Women & Heart Disease

The most important fact about heart disease in women is that heart disease very common among women. American Heart Association statistics show that women in the United States are three to four times more likely to die from Coronary Heart Disease than from Breast Cancer. Another alarming fact is that the major risk factor of cigarette smoking is increasing in young women.

The risk of death from heart disease is declining in the United States, however the rate of drop is less steep for females than for males.

Coronary Heart Disease

In the United States the most common for of heart disease is coronary artery disease (CAD), this is true for women as well as men. The major risk factors for CAD are the same for women as well as men. Elevated cholesterol, cigarette smoking, high blood pressure, diabetes, and family history of heart disease all are major risk factors for CAD in women. Compared to men, the risk of developing CAD is less for women. However, once menopause is reached, the risk for women increases sharply. Being premenopausal does not prevent CAD in women; risk factors must be controlled whenever possible.

There are at least two circumstances in which women do have special risks. The use of oral contraceptives in women who smoke cigarettes has been associated with a significant increase in deep venous thrombosis (blood clots in the legs) and pulmonary embolism (blood clots in the lung). The latter may be a fatal condition. Smoking must be avoided when oral contraceptives are used.

While the premenopausal state does not preclude CAD it does greatly reduce the risk of CAD. Once menopause is reached the rates of CAD in women increases. This raises the question: Should women routinely take hormone replacement therapy (HRT) to try to prevent CAD? At present there is not a definitive answer to this question. Therefore each women must discuss this question with her doctor. There is much data to suggest that HRT does help prevent CAD in women, there is however, not definitive scientific data to prove that HRT should be routine. There are many other factors to consider when making this decision: osteoporosis and the risk of certain cancers must be individualized when making this decision.

The treatment of CAD in women has been examined in detail and some studies have shown that women may not do as well as men when treated with bypass surgery or angioplasty. Latter studies have shown that this may not be true. The factors that impact on the outcome of bypass surgery and angioplasty may place women at a disadvantage. Age is a major risk factor for complications of these procedures and women tend to be older then men when undergoing surgery or angioplasty. The size (diameter) of the coronary artery is also important in bypass surgery and angioplasty with patients with larger arteries doing better than those with smaller arteries. Women tend to have smaller arteries then men.

One aspect of the care of women with CAD that is different than the care of men is that the presenting symptoms are more frequently atypical in nature. The typical chest pressure and heaviness that is typical of angina may not be present in women who present with CAD. This makes diagnosis more difficult and often delays the time from presentation to diagnosis.

Mitral Valve Prolapse

Mitral valve prolapse is common in women and men. This disorder of the mitral valve may be associated with symptoms of chest pains, palpitations, fatigue and other symptoms. When MVP is present it is often necessary to use antibiotic before surgery and dental procedures to prevent infections on the valve (endocarditis prophylaxis). Symptoms are often treated with an exercise program and sometimes drugs called beta-blockers are used. If exercise programs are followed, MVP may be well controlled and a normal life style can be followed.

Special Considerations

The two major issues regarding heart disease in women relate to pregnancy and the increased risk of coronary heart disease after menopause. Pregnancy may rarely be associated with problems in the coronary arteries (heart arteries) and with the aorta (the major blood vessel leaving the heart). While these problems are very rare they can be very serious. Dissection of the coronary arteries or the aorta may cause chest pain or shortness of breath and require evaluation and treatment.

The risk of coronary heart disease increases after menopause and becomes equal to the risk in men. The question of whether hormone replacement therapy will prevent this increase in risk is open.

There are a number of observations which suggest the HRT is useful, however, randomized research trials are underway to hopefully answer this question. Until these studies are complete this decision of each woman is best made one on one with her physicians.