Dr. MJ Bazos MD, Patient Handout
Heart Disease and Women

Are women at risk for heart disease?

Women are at risk for heart disease and heart attacks, just like men. It is a myth that only men have heart attacks. Heart disease is the leading cause of death among women over 65. Heart disease kills more women over 65 than all cancers combined. Women develop heart problems later in life than men -- typically 7 or 8 years later. However, by about age 65, a woman's risk is almost the same as a man's.

What do I need to know about heart disease and heart attacks?

Women are less likely to survive heart attacks than men. No one knows why. It may be that women don't seek or receive treatment as soon as men. Or it may be because women's smaller hearts and blood vessels are more easily damaged. Doctors are working on finding answers to these questions. There's no question, however, that it makes sense to prevent heart problems before they start.

What can I do to protect myself?

For both men and women, the biggest factors that contribute to heart disease are smoking, high blood pressure, high cholesterol, family history (father or brother with heart disease before age 55, or mother or sister with heart disease before age 65) and age. Take a moment to look at your lifestyle, family history and your general health. With this information, you and your family doctor can assess your risk and make a plan to avoid potential problems. Although you can't do much about your family history or your age, you can change many of the other risk factors.
Quit smoking. Smoking more than doubles the risk of heart attack for both men and women. Women who smoke and use birth control pills increase their risk even more. Your doctor can help you quit and stay tobacco-free. Breathing smoke from someone else's cigarettes is bad for your heart and lungs. So if you live with someone who smokes, encourage him or her to quit.
Control your blood pressure. Many of the suggestions on the next pages (lose weight, exercise, eat a healthy diet) also help control high blood pressure. Reducing how much salt you eat can also help. If these steps don't lower your blood pressure, your doctor may recommend medicine.
Control your cholesterol level. If you don't know your level, ask your doctor if it should be checked. Diet is a key part of lowering high cholesterol levels. However, some people may need to take medicines in addition to diet and exercise.
Maintain a healthy weight. Extra weight puts strain on your heart and arteries. If you're overweight, talk to your doctor about a safe way to shed the pounds.
Exercise regularly. Remember, your heart is a muscle. It needs regular exercise to stay in shape. Aerobic exercise, such as brisk walking, swimming, jogging or biking, gives your heart the best workout. You should exercise 30 to 60 minutes, 4 to 6 times a week. Check with your doctor before starting an exercise program.
Eat a low-fat diet. Keep fat calories to 30% or less of the total calories you take in during a day. Information is available to help you make healthy choices. For example, food labels list nutrition information, including fat calories. Many cookbooks have heart-healthy recipes, and some restaurants serve low-fat dishes.
Take care of other health problems. Other health problems, such as diabetes, can contribute to heart disease. Talk to your family doctor for individual advice.
How does estrogen affect heart disease?
When it comes to heart disease, women have an advantage over men: the hormone called estrogen. Estrogen appears to help protect against heart disease by raising the level of good cholesterol and lowering the level of bad cholesterol. Some women use "estrogen replacement therapy" during menopause to put estrogen back into their bodies. "Estrogen replacement therapy," also called "hormone replacement therapy," helps with symptoms of menopause (such as hot flashes) and reduces the risk of osteoporosis (a weakening of the bones). In some studies, women who took estrogen replacement therapy appeared to have a lower risk of heart disease. In other studies, the effect was not seen. More studies are under way that will help doctors determine whether estrogen therapy actually reduces the risk of heart disease in women. Estrogen therapy has both benefits and risks. For example, estrogen may increase the risk of uterine cancer and breast cancer. Your risk factors and family history will be important in weighing the risks and benefits of estrogen therapy. Talk to your doctor about whether it's right for you.

What about aspirin?
Regular use of aspirin lowers the risk of heart attack in men by thinning the blood and lowering the risk of blood clots. Aspirin hasn't been studied as much in women. But the available evidence suggests that it may have the same protective effect in women. However, aspirin can cause gastrointestinal bleeding and other problems. Talk to your doctor about your risk factors for heart disease and whether you should consider taking aspirin.