DOCTOR'S VIEW ARCHIVE

Heart Disease in Women

Medical Author: Carolyn J. Crandall, MD, FACP
Medical Editors: Dennis Lee, M.D., Jay W. Marks, M.D., Daniel Lee Kulick, M.D.

What is the Risk of heart attacks in women?

Coronary artery disease (CAD) and heart attacks are erroneously believed to occur primarily in men. Although it is true that the prevalence of CAD among women is lower before menopause, the risk of CAD rises in women after menopause. At age 75, a woman's risk for CAD is equal to that of a man's. CAD is the leading cause of death and disability in women after menopause. In fact, a 50-year-old woman faces a 46% risk of developing CAD and a 31% risk of dying from coronary artery disease. In contrast, her probability of contracting and dying from breast cancer is 10% and 3%, respectively.

The risk factors for developing CAD in women are the same as in men; they are increased blood cholesterol, high blood pressure, smoking cigarettes, diabetes mellitus, and a family history of coronary heart disease at a young age.

Smoking cigarettes

Even "light" smoking raises the risk of CAD. In one study, middle-aged women who smoked 1 to 14 cigarettes per day had a twofold increase in strokes (caused by atherosclerosis of the arteries to the brain) whereas those who smoked more than 25 cigarettes per day had a risk of stroke 3.7 fold higher than that of nonsmoking women. Furthermore, the combination of smoking and the use of birth control pills increase the risk of heart attacks even further, especially in women over 35.
Quitting smoking immediately begins to reduce the risk of heart attacks. The risk gradually decreases back down to the same risk of nonsmoking women after several years of not smoking.

Cholesterol treatment guidelines in women

Current NCEP (National Cholesterol Education Program) treatment guidelines for undesirable cholesterol levels are the same for women as for men. For more information about the NCEP guidelines, please read The Guidelines on Cholesterol for Adults article.

Diagnosis of heart attacks in women

Women are more likely to encounter delays in establishing the diagnosis of heart attack than men. This is in part because women tend to seek medical care later than men, and in part because diagnosing heart attacks in women can sometimes be more difficult than diagnosing heart attacks in men. The reasons are:

  1. Women are more likely than men to have atypical heart attack symptoms such as neck and shoulder pain, abdominal pain, nausea, vomiting, fatigue, and shortness of breath.
  2. Silent heart attacks (heart attacks with little or no symptoms) are more common among women than among men.
  3. Women have a higher occurrence than men of chest pain that is not caused by heart disease, for example chest pain from spasm of the esophagus.
  4. Women are less likely than men to have the typical findings on the ECG that are necessary to diagnose a heart attack quickly.
  5. Women are more likely than men to have angina (chest pain due to lack of blood supply to the heart muscle) that is caused by spasm of the coronary arteries or caused by disease of the smallest blood vessels (microvasculature disease). Cardiac catheterization with coronary angiograms (x-ray studies of the coronary arteries that are considered most reliable tests for CAD) will reveal normal coronary arteries and therefore cannot be used to diagnose either of these two conditions.
  6. Women are more likely to have misleading, or "false positive" noninvasive tests for CAD then men.