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Heart disease in women: Understand symptoms and risk factors

All women face the threat of heart disease. But becoming aware of symptoms and risks unique to women, as well as eating a heart-healthy diet and exercising, can help protect you.

By Mayo Clinic staff

Although heart disease is often thought of as a problem for men, more women than men die of heart disease each year. Women are six times as likely to die of heart disease as of breast cancer. Heart disease kills more women over 65 than do all cancers combined.

One challenge for women is that their heart disease symptoms can be different from symptoms in men. Fortunately, women can take steps to understand their unique symptoms of heart disease and to begin to reduce their risk of heart disease.

What are the symptoms of a heart attack for women?

The most common symptom of a heart attack in both men and women is some type of pain, pressure or discomfort in the chest. But it's not always severe or even the most prominent symptom, particularly in women. Women are more likely than men to have signs and symptoms unrelated to chest pain, such as:

  • Neck, shoulder, upper back or abdominal discomfort
  • Shortness of breath
  • Nausea or vomiting
  • Sweating
  • Lightheadedness or dizziness
  • Unusual fatigue

These signs and symptoms are more subtle than the obvious crushing chest pain often associated with heart attacks. This may be because women tend to have blockages not only in their main arteries, but also in the smaller arteries that supply blood to the heart — a condition called small vessel heart disease.

Many women tend to show up in emergency rooms after much heart damage has already occurred because their symptoms are not those typically associated with a heart attack. If you experience these symptoms or think you're having a heart attack, call for emergency medical help immediately. Don't drive yourself to the emergency room.

What are the heart disease risk factors for women?

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

  • Metabolic syndrome — a combination of fat around your abdomen, high blood pressure, high blood sugar and high triglycerides — has a greater impact on women than on men.
  • Mental stress and depression affect women's hearts more than men's.
  • Smoking is a greater risk factor for heart disease in women than in men.
  • Low levels of estrogen after menopause pose a significant risk factor for developing cardiovascular disease in the smaller blood vessels (small vessel heart disease).

Is heart disease something only older women should worry about?

No. While heart disease is the leading cause of death for women 65 and older, it's the third-leading cause of death for women 25 to 44 and the second-leading cause of death for women 45 to 64. Women under the age of 65 who have a family history of heart disease should pay particularly close attention to the heart disease risk factors. Still, all women, of all ages, should take heart disease seriously.

Is depression a unique risk factor for heart disease in women?

Depression is twice as common in women as in men, and it increases the risk of heart disease by two to three times compared with those who aren't depressed. Depression makes it difficult to maintain a healthy lifestyle and follow recommended treatment, so talk to your doctor if you're having symptoms of depression, such as loss of interest in your daily activities, feeling hopeless or unexplained changes in your weight.

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References
  1. Mosca L, et al. Evidence-based guidelines for cardiovascular disease prevention in women: 2007 update. Circulation. 2007;49:1230.
  2. Stramba-Badiale M, et al. Cardiovascular diseases in women: A statement from the policy conference of the European Society of Cardiology. European Heart Journal. 2006;27:994.
  3. Wenger NK, et al. Coronary heart disease in women: Update 2008. Clinical Pharmacology & Therapeutics. 2008;83:37.
  4. Frequently asked questions: Heart disease. U.S. Department of Health and Human Services, Office on Women's Health. http://www.4woman.gov/faq/heart-disease.pdf. Accessed Dec. 10, 2008.
  5. Makaryus AN, et al. Diagnostic strategies for heart disease in women: An update on imaging techniques for optimal management. Cardiology in Review. 2007;15:279.
  6. Li TY, et al. Obesity as Compared With Physical Activity in Predicting Risk of Coronary Heart Disease in Women. Circulation. 2006;113:499.
  7. Berger JS, et al. Aspirin for the primary prevention of cardiovascular events in women and men. Journal of the American Medical Association. 2006;295:306.
  8. Antman EM, et al. Use of non-steroidal anti-inflammatory drugs: An update for clinicians: A scientific statement from the American Heart Association. Circulation. 2007;115:1634.

HB00040

Jan. 17, 2009

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