Cardiovascular Disease

August 3, 2011

Cardiovascular disease (CVD) is the major cause of death and disability for U.S. women—43.3% of all female deaths occur from Cardiovascular disease. Overall, one in five women have some form of Cardiovascular disease, but this proportion varies depending on age: only one in seven women have Cardiovascular disease at ages 45-64 years but almost one in three women have Cardiovascular disease at age older than 65. Although women develop coronary artery disease (Coronary artery disease) on average 10-20 years later than men, because they constitute a much larger proportion of the population older than 65, more women than men die annually of myocardial infarction. In the United States in 2000, 505,661 women died of Cardiovascular disease, almost twice as many as combined death from all forms of cancer. Black women have a 71% greater death rate from Coronary artery disease than white women.

Although the death rate from Cardiovascular disease in men has declined, the mortality rate has remained relatively constant for women. Several factors may be contributory. Because women were excluded from older research studies or their proportion was small, less information is available about optimal preventive, diagnostic, and therapeutic modalities. Second, women more often present with “atypical” symptoms of chest pain, which may appear noncardiac and because electrocardiographic stress testing is less accurate in women than in men, some physicians either disregard the symptoms or avoid offering the appropriate testing to diagnose Coronary artery disease in women. Third, because Coronary artery disease (the major contributor to Cardiovascular disease) develops in women later than in men, some misperceive this as a protective mechanism. Women, even with documented Coronary artery disease, are less likely than men to be evaluated for cardiovascular risk factors and to receive adequate counseling and treatment. Women are also less likely than men to be referred to or to enroll in cardiac rehabilitation programs, which provide education about risk factor modification.

Risk factors for Coronary artery disease are comparable in women and men. The risk factors shared with men are: dyslipidemia (presence of abnormal, elevated lipid, or fat, levels in the blood), diabetes, hypertension, smoking, obesity, sedentary lifestyle, and family history. Risk factors increase with age and may worsen after menopause. More than 50% of women older than 45 have hypertension with black women having an 85% higher rate of ambulatory visits for hypertension than white women. Cigarette smoking is present in more than 20% of women > 18 and more younger women are new smokers than young men. At age 55, more than 40% of women have elevated cholesterol, more than 55% are obese, and 25% of women report no regular physical activity. A recent study suggested that moderateintensity physical activity such as walking is associated with a substantial reduction in risk of stroke when compared with physical activity done at an average pace. Diabetes is an increasing disease in women: 5-7% of women >20 years old have diabetes, 5-7% have prediabetes, and another 2-5% have undiagnosed diabetes according to the American Diabetes Association. Diabetes in women increases cardiovascular risk by threeto sevenfold compared with a twoto threefold increase for men. Risk factors must be identified and treated early because atherosclerosis develops over decades before it becomes clinically manifest. The American Heart Association/American College of Cardiology guidelines advise that pregnancy and the preconception period is the “optimal time to review a woman’s risk factor status and health behaviors to reduce future cardiovascular disease.”

A risk factor unique to women is the use of oral contraceptives. High-dose oral contraceptives of prior years increased the incidence of heart attack, deep venous thrombosis, and stroke. The main mechanism appeared to be stimulating clot (thrombus) formation in the heart or brain arteries and leg veins. The current oral contraceptives have much lower estrogen content and do not appear to increase the risk of myocardial infarction or stroke; however, there is still a twofold increased risk of deep venous thrombosis or pulmonary embolism. Women smokers who use oral contraceptives are more likely to develop hypertension, heart attack, and stroke than nonsmokers, a risk that increases with age. Therefore, oral contraceptives are contraindicated in female smokers older than 35 years.

SEE ALSO: Acute myocardial infarction, Cholesterol, Coronary risk factors, Diabetes, Hormone replacement therapy, Hypertension, Oral contraception, Smoking, Stroke, Systemic lupus erythematosus, Venous thromboembolism

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Category: C, Cardiovascular Disease