The numbers are staggering. One woman dies every minute from cardiovascular disease in the U.S. Although heart disease is often thought of as a man’s disease, almost as many women as men die of heart disease. In addition, cardiovascular disease disproportionally affects African American and Latina women.
Cardiovascular disease, which includes heart attacks, heart failure, stroke and diseases of the blood vessels, is the number one cause of death in women in the U.S., accounting for approximately 400,000 deaths annually. While many women fear having breast cancer, more women die of cardiovascular disease than breast cancer. Over 44 million women in the U.S are affected by some form of heart disease, compared to 3.5 million impacted by breast cancer. The good news is that cardiovascular disease is largely preventable in 80-90% of cases.
The southeastern U.S. including Tennessee, Georgia and Alabama, is known as the stroke belt due to its unusually high rate of cardiovascular disease and stroke. While there has been an overall decline in cardiovascular death rates in the U.S. since 1999, researchers at University of Alabama at Birmingham recently found that there has been no change in the cardiovascular death rates in the southern portion of the U.S. In fact, there has been a 16% higher rate of cardiovascular deaths, 22% higher stroke rate and 55% higher rate of heart failure, proving that there is much work to be done to improve women’s heart health in our region.
A primary concern in women’s heart health is the trend in actual awareness. In a 2019 special report in the journal Circulation, Dr. Mary Cushman, professor of medicine at the Larner College of Medicine at the University of Vermont, showed that among more than 1,500 women (mean age 50 years), fewer women were aware that heart disease was the leading cause of death in 2019 than they were 10 years prior. Declines in awareness during this 10-year period were observed in all ages, races and ethnicities except in women aged 65 years or older. The greatest declines in awareness were found in African American women, Hispanic women and in women ages 25-34. Compared with 2009, women in 2019 were more likely to incorrectly identify breast cancer as the leading cause of death.
Coronary artery disease is on the rise in women. Coronary artery disease in both women and men is a disease in which extra fats circulating in the blood are deposited in the wall of the heart arteries forming plaques. As plaques grow, blood flow can be limited, which can lead to a heart attack. Since 2017, there has been an increase in cardiovascular disease in both men and women, with the largest increase in death rates seen in middle-aged women.
The symptoms of heart attack in women can be much different than in men. While women can experience chest pain like men, women also are prone to have subtler symptoms three to four weeks before a heart attack. They may experience dramatic fatigue, sleep disturbance, shortness of breath, sweating, sudden dizziness, nausea, pain in either arm or pain in the neck or upper back. In one study, 43% of women did not have chest pain as a symptom prior to heart attack. Women also can be up to 10 years older when they present with a heart attack, and also are less likely to get life-saving intervention.
Hypertension is the leading global risk factor for cardiovascular disease in both men and women, and is often neglected in women. Obesity is another significant factor that can lead to the development of hypertension as well as type 2 diabetes. Additional risk factors for cardiovascular disease include age, family history of premature coronary artery disease (below age 55 in males or below age 65 in females), high cholesterol and smoking. The presence of diabetes almost doubles the risk of fatal coronary artery disease and smoking is associated with 50% of all coronary events in women. Risk is even elevated with minimal tobacco use. Women who smoke have two times the risk of heart attack as men, and the risk is higher for women smokers over men, regardless of age. Studies indicate that preventative strategies work as well in women as in men but are less frequently used in women.
Women’s risk factors also increase sharply at age 50 or near the age of natural menopause. Menopause is also associated with an increase in LDL (low-density lipoprotein), or bad cholesterol, and a decrease in HDL (high-density lipoprotein), good cholesterol. Menopause results in changes in fat distribution and insulin sensitivity, and also a loss of the protective effects of estrogen over heart disease. Obesity represents a bigger cardiovascular risk in women compared to men. Metabolic syndrome, which is a clustering of risk factors such as hypertension, abdominal obesity and abnormal blood lipids, is also associated with an increased risk of cardiovascular disease. Other factors include a sedentary lifestyle, autoimmune disease, depression, stress and a history of trauma or abuse.
Pregnancy is considered to be nature’s natural stress test for the heart. Pregnancy complications such as preeclampsia (high blood pressure), gestational diabetes or preterm birth can put women at greater risk for heart disease or stroke.
The good news is that heart disease is largely preventable. Getting 30 to 60 minutes of exercise daily, eating a heart-healthy diet that includes plenty of fresh fruits and vegetables and fewer processed foods; maintaining a healthy weight; reducing stress; getting good, quality sleep; and obtaining regular health screenings are important strategies. The American Heart Association has identified seven risk factors that can be improved through lifestyle changes to help achieve ideal cardiovascular health. An online assessment tool called “My Life Check” is available, and a person can enter their age, gender, race, height, weight, eating habits, exercise, blood pressure, cholesterol and smoking status and receive a heart health score. The assessment lets patients know what they are doing well and what needs improving. Go to heart.org/mylifecheck.
Information in this article provided by Dr. Carol Gruver, a cardiologist with the Hamilton Cardiovascular Institute.
