Heart disease is the leading cause of death among women.

• An estimated 90% of women have at least one risk factor for heart disease.
• Heart attack symptoms can be different for women than for men.
• Younger women with heart disease are more likely to die than men of the same age with heart disease. It is especially important for women and their doctors to be aware of early risk detection for primary prevention.
• Despite being the #1 killer, only 13% of women surveyed by the American Heart Association (AHA) thought heart disease was their biggest health risk. Awareness may be a barrier to timely assessment and treatment.
• Only 6% of Fellows of the American College of Cardiology (FACC cardiologists) are women.
• Cardiovascular disease (CVD) can be prevented and reversed with lifestyle changes.

What is cardiovascular disease (CVD)?

Cardiovascular disease includes a large number of unique conditions that can affect not only the heart but also the blood vessels throughout the body including those in the brain (stroke) and extremities (peripheral artery disease). Within the heart, disease can affect the physical structure including the valves (for example, congenital mitral valve prolapse or rheumatic heart disease caused by strep infections) or the muscle wall (for example, cardiomyopathy or congestive heart failure). Cardiovascular disease also includes conditions of vascular function (for example, endothelial dysfunction, angina, or hypertension), inflammation (for example, endo- or myocarditis), or the electrical regulation of the heartbeat (for example, arrhythmia or atrial fibrillation).

What is atherosclerosis?

One type of cardiovascular disease includes physical blockages that can stop blood flow in the coronary vessels and cause ischemia of the heart muscle. When this is severe and sudden, this is what is commonly referred to as myocardial infarction or a "heart attack." However, years of coronary artery disease typically precede the attack with gradual narrowing and blocking of the blood vessels. The blockages are formed by lipid or cholesterol deposits that cause inflammation and form plaques. These plaques calcify, block the vessels, and limit blood flow to the heart muscle. This process is called atherosclerosis. The plaques can also rupture, releasing a thrombus or clot that can block blood flow downstream and cause ischemia (decreased oxygen delivery to tissues) elsewhere in the heart or brain.

Because the body was not designed to have high levels of cholesterol (specifically LDL) in the blood, immune cells called macrophages move it into the blood vessel walls to get it out of the circulation. In this process, it becomes oxidized, and this is what triggers the inflammatory process. The macrophages become overwhelmed with the oxidized LDL, try to engulf it, becoming "foam cells." These foam cells trigger the need for further "clean up," and the body tries to sequester the unhealthy foam cells and forms a hard plaque around it. These plaques cause further inflammation within the tissue of the artery wall; this is how atherosclerosis progresses.

There are differences between how atherosclerosis develops in men and women. In general, women are more likely to have plaque formation in a single coronary vessel and in smaller blood vessels. Overall, atherosclerosis or obstructive cardiovascular disease is a less common form of heart disease among women, although when plaques do form, the plaques are comprised of lipid-filled foam cells, which are both more easily treated and reversed. However, the plaques in women are more likely to rupture than atherosclerotic plaques in men.

The most common heart attack symptom in women is the same as in men — some type of chest pain, pressure or discomfort that lasts more than a few minutes or comes and goes.

But chest pain is not always severe or even the most noticeable symptom, particularly in women. Women often describe heart attack pain as pressure or tightness. And it's possible to have a heart attack without chest pain.

Women are more likely than men to have heart attack symptoms unrelated to chest pain, such as:

• Neck, jaw, shoulder, upper back or upper belly (abdomen) discomfort
• Shortness of breath
• Pain in one or both arms
• Nausea or vomiting
• Sweating
• Lightheadedness or dizziness
• Unusual fatigue
• Heartburn (indigestion)

These symptoms may be vague and not as noticeable as the crushing chest pain often associated with heart attacks. This might be because women tend to have blockages not only in their main arteries but also in the smaller ones that supply blood to the heart — a condition called small vessel heart disease or coronary microvascular disease.

Compared with men, women tend to have symptoms more often when resting, or even when asleep Emotional stress can play a role in triggering heart attack symptoms in women.

Because women's heart attack symptoms can differ from men's, women might be diagnosed less often with heart disease than are men. Women are more likely than men to have a heart attack with no severe blockage in an artery (nonobstructive coronary artery disease).

Heart disease occurs when plaque develops in the arteries and blood vessels that lead to the heart. This blocks important nutrients and oxygen from reaching your heart.

Plaque is a waxy substance made up of cholesterol, fatty molecules, and minerals. Plaque accumulates over time when the inner lining of an artery is damaged by high blood pressure, cigarette smoking, or elevated cholesterol or triglycerides.

In general, heart disease treatment in women and in men is similar. It can include medications, angioplasty and stenting, or coronary bypass surgery.

Some noted differences in heart disease treatment among men and women are:

• Women are less likely to be treated with aspirin and statins to prevent future heart attacks than are men. However, studies show the benefits are similar in both groups.
• Women are less likely than men to have coronary bypass surgery, perhaps because women have less obstructive disease or smaller arteries with more small vessel disease.
• Cardiac rehabilitation can improve health and aid recovery from heart disease. However, women are less likely to be referred for cardiac rehabilitation than men are.

Several traditional risk factors for coronary artery disease — such as high cholesterol, high blood pressure and obesity — affect both women and men. But other factors may play a bigger role in the development of heart disease in women.

Heart disease risk factors for women include:

• Diabetes. Women with diabetes are more likely to develop heart disease than are men with diabetes. Also, because diabetes can change the way women feel pain, there's an increased risk of having a silent heart attack — without symptoms.
• Emotional stress and depression. Stress and depression affect women's hearts more than men's. Depression may make it difficult to maintain a healthy lifestyle and follow recommended treatment for other health conditions.
• Smoking. Smoking is a greater risk factor for heart disease in women than it is in men.
• Inactivity. A lack of physical activity is a major risk factor for heart disease.
• Menopause. Low levels of estrogen after menopause increase the risk of developing disease in smaller blood vessels.
• Pregnancy complications. High blood pressure or diabetes during pregnancy can increase the mother's long-term risk of high blood pressure and diabetes. These conditions also make women more likely to get heart disease.
• Family history of early heart disease. This appears to be a greater risk factor in women than in men.
• Inflammatory diseases. Rheumatoid arthritis, lupus and other inflammatory conditions may increase the risk of heart disease in both men and women.

Women of all ages should take heart disease seriously. Women under age 65 — especially those with a family history of heart disease — also need to pay close attention to heart disease risk factors.

Heart disease in women is more prevalent nowadays. But there are things you can do to protect your heart. Here are some medications to help you with it:

• ACE inhibitors: These drugs help control blood pressure and reduce the risk of strokes, heart attacks, and kidney problems.
• Beta blockers: These drugs slow down your heart rate and reduce blood pressure by reducing the force with which your heart pumps blood into your body.
• Calcium channel blockers: These drugs help relax your blood vessels, so less work is needed from your heart muscle. They can also help prevent angina attacks and chest pain caused by coronary artery disease. These drugs are used for people with high blood pressure or irregular heartbeats, but they aren't recommended if you have diabetes or kidney disease.
• Angiotensin receptor blockers (ARBs): These medications work in a similar way as ACE inhibitors but with fewer side effects such as dizziness. They may also help prevent heart attacks in people who have had one already occurred.
• Statins: Statins are drugs that lower bad cholesterol levels and reduce inflammation in your arteries. They can help prevent heart attacks and strokes if you have CAD or high cholesterol levels.
• Fibrates: Fibrates are drugs that reduce triglycerides (fatty substances in your blood) and increase good HDL cholesterol levels while lowering triglycerides and LDL (bad) cholesterol levels.

Symptoms
Chest pain or pressure,Dizziness or shortness of breath,Fatigue,Fainting or passing out
Conditions
Chest pain,Pressure or discomfort that lasts more than a few minutes or comes and goes
Drugs
ACE inhibitors,Beta blockers,Calcium channel blockers,Diuretics (water pills),Statins