Heart Health in Women

In the past, heart health campaigns and education have often been targeted towards men, as they suffer from heart attacks and other cardiovascular events earlier on than women. On average, a first heart attack for men is at age 65, whereas for women, the average age of a first heart attack is 72.¹ Clinical research in the area has also been focused mainly on men, with over two thirds of all clinical studies on heart disease and stroke based on men.² However, the number one cause of premature death in women is heart disease and stroke.²

Due to differences in symptoms as well as a lack of awareness, 53% of women who have a heart attack do not recognize their symptoms and do not seek medical attention soon enough.² Women are also 33% more likely to experience a stroke than men, and hormonal changes specific to women impact their heart health.² Women should be aware of their unique risk factors to protect themselves from cardiovascular events later in life.

Cardiac Events - Risk Factors that are Unique to Women

There are general factors which determine an individual’s risk for cardiovascular disease. These include: smoking status, age, family history, blood pressure, physical activity level, diet, alcohol intake, weight, and diabetes.³

However, on top of the general factors, being a woman comes with some unique risks which can contribute to the likelihood of experiencing a cardiac event.

The hormone estrogen has a protective effect on women’s hearts.⁴ As women age, the amount of estrogen declines, with menopause causing a significant decrease.⁴ Therefore, menopause is a unique risk factor for women. Menopause is also associated with a decrease in HDL (‘good’ cholesterol), an increase in LDL (‘bad’ cholesterol), and an increase in the proportion of fat to muscle. All are risk factors for cardiovascular disease.⁴

Oral contraceptive pills can significantly impact the risk of stroke for women who smoke, have high blood pressure, are over the age of 35 or have other risk factors for heart disease and stroke.⁵ However, pregnancy also presents cardiovascular risks to women. Pregnancy risks include pre-eclampsia, gestational diabetes, peripartum cardiomyopathy, and pregnancy related stroke.⁵

Stress plays a role in heart health. Although stress is a common concern regardless of your gender, women on average report higher stress levels.⁶ Over time, chronic stress can lead to an increased risk for a cardiovascular event due to the impacts of the hormone cortisol.⁷ Cortisol is a stress hormone that causes the release of fatty acids into the blood; it also raises blood pressure and elevates blood glucose.⁷

10 Ways to Improve Heart Health

The first step to improve your heart health involves lowering your number of risk factors. The following are 10 heart-healthy actions that may aid in protecting the heart and improving your cardiovascular health. 

1. Stop smoking. Easier said than done; however, it is possible. Work with your healthcare provider for guidance.
2. Manage your cholesterol levels.
3. Keep your blood pressure in a healthy range.
4. Improve your response to stressful situations and manage stress in your life.
5. Keep a healthy weight for your body type.
6. Lower your alcohol intake to 1 drink per day.
7. Be physically active for 20-30 minutes each day.
8. Eat a Mediterranean-style diet rich in fruits and vegetables, whole grains, chicken, fish, legumes, nuts and seeds. Lower your intake of processed foods and sugars.
9. Maintain an appropriate sleep schedule and aim for 8 hours each night.
10. Learn about your unique risk factors for cardiovascular disease and follow up with a healthcare professional on what you can do to limit your risk.

Cardiovascular disease and heart attacks are a significant problem for women in North America. With the evolving knowledge and research available on this important health topic, the key is to stay as educated and aware as possible. Your heart will be better for it. 

References:

1. Harvard Health Publishing. The heart attack gender gap. April 2016. Accessed January 26. 2021. https://www.health.harvard.edu/heart-health/the-heart-attack-gender-gap
2. Heart and Stroke. A fighting chance. 2020. Accessed January 26, 2021. https://www.heartandstroke.ca/women?gclid=Cj0KCQiAmL-ABhDFARIsAKywVada8i7E1nP43tz-SYnJRGwryCUfz_BLtoomlokSGINymsncTZlA0gIaAs9vEALw_wcB&gclsrc=aw.ds
3. Wilson PW. Overview of established risk factors for cardiovascular disease. UpToDate Updated. 2018 Jul;13.
4. Zhu D, Chung HF, Dobson AJ, Pandeya N, Giles GG, Bruinsma F, Brunner EJ, Kuh D, Hardy R, Avis NE, Gold EB. Age at natural menopause and risk of incident cardiovascular disease: a pooled analysis of individual patient data. The Lancet Public Health. 2019 Nov 1;4(11):e553-64.
5. Nessa A, Latif SA, Siddiqui NI. Risk of cardiovascular diseases with oral contraceptives. Mymensingh medical journal: MMJ. 2006 Jul 1;15(2):220-4.
6. American Psychological Association. Gender and Stress. 2012. Accessed January 27, 2021. https://www.apa.org/news/press/releases/stress/2010/gender-stress#:~:text=Women%20are%20more%20likely%20than%20men%20(28%20percent%20vs.,10%20(39%20percent)%20men.
7. Dimsdale JE. Psychological stress and cardiovascular disease. Journal of the American College of Cardiology. 2008 Apr 1;51(13):1237-46.
8. Dimsdale JE. Psychological stress and cardiovascular disease. Journal of the American College of Cardiology. 2008 Apr 1;51(13):1237-46.
9. Dimsdale JE. Psychological stress and cardiovascular disease. Journal of the American College of Cardiology. 2008 Apr 1;51(13):1237-46.