Coronary Heart Disease Women and Heart Disease

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Coronary heart disease is the leading cause of death for women. About 80% of women age 40 to 60 have one or more risk factors for coronary heart disease. Having multiple risk factors significantly increases a woman’s chance of developing coronary heart disease.

Fact sheet

Advancing Women’s Heart Health Fact Sheet

Learn how coronary heart disease may be different for women than for men.

View the fact sheet

• Hormonal changes affect a woman’s risk for coronary heart disease. Before menopause, the hormone estrogen provides women with some protection against coronary artery disease. Estrogen raises levels of HDL cholesterol (sometimes called “good” cholesterol) and helps keep the arteries flexible so they can widen to deliver more oxygen to the tissues of the heart in response to chemical and electrical signals. After menopause, estrogen levels drop, increasing a woman’s risk for coronary heart disease.
• The size and structure of the heart is different for women and men. A woman’s heart and blood vessels are smaller, and the muscular walls of women’s hearts are thinner.
• Women are more likely to have heart disease in the smaller arteries of their heart, called coronary microvascular disease. This can make it harder to diagnose and cause delays in treatment.

Women are more likely than men to have medical conditions that raise their risk of coronary heart disease, such as:

• Anemia, especially during pregnancy
• Early menopause (before age 40)
• Endometriosis
• High blood pressure after age 65
• History of problems during pregnancy, including gestational diabetes, preeclampsia, eclampsia (high blood pressure during pregnancy), and giving birth to a baby who is premature or smaller than average
• Hormonal birth control
• Inflammatory and autoimmune diseases
• Lack of physical activity
• Mental health problems, such as stress, marital stress, anxiety, depression, or low social support
• Metabolic syndrome, a group of risk factors that raises your risk for heart disease and other health problems
• Overweight and obesity

Some factors raise women’s risk of coronary heart disease more than they increase the risk for men, including:

• Diabetes
• Low levels of HDL cholesterol
• Mild to moderate high blood pressure
• Smoking

The Heart Truth® talks about coronary heart disease risk factors for women and how to lower them.

• Different activities bring on chest pain. In men, angina tends to worsen with physical activity and go away with rest. Women are more likely than men to have angina while they are resting. In women who have coronary microvascular disease, angina often happens during routine daily activities, such as shopping or cooking, rather than during exercise. Microvascular angina events may last longer and be more painful than other types of angina.
• The location and type of pain may differ. Pain symptoms are different for each person. Women having angina or a heart attack often describe their chest pain as crushing, or they say it feels like pressure, squeezing, or tightness. Women also may have pain in the chest or the neck and throat.
• Mental stress is more likely to trigger angina pain in women than in men.
• Other symptoms common for women include nausea, vomiting, shortness of breath, abdominal pain, sleep problems, tiredness, and lack of energy.

Tests and procedures for diagnosing coronary heart disease are similar for women and men, but women may experience delays in diagnosis or treatment.

• Ask about important diagnostic tests. Doctors may be less likely to refer women for diagnostic tests for coronary heart disease. When women go to the hospital for heart symptoms, they may be more likely than men to experience delays receiving an initial EKG, are less likely to receive care from a heart specialist during hospitalization, and are less likely to receive certain types of treatments and medicines. Younger women are more likely than men to be misdiagnosed and sent home from the emergency department after cardiac events that occur from undiagnosed and untreated vascular heart disease.
• Ask about treatment options that are effective for men and women. Women may be less likely than men to receive aspirin, statins, and beta blockers for treating their heart disease. Although women may be as likely as men to benefit from a pacemaker or a defibrillator, women are less likely to receive these treatments for complications of coronary heart disease. Women may be less likely to receive some heart treatments such as percutaneous coronary intervention or coronary artery bypass grafting than men are, even though research shows that both men and women can benefit from these procedures.
• Know and share your risk factors. Healthcare providers may not recognize a woman’s risk of coronary heart disease. Commonly used risk-scoring systems may not accurately predict risk in women.
• Learn the symptoms and seek medical care right away. Immediate care may help prevent complications such as heart attack or sudden cardiac arrest.