Heart Disease Risk Factors for Women
This web page is based on presentations by Washington University heart surgeon Jennifer Lawton, M.D., with supplemental information from the U.S. Department of Health and Human Services and the American Heart Association.
Cardiovascular disease (CVD) is the No. 1 cause of death for adult women in the United States. More than 500,000 American women die of cardiovascular disease each year — more than die from all forms of cancer combined.
Despite these statistics, perceptions of this health threat lag among women and their physicians. In a recent survey, only 55 percent of women were able to identify CVD as the leading health threat for women. And only 20 percent of 500 physicians who participated in an online study knew that more women than men die from cardiovascular disease each year.1
The good news is that women can take steps to develop a healthier lifestyle and work with their physicians to address the risk factors for CVD. By preventing and controlling these risks, women can lead healthier, longer lives.
Risk Factors
A “risk factor” is a habit or trait that makes a person more likely to develop a disease. The more risk factors for heart disease one has, the greater the chance of developing cardiovascular disease.
Risk factors for heart disease include:
At age55, women are considered at greater risk for heart disease. In addition, women who go through early menopause — either naturally or as a result of a hysterectomy — are twice as likely to develop heart disease as women of the same age who have not gone through menopause.
Heart disease also can be linked to family history. Women with a parent or sibling who had early heart disease — a father or brother who experienced a heart attack before age 55, or a mother or sister who had one before age 65 — are more likely to develop heart disease themselves.2
Although women have no control over age and family history, all other factors can be treated, modified or controlled.
Smoking: Smoking is a very potent risk factor for heart disease. In fact, the risk for women who smoke is up to six times that of non-smoking women. Secondhand smoke also increases the risk for heart attack and stroke — in addition to creating serious health risks for children younger than 18 months of age and others.
The only safe course is to stop smoking or not to start and to avoid passive exposure to smoke. Smoking as a risk for heart disease is eliminated after a person has stopped smoking for two years.
Diabetes Mellitus: Type 2 diabetes is the most common type of diabetes and the form that most commonly develops in adulthood. In type 2 diabetes, the body does not produce enough insulin, or the body ignores it. Insulin is needed for the body to use glucose for energy. Type 2 diabetes is a serious disease that can also lead to kidney and nerve damage and blindness. But, if treated properly, people with the disease can lead long, happy lives.
Approximately 5.6 million Americans have undiagnosed diabetes, including about 2.6 million women.
The risk of type 2 diabetes increases after age 45, and the disease is more likely to occur in those who are overweight, especially if they have extra weight around the waist. Other risk factors are a sedentary lifestyle and family history of the disease. Type 2 diabetes is more common in native Americans, Hispanic Americans, African Americans, Asian Americans and Pacific Islanders.
Diabetes can have a negative impact on heart health by lowering “good” cholesterol and raising “bad” cholesterol (see section on “Cholesterol”). Many people with diabetes also are overweight and have high blood pressure.
About 66 percent to 75 percent of diabetics die of some form of cardiovascular disease.
If you are overweight or have any other risk factors for type 2 diabetes, ask your doctor about getting tested for the disease. Your doctor will help you get your blood glucose under control (you are considered to have diabetes if your fasting blood glucose level is 126 mg/dL or higher). You also need to keep your blood pressure and cholesterol within normal ranges, be physically active, and stop smoking if you smoke.
High Blood Pressure: High blood pressure, also know as hypertension, is a major risk factor for heart disease and stroke. Its incidence is also on the rise in the United States, with about one in five Americans suffering from the disease.
Blood pressure is the pressure exerted by the blood on the artery walls. It is measured in two numbers: the systolic blood pressure (the top number), or amount of arterial pressure when the heart beats, and the diastolic blood pressure (the bottom number), or pressure between heartbeats. Blood pressure readings are interpreted as follows:
- 120/80 mmHg or lower — normal blood pressure
- Between 120 and 139 mmHg for the top number, or between 80 and 89 mmHg for the bottom number — prehypertension
- 140/90 mmHg or higher — high blood pressure
High blood pressure is known as the “silent killer” as it is often not associated with symptoms. Hypertension forces the heart to work harder to pump blood to the brain and body. If your blood pressure is not too high, taking some steps to control it may be enough. These include maintaining a healthy weight, exercising, reducing alcohol consumption, and changing your diet to reduce salt and to emphasize fruits, vegetables, fish, and other low-fat or nutritional foods. Your doctor also may prescribe various medicines to control blood pressure.
High Triglycerides/Cholesterol: Cholesterol is a soft, fatlike substance found in the body’s cells. A certain amount is needed for body functioning, but too much increases the risk of heart disease. About one third of blood cholesterol comes from food.
Cholesterol travels in the blood using special carriers called lipoproteins. Low-density lipoprotein (LDL) is often called “bad” cholesterol because too much of it can lead to buildup of cholesterol and blockage of the arteries. High-density lipoprotein (HDL) is considered “good” cholesterol because it helps remove cholesterol and prevents its buildup in the arteries.
According to American Heart Association guidelines, the optimal levels of cholesterol in women are:
- LDL, less than100 mg/dL
- HDL, greater than 50 mg/dL
- Non HDL (Total – HDL) cholesterol, less than 130 mg/dL
About 50 million adult women in the United Stated (one in every three to five women) have borderline-high to high cholesterol levels. Studies also show that women’s cholesterol values are higher than men’s from age 55 on.
Since one third of blood cholesterol comes from food, women with high cholesterol levels can follow low-cholesterol diets to help reduce the risk of heart disease. Exercise and medications also can be used to bring cholesterol under control.
Triglycerides are another type of fat found in blood and in food and produced in the liver. When a person consumes alcohol or takes in more calories than needed, the level of triglycerides can go up. American Heart Association guidelines specify that the optimal level of triglycerides for women is less than 150 mg/dL. Triglyceride levels can be reduced by controlling weight, exercising, avoiding alcohol and not smoking.
Sedentary Lifestyle: Physical inactivity increases your chances of developing heart disease even if you have no other risk factors. It also contributes to the development of other risk factors such as high blood pressure, diabetes, and being overweight or obese. Yet an alarming percentage of women 18 years and older have no leisure-time physical activity:
- 39 percent of white women
- 57 percent of African-American women
- 57 percent of Hispanic women
- 49 percent of Asian/Pacific Islander women
The American Heart Association, as part of its “Go Red for Women” heart health program, recommends doing aerobic physical activity — activities that use the large muscles of the legs and arms — on most days of the week for 30 to 60 minutes to help your heart work more efficiently. It's important to talk to your doctor before beginning or changing an exercise program.
Obesity: The prevalence of overweight and obese individuals in the United States has reached epidemic proportions. Those who are overweight are more likely to develop heart disease even if they have no other risk factors. Being overweight or obese also increases the likelihood of other risk factors such as diabetes, high blood pressure and high cholesterol. And it makes it more likely that people will suffer from stroke, congestive heart failure, gallbladder disease, arthritis, breathing problems, gout, and cancers of the breast and colon.
People are considered normal weight if their body mass index (BMI) score — a measurement of weight in proportion to height — is between 18.5 and 24.9 kg/m2. (Calculate your BMI.) A person with a BMI from 25 to 29.9 is overweight, and someone with a BMI of 30 or higher is obese. In addition, a woman with a waist size of more than 35 inches is considered at greater risk for heart disease, high blood pressure, diabetes and other serious health problems.
In American women aged 20 to 74 years of age, the percentage who are overweight or obese are as follows:
- White women: 47 percent overweight, 23 percent obese
- African-American women: 68 percent overweight, 38 percent obese
- Mexican-American women: 69 percent overweight, 36 percent obese
Regular exercise and a healthy diet are important for women who are overweight or obese. Several websites with dietary suggestions for heart health include:
Other resources for women who are obese or overweight with medical complications are described on the Washington University Weight Management Program website. The Washington University Section of Minimally Invasive Surgery may offer surgical options for patients who are morbidly obese (BMI of 40 or greater) or severely obese (BMI of 35 or greater) with medical complications.
Multiple Risk Factors
Most women in midlife — ages 40 to 60 — have heart disease risk factors. According to the U.S. Department of Health and Human Services (HHS):
- 33 percent of women ages 40 to 60 have one risk factor for heart disease they might be able to eliminate if they took the proper steps
- Another 31 percent of women in midlife have two modifiable risk factors.
- Another 17 percent of women in midlife have three or more modifiable risk factors.
The Department of HHS also reports that having more than one risk factor is especially serious; having two risk factors increases the chance of heart disease fourfold, and having three or more risk factors increases the risk more than tenfold.
Women of color have higher rates of some risk factors including being overweight or obese (more than 85 percent of African-American women and 78 percent of Hispanic women in midlife are overweight or obese) and having diabetes (14 percent of African-American women and 10 percent of Hispanic women have been diagnosed with diabetes).3
Other Factors That May Affect Heart Disease
Other factors that may affect heart disease among women include postmenopausal hormone replacement therapy, stress and depression, alcohol consumption, birth control pills and sleep apnea. The Healthy Heart Handbook for Women, published by the Department of HHS, covers these topics on pages 49-59.
In women with cardiovascular disease, hormone replacement therapy is not associated with a reduction in coronary heart disease events and may lead to an increased risk of coronary heart disease, thromboembolism, or gallbladder disease (Heart and Estrogen/progestin Replacement Study [HERS] trial). In healthy postmenopausal women, hormone replacement therapy is not recommended for the prevention of cardiovascular disease (Women's Health Initiative by National, Heart, Lung, and Blood Institute). Hormone replacement therapy is listed as a Class III American Heart Association (AHA) guideline indicating it is not beneficial and potentially harmful in the treatment of women with cardiovascular disease (Circulation).
Other Resources
Other resources include:
References
- Mosca L, Linfante AH, Benjamin EJ, Berra K, Hayes SN, Walsh BW, Fabunmi RP, Kwan J, Mills T, Simpson SL. National study of physician awareness and adherence to cardiovascular disease prevention guidelines. Circulation. 2005;111(4):499-510.
- U.S. Department of Health and Human Services. The Healthy Heart Handbook for Women, p. 12.
- U.S. Department of Health and Human Services. The Healthy Heart Handbook for Women, p. 13.