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Women and Heart Disease

Ann Witt, M.D., and Natalie Staats Reiss, Ph.D., edited by Benjamin McDonald, MD

Heart disease is the number one killer of both men and women. Heart disease has several causes, the most common being coronary artery disease (CAD). In CAD there is inflammation and blockage of the arteries that supply blood to the heart. This results in both ischemic heart disease (called angina) and heart attacks. Angina occurs when the flow of blood to the heart is decreased due to a buildup of plaque in the coronary arteries (called atherosclerosis). Because of the plaque, coronary arteries become narrow and stiff and there is a decreased supply of oxygen to the heart muscle.

heart diseaseWhen a woman has a heart attack, there is a complete blockage in her blood vessels that stops blood flow. Typically, a heart attack results in damage to the heart muscle, which makes it more difficult for the heart to pump blood to the rest of the body.

Prevention remains a major focus of heart disease therapy. By preventing the condition, or minimizing associated complications, fewer women will die from heart disease. Women who are at risk of developing heart disease should pay special attention to prevention strategies. A woman is at increased risk of heart disease if she also has hypertension (high blood pressure), diabetes, elevated cholesterol levels, obesity, or a history of heart attack, stroke, or peripheral artery disease (narrowing of the blood vessels in other areas of the body, most commonly the legs).

A woman's best chance of decreasing her risk for developing heart disease is a healthy lifestyle, which includes not smoking, exercising regularly, maintaining a healthy weight, eating a low fat, high fruit and vegetable diet, and restricting dietary sodium to less than 2.3 gm a day. Most women are aware (at least to some degree) that such practices are an important part of staying healthy.  However, they often do not get enough regular physical activity, are obese, exceed the recommended fat and sodium intake limits, and continue to smoke.

In addition to focusing on prevention, women should be aware of the warning signs so that heart disease can be treated early if it develops. Women need to pay particular attention to identifying gender-specific symptoms of a heart attack. The most common symptom of a heart attack is chest pain that radiates to the arm, and women do sometimes experience this symptom. However, more often than men, women experience neck or shoulder pain, sweating, nausea or shortness of breath at the time of their heart attacks. Because these symptoms may be less common and can be confused with the signs of other diseases, women may wait longer to see their doctor. This delay can lengthen the time to diagnosis and treatment, and increase the likelihood of experiencing significant, irreversible damage to the heart, or even death.

Impact on Mental Health:

A person's cardiovascular health can impact her mood. Many people become clinically depressed after a heart attack. Someone's mood can also impact their cardiac functioning. For example, mental stress can trigger cardiac ischemia (angina). One study noted that the likelihood of a heart attack increased 2 fold if there was a period of anger in the preceding 2 hours.

Research suggests that a combination of depression and coronary heart disease is particularly problematic. A person's health care quality of life is worse if they have depressive symptoms along with heart disease. Health care quality of life is a term used to describe a person's perception of the degree to which a medical condition affects their daily life. That means the effect of their medical health on their ability to do physical activities, have healthy relationships with others, work or go to school, and take care of themselves.  Patients who are depressed typically feel like they have more limitations in their daily life than non-depressed patients who have coronary artery disease.

As with many areas of medicine, additional studies are still needed to understand the exact relationship between mental health and heart disease. However, studies to date suggest that certain mental health factors such as depression, chronic stress, lack of social support, hostility, and socioeconomic status increase the likelihood of death or complications from cardiovascular disease. As a result, it is important to focus on treatment of mental health conditions along with coronary artery disease to maximize treatment gains and quality of life. Women who have heart disease and notice changes in mood that: persist for more than a few days, are severe enough to limit daily functioning, or include thoughts of suicide should make it a point to talk to their doctors. Referral to a mental health specialist may be helpful.  This could include a clinician who has expertise in behavioral medicine, or the integration of sociocultural, psychological and biomedical knowledge about health and illness.


When considering prevention and early treatment of heart disease in women, some areas remain controversial. Treatment recommendations have changed in recent years. For instance, hormone replacement therapy (HRT) is no longer recommended routinely at the time of menopause. It was previously thought that HRT improved cholesterol levels and protected women against heart disease. More recent studies challenge its protective role and raise concern that hormone replacement may actually increase a women's chance of heart disease. Please see our later section on Controversies in Menopause for more discussion on hormone replacement by clicking here.

Women who have CAD or who are at risk for CAD should use nonsteroidal anti-inflammatory medications (NSAIDs, e.g., ibuprofen, naprosyn, celebrex) with caution (i.e., only after consulting with their physicians). These types of medications may increase the risk of heart attacks with prolonged use. Further research is underway to better understand the risks associated with NSAID use.

For more information on heart disease diagnosis and treatment please see our topic center on heart disease.


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