Heart Disease Risk Factors in Women

If you are a woman, it is important to understand your heart disease risk—and to do something about it.

While many women (and unfortunately, some doctors) apparently still do not know it, heart disease is the number one killer of women. About a half million women die of heart disease each year in the U.S. In fact, more women than men die from cardiovascular disease—from heart attacks, heart failure, and strokes. To keep your chances of developing heart disease and stroke as low as possible, it is critical for you to control your risk factors.

Which risk factors do you need to be concerned about as a woman? Which ones can you really do something about? Let's take a look.

Non-Controllable Risk Factors

Everybody has the potential for cardiac risk factors they can't do anything about. If you are a woman, here they are:

• You have a family history of premature coronary artery disease or stroke (occurring in male family members younger than 55, or in female family members younger than 65).
• You are age 55 or older.
• You are post-menopausal, or have had your ovaries removed.
• During any pregnancies you had, you experienced pre-eclampsia (significant high blood pressure) or gestational diabetes, or you delivered a low-birth-weight baby.

A family history of premature cardiac disease, especially in a sister or brother, may be a particularly important risk factor in women. Women who have such a family history need to be especially aggressive in managing the cardiac risk factors that can be controlled.

Controllable Risk Factors

Here are the risk factors that are under your control. By addressing them, you can greatly reduce your risk of developing cardiovascular disease:

• Being overweight or obese.
• Sedentary lifestyle (little to no exercise).
• Smoking or using tobacco products (Smoking puts you at risk for a multitude of health problems in addition to heart disease.)
• High blood pressure.
• High total cholesterol, and/or low HDL cholesterol.
• A diagnosis of diabetes.
• A diagnosis of metabolic syndrome.
• Increased C-reactive protein (CRP) levels.
• Using birth control pills, especially if you are also a smoker.

What You Need to Know About These Risk Factors

Most of these controllable risk factors (except the ones dealing with your reproductive system) apply to both men and women. However, there are some special considerations you need to take into account as a woman attempting to reduce your risk of heart disease.

1. Obesity and Sedentary Lifestyle These two risk factors are more common in post-menopausal women than in men the same age. Women tend to be caregivers, and (research suggests) out of a sense of duty many women appear to have a hard time justifying behaviors that are "just for me," such as regular exercise. As a result, older women may be particularly prone to inactivity and obesity, and both are strong risk factors for heart disease and stroke.

2. SmokingSmoking is bad for anyone, but appears to be a particular problem for women. Smoking accounts for the vast majority of heart attacks in women under the age of 45, and is a huge multiplier of risk in women who have a family history of heart disease. And birth control pills make things even worse; the combination of smoking and birth control pills increases the risk of early heart disease by 20-fold.

3. High Blood Pressure Hypertension is a major risk factor for heart disease and stroke. It is very common in women over 55, and evidence suggests that hypertension in women is often undertreated. But good treatment is well worth the effort—ask anyone who has had a stroke.

4. Cholesterol Abnormalities High cholesterol and other lipids greatly increase the risk of heart attack and stroke. Low HDL levels are a more important risk factor in women than in men. Evidence is mounting that achieving very low LDL levels, and/or substantially raising HDL levels, can actually halt or reverse coronary artery disease. In many women, cholesterol can be controlled with diet and exercise, but often drug therapy with statins is also needed.

5. Diabetes Type 2 diabetes is becoming ever more common, right along with one of its root causes—obesity. Diabetes should be thought of as a disease of blood vessels as much as a disease of sugar metabolism, as it greatly increases cardiovascular risk. The risk of heart disease in women with diabetes is increased as much as 6-fold.

6. Metabolic Syndrome Metabolic syndrome, particularly common in post-menopausal women, greatly increases the risk of heart disease and stroke.

7. C-Reactive Protein (CRP) This is a relatively "new" risk factor that may be more important in women than in men. Increased CRP levels indicate active inflammation, and a high CRP level usually can be assumed to mean that blood vessel inflammation is present. Especially in women, inflammation is thought to be a major factor in the erosion or rupture of coronary artery plaques. Recent evidence suggests that reducing CRP levels (with statins) lowers the risk of heart attack in some patients with coronary artery disease.

8. Related Problems During Pregnancy Finally, it now appears that women who develop certain complications during pregnancy—specifically preeclampsia (significant hypertension), gestational diabetes, or delivering low-birth-weight babies—have a significantly higher risk of early cardiovascular disease and death. Women who develop these complications should begin to aggressively manage all their cardiovascular risk factors, and should do so for the rest of their lives.

In summary, controlling the risk factors for heart disease is just as important in women as in men. And if you are a woman, you have a few additional things to think about as you plan your risk reduction strategy.