Heart and Cardiovascular Disease

Do women really need to worry about heart disease?

What is the difference between heart disease and cardiovascular disease?

Is heart disease really the number one cause of death for post-reproductive age women?

What factors increase my chances for heart disease?

How can I reduce my risk for cardiovascular disease?

How much difference can diet and exercise REALLY make on the health of my heart and cardiovascular system?

How does high blood cholesterol affect your risk for heart disease?

I had my cholesterol (or lipid levels) checked but I do not understand the results. What do they mean?

How do I know if I have heart disease? Are there any tests?

I read that women show different signs than men do before a heart attack. What can I do to make sure the emergency room treats me correctly?

I have a friend who is 38 years old. She has irregular or "extra" heartbeats. Her health care provider said that a woman's system changes as she enters menopause and can result in these heartbeats. Are they dangerous? Does this have anything to do with menopause?

What is an arrhythmia? Can you have a heart arrhythmia without having heart disease?

Is it safe to take an aspirin a day to prevent heart disease?

Do birth control pills and hormone replacement therapy (HRT) increase a woman's risk for heart disease?
 

     Also See:

                   High Blood Cholesterol
                   Diabetes
                   Menopause

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Do women really need to worry about heart disease?

Many women think heart disease is a man’s problem. But heart disease is very much a woman’s problem – it is the #1 killer of American women. Increasing age is a factor in heart disease and with people age 65 and over being the fastest growing group in the U.S., heart disease is becoming a growing problem for women.

Heart disease affects women of all racial and ethnic groups, as well as women with other illnesses, such as diabetes. Black women are more likely to die of heart disease than white women.

What is the difference between heart disease and cardiovascular disease?

Heart disease refers to diseases only of the heart and the blood vessel system within the heart. Cardiovascular disease refers to diseases of the heart AND diseases of the blood vessel system within a person’s entire body (such as the brain, legs, and lungs). "Cardio" refers to the heart and "vascular" refers to the blood vessel system. The heart is a strong, muscular pump slightly larger than your fist. It pumps blood continuously through the circulatory system, the network of elastic tubes that allows blood to flow throughout your body. The circulatory system includes two major organs, the heart and lungs, and blood vessels (arteries, capillaries, and veins). Arteries and capillaries carry oxygen- and nutrient-rich blood to all parts of the body. Veins carry oxygen- and nutrient-depleted blood back to the heart and lungs. Heart and blood vessel problems do not happen quickly. Over time, the arteries that bring blood to the heart and brain can become blocked from a buildup of cells, fat, and cholesterol (called plaque). Blockages in the arteries or blood clots can cause a person to have a heart attack or a stroke.

There are many forms of cardiovascular disease and heart disease, and the National Women’s Health Information Center (NWHIC) has provided links at the end of this FAQ for further information. We highlight common cardiovascular diseases here.

Common cardiovascular diseases include:

• Atherosclerosis - Atherosclerosis is a type of arteriosclerosis (or thickening and hardening of the arteries). As we age, some hardening of the arteries can occur naturally. When a person has atherosclerosis, the inner walls of the arteries become narrower due to a buildup of plaque. Plaque results from deposits of fat, cholesterol, and other substances. Blood clots form, blocking blood flow, which can lead to heart attacks and strokes. High blood cholesterol, smoking, high blood pressure, diabetes, obesity, and not being physically active all put you at greater risk for atherosclerosis.

• Coronary heart disease (or coronary artery disease) - Coronary heart disease, the most common form of heart disease, affects the blood vessels (or coronary arteries) of the heart. It causes angina (chest pain) and heart attacks. Women over the age of 40 are more at risk for this disease because heart-related problems tend to increase with age. And, Black women are more likely to die of coronary heart disease than are White women. The good news is that you can do something about preventing this disease. High blood pressure and cholesterol, smoking, obesity, and not being physically active all put you at greater risk for coronary heart disease.

• Angina is a pain or discomfort in the chest that happens when some part of the heart does not receive enough blood. It feels like a pressing or squeezing pain, often in the chest under the breastbone, but sometimes in the shoulders, arms, neck, shoulder, jaw, or back. The most common trigger for angina is physical exertion. Other triggers can be emotional stress, extreme cold or heat, alcohol, and smoking. Angina seldom causes permanent damage to the heart, like a heart attack can. A heart attack happens when the blood flow to a part of the heart is suddenly and permanently cut off.

• Stroke - Lack of blood flow to the brain, from blood clots or broken blood vessels, causes a stroke. In some cases, bleeding in the brain can also cause a stroke. Without a good blood supply, brain cells cannot get enough oxygen and begin to die. You can also have what are sometimes called "mini strokes," or transient ischemic attacks (TIAs), where no damage is done to the brain. TIAs are serious and can put you at higher risk of having a full stroke. Not controlling high blood pressure, smoking, and diabetes all increase your risk for stroke.

• High blood pressure (or hypertension) - There are ways to measure blood pressure and medications to treat high blood pressure (by lowering it). A blood pressure reading measures the force of blood pumped from the heart against the walls of your blood vessels. It is recorded as two numbers: a top number of systolic pressure, or the pressure of blood in the vessels as the heart beats; and a bottom number of diastolic pressure, or the pressure of the blood between heart beats (when the heart rests). Although the average blood pressure reading for adults is 120/80, a slightly higher or lower reading (for either number) may not be a problem. High blood pressure is diagnosed when the reading consistently exceeds 140/90. It is often called a "silent" killer because many people with high blood pressure do not know they have it. High blood pressure can cause heart failure in women, and can also lead to stroke, kidney failure, and other health problems. More than half of all women over age 55 suffer from this serious condition. And, it is more common and more severe in African American women. Talk to your health care provider and get your blood pressure monitored regularly. If you have high blood pressure, diet, exercise, and medicine can help you to lower and control your blood pressure.

• Heart failure - Heart failure means that the heart is not able to pump blood through the body as well as it should. It does NOT mean that the heart literally stops. Heart failure develops slowly over time and can have a large impact on a person’s life and ability to perform daily activities of living, such as dressing, bathing, and getting around.
  
  Congestive heart failure is a term often used to describe heart failure. But congestion, or the buildup of fluid, is only one symptom of heart failure and does not occur in all people who have heart failure. There are two main categories of heart failure – systolic and diastolic - and within each category, symptoms can differ from person to person. Systolic heart failure happens when the heart’s ability to pump blood decreases. The heart cannot push enough blood into the circulatory system, causing blood coming into the heart from the lungs to back up and leak fluid into the lungs (called pulmonary congestion). Diastolic heart failure occurs when the heart has trouble relaxing or resting. The heart muscle becomes stiff and cannot fill with blood, causing fluid to buildup (most often in the feet, ankles, and legs) and lung congestion. Talk with your health care provider right away if you have any of the signs of heart failure. There are drugs to treat heart failure. Having a healthy diet and getting regular exercise can lower your risk for heart failure.

Is heart disease really the number one cause of death for post-reproductive age women?

Heart disease is the number one cause of death for both women and men in the United States. Stroke is the third leading cause of death for American women (cancer is number two). Almost twice as many women die from cardiovascular diseases than from all forms of cancer combined. Men have heart attacks and strokes more often then do women. But, the death rate for women from cardiovascular disease is higher. As women age, particularly after menopause, they become more at risk for cardiovascular disease. Lower levels of estrogen during and after menopause are thought to increase a woman’s risk for cardiovascular disease. Early menopause, natural or surgical, can double a woman’s risk for developing coronary heart disease. Younger women are also at risk for cardiovascular disease if they smoke or have high blood pressure, diabetes, high cholesterol levels, and a family history of cardiovascular disease at young ages. Women with congenital heart disease (born with a heart defect) have a higher risk of having a baby with a heart defect.

What factors increase my chances for heart disease?

Many factors put a woman at risk for cardiovascular disease. The more risk factors a woman has, the greater the chance that she will have a heart attack or stroke. There are some factors that you can’t control such as getting older, family health history, and race. But you can do something about the three biggest risk factors for cardiovascular disease - cigarette smoking, high blood pressure, and high blood cholesterol. Stopping smoking will reduce your risk and you can get help, through support groups, special behavior change programs, and medication, to quit. High blood pressure and high blood cholesterol can be controlled through diet, exercise, and medication. Talk with your health care provider about developing a plan for cardiovascular health.

Studies have shown that physical inactivity adds to a person’s risk for getting cardiovascular disease. People who are not active are twice as likely to develop cardiovascular disease compared to those who are more active. Excess body weight in women is linked with coronary heart disease, stroke, congestive heart failure, and death from heart-related causes. The more overweight you are, the higher your risk for heart disease.

Diabetes, sometimes referred to as high blood sugar, is a serious condition that raises a woman’s risk for cardiovascular disease. Women with diabetes have a greater risk of heart disease and stroke than do women without diabetes. Diabetes, high blood pressure, high cholesterol, and obesity often go hand-in-hand, raising a person’s risk for heart disease. And, diabetes has been found to double the risk of a second heart attack in women but not in men.

Being around tobacco smoke for large amounts of time, or all the time, can increase a person’s risk for cardiovascular disease, even if you do not smoke. Today’s low-dose birth control pills carry a much lower risk of heart disease and stroke than the higher-dose earlier pills did. But this is not the case for women who smoke or have high blood pressure.

How can I reduce my risk for cardiovascular disease?

Regular physical activity can help you reduce your risk of cardiovascular disease. Being active helps women take off extra pounds, helps to control blood pressure, lessens a diabetic's need for insulin, and boosts the level of "good" cholesterol. Some studies show that being inactive increases the risk of heart attack. Other ways to reduce your risk include:

• Quit smoking

• Cut back on foods high in fat, saturated fat, and cholesterol

• Check blood pressure, cholesterol, and blood sugar levels and keep them under control.

• Exercise at least 30 minutes a day on most (if not all) days of the week

• Lose weight if you are overweight and keep at a healthy weight

•  Learn how to reduce and manage stress

How much difference can diet and exercise REALLY make on the health of my heart and cardiovascular system?

Having a low fat, low cholesterol diet and getting regular exercise are excellent health habits for all women to have. These good health habits will lower blood pressure and keep blood sugar and blood cholesterol levels healthy. Studies have shown that being physically active decreases the risk of cardiovascular disease, high blood pressure, and diabetes.

Women, along with most Americans, are becoming more and more inactive. About 60% of American women do not engage in the recommended amount of physical activity needed to maintain health. The Surgeon General recommends getting 30 minutes of moderate activity on most, and preferably all, days of the week to protect heart and overall health. This includes activities such as brisk walking, bicycling, and gardening. You do not have to do the activity for 30 minutes in a row; you can divide it into shorter periods of at least 10 minutes each. Women who have had heart attacks might worry about exercising after their recovery. Studies have shown that people who include regular physical activity in their lives after a heart attack, improve their chances of survival. If you have had a heart attack, talk with your health care provider about developing an exercise plan.

How does high blood cholesterol affect your risk for heart disease?

Almost 25 percent of American women have blood cholesterol levels high enough to put them at risk for heart disease. Cholesterol is a waxy substance found in all parts of the body. It makes cell membranes, some hormones, and Vitamin D. Cholesterol comes from two sources: your body and the food you eat. Your liver makes all the cholesterol your body needs. Eating too much cholesterol in animal foods like meats, whole milk dairy products, egg yolks, poultry, and fish can make your cholesterol go up.

Cholesterol travels through the blood in packages called lipoproteins. There are two different types of lipoproteins – low density lipoprotein (LDL) and high density lipoprotein (HDL). LDL is often called the "bad" type of cholesterol because it can cause buildup and blockage in the arteries that carry blood to your heart. HDL is known as "good" cholesterol because it helps remove cholesterol from the blood, preventing buildup and blockage in the arteries. The higher your cholesterol, the greater your risk for heart disease.

From the time women turn 20 years old, their blood cholesterol levels start to rise. From age 40, they rise sharply and increase until about age 60. Being overweight and physically inactive also can raise your level of bad (LDL) cholesterol and lower your level of good (HDL) cholesterol. Family history (genes) can also affect how your body makes and handles cholesterol. All women age 20 and over need to have their blood cholesterol checked. High blood cholesterol is an important risk factor for heart disease that you can help control with diet, exercise (which will increase HDL and lower LDL), and quitting smoking. In some cases, your health care provider might prescribe cholesterol-lowering medication.

I had my cholesterol (or lipid levels) checked but I do not understand the results. What do they mean?

Cholesterol levels are checked with a blood test that measures the amount of LDL ("bad" cholesterol or low density lipoprotein), HDL ("good" cholesterol or high density lipoprotein), and total cholesterol in your body.

• The best LDL levels are those less than 100. LDL levels between 100 and 129 are okay but a bit high, between 130 and 159 are borderline high, and 160 and above are high. High LDL levels can cause buildup and blockage in the arteries that carry blood to the heart.

• The lower the HDL level, the higher the heart disease risk. An HDL level less than 40 is a major risk factor for heart disease. An HDL level greater than 60 will protect the heart.

• Total cholesterol, the sum of all cholesterol in your blood, is best if less than 200, borderline-high if between 200-239, and high if 240 or above.

Talk with your health care provider about the results of your blood cholesterol test and what it means for your health and risk of heart disease. There are ways you can control your blood cholesterol including:

• getting your cholesterol checked, understanding what the numbers mean;

• controlling your weight;

• following a treatment program your health care provider prescribes (such as medication and cutting back on foods high in saturated fat and cholesterol);

•  exercising regularly;

•  quitting smoking.

How do I know if I have heart disease? Are there any tests?

Heart disease can often have no symptoms, which is why it is called a "silent" killer. But, there are some symptoms that can alert you to a possible problem. Chest or arm discomfort, especially while under stress or during activity, is a classic symptom of heart, and is a warning sign of a heart attack. Women or older people may also have fatigue (with no reason why), shortness of breath, dizziness, nausea, or abnormal heart beats (or palpitations).

Talk with your health care provider if you think you may be having any symptoms of heart disease. Your health care provider will first take a complete medical history and do a physical exam. There are many tests for heart disease. The choice of which (and how many) tests to perform depends on a person’s symptoms and history of heart problems. A health care provider will most often start with simple tests, which may lead to tests that are more complex. More than one test may be needed because each test gives different information. Tests can be either invasive or noninvasive. Invasive tests involve the insertion of needles, instruments, or fluids into the body; noninvasive tests do not.

I read that women show different signs than men do before a heart attack. What can I do to make sure the emergency room treats me correctly?

Learning what the signs and signals of heart attack are is important for all women. While most women know the "classic" signs of heart attack such as chest pain, shortness of breath, pain in the arm, and tightness in the chest, most do not know the less common signs women can have like nausea, sweating, fatigue, and dizziness.

Chest pain can also be due to something other than a heart attack, and needs to be carefully looked at by your health care provider. All chest pain must be taken seriously and women should not wait until it becomes severe to seek help. Some studies have shown that women who tell their health care providers about chest pain are not treated as aggressively as are men. Also, women may describe chest pain differently than men and be more likely to think it is due to something else (like indigestion, being tired). Women who are not satisfied with a health care provider’s evaluation of their chest discomfort need to seek another opinion.

If you think you are having a heart attack, call 911 right away or go to an

emergency room. Make sure you communicate all your symptoms to the emergency room (ER) team, along with your medical history. Notify your health care provider as soon as possible and be sure to see him or her to develop a follow-up plan. There are new blood tests being used in ERs to determine heart attack or malfunction, called the creatine kinase (CK) and CK enzyme (CK-MB) tests. Talk with your health care provider for more information about these types of blood tests.

I have a friend who is 38 years old. She has irregular or "extra" heartbeats. Her health care provider said that a woman's system changes as she enters menopause and can result in these heartbeats. Are they dangerous? Does this have anything to do with menopause?

"Extra" heartbeats, also called palpitations, or premature ventricular contractions (PVCs) happen when there is irritation in the lower part of the heart’s pumping chambers. PVCs interrupt the normal heart rhythm and cause an irregular beat that can feel like a "missed beat" or a "flip-flop" in the chest. This can be harmless or it may lead to problems that are more serious.

If a woman has palpitations and other symptoms such as dizziness or shortness of breath, she should tell her health care provider right away. The health care provider will take a complete medical history and perform a physical exam, and may order further tests to determine the cause of the palpitations. In some people, caffeinated products (coffee, candy bars), alcohol, and stress can cause palpitations. When a woman is in perimenopause (the time before menopause), changing hormone levels can also cause harmless palpitations.

As women age, particularly after menopause, they become more at risk for cardiovascular disease. Lower levels of estrogen during and after menopause are thought to contribute to increased risk for cardiovascular disease.

What is an arrhythmia? Can you have a heart arrhythmia without having heart disease?

Most people have felt their heart beat very fast, felt a fluttering in their chest, or noticed that their heart skipped a beat. Almost everyone has also felt dizzy, faint, or out of breath or had chest pains at one time or another. While these experiences of heart arrhythmias (a change in the regular beat of the heart) can create anxiety, they are, for most people, harmless. As adults age, they are more likely to get arrhythmias. Only a very small number of people have arrhythmias that are dangerous. Don’t panic if you have a few flutters or your heart races once in a while. If you have questions about your heart rhythm or symptoms, talk with your health care provider.

Is it safe to take an aspirin a day to prevent heart disease?

If you have already had a heart attack, aspirin helps to lower the risk of having another one. It also helps to keep arteries open in those who have had a heart bypass or other artery-opening procedure such as coronary angioplasty. But, because of its risks, aspirin is NOT approved by the Food and Drug Administration for preventing heart attacks in healthy people. It may even be harmful for some persons, especially those with no risk of heart disease. Talk to your health care provider about whether taking aspirin is right for you. Be sure not to confuse aspirin with other common pain relieving products such as acetaminophen (Tylenol), ibuprofen (Advil, Motrin), or naproxyn sodium (Aleve).

Do birth control pills and hormone replacement therapy (HRT) increase a woman’s risk for heart disease?

Birth control pills have little increased risk of heart disease for women who have not gone through menopause (when periods stop). But, they do pose heart disease risks for some women, especially in women with high blood pressure and in women who smoke.

Menopause may increase a woman’s risk for heart disease, due to lower levels of estrogen. Hormone replacement therapy (HRT) works by raising estrogen levels and reducing common symptoms of menopause such as hot flashes and night sweats. While HRT can reduce risk for heart disease after menopause, it also may increase the risk of other diseases, such as breast cancer.

Recent studies have shown that women who have gone through menopause and who have heart disease, may have a greater risk of another cardiac event (like heart attack) after starting HRT, at least in the short-term. For women who have had strokes, their risk for having another stroke goes up when they start taking HRT. Because of these research findings, the American Heart Association recommends that women should not be given HRT to prevent heart disease, and that women with heart disease or who have had a stroke should not start taking hormones.

If you are taking birth control pills or HRT, watch for signs of trouble, such as abnormal bleeding, breast lumps, shortness of breath, dizziness, severe headaches, pain in your calves or chest, and report them to your health care provider right away. Also have, at the least, a yearly exam. Talk with your health care provider about whether hormones are right for you.

from The Office On Women's Health - US Department of Health and Human Services

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