Bone loss, breast cancer—these and other health issues affecting scores of women get a lot of deserved attention and inspire health changes that can go a long way in preventing them from becoming part of your future. What’s unfortunate, though, is that there isn’t as much recognition of a woman’s risk of heart disease—even though it is the number one health concern facing American women today.
Heart disease, once commonly thought of as a “man’s disease,” is anything but. In the United States, approximately 6 million women have some form of coronary heart disease—many of whom don’t even know it. And sadly, one in three women won’t survive the disease, which claims more lives than cancer, Alzheimer’s and accidents combined.
Part of this is due to the same risk factors that affect everyone, regardless of gender. But specific aspects of a woman’s physiology and health journey can play a role, too.
A Woman’s Heart
Women and men have differences when it comes to their anatomy, but not just in the ways that may easily come to mind. First, your heart is smaller than a man’s. It may work harder, beating more times per minute to make up for its size and taking longer to relax after each pump. Perhaps most important, though, are differences in the arteries. Women have a greater occurrence of microvascular dysfunction—when the small arteries in the heart become narrowed and less elastic—than men, making it easier for that plaque to build up. On top of that, your arteries are smaller than a man’s, too. This may be one of the reasons heart disease is harder to detect in women: In most cases, men have “clumps” that appear in main arteries. While this can happen in women, they may also experience a more even distribution of plaque throughout smaller, less obvious surrounding blood vessels.
Women-Only Health Concerns
Menopause is perhaps one of the most defining differences between a man and woman’s risk of heart disease. Women’s risk of heart disease starts to notably increase as estrogen levels decrease, which affects the endothelium (the inner lining of artery walls). The endothelium "sets the tone" of the artery, impacts how easily cholesterol particles migrate into the wall and become deposited as plaque, and also plays a role in how prone those plaques are to rupture. Additionally, estrogen is known to improve insulin sensitivity—a key concern that could lead to heart disease—and encourage higher HDL or "good cholesterol" and lower LDL or "bad cholesterol" (the latter type can clog blood vessels). Though maintaining a healthy weight—which helps prevent your heart from being overtaxed and can help protect you from other heart-affecting diseases—can become more challenging for anyone with age, plummeting estrogen can make this even harder for women.
Research has also shown that women who develop high blood pressure during pregnancy, known as preeclampsia, are twice as likely to develop heart disease in the future, although it’s unknown if the increased risk is due to pre-pregnancy factors as well. Women with high blood pressure, independent of pregnancy, are almost four times more likely to develop coronary heart disease than women with normal blood pressure (120/80 mmHg).
Diabetes, while not exclusive to women, of course, can pose some specific concerns for women, too. People with the disease are more likely to develop heart disease than those who don’t. But women with this health issue who are also obese and have hypertension tend to suffer a higher risk of developing cardiovascular issues than men in the same boat. Women who fall into this group who have also already had a heart attack have double the risk of a second attack and an increased chance of heart failure, compared to peers who haven’t suffered such an event.
Prevention Starts Now
All of this information may be overwhelming—even scary. But though heart disease may be the biggest threat to your health, it’s also the most preventable.
Get moving. Aim for at least 150 minutes of moderate and 75 minutes of vigorous aerobic exercise per week. Heart-pumping activities ranging from a brisk walk or competitive tennis match to a Zumba class or a lap session in the pool all count.
Eat well. Heart-healthy picks include fruits and vegetables—especially berries, broccoli, spinach and other bioflavonoid-rich choices, which reduce inflammation and encourage blood flow—whole-grains, high-fiber foods and fish (particularly those rich in omega-3s, like salmon). Try to get most of your dietary fats from fish, nuts and seeds and extra virgin olive oil, all of which have beneficial effects on artery elasticity. Foods containing sodium and sugar are worth trying hard to limit, and it's best to avoid trans fats entirely.
Drink wisely. Many raise a glass to toast studies that suggest that moderate alcohol intake (one drink or less per day) may reduce heart disease. While that may be true, downing more than that could have the opposite effect.
Work to manage stress. Continuously high levels keep your body on “high alert,” potentially contributing to increased heart rate, elevated cholesterol and other health consequences. Cultivate and work in outlets for stress and strategies for self care such as yoga, meditation, talking to a supportive friend or getting a massage. Relaxation not only helps you feel better but can improve endothelial function and help arteries become more elastic.
Quit smoking. Women smokers are nearly twice as likely to die of sudden cardiac death compared to women who have never smoked. Commit to taking this important step for your health; nicotine replacement therapy may be a helpful tool.
Keep your blood pressure in check. Maintain ideal numbers (less than 120/80 mmHg); all four of the above strategies can help you with this goal.
A Note About Hormone Replacement Therapy
Some women turn to hormone therapy to relieve symptoms of menopause. Research is mixed and experts are still studying the effects of this therapy on heart disease risk in postmenopausal women, but there is data that suggests that estrogen may decrease the risk of heart disease when taken soon after menopause sets in. The most recent findings come from the Kronos Early Estrogen Prevention Study (KEEPS), involving more than 700 women, which concluded that an estrogen/progesterone treatment started soon after menopause appears to be safe, relieves many women of menopause symptoms, and improves mood, bone density and several markers of cardiovascular risk.
Still, hormone therapy is an individual decision, and it’s not prescribed primarily to reduce the risk of disease. If you're considering it, talk with your doctor about the possible heart-related risks, which vary depending on a number of factors: whether estrogen is given alone or with a progestin; the dose and type of estrogen; if it’s taken orally (which can increase triglycerides, clotting factors and your C-reactive protein level—a marker for inflammation); your current age and age at menopause; and family medical history.