessment
Work together to decide when and how often you need to be followed.
Live heart healthy by exercising daily, eating right, not smoking, managing stress, and knowing your cholesterol and blood pressure numbers.

8 Steps for Taking Care of You

If you or a loved one had preeclampsia or diabetes during pregnancy or a preterm birth, don't despair. You can take steps to protect your heart and overall health post-pregnancy. Start with knowing your increased risk for cardiovascular issues and reminding your doctors about your health history.

Stay positive and live a heart-healthy lifestyle:

Adopt a healthy eating plan
Get regular exercise
After your pregnancy, reach and maintain a healthy body weight
Avoid smoking
Limit how much alcohol you drink
Get enough sleep
Manage stress

Know and keep up with your risk for heart disease and stroke; remember to talk with your health care team if you had problems during pregnancy—even if they have gone away. You can work together to come up with a plan to track and manage your risk over time.

Questions to Ask

It's important to talk with your OB/GYN and, even more important, your primary care doctor who will care for you for many years to come after you're done having children. Here are some questions to help start and continue the conversation:

How can [preeclampsia, gestational diabetes, having a baby early] affect my general heart health?
I've heard [preeclampsia, gestational diabetes, having a baby early] has been linked to heart problems down the line. What is my personal, 10-year risk of developing heart disease or having a stroke?
I can't control my pregnancy-related health history, but what things can I do to lower the chances that I will develop heart disease or stroke?
What are my heart numbers (for example, cholesterol, blood pressure and blood sugar levels)?
What can I do to reduce the chance of having [preeclampsia, gestational diabetes, a preterm birth] in my next pregnancy?
Might having [preeclampsia, gestational diabetes or a preterm birth] be a signal of larger heart issues that we aren't aware of?
I know exercise and better eating can go a long way to protecting my heart health. Are there resources to help me get started?
At what point would you suggest that I consult a cardiologist?

Resources to Help

In addition to resources on CardioSmart.org, you can learn more about acquired heart risks in pregnancy at the following websites:

American Diabetes Association
www.diabetes.org
search 'gestational diabetes'

American Pregnancy Association
www.americanpregnancy.org

March of Dimes
www.marchofdimes.org

Medline Plus - U.S. Library of Medicine
https://medlineplus.org
search 'preeclampsia', 'gestational diabetes' or 'preterm or premature birth'

Preeclampsia Foundation
www.preeclampsia.org

Setting the Record Straight on Women and Heart Disease

We assume a lot about our heart health. When we're young, it's easy to pass heart disease off as something that afflicts only older generations. But it's not always so. In fact, heart disease is becoming more common at younger ages due, in part, to climbing rates of diabetes and obesity. We know women with diabetes develop heart disease at younger ages. And all women have a higher chance of heart problems after menopause.

Heart disease is the No. 1 killer of men and women in the United States. Yet, many misunderstandings remain about how heart disease affects women. Learning about heart disease is one of the best ways women can protect their hearts. All told, 80% of heart disease and stroke events could be prevented through lifestyle changes. But women, in particular, are largely unaware of their personal risk or chance of getting heart disease.

If you are a woman or care for one, keep these points in mind:

Heart disease is NOT only a man's disease.

Coronary heart disease affects women and men alike, and women tend to have worse outcomes. For example, more women die of coronary artery disease than men and fewer women will survive a first heart attack. Women surviving a heart attack also tend to have longer hospital stays and higher risk of death while in the hospital.

Heart disease, not breast cancer, is the No. 1 killer of women.

On average, 1 in 3 women will develop heart disease at some point in their lifetime compared with 1 in 8 who will get breast cancer.

It can happen at any age.

While coronary heart disease is more likely to develop as we age, it also strikes younger women. For example, heart disease can happen in young women who have:

Pregnancy-related complications such as spontaneous coronary artery dissection (SCAD), a sudden tear in one of the heart's blood vessels
Coronary vasospasm, an abrupt tightening and narrowing of the heart's arteries
Premature narrowing of the heart's arteries (atherosclerosis)
Familial hypercholesterolemia, a disorder passed down in families that causes dangerously high levels of LDL or "bad" cholesterol

You may not be as heart-healthy as you think.

Most women—a full 90%—have one or more risk factors for heart disease or stroke.

The good news is that many of these risk factors—high cholesterol, high blood pressure, being overweight, or smoking, for example—are modifiable. That means you can take steps to reduce your risk, such as giving up smoking, maintaining a healthy weight, finding ways to fit more activity into your life, and eating more fruit, vegetables and fish. There are also risk factors that affect only women.

Heart disease can look very different in men and women.

Men are more likely to develop the "classic" narrowing or blockage in the coronary arteries, the blood vessels that supply blood to the heart itself, which can be detected with standard testing. But women may not have the classic, obstructive blockages typically seen in men, yet they still have reduced blood flow to the heart or suffer a heart attack.

For a long time, when no obstructive lesion was seen, these women were told there was nothing wrong with their hearts. But we now know from research that this is not the case.

Symptoms of a heart attack can be and feel different, too.

For some women, the first sign of heart disease is a heart attack, heart failure or a problem with how the heart beats. Because coronary artery disease can be silent or subtle, knowing your risk factors now and as you get older is critical.

Not all treatments are equally given.

While there have been major advances in treating heart disease, women are less likely than men to receive potentially life-saving treatments.

Women are less likely to receive early aspirin, beta blockers and other guideline-recommended therapies. They are less likely to undergo reperfusion and other treatments, and less likely to be offered preventive advice about how to make heart-healthy lifestyle changes. Interventions, including stenting or bypass surgery, tend not to be used as aggressively in women. After a heart attack, women are also less likely to take part in cardiac rehabilitation, which can improve overall health, and prevent deaths and repeat heart attacks.

Resources

To learn more about coronary artery disease, visit CardioSmart's CAD condition center. In addition to the resources on CardioSmart.org, you can find out more about heart disease in women at:

WomenHeart
www.womenheart.org

The American Heart Association – Go Red for Women
www.goredforwomen.org

National Lung, Blood and Heart Institute
www.nhlbi.nih.gov/health/educational/hearttruth/lower-risk

U.S. National Library of Medicine
www.medlineplus.com
Search "coronary artery or heart disease and women"

WISEWOMEN
https://www.cdc.gov/wisewoman

Source: https://www.cardiosmart.org/topics/women-and-heart-disease