Women and coronary artery disease
Why is it important for women to learn about coronary artery disease?
Coronary artery disease is the number one cause of death of women in the United States. As many women die from coronary artery disease as from the next five leading causes of death combined (cancer, chronic obstructive pulmonary disease, Alzheimer's, diabetes, and accidents).
But many women underestimate the threat coronary artery disease (CAD) poses to their health. And many women do not know what they can do to help prevent heart disease.
What is coronary artery disease?
Coronary artery disease is caused by the gradual buildup of plaque (made of fat, cholesterol, and other substances) on the inside walls of the coronary arteries. These arteries supply oxygen-rich blood to the heart. Over time, the plaque deposits grow large enough to narrow the arteries' inside channels, decreasing blood flow to heart muscle. If the plaque becomes unstable and ruptures, a blood clot can form at the rupture site and block blood flow, resulting in a heart attack. See a picture of how plaque causes a heart attack.
What factors lead to coronary artery disease and death in women?
The rate of coronary artery disease increases 2 to 3 times after menopause, the time of life when a woman's menstrual periods stop.1 This increase is not completely understood. But cholesterol, high blood pressure, and fat around the abdomen—all risk factors for coronary artery disease—also increase around this time.
Other risk factors for coronary artery disease include smoking, diabetes, obesity, lack of exercise, and family history. Using birth control pills might increase your risk if you smoke and are older than 35 or if you have a family history of atherosclerosis or blood-clotting disorders.
How will my doctor determine my risk for coronary artery disease?
Your doctor will calculate your risk for coronary artery disease by assessing the number of risk factors you have. Risk factors include:
- High LDL cholesterol level (greater than 130).
- Low HDL cholesterol (less than 40 mg/dL).
- Cigarette smoking.
- High blood pressure (140/90 mm Hg or greater) or taking medicine to treat high blood pressure.
- Family history of early coronary artery disease.
- Being older than 65, or having gone through early menopause.
To find out your risk of a heart attack, see:
What can women do to prevent coronary artery disease?
Women can use healthy lifestyle changes and medicines to help prevent coronary artery disease. Women can also balance the risks and benefits of hormone replacement therapy when they decide whether or not to use it.
The American Heart Association published specific guidelines for preventing and treating coronary artery disease in women.2 These guidelines address lifestyle changes, medicines and supplements, and hormone therapy in menopausal women. Ask your doctor which recommendations are appropriate for you.
- Stop smoking, and avoid secondhand smoke.
- Eat a heart-healthy diet, which focuses on adding more healthy foods to your diet and cutting back on foods that are not so good for you. For more information, see:
- Try to do moderate activity at least 2½ hours a week. Or try to do vigorous activity at least 1¼ hours a week. It's fine to be active in blocks of 10 minutes or more throughout your day and week.3
- Keep your body mass index (BMI) between 18.5 and 24.9 and your waist circumference less than 35 inches. To figure out your BMI, see the body mass index (BMI) chart for adults.
- If you drink, do so in moderation (an average of one drink a day for women). If you do not drink, don't start.
- When high blood pressure (140/90 mm Hg or higher) cannot be controlled with lifestyle approaches, consider medicines to control it.
- Lipid-lowering medicine (usually statins) and lifestyle changes are recommended for women at intermediate to high risk of coronary artery disease.
- Your doctor may suggest that you take a daily, low-dose aspirin if the benefits of aspirin to prevent a stroke are greater than the risk of stomach bleeding from taking daily aspirin. But the daily use of low-dose aspirin in healthy women who are at low risk of stroke is not recommended.
- If you have been diagnosed with CAD or have had a heart attack, you will probably take medicines that lower the workload on your heart. These medicines include beta-blockers, angiotensin-converting enzyme (ACE) inhibitors, or angiotensin II receptor blockers (ARBs).
Taking estrogen with or without progestin does not prevent coronary artery disease. In fact, if you are 10 or more years past menopause, taking hormone therapy may raise your risk of coronary artery disease.4
Talk to your doctor about your risks with hormone therapy. And carefully weigh the benefits against the risks of taking it. If you need relief for symptoms of menopause, hormone therapy is one choice you can think about. But there are other types of treatment for problems like hot flashes and sleep problems. For more information, see the topic Menopause and Perimenopause.
What are symptoms of coronary artery disease and heart attack?
Knowing symptoms of a heart attack can help save lives. So even if you're not sure that your symptoms are from a heart attack, do not delay seeking care. Do not wait more than 5 minutes to call 911 if you think you or someone else is having a heart attack.
Coronary artery disease symptoms might happen when the heart is working harder and needs more oxygen, such as during exercise. These symptoms typically go away with rest. The most common symptoms are:
- Chest discomfort or pain, called angina (say “ANN-juh-nuh” or “ann-JY-nuh”).
- Shortness of breath.
Some people may feel tingling or numbness in their arm, hand, or jaw when they have angina. Chest pain that begins suddenly or lasts only a few seconds is less likely to be angina.
Heart attack symptoms do not go away with rest. Symptoms include:
- Chest discomfort or pain.
- Discomfort or pain in other parts of the upper body, including arms, back, neck, jaw, or stomach.
- Shortness of breath.
- Cold sweat.
- Lightheadedness or dizziness.
The most common symptom for both women and men is chest pain or discomfort. But women are somewhat more likely than men to have other symptoms like shortness of breath, nausea, and back or jaw pain.
Women are also more likely than men to delay seeking help for a possible heart attack. Women delay for many reasons, like not being sure it is a heart attack, or not wanting to bother others. But it is better to be safe than sorry. If you have symptoms of a possible heart attack that last for 5 minutes, call 911 right away.
When you get to the hospital, do not be afraid to speak up for what you need. Be sure your doctors know that you think you might be having a heart attack so that you can get the tests and care you need.
- Lloyd-Jones D, et al. (2009). Heart disease and stroke statistics 2009 update. Circulation, 119(3): e21–e181. Available online: http://circ.ahajournals.org/cgi/reprint/CIRCULATIONAHA.108.191261.
- Mosca L, et al. (2007). Evidence-based guidelines for cardiovascular disease prevention in women: 2007 update. Circulation, 115(11): 1481–1501.
- U.S. Department of Health and Human Services (2008). 2008 Physical Activity Guidelines for Americans (ODPHP Publication No. U0036). Washington, DC: U.S. Government Printing Office. Available online: http://www.health.gov/paguidelines/pdf/paguide.pdf.
- Rossouw JE, et al. (2007). Postmenopausal hormone therapy and risk of cardiovascular disease by age and years since menopause. JAMA, 297(13): 1465–1477.
Last Updated: May 29, 2008