Preventing Cardiovascular Disease in Women

The leading cause of death in women, and an important cause of disability, is cardiovascular disease. Yet many women and their physicians underestimate the risk of heart disease. Physicians should be concerned both with preventing primary cardiovascular disease symptoms that can lead to an initial heart attack as well as preventing subsequent attacks. Certain underserved populations, such as poor and minority women, are less likely to get state-of-the-art care for cardiovascular disease.

A 1995 poll found that four of five women and one in three primary care physicians were unaware that cardiovascular disease is the number one killer of women. Men are more likely to be offered treatment to prevent subsequent heart attacks. As a result, the number of cardiovascular deaths has decreased in men, but not in women. Compared to men, women are more likely to be misdiagnosed and are more likely to die of their first heart attack.

On average, symptoms of heart disease usually begin later in life in women than in men. The risk of cardiovascular disease increases after menopause. Though women may recognize that chest pain or pressure can signal a heart attack, they may not realize that neck, jaw or shoulder pain, nausea, fatigue or shortness of breath may be important warning signs as well. In fact, where the chest pain or pressure of typical angina predicts heart disease in 80 to 99 percent of men, it is only predictive in 50 to 60 percent of women. Evaluation of risk factors, such as diabetes, hypertension and stress, can help physicians estimate the likelihood of cardiovascular disease in women with chest pain.

Risk Factors

Prevention of heart disease depends on reducing risk factors. The most common risk factor for cardiovascular disease in women is a sedentary lifestyle. According to the National Center for Health Statistics, 39 percent of white women and 57 percent of women of color do not get enough physical exercise. Rates of physical inactivity are highest among poor women. Conversely, 30 to 45 minutes of walking three times a week reduces the risk of heart attack in women by 50 percent. Exercise may also help prevent obesity, another risk factor for cardiovascular disease, and a major risk factor for developing type 2 (adult-onset) diabetes.

Diabetes contributes even more to the risk of heart disease in women than men. Women typically have higher levels of HDL (or so-called "good") cholesterol, and exercise tends to raise HDL levels. There are not enough studies yet to be able to say that cholesterol-lowering medications will prevent first heart attacks in women, although they have been shown effective in men.

Prevention Efforts

Exercise, smoking cessation, aspirin therapy and treatment of high blood pressure are proven to be effective measures for the prevention of initial cardiovascular disease in women. However, the role of cholesterol-lowering agents and hormone replacement therapy for women has not been well established in preventing the onset of cardiovascular disease. Observational studies have shown that the risk of heart disease decreases by one-third two years after smoking cessation. However, women find it more difficult to quit smoking than men and are more likely to relapse. In women with known cardiovascular disease, cholesterol-lowering agents have been shown to be helpful in preventing subsequent heart attacks; hormone replacement therapy has not been shown effective, although a major study is underway with results due in 2006.

Other prevention measures in women with known cardiovascular disease have been shown effective, but are underused, particularly in minority women. Women, in general, are less likely to undergo angioplasty (in which a balloon-like device is inserted to open an artery) or coronar artery bypass surgery. They are less likely than men to be referred for exercise rehabilitation after a heart attack and are less likely to remain enrolled. Effective risk-reduction measures for women with cardiovascular disease include exercise, a low-fat diet, cholesterol-lowering agents, aspirin, beta blockers, high blood-pressure medications, rehabilitation and revascularization (in which veins or arteries are rerouted to improve blood flow).

This information is based on an article by the authors listed below that appeared in the April 1, 2001 issue of American Family Physician.

Each year, Medical College of Wisconsin physicians care for more than 180,000 patients, representing nearly 500,000 patient visits. Medical College physicians practice at Children's Hospital of Wisconsin, Froedtert Memorial Lutheran Hospital, the Milwaukee VA Medical Center, and many other hospitals and clinics in Milwaukee and southeastern Wisconsin.