Heart disease is harder on women, making prevention efforts extra important for them at all ages.

Fifty years ago, articles on women and heart disease focused mainly on how to take care of a husband after a heart attack. Today, it should be the other way around. More women than men die of heart disease, and it is the leading cause of death among women. It far outstrips breast cancer — 1 in 2 women die of heart disease, compared with 1 in 12 of breast cancer.

Heart disease and stroke are more deadly and debilitating for women than men. The heap of studies demonstrating differences between the sexes in treating, surviving, and living with cardiovascular conditions is growing into a small mountain. Compared with men, women are

more likely to die from a heart attack or stroke or have another one after recovery

more likely to die in the hospital after bypass surgery or angioplasty and less likely to see improvements in quality of life after these procedures

more likely to develop heart failure after a heart attack

harmed more by a stroke

more limited by chest pain (angina)

Add to these the fact that you can’t really “fix” heart disease once it has begun, as you can an infection or broken bone, and you can see why prevention is even more important for women than it is for men.

Fortunately, there are a number of things women can do to prevent heart disease, stroke, and the myriad other conditions that stem from cholesterol-clogged and inflamed arteries. The American Heart Association has assembled a list of proven prevention strategies for women at high, moderate, and low risk (see Priorities for prevention, below).

Risk at all ages, stages
Women in their 30s, 40s, and 50s who write off heart disease as a “man’s disease” or as a problem lurking far ahead are making a big mistake. Heart disease doesn’t discriminate by sex. More than 80,000 American women under age 65 have heart attacks each year, and about 35,000 die of heart disease or stroke.

Deaths from cardiovascular disease

Cholesterol-filled plaque begins to accumulate as early as the teen years. By one’s 30s, 40s, and 50s it can already be changing the architecture of arteries. It is this process, known as atherosclerosis, that leads to heart attacks, strokes, peripheral artery disease, eroded heart valves, and possibly to memory loss and Alzheimer’s disease. Making healthy changes early can help stave these off.

To counter the notion that heart disease is just for old women, the National Heart, Lung, and Blood Institute has collected stories from younger women about their brushes with heart disease. We’ve included a few here. More are available at www.hearttruth.gov.

Menopause — a special time
Menopause represents a kind of continental divide for the heart and arteries. Before it, women seem to have extra protection not enjoyed by men against heart disease and stroke. After it, they don’t.

Estrogen and other hormones made by the ovaries keep the lining of blood vessels healthy, favorably affect HDL (good) cholesterol and LDL (bad) cholesterol, and work to keep blood from clotting too readily. As production of these hormones dwindles, giving rise to hot flashes and other symptoms of menopause, their cardiovascular protection evaporates.

Claudette, 49

I started having pain in my chest and face during exercise, and finally went to the cardiologist. I never thought that the pain in my face could be related to my heart, so I was shocked when the tests showed that I had had a heart attack.
 

The Women’s Healthy Lifestyle Project was a clinical trial designed to see if changes in diet and exercise could prevent the weight gain and cholesterol changes that often accompany menopause. As part of the study, researchers measured the inner thickness of the carotid arteries, the main vessels feeding the brain. The thicker the inner wall, the greater the buildup of damaging plaque.

In this study, artery wall thickness increased faster during menopause than it did beforehand. This suggests that menopause accelerates the progression of atherosclerosis. Of equal interest, among women in the study who switched to a healthier diet and exercised more, the steady creep of atherosclerosis slowed significantly.

Know your numbers
Everyone can benefit from making healthy changes. But the urgency and intensity of such changes depend on how close you are to the top of the heart attack risk list. The greater your risk, the greater the payoff from prevention efforts.

Despite the way it sounds, taking steps to prevent a heart attack or stroke after you’ve already had one is not akin to closing the barn door after the horse has bolted. In fact, that’s when prevention efforts are extra important, since the chances of having a repeat heart attack or stroke are higher than the chances of having a first one. Guarding against a repeat attack can keep your heart functioning normally.

Stephanie, 38

It’s only been a few weeks since I had a heart attack and it really hasn’t sunk in. I just keep thinking “I’m too young for this.” …I know I need to make changes, but it’s easier said than done.
 

The most important numbers you need to know are your blood pressure and your cholesterol. Total cholesterol isn’t good enough — make sure you also know your LDL (bad) and HDL (good) cholesterol levels.

You can translate this information into your odds of having a heart attack by tallying up your Framingham risk score. Your doctor or nurse should be able to do this during an office visit. You can do it online at hin.nhlbi.nih.gov/atpiii/calculator.asp. (If you don’t have access to the Internet, send a note to the Ask the Doctor address on page 8 and we will send you a paper-and-pencil version.)

According to this scoring system, high risk means a 20% or higher chance of having a heart attack during the next 10 years. Moderate risk is between 10% and 20%, and low risk is under 10%.

High risk doesn’t mean you should make out a will today (though it’s never too early to do that and, while you are at it, to make out a medical directive on what kinds of treatment you’d like in different circumstances and who will make health care decisions for you if you can’t). It does mean you should get serious about prevention. Moderate risk also calls for substantial improvements in lifestyle, though drug therapy may depend on your other risk factors. Low risk doesn’t mean you should relax and go crazy, but rather keep on doing what you’re doing.

Make changes that matter
Magazines, television, and the Internet are full of quick or sure fixes for heart disease. Avoid them. Only a handful of strategies have been proven to make a difference (see below, Priorities for prevention). Many are two- or threefers — in addition to protecting your heart, they also work against cancer, type 2 diabetes, and other chronic diseases.

Priorities for prevention

Guidelines from the American Heart Association that are also endorsed by a dozen leading health organizations offer concrete steps to help women prevent heart attack and stroke. The guidelines list strategies proven to work or those with good evidence supporting their use, as well as those that aren’t worth doing. (Virtually all of these apply to men, too.)

High risk of heart attack or stroke

Stop smoking

Increase physical activity (cardiac rehabilitation if appropriate)

Adopt a heart-healthy eating plan

Lose weight or prevent weight gain

Control blood pressure

Control cholesterol

Take aspirin and a statin, as well as a beta blocker or ACE inhibitor if needed

Control blood sugar if diabetic

Evaluate and treat depression

Intermediate risk

Stop smoking

Increase physical activity

Adopt a heart-healthy eating plan

Lose weight or prevent weight gain

Control blood pressure

Control cholesterol

Take aspirin if your doctor recommends it

Low risk

Stop smoking

Increase physical activity

Adopt a heart-healthy eating plan

Lose weight or prevent weight gain

Focus on other cardiovascular risk factors as needed

Not useful or effective, or may cause more harm than benefit

Hormone replacement therapy

Antioxidant supplements

Aspirin for women at low risk of heart disease
 

You don’t need to aim for a complete transformation all at once. Small changes in diet, exercise, or weight can make a big difference in your health. Setting goals you can realistically achieve, and then meeting them, can snowball into even bigger improvements.

Does striving to lead a healthier lifestyle really pay off? Consider this provocative finding from the Nurses’ Health Study. Over a 14-year period, women in the low-risk category — nonsmokers with a healthy weight who exercised regularly, ate a healthy diet, and had an alcoholic drink every other day — were 83% less likely to have had a heart attack or died of heart disease compared with all the other women.

Drug therapy can’t touch results like that.