Coronary Heart Disease Risk Factors in Women

In general, women have the same coronary heart disease risk factors that men do. But these risk factors may affect women differently.

Early on, studies detected that, before the age of 50, men have a higher short-term risk of coronary disease. Using Framingham 10-year risk scoring, a comparison of a man and a woman and their risk factors is provided below.

Coronary heart disease risk factors in women
Women who reach age 50 with few or no risk factors for heart disease
tend to live much longer lives.

In this example, the man has high total cholesterol, relatively low HDL cholesterol, and he smokes but doesn't take blood pressure medication for high blood pressure. His risk of a heart attack or death from coronary heart disease is 20 percent. In comparison, a woman with identical risk factors has only an 8 percent risk of heart attack or death from coronary heart disease.


Woman Man
Age 50 50
Total Cholesterol 240 mg/dL 240 mg/dL
HDL Cholesterol 42 mg/dL 42 mg/dL
Smoker Yes Yes
Systolic Blood Pressure 140 mm Hg 140 mm Hg
Currently on medication
to treat high blood pressure
No
No
10-Year Risk 20% 8%

Because of the disparity in short-term risk between men and women, prevention and education efforts have traditionally targeted men. But now that's changing because it's become increasingly apparent that coronary heart disease significantly affects women, too.

A study that looked at the lifetime risk of cardiovascular disease found that people who have certain risk factors at age 50 -- such as high cholesterol, high blood pressure, diabetes, and/or overweight or obesity -- are more likely to develop cardiovascular disease and to have a shorter life span.

In comparison, those who have no risk factors at age 50 are unlikely to develop cardiovascular disease and are likely to have a longer life span. Those men and women who had fewer than two risk factors at age 50 lived an average of 11 years and 8 years longer, respectively, compared with men and women who had two or more risk factors.

The key message is this: If a woman were to embrace healthy habits early on so that she had fewer risk factors when she reached age 50, she may have a lower risk of cardiovascular disease and a markedly longer life.

As women age, though, their risk will increase. Find out why menopause might be a major factor on the next page.

For more information on coronary heart disease, see:
This information is solely for informational purposes. IT IS NOT INTENDED TO PROVIDE MEDICAL ADVICE. Neither the Editors of Consumer Guide (R), Publications International, Ltd., the author nor publisher take responsibility for any possible consequences from any treatment, procedure, exercise, dietary modification, action or application of medication which results from reading or following the information contained in this information. The publication of this information does not constitute the practice of medicine, and this information does not replace the advice of your physician or other health care provider. Before undertaking any course of treatment, the reader must seek the advice of their physician or other health care provider.

Menopause and Coronary Heart Disease

Among the other changes that come during menopause, women's risk of heart disease increases during this time.

Although a woman's short-term risk of coronary heart disease is generally lower than a man's before the age of 50 (unless she has diabetes, in which case her risk is similar to her male counterpart), her "lifetime risk" greatly increases with age. Menopause appears to be the tipping point at which women's risk of coronary heart disease catches up with men's risk.

Many doctors and scientists believe that much of this effect is due to estrogen, which is produced during a woman's fertile years. Estrogen lowers LDL cholesterol and raises HDL cholesterol.


After menopause, however, when the ovaries stop production, estrogen's protective effect is lost. The rate of coronary heart disease in women who have experienced menopause is actually two to three times that of women in the same age group who have not experienced menopause. And compared with women who experience menopause at age 50 or later, women who reach menopause before age 45 are at an increased risk.

One theory suggests that the protection of the pre-menopausal years is related to iron lost through menstrual blood. Iron contributes to the oxidation of cells, and research has shown that it is associated with increased atherosclerosis.

When women menstruate, they lose iron, but after menopause, iron can build up in the body. Excess iron can be found in the blood, but it's also stored in organs such as the heart and liver. It's important that once women reach menopause they no longer take multivitamins or supplements with iron in them.


In the past, hormone replacement therapy was thought to have a beneficial effect on coronary heart disease. Up until 1998, most studies suggested that estrogen/progestin (hormone) therapy reduced heart attack rates in women. In 1998, however, the Heart and Estrogen/Progestin Replacement Study (HERS) found that hormone therapy resulted in an increase in events related to coronary heart disease and had no benefits on cardiovascular health. Moreover, estrogen/progestin caused venous thromboembolism, a condition in which blood clots develop in the leg and can travel to the lungs.

Four years later, the Women's Health Initiative (WHI) Estrogen-Plus-Progestin Study was ended prematurely because the risks were found to outweigh the benefits of hormone therapy. In fact, estrogen/progestin caused an increased risk of events related to coronary heart disease, stroke, breast cancer, and pulmonary embolism.

Although the women taking estrogen/progestin did have a decreased risk of hip fracture and colon cancer, the harm from hormone therapy overshadowed the benefits. In addition, subsequent findings indicated a significant two-fold increase in mental decline or dementia among women older than age 65 who took hormone therapy.


The WHI Estrogen-Alone Study, which examined the effect of estrogen without progestin on women who had a hysterectomy, also found that there was no benefit in preventing coronary heart disease in women, although early events appeared less pronounced.

As a result of the findings from the HERS and WHI studies, hormone therapy is no longer recommended to prevent coronary heart disease in women, and doctors are directed to treat symptoms of menopause with the lowest dose of hormones for the shortest time possible.  

Unfortunately, weight gain frequently accompanies menopause; this leads to an increase in risk factors associated with the metabolic syndrome, including increased abdominal obesity, decreased levels of HDL cholesterol, and elevated levels of blood pressure, blood glucose, and triglycerides. Overall, a menopausal woman with these untreated risk factors is more vulnerable to all the manifestations of coronary heart disease, including heart attack, heart failure, and sudden cardiac death.

But it's not just menopause that increases a woman's risk of coronary heart disease. Other risk factors play a significant role, too.

One factor in particular, cholesterol, is affected by menopause. The next page details the risk in women from cholesterol, and how it changes after menopause.

For more information on coronary heart disease, see:

This information is solely for informational purposes. IT IS NOT INTENDED TO PROVIDE MEDICAL ADVICE. Neither the Editors of Consumer Guide (R), Publications International, Ltd., the author nor publisher take responsibility for any possible consequences from any treatment, procedure, exercise, dietary modification, action or application of medication which results from reading or following the information contained in this information. The publication of this information does not constitute the practice of medicine, and this information does not replace the advice of your physician or other health care provider. Before undertaking any course of treatment, the reader must seek the advice of their physician or other health care provider.

Cholesterol in Women

High cholesterol is one example in which the way men and women are affected by a condition and the subsequent treatment that would be appropriate are different. It's true that high cholesterol in either gender increases the risk of coronary heart disease. However, women under the age of 50 don't often have a cholesterol level that would warrant typical treatment to lower cholesterol. This is because, before menopause, women tend to have a higher HDL-cholesterol level that protects them. But after menopause, these protective levels of HDL cholesterol can drop.

Regardless of whether a woman has experienced menopause or not, high cholesterol levels -- although not high enough to receive intensive treatment -- should be lowered. This usually means making lifestyle changes that embrace healthy habits, including a balanced diet, losing excess weight, quitting smoking, and engaging in regular physical activity.

In older women, levels of triglycerides provide an excellent indicator of coronary heart disease. This may be a result of increased insulin resistance, which typically occurs after menopause and is associated with a higher level of triglycerides.

Women are also more likely than men to develop high blood pressure at an advanced age. The next page explains how this condition affects women.

For more information on coronary heart disease, see:
This information is solely for informational purposes. IT IS NOT INTENDED TO PROVIDE MEDICAL ADVICE. Neither the Editors of Consumer Guide (R), Publications International, Ltd., the author nor publisher take responsibility for any possible consequences from any treatment, procedure, exercise, dietary modification, action or application of medication which results from reading or following the information contained in this information. The publication of this information does not constitute the practice of medicine, and this information does not replace the advice of your physician or other health care provider. Before undertaking any course of treatment, the reader must seek the advice of their physician or other health care provider.

High Blood Pressure in Women

High blood pressure in women becomes more of a concern as they age. This condition is the most common cardiovascular disease in the United States and a serious risk factor of coronary heart disease and stroke. But according to the American Heart Association, men have a greater risk of high blood pressure until age 55, and after 55, women are more likely to develop high blood pressure.

Blood pressure begins to become a risk factor of coronary heart disease when it exceeds 115/75 mm Hg. Pre-hypertension is defined as a systolic blood pressure between 120 and 139 mm Hg or a diastolic blood pressure between 80 and 89 mm Hg, and lifestyle changes, which may be especially beneficial for women, are recommended at this point.

Weight loss and the Dietary Approaches to Stop Hypertension (DASH) diet, which restricts sodium, can significantly improve blood pressure. If lifestyle changes don't result in lower blood pressure, or blood pressure is 140/90 mm Hg or greater, medication may be necessary.

The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial -- which specifically targeted women -- compared three antihypertensive drugs in people who had high blood pressure. While all of them reduced risk of coronary heart disease, the diuretic chlorthalidone lowered the risk of heart failure more than amlodipine (a calcium channel blocker), and it also lowered the risk of stroke more than lisinopril (an ACE inhibitor). The results from this study suggest that a diuretic, included as part of a multi-drug regimen, can be particularly beneficial.

Diabetes should be of particular concern to women who are at risk of coronary heart disease. Find out why on the next page.

For more information on coronary heart disease, see:
This information is solely for informational purposes. IT IS NOT INTENDED TO PROVIDE MEDICAL ADVICE. Neither the Editors of Consumer Guide (R), Publications International, Ltd., the author nor publisher take responsibility for any possible consequences from any treatment, procedure, exercise, dietary modification, action or application of medication which results from reading or following the information contained in this information. The publication of this information does not constitute the practice of medicine, and this information does not replace the advice of your physician or other health care provider. Before undertaking any course of treatment, the reader must seek the advice of their physician or other health care provider.

Diabetes in Women

The development of diabetes in women -- who naturally experience an increase in the risk of coronary heart disease as they age as a result of menopause -- is especially worrisome because diabetes significantly adds to this risk. In fact, diabetes has been shown to be more dangerous for women than men.

Studies of women with impaired glucose tolerance (levels of glucose in the bloodstream that are above normal but do not yet signal diabetes, also referred to as pre-diabetes) have demonstrated the advantages of regular exercise and a healthy diet, which contribute to weight loss.

Both the Finnish Diabetes Prevention Study and the Diabetes Prevention Program study found that the participants who made lifestyle changes, such as losing weight and increasing the level of physical activity, could reduce by almost 60 percent within three years the progression of impaired glucose tolerance to diabetes. Moreover, the Diabetes Prevention Program study found that lifestyle changes were even more effective than medication at reducing the incidence of diabetes.

Diabetes is so serious that it actually catapults women -- who usually have a lower risk of coronary heart disease than men before menopause -- to the same level of risk as men. Prevention is key to preventing the development of type 2 diabetes. This includes a balanced diet, losing excess weight, and engaging in regular physical activity.

For more information on coronary heart disease, see:

ABOUT THE AUTHOR

Dr. Neil Stone is a professor of clinical medicine in cardiology at the Feinberg School of Medicine of Northwestern University and a practicing internist-cardiologist-lipidologist at Northwestern Memorial Hospital. He also serves as the Medical Director of the Vascular Center for the Bluhm Cardiovascular Institute. Dr. Stone was a member of the first and third National Cholesterol Education Program Adult Treatment Panels and a past chairman of the American Heart Association Nutrition Committee and Clinical Affairs Committee.

This information is solely for informational purposes. IT IS NOT INTENDED TO PROVIDE MEDICAL ADVICE. Neither the Editors of Consumer Guide (R), Publications International, Ltd., the author nor publisher take responsibility for any possible consequences from any treatment, procedure, exercise, dietary modification, action or application of medication which results from reading or following the information contained in this information. The publication of this information does not constitute the practice of medicine, and this information does not replace the advice of your physician or other health care provider. Before undertaking any course of treatment, the reader must seek the advice of their physician or other health care provider.