Heart Disease in Women: The Heart Does Not Discriminate
Published September 2009 / Reviewed April 2011
Contrary to popular belief, diseases that affect the heart and blood vessels (cardiovascular and vascular disease) affect men and women in nearly equal numbers.
Many people believe that men are more prone to heart attacks and heart problems, while women are relatively immune to these problems. This misconception is partly due to the fact 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. Even though the risk of heart disease increases with aging in both men and women, this increase is far more dramatic in women.
Most females are well-informed, and appropriately concerned, about such health issues as breast and uterine cancer. However, in truth, the incidence of heart disease in women is much greater. For example, recent estimates are that, between the ages of 45-65 years, 1 in 10 women have some form of heart disease. With further aging, the ratio increases to 1 in 4 (over the age of 65 years). In fact, people are often surprised to find out that cardiovascular disease is the leading cause of death and disability in women in the U.S.
Risk factors are habits or traits that increase a person's risk of developing disease. The risk factors for heart disease do not differentiate between women and men. These include:
- Cigarette smoking
- High Blood Pressure/Hypertension
- High levels of bad (LDL) cholesterol
- Low levels of good (HDL) cholesterol
- Family history of heart disease
- Physical inactivity
Many of these factors can be modified to reduce your risk. Modifying risk factors is one means of taking control of your health status, and decreasing the risk of cardiovascular disease. As a bonus, this will also lead to an increase in your overall sense of well-being. For more information on reducing risk factors, go to our articles on High Blood Pressure, Diabetes, and Nutrition, under Healthnotes at RochesterHealth.com.
It is estimated that cigarette smoking is associated with about half of all heart attack events in women. In a large study, the incidence of heart attacks was increased six-fold in women who smoked (compared to non-smokers) . In addition, The Nurses' Health Study  reported a strong relationship between cigarette smoking and stroke (among young and middle-aged women). Despite these disturbing findings, smoking rates have declined less for women (as compared to men) in the U.S.
Diabetes is also a significant risk factor in women, increasing the risk of coronary heart disease several times. Among people with diabetes, cardiovascular disease is a major complication and the leading cause of premature death. Obesity, and associated diabetes, are becoming epidemic in our society.
In the face of this evidence, what can the average person do? Part of the answer lies in "an ounce of prevention". Partner with your healthcare provider to assess your personal risk factor profile. This only requires a medical history and physical exam, along with some simple blood tests. Once you know your risk profile, then you can devise a realistic plan to modify your health behaviors in order to reduce your personal risk of heart disease. Of course, this should be done in conjunction with your healthcare provider.
In addition, increasing your daily activity can have a significant effect on your risk profile. A recent article in the Journal of the American Medical Association confirmed that physically active women have significantly lower rates of coronary heart disease compared to 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. More frequent exercise is even more beneficial. The American Heart Association (AHA) recommends 30 minutes of exercise on most days. Overly strenuous activities are not necessary to attain the benefits of exercise. These benefits include:
- Decreased risk of developing diabetes and hypertension.
- Helps control weight and reduce body fat.
- Increases good (High Density Lipoprotein) cholesterol.
- Promotes your sense of well-being by improving mood and reducing anxiety/tension.
- Helps to manage diabetes, particularly in diabetics who are overweight.
- Helps to reduce blood pressure in those with hypertension.
This is one example of risk factor modification. Public Health initiatives such as the AHA "Go Red for Women" campaign help to inform and educate women to be pro-active about their risk of heart disease, and how relatively simple modifications in their health behaviors can reduce their chance of developing heart disease. Other initiatives, such as the growing fields of Women's Health and gender-based biology, hold great promise to promote the health and well-being of women in the new millennium.
1, Haakan, Meyer, et.al. Tremendous Impact of Smoking on Mortality. Presented at EuroPRevent meetings of the European Society of Cardiology, 2009.
2. Colditz GA, Bonita R, Stampfer MJ, Willett WC, Rosner B, Speizer FE, Hennekens CH. Cigarette smoking and risk of stroke in middle-aged women. N Engl J Med. 1988 Apr 14;318(15):937-41.
3. I-Min Lee, MBBS,ScD; Kathryn M. Rexrode, MD; Nancy R. Cook, ScD; JoAnn E. Manson, MD,DrPH; Julie E. Buring, ScD. Physical Activity and Coronary Heart Disease in Women. JAMA. 2001;285:1447-1454.
Thomas Rocco, Jr., MD
Thomas A. Rocco, Jr., MD, F.A.C.C., F.A.H.A. is a Clinical Associate Professor of Medicine at the University of Rochester Medical Center and a Consultant in Cardiology and Cardiovascular Research at the Veterans Administration. He formerly directed the departments of Cardiology at Highland Hospital and Unity Hospital. His clinical and research interests include Preventive Cardiology, Hypertension, Congestive Heart Failure, and Geriatric Cardiology. He is the Principle Investigator on several clinical research projects, has lectured and published extensively, and has served on numerous community boards and agencies.
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