Many women today do not recognize heart disease as being a leading problem and cause of death among women.  In fact, if asked, most women would name cancer as the greatest health problem facing women. Yet, the American Heart Association estimates that one in two women will eventually die of heart disease or stroke, compared with one in 27 who will eventually die of breast cancer. 

There are several factors that increase the risk of heart disease and stroke in women.  Some of them can be changed and some cannot.  But the more risk factors a woman has, the greater the chance that she may develop heart disease or have a stroke.

Increasing Age -- The chances of developing heart disease increase as women grow older.  As women approach the age of menopause, their risk of heart disease and stroke begins to rise and continues to rise with age.  About four in five people who die of coronary heart disease are age 65 or older.

Family History -- Both women and men are more likely to develop heart disease or stroke if their close blood relatives have had them.  Race is also a factor.  African-American women have a greater risk of heart disease and stroke than Caucasian women – in large part because African Americans have higher average blood pressure levels.

Cigarette and Tobacco Smoke -- Women who smoke cigarettes or cigars have a much higher risk of death from heart disease and stroke.  Overall, smokers’ risk of heart attack is significantly higher than that of nonsmokers.  What’s more, smokers who have a heart attack are more likely to die and die suddenly (within an hour) than are nonsmokers.

High Blood Pressure -- More than 50 million Americans have high blood pressure and nearly half are women.  Women who have a family history of high blood pressure – especially African-American women – and women who are overweight are also at high risk.

High Blood Cholesterol --Studies show that women’s cholesterol is higher than men’s from age 55 on.  Women should be sure to get regular cholesterol screenings and maintain a low-fat, low-cholesterol diet.

Physical Activity -- Studies have found that lack of physical activity is a risk factor for coronary heart disease.  Even regular moderate exercise is beneficial.

Obesity -- As many as 35 million women are overweight.  The risk for heart disease is particularly high in women who have excess abdominal fat.

Diabetes -- More than 80 percent of those who have diabetes die of some form of heart or blood vessel disease.

Warning Signs -- It’s also important for women to recognize warning signs.  Classic signals of heart disease include chest discomfort, which may be pressure, fullness, or heavy sensation beneath the sternum (or breast bone), which most often occurs with exertion and is relieved by rest.  However, there may be atypical symptoms such as shortness of breath, fatigue, or an intolerance to exercise and physical exertion. 

Heart disease is typically more difficult to diagnose in women because women may have more atypical symptoms, such as heartburn, nausea or indigestion, which may make it difficult to separate heart disease from ulcer or other gastrointestinal problems.  They may also more often have chest pain, suggestive of angina or heart disease, when no heart disease is present.   

Reducing the Risk

There are a number of steps women can take to reduce their risk of heart disease and stroke.  Take together, these may provide the greatest chance to maintain a healthy heart.

• Quit smoking
• Decrease high blood pressure (in some people this can be done by losing weight, quitting smoking and maintaining a low-fat, low-cholesterol diet).
• Reduce high cholesterol and triglycerides (get regular cholesterol screenings and maintain a healthy diet).
• Be more physically active (even moderate exercise on a regular basis is beneficial -- for example, walk once a day for 20 minutes).
• Talk with your doctor about hormone therapies if you have passed menopause.  For women, heart disease becomes a significant problem after menopause. Heart disease is more often a problem in women over the age of 65; however, if there is premature or surgical menopause, heart disease may occur at a younger age, particularly in the absence of hormonal replacement.
• Control or delay diabetes with the help of your doctor.
• Maintain a healthy weight and eat a healthful diet (high in fruits, vegetables, fibers and cereals -- low in saturated fats.).
• Moderate any use of alcohol.
• Adopt healthy ways of dealing with stress in your life.  For example, take a break from work and home duties, read a book, take daily walks and avoid negative people in your life.

Women need to make it a point to ask their doctor about the risks specific to women and preventative measures that can be taken.  Nothing is more important than arming yourself with knowledge to battle heart disease.

Dr. Phlaum is board certified in Internal Medicine and Cardiovascular Disease.  He is one of many quality physicians on staff at Des Peres Hospital.