Women and Coronary Artery Disease

Topic Overview

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

Coronary artery disease is a leading cause of death for women throughout the world. More women die from heart disease than from cancer, chronic obstructive pulmonary disease, Alzheimer's, and accidents combined.1

But many women underestimate the threat coronary artery disease (CAD) poses to their health. And many women do not know what they can do to help prevent heart disease.

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. These arteries supply oxygen-rich blood to the heart. Over time, the plaque deposits grow large enough to narrow the arteries' inside channels, 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, resulting in a heart attack. See a picture of how plaque causes a heart attack.

Coronary artery disease seems to happen slightly differently in women compared to men. For example, plaque might build up differently in a woman's arteries so that a doctor cannot see a blockage during a cardiac catheterization test. Researchers are trying to understand these differences to help find the best ways to diagnose and treat women who have CAD.

What increases a woman's risk?

Women have unique risk factors for heart disease. These include pregnancy-related problems as well as medicines they may be taking, such as birth control pills or hormone therapy.

Menopause. A woman's chance of getting coronary artery disease is higher after menopause. This higher chance is not completely understood. But cholesterol, high blood pressure, and fat around the abdomen—all things that raise the risk for coronary artery disease—also increase around this time.

Hormone therapy (HT). If you have menopausal symptoms such as hot flashes and vaginal dryness, you might consider hormone therapy to relieve your symptoms. Because menopause and hormones are linked with the health of your blood vessels, you and your doctor will discuss your health and your risk of heart disease to make sure hormone therapy is safe for you. Risk for heart disease and other health problems varies based on when you start HT in menopause and how long you take it. Short-term use of hormone therapy in early menopause has less risk than when it is started later in menopause. Risk also depends on the type of HT used (estrogen or estrogen plus progestin).2

Birth control pills. Using birth control pills might increase your risk if you smoke and are older than 35 or if you have a family history of atherosclerosis or blood-clotting disorders. Healthy, young, nonsmoking women probably do not increase their risk of coronary artery disease (CAD) when they take low-dose birth control pills.

Pregnancy-related problems. A problem during pregnancy called preeclampsia has been linked to a higher risk of heart disease later in life. Experts are studying whether other pregnancy-related problems are linked to heart disease. Tell your doctor about any problems you had during pregnancy.

Immune diseases. Some immune-related diseases, such as lupus and rheumatoid arthritis, have been linked with a higher risk of heart disease in women.

Heart disease risk factors for both women and men

Risk factors for coronary artery disease that are common in women and men include smoking, diabetes, obesity, lack of exercise, and family history.

How will my doctor determine my risk for coronary artery disease?

Your doctor will calculate your risk for coronary artery disease by assessing the number of risk factors you have. Your doctor might use this tool to calculate your risk of a heart attack:

Interactive Tool: Are You at Risk for a Heart Attack?

Your doctor might find your risk for coronary artery disease using a different, but similar, method. These methods give you and your doctor a good idea about your risk. And they can help you decide if you should take steps to prevent a heart attack or stroke.

What can women do to prevent coronary artery disease?

Women can use healthy lifestyle changes and medicines to help prevent coronary artery disease. Women can also balance the risks and benefits of hormone therapy when they decide whether or not to use it.

Healthy lifestyle

A healthy lifestyle can help prevent heart disease. And it can help you manage other problems that raise your risk of heart disease. These problems include high blood pressure, high cholesterol, and diabetes.

  • Stop smoking, and avoid secondhand smoke.
  • Eat a heart-healthy diet, which focuses on adding more healthy foods to your diet and cutting back on foods that are not so good for you. Heart-healthy eating plans include the:
    American Heart Association Healthy Diet.
    Click here to view an Actionset.DASH Diet.
  • Be active. Try to do moderate activity at least 2½ hours a week. Or try to do vigorous activity at least 1¼ hours a week. It's fine to be active in blocks of 10 minutes or more throughout your day and week. Do strength exercises at least 2 days a week. For more information, see the topic:
    Fitness.
  • Keep your body mass index (BMI) between 18.5 and 24.9 and your waist circumference less than 35 inches. To check your BMI:
    Interactive Tool: Is Your BMI Increasing Your Health Risks?
  • If you drink alcohol, do so in moderation (an average of 1 drink a day for women). If you do not drink, don't start.
Medicines

You might take medicines, along with making healthy lifestyle changes, to lower your risk of heart disease. If you already have heart disease, medicine can help you prevent a heart attack or stroke. You might take:

  • High blood pressure medicine.
  • High cholesterol medicine.
  • Aspirin. Your doctor may suggest that you take a daily, low-dose aspirin if the benefits of aspirin to prevent a stroke are greater than the risk of stomach bleeding from taking daily aspirin. But the daily use of low-dose aspirin in healthy women who are at low risk of stroke is not recommended.3
  • An anticoagulant, also called a blood thinner, to lower your risk of stroke if you have atrial fibrillation.
  • Medicine to lower the workload on your heart. If you have been diagnosed with CAD or have had a heart attack, you will probably take heart medicines like beta-blockers, angiotensin-converting enzyme (ACE) inhibitors, or angiotensin II receptor blockers (ARBs).
Birth control and hormone therapy
  • Talk with your doctor about what type of birth control is right for you. Healthy, young, nonsmoking women probably do not increase their risk of heart disease when they take low-dose birth control pills. But birth control pills are more likely to increase a woman's risk if she is older than 35 and smokes cigarettes.
  • Talk to your doctor about your risk with hormone therapy. And carefully weigh the benefits against the risks of taking it. If you need relief for symptoms of menopause, hormone therapy is one choice you can think about. But there are other types of treatment for problems like hot flashes and sleep problems. For more information, see the topic Menopause and Perimenopause.

What are symptoms of coronary artery disease and heart attack?

Knowing symptoms of a heart attack can help save lives. So even if you're not sure that your symptoms are from a heart attack, do not delay seeking care. Do not wait more than 5 minutes to call 911 if you think you or someone else is having a heart attack.

Women are more likely than men to delay seeking help for a possible heart attack. Women delay for many reasons, like not being sure it is a heart attack or not wanting to bother others. But it is better to be safe than sorry.

Pay attention to your symptoms, know what is typical for you, learn how to control it, and know when to call for help.

Angina symptoms

Angina (say "ANN-juh-nuh" or "ann-JY-nuh") symptoms happen when there is not enough blood flow to the heart.

Most people feel angina symptoms in their chest. The most common symptom is chest pain or pressure, or a strange feeling in the chest. But you might feel symptoms in other parts of your body. Some people feel pain, pressure, or a strange feeling in the back, neck, jaw, or upper belly, or in one or both shoulders or arms.

Other symptoms of angina include shortness of breath, nausea or vomiting, lightheadedness or sudden weakness, or a fast or irregular heartbeat.

Women are somewhat more likely than men to have other symptoms like shortness of breath, nausea, and back or jaw pain. Some women describe their symptoms as mild. Others feel tired when they have angina.

Stable angina occurs at predictable times and may continue without much change for years. It is relieved by rest or nitrates (nitroglycerin) and usually lasts less than 5 minutes. Unstable angina is a change in the usual pattern of angina. It means blood flow has slowed suddenly. It is an emergency. It is a warning sign that a heart attack may soon occur.

Heart attack symptoms

For men and women, the most common symptom is chest pain or pressure. But women are somewhat more likely than men to have other symptoms like shortness of breath, nausea, and back or jaw pain.

Heart attack symptoms include:

  • Chest pain or pressure, or a strange feeling in the chest.
  • Sweating.
  • Shortness of breath.
  • Nausea or vomiting.
  • Pain, pressure, or a strange feeling in the back, neck, jaw, or upper belly, or in one or both shoulders or arms.
  • Lightheadedness or sudden weakness.
  • A fast or irregular heartbeat.

After you call 911, the operator may tell you to chew 1 adult-strength or 2 to 4 low-dose aspirin. Wait for an ambulance. Do not try to drive yourself.

When you get to the hospital, do not be afraid to speak up for what you need. Be sure your doctors know that you think you might be having a heart attack so that you can get the tests and care you need.

Other Places To Get Help

Organizations

American Heart Association (AHA)
7272 Greenville Avenue
Dallas, TX  75231
Phone: 1-800-AHA-USA1 (1-800-242-8721)
Web Address: www.heart.org
 

Visit the American Heart Association (AHA) website for information on physical activity, diet, and various heart-related conditions. You can search for information on heart disease and stroke, share information with friends and family, and use tools to help you make heart-healthy goals and plans. Contact the AHA to find your nearest local or state AHA group. The AHA provides brochures and information about support groups and community programs, including Mended Hearts, a nationwide organization whose members visit people with heart problems and provide information and support.


Women's Heart Foundation
Phone: (609) 771-9600
Email: bonnie@womensheart.org
Web Address: www.womensheart.org
 

The Women's Heart Foundation provides education for women about preventing and treating heart disease. Information covers caregiving, exercise, nutrition, and medical and surgical treatments. The information focuses on the unique needs of women who have heart disease.


References

Citations

  1. Mosca L, et al. (2011). Effectiveness-based guidelines for the prevention of cardiovascular disease in women 2011 update: A guideline from the American Heart Association. Circulation, 123(11): 1243–1262.
  2. North American Menopause Society (2012). The 2012 hormone therapy position statement of the North American Menopause Society. Menopause, 19(3): 257–271. Also available online: http://www.menopause.org/PSht12.pdf.
  3. U.S. Preventive Services Task Force (2009). Aspirin for the prevention of cardiovascular disease. Available online: http://www.uspreventiveservicestaskforce.org/uspstf/uspsasmi.htm.

Other Works Consulted

  • Charney P (2011). Women and coronary artery disease. In V Fuster et al., eds., Hurst's The Heart, 13th ed., vol. 2, pp. 2226–2240. New York: McGraw-Hill.
  • Hsia J, Manson JE (2007). Women and heart disease. In EJ Topol, ed., Textbook of Cardiovascular Medicine, 3rd ed., pp. 553–560. Philadelphia: Lippincott Williams and Wilkins.
  • Mosca L, et al. (2011). Effectiveness-based guidelines for the prevention of cardiovascular disease in women 2011 update: A guideline from the American Heart Association. Circulation, 123(11): 1243–1262.
  • Newby LK, Douglas PS (2012). Cardiovascular disease in women. In RO Bonow et al., eds., Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine, 9th ed., vol. 2, pp. 1757–1767. Philadelphia: Saunders.
  • North American Menopause Society (2012). The 2012 hormone therapy position statement of the North American Menopause Society. Menopause, 19(3): 257–271. Also available online: http://www.menopause.org/PSht12.pdf.
  • U.S. Preventive Services Task Force (2009). Aspirin for the prevention of cardiovascular disease. Available online: http://www.uspreventiveservicestaskforce.org/uspstf/uspsasmi.htm.

Credits

By Healthwise Staff
Rakesh K. Pai, MD, FACC - Cardiology, Electrophysiology
Robert A. Kloner, MD, PhD - Cardiology
Last Revised January 17, 2013

This information does not replace the advice of a doctor. Healthwise, Incorporated disclaims any warranty or liability for your use of this information. Your use of this information means that you agree to the Terms of Use. How this information was developed to help you make better health decisions.

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