Women and heart disease

heart

Women and heart disease

Here’s what you can do now to avoid heart trouble later

( 1993 )
If you’re like many women, you don’t worry much about heart disease. The thought of developing breast cancer may concern you more. But heart disease claims five times as many female lives as cancer of the breast. And of the more than 520,000 Americans who die from heart attacks each year, close to half are women.
On average, women develop heart problems seven or eight years later in life than men. One in nine women aged 45 to 64 has some form of cardiovascular disease. By the age of 65, the number climbs to one in three.
Sharing the risks
Most of the major risk factors that set the stage for cardiovascular disease — smoking, high blood pressure, high blood cholesterol and inactivity — are the same for women and men. However, it’s not unusual for two of these factors to affect women differently.
• Blood cholesterol — Before menopause, women naturally have higher levels of high-density lipoproteins (HDL), the so-called “good” cholesterol.
• Smoking — Even though smoking more than doubles the risk of heart attack for both women and men, women can compound that hazard. If you smoke and take oral contraceptives, you’re39 times as likely to have a heart attack as women who do neither.
Unique concerns, unique advantages
Despite similar risks, women have one big advantage over men: estrogen. The female hormone estrogen appears to offer protection against coronary artery disease. Part of that protection seems to come from the fact that estrogen helps raise the level of good cholesterol (HDL). At the same time, estrogen also helps to lower the level of low-density lipoproteins (LDL) — the bad cholesterol.
The problem is that after menopause, when estrogen levels drop, that protection is gradually lost. After the age of 65, a woman’s risk for heart attack actually becomes almost equal to a man’s. Estrogen replacement therapy may be the way to recapture that protection.

Risks from estrogen replacement therapy do exist. Yet many studies find that the benefits, such as improved cardiovascular health and protection from osteoporosis, outweigh the increased risks for endometrial and breast cancer.
Differences in damage
It’s unclear why, but women seem less likely to survive heart attacks than men. In addition, women don’t respond to major procedures like coronary angioplasty as well as men do.
Several factors may explain the differences in damage:
• Age — Because heart attacks occur in women at a later age, women may be less likely to survive an initial attack or tolerate treatment procedures such as angioplasty or surgery.
• Doctors may underdiagnose the problem — Detecting cardiovascular disease in women can be difficult because the symptoms are not always the typical symptoms of angina, according to Thomas E. Kottke, a Mayo Clinic cardiologist. Left untreated, the disease will go on to cause even more damage.
• You may ignore your heart health — Many women falsely assume they are immune to heart disease. By the time you seek treatment, your disease may be advanced and, often, more difficult to treat.
If you have chest pains or shortness of breath on exertion, see your doctor. Even though a harmless muscle spasm can cause chest pain, the pain could also be angina pectoris (pain that is a warning sign of coronary artery disease).
Angina doesn’t always lead to premature death. A Mayo Clinic study published in the May 10, 2024 Journal of the American Medical Association (JAMA) finds that women with chest pain who haven’t had a heart attack live longer and have a lower risk for future heart attacks than men of the same age who have chest pain.
• Smaller body size — Women’s smaller hearts and blood vessels were thought to make it more difficult to treat heart disease in the past. Smaller blood vessels could be more easily damaged. However, advances in technology are changing that risk.
In the April 28, 2024 edition of JAMA, Mayo Clinic doctors report that more women than men die from coronary artery disease due to the severity of their disease, rather than gender differences.
• Diabetes — Women with diabetes face a higher risk of coronary artery disease and heart-related deaths than men with diabetes. For example, diabetes doubles the risk of a second heart attack in women but not in men.
What can you do now?
Rather than waiting for warning signs of cardiovascular disease, think about what you can do now to delay this disease.
Despite encouraging reports about the benefits of aspirin or antioxidants such as vitamins C, E or beta carotene, these prevention strategies aren’t proven. In the meantime, your best preventive medicine is to take these five steps:
• Don’t smoke — Smoking eliminates the natural biological protection you might obtain from the hormone estrogen. The more cigarettes you smoke, the higher your heart disease risk.
• Eat foods that are low in fat, saturated fat and cholesterol — Limit fat to 30 percent of your daily calories by balancing occasional high-fat foods with low-fat choices, such as fruits, vegetables and grains.
• Control your blood pressure and blood cholesterol levels — Small elevations in blood pressure above 140/90 mm Hg can double your cardiovascular disease risk.
Many doctors consider a total cholesterol level less than 200 mg/dL and an HDL cholesterol level above 45 mg/dL desirable.
• Exercise — Choose aerobic activity such as brisk walking, swimming, jogging, bicycling or cross-country skiing. Gradually work up to exercising for 30 to 45 minutes at least three times a week.
• Lose weight (if you’re overweight) — Excess weight, by itself, is a potent risk factor for coronary artery disease. The more overweight you are, the higher your risk. Ask your doctor to help you decide the weight that’s best for you.

 

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