Why is it important for women to learn about coronary artery disease?

Coronary artery disease is the number one cause of death of women in the United States. As many women die from coronary artery disease as from the next five leading causes of death combined (cancer, chronic obstructive pulmonary disease, Alzheimer's, diabetes, and accidents).

But many women underestimate the threat coronary artery disease (CAD) poses to their health. And many women do not know what they can do to help prevent heart disease.

What is coronary artery disease?

Coronary artery disease is caused by the gradual buildup of plaque (made of fat, cholesterol and other substances) on the inside walls of the coronary arteries. These arteries supply oxygen-rich blood to the heart. Over time, the plaque deposits grow large enough to narrow the arteries' inside channels, decreasing blood flow to heart muscle. If the plaque becomes unstable and ruptures, a blood clot can form at the rupture site and block blood flow, resulting in a heart attack. See a picture of how plaque causes a heart attack.

What factors lead to coronary artery disease and death in women?

The rate of coronary artery disease increases 2 to 3 times after menopause, the time of life when a woman's menstrual periods stop.¹ This increase is not completely understood. But cholesterol, high blood pressure, and fat around the abdomen-all risk factors for coronary artery disease-also increase around this time.

Other risk factors for coronary artery disease include smoking, diabetes, obesity, lack of exercise, and family history. Using birth control pills might increase your risk if you smoke and are older than 35 or if you have a family history of atherosclerosis or blood-clotting disorders.

How will my doctor determine my risk for coronary artery disease?

Your doctor will calculate your risk for coronary artery disease by assessing the number of risk factors you have. Risk factors include:

• High LDL cholesterol level (greater than 130).
• Low HDL cholesterol (less than 40 mg/dL).
• Cigarette smoking.
• High blood pressure (140/90 mm Hg or greater) or taking medication to treat high blood pressure.
• Family history of early coronary artery disease.
• Being older than 65, or having gone through early menopause.

To find out your risk of a heart attack, see:

Interactive Tool: Are You at Risk for a Heart Attack?

What can women do to prevent coronary artery disease?

Women can use healthy lifestyle changes and medicines to help prevent coronary artery disease. Women can also balance the risks and benefits of hormone replacement therapy when they decide whether or not to use it.

The American Heart Association published specific guidelines for preventing and treating coronary artery disease in women.² These guidelines address lifestyle changes, medicines and supplements, and hormone therapy in menopausal women. Ask your doctor which recommendations are appropriate for you.

Lifestyle changes

• Stop smoking, and avoid secondhand smoke.
• Eat a heart-healthy diet, which focuses on adding more healthy foods to your diet and cutting back on foods that are not so good for you. For more information, see:

  Heart problems: Eating a heart-healthy diet.

• Try to do moderate activity at least 2½ hours a week. Or try to do vigorous activity at least 1¼ hours a week. It's fine to be active in blocks of 10 minutes or more throughout your day and week.³
• Keep your body mass index (BMI) between 18.5 and 24.9 and your waist circumference less than 35 inches. To figure out your BMI, see the body mass index (BMI) chart for adults.
• If you drink, do so in moderation (an average of one drink a day for women). If you do not drink, don't start.

Medicines

• When high blood pressure (140/90 mm Hg or higher) cannot be controlled with lifestyle approaches, consider medications to control it.
• Lipid-lowering medicine (usually statins) and lifestyle changes are recommended for women at intermediate to high risk of coronary artery disease.
• Your doctor may suggest that you take a daily, low-dose aspirin if the benefits of aspirin to prevent a stroke are greater than the risk of stomach bleeding from taking daily aspirin. But the daily use of low-dose aspirin in healthy women who are at low risk of stroke is not recommended.
• If you have been diagnosed with CAD or have had a heart attack, you will probably take medicines that lower the workload on your heart. These medicines include beta-blockers, angiotensin-converting enzyme (ACE) inhibitors, or angiotensin II receptor blockers (ARBs).

Hormone therapy

• Taking estrogen with or without progestin does not prevent coronary artery disease. In fact, if you are 10 or more years past menopause, taking hormone therapy may raise your risk of coronary artery disease.⁴
• Talk to your doctor about your risks with hormone therapy. And carefully weigh the benefits against the risks of taking it. If you need relief for symptoms of menopause, hormone therapy is one choice you can think about. But there are other types of treatment for problems like hot flashes and sleep problems. For more information, see the topic Menopause and Perimenopause.

What are symptoms of coronary artery disease and heart attack?