Heart Disease

Heart disease is extremely common, progressive if left untreated, and often fatal. More women die from heart attacks every year than men. In fact, heart disease accounts for 1 in every 5 female deaths. It is the number one killer of women in the U.S.

The most common form of heart disease is ischemic heart disease, which usually develops gradually over time, and often without symptoms. This occurs when the arteries of the heart, which supply oxygen-rich blood to the heart muscle, cannot deliver enough blood to the heart because of narrowing of the arteries. Most of the time, this narrowing is caused by coronary artery disease (CAD), also referred to as coronary heart disease (CHD).

CAD is the buildup of a waxy substance called plaque, through a process known as atherosclerosis. As plaque builds inside the artery walls, the arteries become narrower and narrower, which makes it much harder for blood to flow through the artery. If a plaque ruptures or a blood clot forms within a coronary artery, blood is prevented from reaching the heart muscle, resulting in a heart attack or, potentially, even cardiac arrest.

A growing body of research shows that women experience symptoms of a heart attack differently than men. Many women have no symptoms at all or experience symptoms unrelated to chest pain. When symptoms do occur, they often occur in combination and strike suddenly, including:
  • A dull, heavy or sharp pain in the center of the chest, called angina
  • Chest discomfort or tightness
  • Pain or discomfort in one or both arms
  • Pain in the jaw, throat or neck
  • Pain in the back or upper abdomen
  • Shortness of breath
  • Nausea and vomiting
  • Breaking out in a cold sweat
  • Dizziness, lightheadedness or fainting
  • Feeling of impending doom
  • Extreme fatigue
Behavior:
  • Know the symptoms of a heart attack. Chest pain or discomfort is still a common symptom, but women are more likely than men to experience other symptoms, including shortness of breath, nausea and vomiting, back or jaw pain, and extreme fatigue.
  • If you think you or someone you know might be having a heart attack, don’t hesitate: Call 911. Women are more likely than men to die of their first heart attack, possibly because they mistake their symptoms for something less serious.

Diet:
  • Eat a heart-healthy diet high in fiber, rich in vitamins and minerals, and low in calories and saturated fat. The DASH (Dietary Approaches to Stop Hypertension) diet and Mediterranean diet are both proven ways to reduce your risk of heart disease and heart attack. Whole-food, plant-based diets also significantly reduce the risk of heart disease and cardiovascular events like heart attack and stroke.
  • Limit your alcohol intake. Moderate drinking—which for women consists of one alcoholic drink per day—is considered safe, but more than that may raise your blood pressure and blood lipids, increase the risk of cardiomyopathy (weakening of the heart muscle), spark arrhythmia (irregular heart rhythm) and cause weight gain.

Exercise:
  • Move your body every day. Women who get about 30 minutes of moderate exercise a day tend to have lower blood pressure, cholesterol and weight than women who don’t. They also tend to live longer.
  • Examples of moderate exercise include brisk walking, biking, raking leaves and gardening.
  • If you don’t have time to exercise 30 minutes every day, try to get 30 minutes of vigorous aerobic exercise three times a week. Examples of vigorous exercise include running, jogging, swimming and cross-country skiing.
  • In addition to aerobic exercise, the American Heart Association (AHA) recommends moderate to high-intensity muscle strengthening exercise at least two days a week.

Lifestyle Factors:
  • If you are a smoker, please quit. This is one of the most important steps you can take to improve your overall health. Women who smoke are two to six times more likely to suffer a heart attack than women who don’t, and the risk increases with each additional cigarette smoked per day.
  • Maintain a healthy weight. Overweight women are more likely to develop heart-related problems than women at a healthy weight, even if they have no other risk factors. The AHA guidelines for women recommend a body mass index (BMI) between 18.5 and 24.9 and a waist circumference of less than 35 inches.

Stress Management:
  • Reduce the amount of stress in your life by making sure you get enough sleep, saying no to additional responsibilities when you feel overwhelmed, and taking time for activities you enjoy.
  • During stressful moments, reduce your heart rate and blood pressure through deep breathing, guided imagery, mindfulness or taking a short break.
Treatment for heart disease depends on several factors, including the severity of heart disease, your personal health history and risk factors, and presence of other health conditions.

Treatments for Heart Disease

Medication:
  • Statins: Reduce blood cholesterol by interrupting production of cholesterol in the liver. Common statins include atorvastatin, rosuvastatin and simvastatin.
  • Non-statin drugs: May be an option if statins fail to lower blood cholesterol or are not tolerated.
  • Low-dose aspirin: May help prevent heart attack in people who have already had a heart attack or cardiac procedure.
  • Anticoagulants: Also called blood thinners, these medications decrease the blood’s ability to clot. Common anticoagulants include warfarin and rivaroxaban.
  • Antiplatelet medications: Prevent blood platelets from sticking together, so blood clots are less likely to form. Drugs in this class include clopidogrel, ticagrelor, prasugrel, dipyridamole and aspirin.
  • Dual antiplatelet therapy (DAPT): Treats heart disease with two different antiplatelets at the same time, one of them being aspirin.
  • Calcium channel blockers: Prevent calcium from entering the cells of the blood vessels and heart. This may relax blood vessels and/or reduce heart rate. Examples include amlodipine and nimodipine.
  • Angiotensin-converting enzyme (ACE) inhibitors: Expand blood vessels and decrease levels of angiotensin II. These actions allow blood to flow more freely, lowering blood pressure. Common ACE inhibitors include lisinopril, ramipril, captopril and benazepril.
  • Angiotensin II receptor blockers (ARBs): Prevent angiotensin II from affecting blood vessels, preventing blood pressure from climbing too high. Examples include candesartan, losartan and valsartan.
  • Angiotensin receptor neprilysin inhibitors (ARNIs): A new drug class combination of an ARB and a neprilysin inhibitor. Neprilysin is an enzyme that breaks down substances in the body that keep arteries open. By limiting this enzyme, these medications help keep arteries open and improve blood flow.
  • Nitrates: Also called vasodilators, these medications relax blood vessels, increase blood supply to the heart and reduce the heart’s workload. These include nitroglycerin tablets and nesiritide. Vasodilators are available as chewable tablets, capsules and topical applications.
  • Digitalis preparations: Drugs that make the heart pump with greater force. Digoxin is a commonly prescribed digitalis preparation.
  • Diuretics: Help the body get rid of excess fluids and sodium. This lowers the heart’s workload and reduces blood pressure and swelling. Common diuretics include hydrochlorothiazide, amiloride and furosemide.
  • Beta blockers: Decrease the heart rate, lowering blood pressure and causing the heart to beat less forcefully. Common beta blockers include propranolol and bisoprolol.

Surgery:
  • Angioplasty: Opens a blocked artery. The procedure involves threading special tubing with a deflated balloon at the end into the coronary arteries. Once the balloon is in place, it is inflated to widen narrowed areas. A stent may also be implanted to keep the artery open and reduce symptoms such as angina.
  • Laser angioplasty: Similar to angioplasty, but uses a catheter with a laser tip instead of a balloon to open the blocked artery.
  • Atherectomy: An alternative to angioplasty that removes plaque from a blocked artery.
  • Radiofrequency ablation: Used to treat heart arrhythmias. This procedure involves guiding a catheter with an electrode on the tip through the veins and into the heart. The catheter is directed to areas where the abnormal heart rhythm originates and sends radiofrequency energy to destroy the muscle cells in that area, thus eliminating the arrhythmia.
  • Heart valve replacement: Used to replace an unhealthy heart valve with a healthy one.
  • Bypass surgery or coronary artery bypass graft (CABG): Treats blocked arteries, improves blood flow to the heart, reduces risk of heart attack, and improves overall health and well-being. It involves taking veins or arteries from other parts of the body and placing them in the area of the blockage to bypass the clogged artery and improve blood flow to the heart.
  • Minimally invasive heart surgery: Less invasive than open heart bypass surgery or CABG. Small incisions are used to gain access inside the chest to perform the bypass. Unlike open heart bypass surgery or CABG, which is done while the heart is stopped, this surgery is done when the heart is still beating.

Cardiac Rehabilitation: Women who have recently had a heart attack or a procedure such as angioplasty or bypass surgery should participate in cardiac rehabilitation (rehab). Cardiac rehab helps heart patients recover and improve their overall physical and mental health, reduces hospitalization and reduces the risk of dying. It also provides tools to help prevent another cardiac event. Cardiac rehab includes psychological counseling, emotional support, monitored exercise, nutrition counseling, help with modifying risk factors and tips for returning to work.
How common is heart disease in women?
Though many women regard heart disease as more likely to affect men, nothing could be further from the truth. Heart disease is the number one cause of death in women. Six times as many women die from heart attack, stroke and other forms of heart disease than from breast cancer each year. Since 1984, more women than men have died from cardiovascular disease.

Are there symptoms of heart disease other than heart attack?
In addition to heart attack, heart disease can cause arrhythmia (irregular heart rhythm), heart failure and heart valve problems. Symptoms of arrhythmia include heart palpitations and a fluttering sensation in the chest. Symptoms of heart failure include fatigue; shortness of breath; and swelling in the legs, ankles, feet, neck veins or abdomen. In women with heart valve problems, valves may not open wide enough to allow the proper amount of blood to flow through (stenosis), OR valves may not close tightly enough, allowing blood to leak through where it shouldn’t.

What are the risk factors for heart disease?
The primary risk factors for heart disease in women are smoking, high blood pressure, high triglycerides, high cholesterol, a sedentary lifestyle, excess weight or obesity, diabetes or prediabetes, high c-reactive protein (CRP), systemic autoimmune diseases (such as lupus and rheumatoid arthritis), family history of heart disease, personal history of preeclampsia, and age. Perimenopausal and postmenopausal women are at increased risk due to the loss of estrogen.

No one in my family has ever had heart disease. Does that mean I don’t need to worry about it?
A family history of heart disease may increase risk for heart disease, but it plays a much smaller role than other risk factors—including smoking, diabetes, excess weight, a sedentary lifestyle, high blood pressure and high cholesterol. Even if you have no family history of heart disease, the presence of other risk factors can outweigh the influence of good genes.

Do birth control pills increase my risk for heart disease?
Oral contraceptives used to have much higher doses of estrogen than they do today. These high-dose pills increased risk of heart and vascular disease, especially among women who smoked. Today’s pills contain lower doses of estrogen, and though they still may increase a woman’s blood pressure, they generally don’t increase her risk of heart or vascular disease. The exception is for women who smoke—even with the low-dose pill, smoking boosts a woman’s risk of cardiovascular problems, particularly if she is over 35.

Why does a woman’s risk of heart disease go up after menopause?
Prior to menopause, naturally circulating estrogen in a woman’s body may help keep her arteries free from plaque, although the exact mechanism isn’t understood. Estrogen also helps keep the lining of the blood vessels thin and pliable. When estrogen levels drop during menopause, these protective effects fade as well, and the risk of heart disease increases.

What can I do to prevent heart disease?
In addition to eating a healthy diet, getting plenty of exercise and drinking only in moderation, make annual checkups a priority and abide by your health care provider’s recommendations. All women over age 20 should have their blood cholesterol checked every four to six years and their blood pressure checked every one to two years. If either reading falls outside the normal range, make appropriate lifestyle changes sooner rather than later.

Should I exercise if I’ve been diagnosed with heart disease?
Yes, getting exercise is incredibly important for you, as it will help strengthen your heart muscle, lower your blood pressure, decrease cholesterol and keep your blood sugar in check. It can also help you lose weight, reducing your risk of complications from heart disease. That being said, be sure to clear any exercise with your health care provider ahead of time and follow all of their guidelines and recommendations.