Today, over 41 million women suffer from cardiovascular disease (coronary heart disease, stroke, and congestive heart failure, etc.). Heart disease is known as the major cause of death among women and a survey states that almost 450,000 women above the age of 65 die annually from it. However, heart disease is preventable and increasing awareness of personal risk and preventative measures is a key element of healthcare for women.
Current research has helped explain the underlining contributions to these reductions in mortality. Evidence-based medical therapies have decreased death rates by 47%, and behavior changes to alter risk factors have reduced death rates by 44%. Therefore, a woman can decrease her CHD risk by targeting lifestyle habits.
The Nurses’ Health Study is a large cohort study designed to assess the effects of a combination of lifestyle practices on the risk of coronary heart disease. Findings from this longitudinal, observational study demonstrated that a woman was able to decrease the incidence of a coronary event by more than 80% through not smoking, maintaining normal body weight (body mass index or BMI < 25 kg/m2), consuming a healthy diet, participating in moderate to vigorous exercise for 30 minutes a day, and consuming a moderate amount of alcohol.
Over the 14-year period studied, the incidence of CHD declined by 31% across all age groups. Research has demonstrated that primary prevention can help decrease the incidence of CHD as well as the associated mortality rates. The purpose of this article is to describe the assessment of risk factors associated with CHD, present the current evidence on prevention of CHD, and discuss guidelines for implementing findings in practice.
Assessment of Risk Factors
An important first step in assessing a woman’s risk for CHD is to collect information on her medical, social/lifestyle, and family history. A thorough evaluation of the medical history including pre-existing medical conditions, such as hypertension, dyslipidemia, and diabetes, is necessary to determine the woman’s baseline risk. Patients with diabetes are at a higher risk for CHD and have two times the risk of myocardial infarction (MI) compared to the general population.
Elevated blood pressure and abnormal lipids are both strong, independent risk factors for CHD. Assessment of the social and lifestyle history provides information regarding behaviors, such as smoking, alcohol consumption, dietary habits and physical activity. Smoking, obesity, a diet high in fat, and a sedentary lifestyle are all risk factors for heart disease.
Precordial or retrosternal chest pain or pressure is one of the classic symptoms of a MI. The quality of the pain has been described as heaviness, crushing, aching, burning, or squeezing and has been noted to radiate to the jaw, neck, arms, or back.
Other associated symptoms include shortness of breath, nausea/vomiting, diaphoresis, and lightheadedness. Research shows that about 33% of patients present without chest pain, and symptoms in women tend to be more atypical, e.g., the absence of chest pain is more common in women than men. Women also tend to present with more associated symptoms such as middle or upper back pain, neck or jaw pain, shortness of breath, indigestion, and fatigue.
Framingham risk assessment
Risk factor assessment provides the chance to identify asymptomatic women who are in danger of developing CHD in the long term. The Framingham Risk Score (FRS) is a tool that may be utilized to assess one’s 10-year likelihood of MI or CHD death by assigning a point value to each of five established risk factors— age, total cholesterol, HDL-C, blood pressure, and cigarette smoking.
The total score is used to determine low (<10% risk of MI or CHD death), intermediate risk (10–20% risk), or high-risk (>20% risk). Because overall lifetime risk for CVD approaches 1 in every 2 women and this score is focused on 10-year risk, the FRS should be used as part of the total risk assessment that includes medical, lifestyle, and family history.
Food items that should be restricted in a woman’s diet include saturated fat, trans fat, cholesterol, added sugars, and salt.The intake of saturated fat, trans fat, and cholesterol should be limited to < 7% of fat intake, < 1% of fat intake and < 300 mg, respectively.
Trans fats are partially hydrogenated fats created by adding hydrogen to liquid vegetable oils making the oils solid for use in bakery items, pre-packaged snacks, and deep-fried foods.In order to achieve these fat intake goals, women should consume lean meats or meat alternatives and dairy products that are fat free or low fat. Total dietary fat intake should not exceed 35% of total daily caloric intake.
The Women’s Health Initiative Observational Study enrolled 73,743 postmenopausal women to examine total physical activity score, walking, vigorous exercise, and hours spent sitting or sleeping as predictors of cardiovascular events.
They found that the total physical activity score at baseline exhibited a strong inverse relationship with CHD. The more activity a woman participated in, the lower her risk for the development of disease. Women who exercised for 2.5 hours per week, by either walking or through vigorous exercise, had decreased their risk for CHD by 30%.
Cardiovascular risk decreased less in women who spent more time sitting or lying compared to those who moved around more.
Body weight management is critically important for promoting cardiac health because obesity is linked to cardiac arrhythmias, congestive heart failure, ischemic heart disease, and sudden death; obesity was added as an independent risk factor for CHD more than ten years ago. For women who are overweight or obese, the recommended initial weight loss goal is 10% of baseline weight because losing and maintaining a moderate 10% weight loss is associated with improvement in insulin resistance, hypertension, dyslipidemia, and inflammation.
Although there is limited evidence from randomized trials, it is still strongly recommended that women refrain from smoking or exposing themselves to second hand smoke. Smoking cessation has been identified as an important lifestyle intervention in the prevention of CHD. The Nurse’s Health Study clearly demonstrated a decrease in coronary events through changes in lifestyle including smoking cessation. As mentioned previously, the risk of CHD declined by 31% across all age groups, and these results were consistent with a decrease in smoking by 41%.
CHD is the leading cause of death among women, and the risk greatly increases as a woman reaches menopause. Engaging in healthier behaviors including maintaining a healthy weight, leading a non-sedentary lifestyle, and refraining from smoking significantly decreasesa woman’s risk of developing CHD.
- Lloyd-Jones D, Adams R, Carnethon M, et al. Heart disease and stroke statistics- 2009 update: A report from the American Heart Association Statistics Committee and Stroke Statistics
- Ford ES, Capewell S. Coronary heart disease mortality among young adults in the U.S. from 1980 through 2002: Concealed leveling of mortality rates. J Am Coll Cardiol. 2007;50(22):2128–2132. [PubMed] [Google Scholar]
- Ford ES, Ajani UA, Croft JB, et al. Explaining the decrease in U.S. deaths from coronary disease, 1980–2000. N Engl J Med. 2007;356(23):2388–2398. [PubMed] [Google Scholar]4. Manson JE, Hu FB, Rich-Edwards JW, et al. A prospective study of walking as compared with vigorous exercise in the prevention of coronary heart disease in women. N Engl J Med. 1999;341(9):650–658. (B) [PubMed] [Google Scholar]