Women and Coronary Artery Disease

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

Reference Coronary artery disease Opens New Window 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.^{Reference 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 Reference plaque Opens New Window (made of fat, Reference cholesterol Opens New Window and other substances) on the inside walls of the Reference coronary arteries Opens New Window. 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 Reference heart attack Opens New Window. See a picture of Reference how plaque causes a heart attack Opens New Window Reference Opens New Window.

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 Reference cardiac catheterization Opens New Window test. Researchers are trying to understand these differences to help find the best ways to diagnose and treat women who have CAD.

What leads to coronary artery disease in women?

Women have unique risk factors for heart disease. These include Reference birth control pills, hormone therapy, and pregnancy-related problems.

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

Hormone therapy. Taking Reference estrogen Opens New Window with or without Reference progestin Opens New Window does not prevent coronary artery disease. In fact, if you are 10 or more years past menopause, taking Reference hormone therapy Opens New Window may raise your risk of coronary artery disease.^{Reference 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 Reference atherosclerosis Opens New Window 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 Reference preeclampsia Opens New Window 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 Reference lupus Opens New Window and Reference rheumatoid arthritis Opens New Window, have been linked with a higher risk of heart disease in women.

Heart disease risk factors for both women and men

Reference 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:

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

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:

  Reference American Heart Association Healthy Diet.

  Reference Reference DASH Diet.

• Be active. Try to do Reference moderate activity Opens New Window at least 2½ hours a week. Or try to do Reference vigorous activity Opens New Window 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:

  Reference Fitness.

• Keep your Reference body mass index (BMI) Opens New Window between 18.5 and 24.9 and your waist circumference less than 35 inches. To check your BMI:

  Reference Interactive Tool: Is Your BMI Increasing Your Health Risks? Reference

• 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:

• Reference High blood pressure Opens New Window medicine.
• Reference High cholesterol Opens New Window 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.^{Reference 3}
• An Reference anticoagulant Opens New Window, 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 risks 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 Reference 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 Reference other parts of your body Opens New Window Reference Opens New Window. 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.

Reference Stable angina Opens New Window 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. Reference Unstable angina Opens New Window 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.

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