American Heart Month

Heart Health in Women

Heart disease is the number 1 killer of American women, with mortality exceeding those deaths attributed to all forms of cancer combined. Yet women in the U.S. often experience delay in important heart health diagnoses due to lack of presenting symptoms, display of differing symptoms that are hard to recognize and identify, or having certain heart disease types that can be difficult to diagnose. Delay in diagnosis, care and treatment increases risk of cardiovascular issues like heart attack, stroke and even death.

Sobering cardiovascular health statistics relating to women:

Among women, 90% have 1 or more risk factors for heart disease at some point in their lives, according to American Heart Association (AHA) statistics.
Among females 20 years and older, nearly 45% have some form of cardiovascular disease.
Less than 50% of U.S. women beginning pregnancy have good heart health.
Cardiovascular disease is the number 1 killer of new moms, accounting for more than 33% of total U.S. maternal deaths.
Black women within the U.S. have some of the highest known maternal mortality rates.
51.9% of high blood pressure deaths, known as hypertension, occur in women.
Of all American women, 57.6% of Black females have hypertension – more than any other ethnicity group.
There are an estimated 4.1 million female stroke survivors living today.
Women represent approximately 57.5% of total stroke deaths annually.
80% of cardiovascular diseases are preventable through education and lifestyle changes.
Only 44% of U.S. women recognize cardiovascular disease as the greatest threat to their health.

February is designated American Heart Month. Your local Capital Women’s Care team of women’s health professionals offers you important information about women’s heart health, including what heart health issues you need to be vigilant for throughout each decade of your life, from teens through the post-menopausal and senior years. Additionally, we explain heart-health risks specific to women and offer vital tips you can implement to optimize your own heart health, so you achieve and enjoy a long quality life.

Teen Years

During this formative decade, young women can establish practices that offer a strong foundation benefitting their personal heart health:

Eat a balanced, healthy diet and drink plenty of water.
Get a quality night’s sleep daily.
Develop, initiate and practice coping and mindfulness skills to minimize stress and negative thoughts which can lead to depression, anxiety and high blood pressure.
Develop and nurture a personal positive body image to reduce eating disorders and over-exercise, 2 threats to sound heart health in younger women.
Avoid smoking, vaping, illicit substance, prescription drug, and alcohol misuse and abuse. All such risky behaviors significantly impact your heart, plus overall physical health.
Maintain a healthy body weight and BMI (Body Mass Index) to ward off overweightness, obesity and type 2 diabetes.
Monitor monthly menstrual cycles for symptoms of health issues like polycystic ovary syndrome (PCOS) or endometriosis, which can impact female heart health.

Reproductive Years

Pregnancy and its effects can impact a woman’s heart health, as 10 to 20% of American women experience a health issue sometime during pregnancy. Multiple pregnancies throughout reproductive years may also impact women’s heart health.

Some heart-related health issues to watch for during pregnancy include:

high blood pressure, preeclampsia and gestational diabetes during pregnancy greatly increase a women’s risk for developing cardiovascular disease later in life.
an irregular heartbeat (arrhythmia)
myocardial ischemia
peripartum cardiomyopathy
deep vein thrombosis (DVT) and pulmonary embolisms, conditions that are 4-5 times more common among pregnant women within 6 months of giving birth.
Spontaneous coronary artery dissection (SCAD) is a life-threatening condition that presents with a tear in 1 or more of the arteries supplying blood to the heart. About 4 in 5 people who experience SCAD are female, with about 1 in 3 cases denoted as pregnancy related. SCAD usually occurs within 1 week of giving birth, but it may occur in late pregnancy or within 6 weeks post-delivery.

Peri-Menopausal Years

Perimenopause signals the eventual end of childbearing in women. Monthly menstrual cycles may diminish or become erratic, with duration and flow characteristics changing as estrogen levels change within your body. It’s important to note that even during such changes in your monthly cycle, pregnancy is still possible.

Lowered estrogen levels negatively impact your body’s ability to regulate blood cholesterol. This includes a spike in low-density lipoprotein (LDL or bad cholesterol) levels, which in turn increases your susceptibility to heart disease. Furthermore, the amount of high-density lipoprotein (HDL or good cholesterol) in the body could plunge as women age. Low HDL is another contributing factor for cardiovascular complications.

Additionally, heart palpitations may begin during perimenopause. Occasionally, perimenopause heart palpitations could indicate a major medical issue like hyperthyroidism or arrhythmia.

It’s critical to see your doctor if you experience any of these symptoms:

increased frequency of heart palpitations
longer duration of palpitations more than a couple of minutes
and/or gradual worsening of palpitations.

Seek emergency medical treatment immediately if you develop chest pain, shortness of breath, fainting or dizziness in association with perimenopause heart palpitations.

Check your medications, both OTC and prescription, for adverse side effects. Some may cause perimenopause heart palpitations.

Women during this time may begin metabolic syndrome symptoms, a group of health risks that include large waist size, elevated blood pressure, glucose intolerance, low HDL cholesterol and high triglycerides. Metabolic syndrome increases risk of developing heart disease, stroke and diabetes. Harvard Medical School research suggests that for women, metabolic syndrome is the most important risk factor for having heart attacks at an unusually early age. In a study of patients undergoing bypass surgery, metabolic syndrome produced a greater risk for women than it did for men of dying within 8 years.

Menopausal Years and Beyond

Lower estrogen levels are a driving factor in heart issues in women after menopause. Estrogen plays a major role in the flexibility of the inner layer of artery walls. It aids expansion and contraction, enabling blood to flow. Estrogen loss also causes arteries and veins to lose some pressure, causing a drop in their strength and elasticity, which can lead to higher blood pressure.

Women’s metabolism and digestion also slow during menopause, leading to potential weight gain. Overweightness and obesity increase women’s risk of cardiac problems, from rising blood pressure to heart attack or even stroke.

Additionally, menopause can influence women’s cardiac health through increased risk of major fluctuations in blood cholesterol levels. Estrogen levels impact LDL cholesterol levels, known as “bad cholesterol.” When a woman’s body produces less estrogen, “bad cholesterol” levels often increase, heightening risk of blocked veins and arteries, unexplained bruising and even heart attacks.

Heart rate can also be affected by menopause. This is caused by vein blockages created by hormonal changes, affecting blood circulation.

It’s important to report abnormalities in heart rate or dizziness to your practitioner to rule out undiagnosed cardiac problems. Finally, if you have a previously diagnosed heart issue and are receiving treatment, it’s vital you pay extra attention to symptoms your practitioner recommends you to closely monitor.

Women over age 65 years face increased heart issue risks if they have low HDL, high triglycerides or diabetes, a condition that increases women’s heart disease risk over that of men. Women with diabetes more often have added heart health risk factors like obesity, hypertension and high cholesterol, key factors of increased heart health risks.

Heart Disease Risks in Women

There are many common heart disease risk factors women need to be vigilant about, according to Yale medical experts. These risks include:

high blood pressure
high cholesterol
sedentary lifestyle
overweightness or obesity
family history of heart attacks and/or heart disease
age (The older your age, the higher your risk. However, women generally develop coronary artery disease [CAD] 10 years later in life than men, unless diagnosed with diabetes.)
cigarette smoking, an especially greater danger to pre-menopausal young women due to proven significant increased risk in heart attack.
and type 2 diabetes, an indicator of the presence of underlying cardiovascular disease. Medical experts state women with diabetes prior to menopause onset lose the 10-year advantage women have over men regarding coronary heart disease risk.

Cardiovascular Diseases and Women

Certain types of heart problems affect women more so than men, including:

Chest pain (angina) is experienced by about 4 million U.S. women. Chest pain and discomfort are both indicators of angina. Angina also affects men; however, women are more likely than men to get 2 specific types:

Stable angina is the most common angina type. Women with stable angina may experience chest pain during physical activity or during times of stress. The chest pain usually goes away with rest. However, it can develop into unstable angina, the type that happens most often while you are resting or sleeping. Unstable angina can lead to heart attack or cardiac arrest.
Variant (Prinzmetal's) angina is a rare type of unstable angina. It’s caused by a spasm in the coronary arteries, which carry blood to the heart muscle. Spasm triggers can include exposure to cold weather, stress, smoking or cocaine use. These spasms can lead to painful attacks, often while resting or sleeping. This form of unstable angina rarely causes heart attack and can be treated with medicine.

Cardiac syndrome X is a health problem that happens when people with healthy, unblocked arteries have chest pain (angina) and coronary artery spasms, caused when the artery pinches itself closed. The exact causes of cardiac syndrome X are not known. Some possible causes include:

Coronary microvascular disease (MVD). In some women, cardiac syndrome X may be caused by MVD, a disease found in tiny arteries near the heart. These arteries are too small to see on an angiogram. Women with MVD are often younger than 50 and have a higher risk for heart attack. MVD affects about half of women with cardiac syndrome X.
Hormonal changes. Changes in estrogen levels after menopause could make women more likely to have heart problems. Most women with cardiac syndrome X are postmenopausal or are going through menopause.

Broken heart syndrome, also called stress-induced cardiomyopathy (or takotsubo cardiomyopathy), can happen even in those who are healthy. Researchers don’t know its exact cause. Symptoms are often triggered by extreme stress, like intense grief, anger or surprise. Women are more likely than men to experience broken heart syndrome. Experts believe a surge of stress hormones "stuns" the heart, causing intense, short-lived symptoms that usually don't cause permanent heart damage.

Most women who experience broken heart syndrome are older, between 58 and 75 years old, and probably occur due to drop in estrogen levels after menopause.

Broken heart syndrome can be misdiagnosed as a heart attack. The symptoms and test results are similar, but there are no blocked heart arteries. Instead, a part of the heart temporarily enlarges while the rest of the heart works normally. Broken heart syndrome can lead to short-term heart failure and is often easily treated.

Heart Disease Symptoms in Women

The Centers for Disease Control (CDC) iterates women have varying experiences and symptoms relating to heart disease.

Although some women present no symptoms whatsoever, others may have:

angina (dull and heavy or sharp chest pain or discomfort)
pain in the neck, jaw, or throat
and/or pain in the upper abdomen or back.

These symptoms may happen when you’re resting or when you’re doing regular daily activities.

Women also may have other symptoms, including nausea, vomiting or fatigue.

Sometimes heart disease may be “silent” and not diagnosed until other symptoms or emergencies occur, including:

Heart attack: Chest pain or discomfort, upper back or neck pain, indigestion, heartburn, nausea or vomiting, extreme fatigue, upper body discomfort, dizziness, and shortness of breath.
Arrhythmia: Fluttering feelings within the chest (palpitations.)
Heart failure: Shortness of breath, fatigue, or swelling of the feet, ankles, legs, abdomen or neck veins

If you have any of the above symptoms, call 9-1-1 immediately.

7 Ways to Maximize Your Heart Health

Fortunately, there are many factors within your control to minimize heart disease risk. Implementing these tips within your daily life can help you achieve optimal heart health, no matter your age:

Know your risk factors. Whether it’s family history or personal medical issues that contribute to heart disease, be vigilant about your overall health. Appropriate diagnoses and management of personal health issues maximizes your heart health.
Manage current health conditions. Diabetes, high blood pressure and high cholesterol especially contribute significant risk increase in heart health issues. Talk to your Capital Women’s Care practitioner to confirm the best treatment plan for you.
Recognize important symptoms of heart attack in women and call 9-1-1 if necessary. A woman suffers a heart attack every 100 seconds in the U.S. Yet according to an American Heart Association (AHA) survey, 1 in every 3 women said they would not call 911 if they thought they were having a heart attack, and few were aware of the most common heart attack symptoms besides chest pain.
Implement personal stress management techniques to avoid increased cortisol production in the body, which can increase risk of heart attack and other cardiovascular issues.
Do regular physical activity and maintain a healthy weight. Find an activity you enjoy doing and plan for 30 minutes of physical activity daily. Eat a healthy diet low in saturated/trans fats, sodium, added sugars and processed foods while highlighting lean proteins like fish and chicken, whole grains along with whole fruits and vegetables in your daily diet.
If you smoke, try to quit. Check out How Smoking Affects Heart Health and learn more about medicines to help you quit.
Avoid illicit/prescription drug and alcohol misuse and abuse to maintain optimal heart health.

Your local Capital Women’s Care team of women’s health professionals is here to answer your questions or address your concerns relating to women’s heart health or any women’s health issue. Our family of caring, compassionate doctors, nurses and support staff prioritize your health and wellbeing so you can achieve and enjoy a long quality life.