Heart disease is the number one killer of both men and women in the United States. Fortunately, the condition is often highly preventable through lifestyle changes, medication or both. February is American Heart Month — a month dedicated to raising awareness about heart disease and its associated risk factors.

What is Heart Disease?

"Heart disease" is a broad term that covers several specific heart conditions and is often used interchangeably with "cardiovascular disease." However, these terms are not exactly the same. Heart disease refers to diseases of the heart and the blood vessel system within the heart. Cardiovascular disease refers to diseases of the heart and the blood vessel system within the entire body.

Coronary heart disease (CHD) is the most common form of heart disease and is characterized by the narrowing of the small blood vessels that supply blood and oxygen to the heart. This narrowing of the blood vessels is caused by a build–up of plaque in the arteries (atherosclerosis) that can impede the flow of blood to the heart, resulting in chest pain (angina) and/or shortness of breath. If blood flow is stopped completely, a heart attack can occur. In some cases, the first sign of CHD is a heart attack. Men in their 40s have a higher risk of developing CHD than women. As women age, however, their risk increases until it is almost equal to that of men.

Other common types of heart disease include irregular heartbeat (arrhythmia), heart valve conditions and heart failure.

Women and Heart Disease

American Heart Month kicked off on February 1 with National Wear Red Day┬« -— a day when individuals across America wear red to show support for women's heart disease awareness*. The Heart Truth┬«, a public service initiative sponsored by the National Heart Lung and Blood Institute (NHLBI), created and introduced the Red Dress in 2002 as the national symbol for women's heart disease awareness. This campaign provides a personal and urgent wakeup call to all women by encouraging them to understand and modify their heart disease risk factors. The campaign has seen tremendous progress since its inception, including a 21 percent decrease in female deaths related to heart disease and a 23 percent increase in the number of women who are aware that heart disease is their number one health threat.

Heart disease is still often thought of as a "men's disease," yet in every year since 1984, heart disease has killed more women than men. Women die from heart disease at an average rate of one death per minute. According to the American Heart Association's (AHA) Heart Disease and Stroke Statistics 2013 Update, approximately 42.9 million American women (more than 1 in 3) are currently living with some form of heart disease. This number includes almost half of all African–American women, more than one–third of all Caucasian women and slightly less than one–third of Mexican–American women. Despite the statistics, only one in five American women believes that heart disease is her greatest health threat.

There are many similarities in the way heart disease affects men and women, but there are also some important differences, such as risk factors and signs of a heart attack.

Risk Factors

Men and women face many of the same heart disease risk factors:

  • Age
  • Family history
  • Cigarette smoking
  • High blood pressure
  • High blood cholesterol
  • Overweight/obesity
  • Lack of physical activity
  • Diabetes
  • Metabolic syndrome
  • Increased levels of C–reactive protein (CRP)
Some risk factors play a more significant role in the development of heart disease among women:
  • Metabolic syndrome: Metabolic syndrome refers to a group of risk factors such as abdominal obesity and high triglyceride level that greatly increase an individual's risk of developing heart disease and stroke. Metabolic syndrome is very common in post–menopausal women.
  • C–reactive protein (CRP): An individual's C–reactive protein level is a newly–recognized heart disease risk factor. C–reactive protein is found in the blood and rises in response to any type of inflammation such as that caused by infections, arthritis and tumors. Inflammation is believed to be a major contributing factor in the erosion or rupture of coronary artery plaques, particularly in women.
  • Smoking: Smoking is a greater heart disease risk factor among women than it is among men. A recent study in Circulation: Arrhythmia & Electrophysiology found that, for every five years a woman smoked, her risk of sudden cardiac death increased by eight percent. Women who smoked 25 or more cigarettes a day were three times more likely to suffer sudden cardiac death compared to women who did not smoke. Women who smoked for more than 35 years had a two–and–a–half–times greater risk of sudden cardiac death than women who had never smoked.
  • Depression and stress: Depression often leads to chronic stress that increases an individual's heart rate and blood pressure — conditions that can lead to an increased risk of heart disease. Studies have found that women are more likely than men to suffer from depression.
  • Complications during pregnancy: Women who have complications during pregnancy including preeclampsia, gestational diabetes or delivery of a low–birth–weight baby have been shown to have a significantly higher risk of early heart disease and death.
  • Menopause: Studies have shown that women experience an increased risk of heart disease after menopause because of decreased estrogen levels.

Ninety percent of women have one or more risk factor. Each risk factor greatly increases an individual's chance of developing heart disease. Having more than one risk factor is especially serious as risk factors tend to compound each other's effects.

To reduce the risk of heart disease, all risk factors need to be addressed through lifestyle changes when possible. Important lifestyle changes include quitting smoking, losing weight, changing dietary habits, reducing stress and engaging in regular physical activity. Research suggests that even small lifestyle changes can reduce the risk of heart disease. In addition to lifestyle modifications, a physician may prescribe medication(s) to treat heart disease and/or heart disease risk factors. There are a variety of medications that may be prescribed including blood pressure medications, cholesterol medications, beta blockers and blood thinning medications.

Heart Attack

According to the AHA, someone in the U.S. has a heart attack approximately every 34 seconds. For both men and women, the most common sign of a heart attack is chest pain, pressure or discomfort. Other common symptoms include discomfort in one or both arms, the back, neck, jaw or stomach; shortness of breath; and/or nausea, lightheadedness and cold sweats. While chest pain is still the most common symptom among women, studies have shown that women are more likely than men to have symptoms other than chest pain or discomfort when having a heart attack. Women are also more likely to have these uncommon heart attack warning signs:

  • Heartburn
  • Loss of appetite
  • Tiredness or weakness
  • Coughing
  • Heart flutters
A heart attack is a medical emergency. Anyone experiencing any of the warning signs should call 911 immediately and be transported to the hospital by ambulance so that life–saving treatment can be started on the way to the hospital.

The good news is that heart disease deaths among men and women have been declining over the past 30 years. Unfortunately, deaths among women have been declining at a slower rate. Heart health is one of the most important components of overall health and well–being. Many of the risk factors for heart disease are modifiable and can be controlled. Speak to your physician about your personal heart disease risk factors and the ways in which you can modify and/or reduce them.

* The photo shown in this article is EHE's 2013 National Wear Red Day photo. This year's photo, which features twenty–eight EHE International women wearing stunning red evening gowns, was taken in front of the "Rhythms of Infinity" wall at 30 Rockefeller Plaza and will be on display in a window at 10 Rockefeller Plaza throughout February. The window also highlights a decade of EHE International's support of this very important women's health issue.

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