The major risk factors for cardiovascular disease include:
Smoking is also a significant risk factor for the development of emphysema as well as lung cancer.
Women are more susceptible to the effects of smoking than men are. Menopause also predisposes women to the development of cardiovascular disease. Cardiovascular disease is the leading cause of death among men and women; however, women tend to receive less aggressive diagnostic testing and treatment and have a higher mortality rate after a heart attack than men.
The symptoms of emphysema or chronic obstructive lung disease vary slightly between men and women. Men tend to be diagnosed with emphysema at an earlier stage than women are, in part because of physician bias. Women are diagnosed when their symptoms become prominent. Men complain more of a productive cough while women complain of breathing difficulties. With respect to cardiac disease, symptoms of heart attacks are not as well recognized in women as in men. Women are more likely to have symptoms other than chest pain, such as:
Cardiovascular disease affects men at an earlier age than women since the pre-menopausal years are thought to protect against heart disease. After menopause, the diagnosis of heart disease increases in women. The rate of heart disease is higher in African American, Mexican American, and Native American women. Chronic lung disease such as emphysema affects mostly smokers in their 50s. Patients with a rare congenital predisposition to the development of emphysema develop disease at an earlier age.
Statistics have shown that the number of deaths from heart disease have been slowly declining from the 1960s to the mid 1990s for both women and men. This decline is smaller in magnitude among African American women and men. However, given the growing problem of obesity, these trends may differ from the mid 1990s to the present. Despite the improvement in survival rates, heart disease remains the leading cause of death for American men and women. Therefore, it is important to maintain a healthy lifestyle and to reduce risk factors for heart disease.
In cardiovascular disease, risk modification is an important intervention. Having a primary care physician is an important first step. Women and Infants now has a primary care practice for women with expertise in risk modification for cardiovascular disease. Detecting diabetes, hypertension and hypercholesterolemia and controlling those diseases with lifestyle modifications and medications as needed are important steps in the management of any adult. Smoking cessation is also crucial for the prevention of both coronary disease and lung disease such as emphysema. Aerobic exercise also helps reduce cardiac risk factors. Experts recommend that smokers be screened for chronic lung disease as the discovery of such disease is good incentive for those patients to quit.
Diabetic women should take a daily aspirin to prevent heart attacks in conjunction with other risk modifying steps. A 2005 study of more than 39,000 demonstrated that taking a daily aspirin also decreases the risk of stroke among women over age 45 (Ridker et al., NEJM, 2005). Among women over 65, taking an aspirin daily also reduced the incidence of heart attack. A daily aspirin, however, did not reduce heart attacks in relatively healthy women between the ages of 45 and 65.
No, the use of hormone replacement therapy can actually increase the risk of heart disease. According to the Women's Health Initiative - a study of more than 19,000 women - the risks of oral hormone replacement therapy (HRT) outweighed its benefits, causing more heart disease and stroke among women using combination (estrogen and progesterone) HRT than those not using HRT. For women who have undergone a hysterectomy, using oral estrogen replacement therapy was associated with a higher risk of stroke but not heart disease.
This depends on the type of birth control used. Contraceptive methods containing both estrogen and progesterone (most oral contraceptive pills, the skin patch, and the vaginal ring) have been associated with higher rates of heart disease. However, because the risk of heart disease among women of reproductive age is relatively low, combination hormonal contraception will only cause a small increase in the number of cases of heart disease. Therefore, these forms of contraception can be used safely in healthy women. Women who already have risk factors for heart disease (smoking, diabetes, high blood pressure, high cholesterol, family history of heart attack), however, should ask their primary care doctor which method of birth control is safest for them.
Chest pain with exertion that resolves with rest is the first sign of coronary disease in many cases. Breathing difficulties with exertion may be an indicator of heart or lung disease. A productive cough is a sign of emphysema or chronic bronchitis but is not specific. Development of any of the above symptoms should prompt you to seek help from your primary care physician.
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