Heart Disease Risk Factors
Women: Cardiovascular Disease Risk Factors

Heart Health

Women Smokers

Heart Disease Risk Factors

Contents

Introduction
Modifiable Risk Factors
Non-Modifiable Risk Factors
Special Risk Factors For Women


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Heart Disease in Women
The Human Body

Risk Factors: Explained

Any condition which increases the odds of developing a disease is known as a risk factor. Major risk factors are divided into modifiable (those you can do something about) such as smoking or drinking and fixed non-modifiable risk factors (those you can’t do anything about), such as age, gender and genetics. Many of the risk factors associated with heart disease (also known as cardiovascular disease, CVD) are thought to be similar for both men and women. However major differences still exist between the genders and these include biological, medical and social factors. Below is an explanation of the common risk factors (both modifiable and non-modifiable) of heart disease as well as an explanation of the differences between the sexes.

Modifiable Risk Factors

High Cholesterol

Cholesterol is a waxy substance which is produced naturally by the liver. An excess of cholesterol is usually caused by diet. This extra cholesterol accumulates in the arteries (a process known as atherosclerosis) leading to blockages and sometimes heart attacks. There are 2 types of cholesterol, LDL (low-density lipoprotein) and HDL (high-density lipoprotein). The balance of LDL and HDL determines the risk of CVD. LDL is the 'bad' cholesterol which causes deposits in the arteries while HDL is the 'good' cholesterol which reverses its affects. It is recommended that all adults aged 20 or older should be tested for cholesterol every 5 years. This blood test is known as a fasting lipoprotein profile. It tests HDL, LDL and triglycerides levels and is carried out after a 9-12 hour fast. A total cholesterol level of 200-230 mg/dL is considered borderline high for risk of heart disease and 240 mg/dL and higher is considered high risk.

American Heart Disease Statistics and UK Heart Disease Statistics.

Smoking

The rate of heart disease increases 6-fold in women who smoke tobacco (compared to 3-fold in men). Smoking accounts for about 1 in 5 heart disease deaths. It draws chemicals into the lungs and circulatory system, causing the heart to beat more forcefully. This causes high blood pressure. Blood vessels also narrow. It also lowers the levels of good cholesterol and increases the risk of thrombosis (blood clots) and atherosclerosis. While marijuana notably is not an established risk factor for heart disease, it can act as a rare trigger for a heart attack. This is because it increases blood pressure within the first hour of use thus increases the risk of heart attack 5-fold. Cocaine users increase this risk factor 24-fold. Exposure to passive smoking also increases CVD risks.

Hypertension (High Blood Pressure)

High blood pressure (hypertension) increases the risk of heart disease and stroke. The higher the pressure, the higher the risk. If high blood pressure is combined with other risk factors, the risk of CDV increases again. It is estimated that if diastolic blood pressure could be lowered in general by just 5-6 mm Hg, there would be 25 percent fewer deaths from heart disease. As a general rule, for those over 40 years of age, each 20 mm Hg increase in systolic blood pressure or 10 mm Hg increase in diastolic pressure doubles the risk of heart disease. As hypertension has no symptoms, it is important to have your blood pressure tested once a year. 60 million Americans are estimated to suffer high blood pressure, many of whom do not know it. See, why is high blood pressure dangerous?

Interesting
See natural remedies for heart disease for drug-free alternatives to preventing heart problems. Additionally see our list of books on heart disease including resources on reducing your risk factors.

Obesity

Obesity is defined in terms of BMI (body mass index). A person with a BMI of higher than 25 is considered overweight, a person with a BMI over 30 is considered obese. Overweight people have a higher risk of developing diabetes and heart disease. Obesity in women is also linked to high blood pressure, elevated triglycerides and decreased 'good' cholesterol levels.

Physical Inactivity

People who lead a sedentary life are nearly twice as likely to suffer heart attacks as those who exercise regularly. Exercise raises good cholesterol levels, lowers blood pressure and insulin resistance as well as reduces the chance of obesity. Even moderate exercise can lower the risk. This is why cardiac patients are recommended participating in a cardiac exercise program.

Diabetes

The risk of stroke and heart attack increases 2 to 4-fold in people with type 2 diabetes. They also have a higher rate of death during and after heart attacks. About 75 percent of people with diabetes die of some form of CVD. Diabetes causes higher levels of blood glucose which appears to be associated with increased CVD risk - even in people without diabetes. If you are aged over 40 it is worth talking to your doctor about being screened for prediabetes, particularly if you display any signs of diabetes.

Pregnancy

Pregnancy can increase the risk of heart problems occurring, even in women who have healthy hearts. Having a baby stresses the heart and circulatory system and during pregnancy our blood volume increases by nearly 50 percent to nourish the growing fetus. This can lead to temporary side effects such as heart murmurs and heart palpitations, as well as increased blood pressure. See: Heart disease and pregnancy for more details.

Alcohol

Recent research shows that drinking moderate amounts of alcohol (particularly red wine) can protect the heart against disease by raising good cholesterol levels and decreasing the chances of blood clots. Excessive drinking however can increase triglyceride levels, blood pressure and the risk of obesity (through calorie intake).

Stress

How people cope with stress can affect their risk of developing heart disease. The link is not clearly understood, but it appears that stress keeps blood pressure raised and promotes blood clotting factors. It may also act indirectly by causing people to 'comfort eat' with junk food, smoke or drink. Take the online stress test to discover your risk of stress-related illness. Read more in our article the dangers of stress.

Metabolic Syndrome

Metabolic syndrome is the presence of a cluster of risk factors which together increase the risk of heart disease. It is characterized by fat around the belly (central obesity), abnormal lipid levels, high blood pressure, insulin resistance and a situation which favors the inflammation and clot formation in blood vessels. Metabolic syndrome is diagnosed if 3 of the 5 criteria exist:

• A waist circumference equal to or greater than 35 inches (89 cm) in women and 40 inches (102 cm) in men.
• Fasting triglycerides equal to or greater than 150 mg/dL.
• HDL cholesterol equal to or greater than 50 mg/dL in women (40 mg/dL in men).
• Blood pressure equal to or greater than 130/equal or to greater than 85 mm Hg.
• Fasting glucose equal to or greater than 100 mg/dL.

Yellow Patches Around The Eyes

According to a recent study of 13,000 people published in the British Medical Journal in 2011, yellow markings on the skin around the eyes can be an early sign of heart disease. The condition is medically termed xanthelasma (image), and is caused by deposits of cholesterol which are soft and pain-free. They do not cause any problems with vision and many people will get them treated by a dermatologist. They should however be considered a warning sign as people with xanthelasma are more likely to die of a heart attack within 10 years than those who do not. According to researchers, the prevalence of yellow markings is as common in women as men. However, it is usually a better predictor of heart disease and heart attacks in women, especially if it occurs in women under the age of 55. The study also discovered that gray or white rings found around the cornea of the eye (termed arcus corneae - image) is not linked to cardiovascular disease. The study concluded that doctors should be aware of xanthelasma and it's possible implications.

Ear Lobe Crease

An ear lobe crease (image) is a line that run diagonally across the ear lobe. It has been proven in numerous studies that this crease can be an indication that the person has heart disease. One Swedish study found the crease in 68 percent of people who died of CHD and in 80 percent of those who died under the age of 40. Another Turkish study found that 91 percent of patients admitted to the Montreal Heart Institute had ear lobe creases. If you do have an ear lobe crease it is worth paying attention to your heart health.

Non-Modifiable Risk Factors

Age

Nearly 4 out of every 5 people who develop heart disease, do so after the age of 65. This is because fatty deposits take time to accumulate in the arteries and they are ultimately responsible for most heart attacks. Although CVD tends to develop later in life in women than men, when it does occur it is more likely to be fatal. Women who have heart attacks are twice as likely as men to die within the first two months. See Heart Attacks in Women.

Gender

In general men have a higher risk of heart attack than women at any given age - but this gender difference tends to reduce as women become older. This is one of the reasons why a myth has grown up that heart disease is not a female issue. Yet 2.5 million American women are hospitalized for cardiovascular disease every year and half a million will die from heart disease. Even if the risk factor of women lags 10 to 15 years behind men, it is still the leading cause of death in women (above all cancers combined). See also: Coronary heart disease in women.

Genetics

Sometimes heart disease is heredity. If either parent had heart disease (particularly prematurely) this increases the child's risk. Risks increase if any male members of the family, father, brother or grandfather developed CDV before 55 or mother, sister and grandmother before the age of 65.

Race

Certain racial groups have higher risk factors of heart disease. More than 25 percent of Mexican Americans have heart disease. American Indians and native Hawaiians also have increased risks. African Americans have higher rates of stroke, heart attack, high blood pressure and heart failure (image). People of South Asian descent are high risk but Japanese are low risk.

Special Risk Factors For Women

Biological Differences

The risk of heart disease is low in women of reproductive age, regardless of whether or not they use oral contraceptives. After menopause this risk factor increases 2 or 3 times. An oophorectomy (surgical removal of both ovaries) increases the risk of heart attacks 3-fold by starting early menopause. This may be because after menopause estrogen production slows down and it is thought that estrogen helps protect against the build up of deposits in the arteries (atherosclerosis, read about the effects of estrogen). Although heart disease occurs later in women than men, it is more likely to be fatal when it does occur. The exact reasons for this are not well studied. It is known that the woman's heart and arteries are lighter than men and this may be a factor in the speed of atherosclerosis development. Drugs and operations for heart disease appear to be less successful in women than men. This may be because they are generally older when problems occur. Coronary heart disease treatment procedures such as coronary heart bypass surgery and coronary angioplasty are not offered to women as much as men. Although long-term survival rates after these procedures are comparable between the sexes, women tend to develop more complications such as serious bleeding. See also, development of the female body.

Lack Of Medical Attention

Very often it takes longer for a woman than a man to be diagnosed with heart disease. This is because doctors and women themselves are less likely to spot the symptoms for what they are. As a result, women are less likely to be sent for an electrocardiogram test (ECG) which tests the heart's performance. Even when they do have an ECG, women's hearts seem to respond differently to men given the same circumstances and it can be difficult to interpret the results. Women are less likely to be sent for a coronary angiography which can show blockages in the arteries. They receive fewer invasive surgeries than men with the same conditions and are less frequently referred to cardiac rehabilitation centers. Whether all means that women are receiving too little care, or that men are receiving too much, or that it is all proportionate to risk has yet to be clarified.

Testing Options

See Heart Disease Testing, also
Chemical Stress Test
Event Monitor
Exercise Stress Test
Echocardiogram

Holter Monitor - 24 hour test
Heart Catheterization
Nuclear Heart Scan
Vascular Screening

Social Differences

Older women are less likely than men to have a spouse (men die earlier) to push them to seek medical care if they fall ill or to help them around the house if they come out of hospital. They are also more likely to suffer effects of depression and anxiety after a heart attack. This may be because they tend to be sicker than their male counterparts and less able to resume normal life. All this can lead to slower recovery times.

  Related Articles on Heart Disease in Women

For more about the heart see the following:

Chest Pain Clinics: specialist care for the chest pains.
Chest Problems: symptom checker and list of health conditions.

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