Women and Coronary Artery Disease

Why is it important for women to learn about coronary artery disease?

Many women underestimate the threat coronary artery disease poses to their health. Coronary artery disease is this country's number one killer of women. Yet, in a recent survey, 50% of women replied that they still considered cancer their greatest health threat. Only 13% cited coronary artery disease as their biggest concern. ¹

Health campaigns over the past decade have promoted heart disease prevention by encouraging people to lower their blood pressure and cholesterol, change their diet and exercise habits, quit smoking, and improve their medical care. However, many women are missing this message. In a study of 1,820 people hospitalized for heart attacks from 1979 to 1994, heart attack rates for men dropped by 8 percent, while heart attacks in women increased by 36 percent. ²

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, which supply oxygen-rich blood to the heart. Over time, the plaque deposits grow large enough to narrow the arteries' inside channel, 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 altogether, resulting in 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.

In the past, medical research on heart disease was primarily focused on men. Now, researchers recognize that there are significant differences in coronary artery disease in women and men. For example, men usually have typical heart attack symptoms: chest pain that grips the chest and spreads to the shoulders, neck, and arms. Although women can have these symptoms, too, many women have less common symptoms such as breathlessness, heartburn, nausea, or fatigue. Heart attacks in women are often brought on by anxiety or mental stress or even sleep, while heart attacks in men more often come on with exercise or exertion.

Because women do not always have the classic heart attack symptoms or typical onset of heart attacks, they may delay seeking care or, when they do seek care, may not be treated as aggressively as men.

What can women do to prevent coronary artery disease?

In response to these concerns, the American Heart Association recently published specific guidelines for preventing and treating coronary artery disease in women. ³ These guidelines address lifestyle changes, medications and supplements, and hormone therapy in menopausal women. Ask your doctor which recommendations are appropriate for you.

Lifestyle changes

• Stop smoking, and avoid secondhand smoke.
• Do at least 30 minutes of moderate-intensity activity, such as brisk walking, on most days of the week.
• Eat a heart-healthy diet and limit saturated fat to less than 10% of calories, cholesterol intake to less than 300 mg, and avoid trans fats.
• Keep your body mass index (BMI) between 18.5 and 24.9 and your waist circumference less than 35 inches. To determine your BMI, see the healthy weight chart for adults.
• If you have coronary artery disease, be evaluated for depression.
• If you drink, do so in moderation (an average of one drink per day for women). If you do not drink, don't start.
• Adopt the DASH (Dietary Approaches to Stop Hypertension) eating plan, and reduce daily salt intake if you have high blood pressure.

Medications

• When high blood pressure (140/90 mm Hg or higher) cannot be controlled with lifestyle approaches, consider medications to control it.
• Lipid-lowering medication (usually statins) and lifestyle changes are recommended for women at intermediate to high risk of coronary artery disease.
• Women with diabetes should keep their hemoglobin A_1c (HbA_1c) level at less than 7%. HbA