Heart disease is the leading cause of death in the United States. Stroke is the fifth leading cause of death in the United States. Heart disease and stroke, along with other cardiovascular diseases, account for approximately $320 billion in health care expenditures and related expenses annually. Fortunately, they are also among the most preventable.
What is Cardiovascular Disease?
Cardiovascular disease can refer to a number of conditions: such as Heart Attacks, Stroke, Heart Failure, arrhythmias, heart valve problems. In the table below you can see that both Heart attacks and strokes are listed in the top ten causes of death.
Cardiovascular Disease in Women
Although heart disease is sometimes thought of as a man’s disease, almost as many women as men die each year of heart disease in the United States.
Heart disease is the leading cause of death for women in the United States, killing 299,578 women in 2017—or about 1 in every 5 female deaths.
Heart disease is the leading cause of death for African American and white women in the United States. Among American Indian and Alaska Native women, heart disease and cancer cause roughly the same number of deaths each year. For Hispanic and Asian or Pacific Islander women, heart disease is second only to cancer as a cause of death.
- About 1 in 16 women age 20 and older (6.2%) have coronary heart disease, the most common type of heart disease:4
- About 1 in 16 white women (6.1%), black women (6.5%), and Hispanic women (6%)
- About 1 in 30 Asian women (3.2%)
This map shows death rates from heart disease in women in the United States. The darker red indicates a higher death rate.
The leading modifiable (controllable) risk factors for heart disease and stroke are:
- High blood pressure
- High cholesterol
- Cigarette smoking
- Diabetes
- Unhealthy diet and physical inactivity
- Healthy Food
- Overweight and obesity
There are significant disparities in the following based on gender, age, race/ethnicity, geographic area, and socioeconomic status:
Women have a higher prevalence of obesity, especially in black women
Heart disease risk factors for women
Several traditional risk factors for coronary artery disease — such as high cholesterol, high blood pressure, and obesity — affect both women and men. But other factors can play a bigger role in the development of heart disease in women.
Heart disease risk factors for women include:
- Diabetes. Women with diabetes are more likely to develop heart disease than are men with diabetes. Also, because diabetes can change the way you feel pain, you’re at greater risk of having a silent heart attack — without symptoms.
- Mental stress and depression. Stress and depression affect women’s hearts more than men’s. Depression makes it difficult to maintain a healthy lifestyle and follow recommended treatment.
- Smoking. Smoking is a greater risk factor for heart disease in women than it is in men.
- Inactivity. A lack of physical activity is a major risk factor for heart disease. Some research has found women to be less active than men.
- Menopause. Low levels of estrogen after menopause pose a significant risk of developing the disease in smaller blood vessels.
- Pregnancy complications. High blood pressure or diabetes during pregnancy can increase the mother’s long-term risk of high blood pressure and diabetes. The conditions also make women more likely to get heart disease.
- Family history of early heart disease. This appears to be a greater risk factor in women than in men.
- Inflammatory diseases. Rheumatoid arthritis, lupus, and others can increase the risk of heart disease in both men and women.
Is heart disease something only older women should worry about?
No. Women of all ages should take heart disease seriously. Women under age 65 — especially those with a family history of heart disease — also need to pay close attention to heart disease risk factors.
What can women do to reduce their risk of heart disease?
Living a healthy lifestyle can help reduce the risk of heart disease. Try these heart-healthy strategies:
- Quit smoking. If you don’t smoke, don’t start. Try to avoid exposure to secondhand smoke, which also can damage blood vessels.
- Exercise regularly. In general, everybody should do moderate exercise, such as walking at a brisk pace, on most days of the week.
- Maintain a healthy weight. Ask your doctor what weight is best for you. If you’re overweight, losing even a few pounds can lower blood pressure and reduce the risk of diabetes.
- Eat a healthy diet. Opt for whole grains, a variety of fruits and vegetables, low-fat or fat-free dairy products, and lean meats. Avoid saturated or trans fats, added sugars, and high amounts of salt.
- Manage your stress. Stress can cause your arteries to tighten, which can increase your risk of heart disease, particularly coronary microvascular disease.
- Limit alcohol. If you have more than one drink a day, cut back. One drink is approximately 12 ounces (360 milliliters) of beer, 5 ounces (150 milliliters) of wine, or 1.5 ounces (45 milliliters) of distilled spirits, such as vodka or whiskey.
- Follow your treatment plan.Take your medications as prescribed, such as blood pressure medications, blood thinners, and aspirin.
- Manage other health conditions. High blood pressure, high cholesterol, and diabetes increase the risk of heart disease.
Sex differences in coronary risk and treatment
Research is identifying gender differences in heart disease that may help fine-tune prevention, diagnosis, and treatment in women. Here are some examples.
Blood lipids. Before menopause, a woman’s own estrogen helps protect her from heart disease by increasing HDL (good) cholesterol and decreasing LDL (bad) cholesterol. After menopause, women have higher concentrations of total cholesterol than men do. But this alone doesn’t explain the sudden rise in heart disease risk after menopause. Elevated triglycerides are an important contributor to cardiovascular risk in women. Low HDL and high triglycerides appear to be the only factors that increase the risk of death from heart disease in women over age 65.
Diabetes. Diabetes increases the risk of heart disease in women more than it does in men, perhaps because women with diabetes more often have added risk factors, such as obesity, hypertension, and high cholesterol. Although women usually develop heart disease about 10 years later than men, diabetes erases that advantage. In women who’ve already had a heart attack, diabetes doubles the risk for a second heart attack and increases the risk for heart failure.
Metabolic syndrome. This is a group of health risks — large waist size, elevated blood pressure, glucose intolerance, low HDL cholesterol, and high triglycerides — that increase your chance of developing heart disease, stroke, and diabetes. Harvard Medical School research suggests that, for women, metabolic syndrome is the most important risk factor for having heart attacks at an unusually early age. In a study of patients undergoing bypass surgery, metabolic syndrome produced a greater risk for women than it did for men dying within eight years.
Smoking. Women who smoke are more likely to have a heart attack than male smokers. Women are also less likely to succeed in quitting, and women who do quit are more likely to start again. Moreover, women may not find nicotine replacement as effective, and — because the menstrual cycle affects tobacco withdrawal symptoms — they may get inconsistent results with anti-smoking medications.
Symptoms. Many women don’t experience the crushing chest pain that is a classic symptom of a heart attack in men. Some feel extremely tired or short of breath. Other atypical symptoms include nausea and abdominal, neck, and shoulder pain. In one study, women reported deep fatigue and disturbed sleep as much as a month or two before a heart attack. During a heart attack, only about one in eight women reported chest pain; even then, they described it as pressure, aching, or tightness rather than pain.
Diagnosis and treatment. Women have smaller and lighter coronary arteries than men do. This makes angiography, angioplasty, and coronary bypass surgery more difficult to do, thereby reducing a woman’s chance of receiving a proper diagnosis and having a good outcome. Women tend to have more complications following surgery. And they’re twice as likely to continue having symptoms several years after coronary angioplasty. (They’re usually older than men and have more chronic conditions at the time of their first coronary event.)
Take Away: Coronary artery disease is preventable