JUNE 2004

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Women vs. Men:
Who’s Losing More to Heart Disease?

According to the American Heart Association statistics, heart disease killed nearly 498,863 US women in 2001, more than the 432,245 US men who died from heart disease that year. In Canada, the Heart and Stroke Foundation reported that 39,134 women and 39,808 men died of heart disease and stroke in 2000 -- that’s 37% of all deaths for women versus 35% of all deaths for men. Women are at greater risk for heart disease than they think.

After age 55, more than half of all deaths in women are caused by heart disease. While a man’s risk for heart disease increases significantly after age 45, a woman’s risk increases after menopause, whatever her age. In fact, heart disease rates in postmenopausal women are two to three times higher than those in premenopausal women the same age. This fact leads some to suggest that the body’s estrogen provides some protective benefits. Women who experience premature menopause (before age 40), natural or induced, may have an even greater risk than women who reach menopause at the average age.

Heart disease is often detected later in women than in men due to the difference in symptoms. Women can experience classic symptoms, similar to those men experience, such as chest pain or pain in the left arm. However, many times women’s symptoms are much different, including indigestion, fatigue, nausea, heartburn, and shortness of breath. Most women are not aware that these can be signals of heart disease.

Not only are symptoms different for women. Women are also less likely than men to receive treatment for heart disease. Studies have shown that US women receive less than a third of all angioplasties, stents, implantable defibrillators, and bypass surgeries each year. Women will benefit from reporting their symptoms to healthcare providers and asking whether cardiovascular examinations are needed.

And just as the symptoms and treatments of heart disease are different for women than men, so are some of the risk factors. Heart disease risk factors for women include:

  • Advancing age, especially after age 65
  • Black race/ethnicity
  • Cigarette smoking
  • Physical inactivity
  • High blood pressure
  • Abnormal cholesterol levels
  • Stress
  • Diabetes
  • Drinking more than three alcoholic beverages daily
  • Family history (a close blood relative who had a stroke; a father or brother who had a heart attack before age 55; a mother or sister who had a heart attack before age 65)
  • Weight more than 20% over ideal
  • Premature menopause, especially if reached before age 35

Whatever their risk for heart disease, all women should definitely adopt a preventive strategy for optimal heart health. The following guidelines are an important part of creating a heart-healthy lifestyle:

  • Stop smoking. Smokers are considerably more likely to have a heart attack than nonsmokers. When women stop smoking, no matter how long or how much they smoked, the risk for heart disease drops rapidly. Avoidance of second-hand smoke is also an important heart health strategy.
  • Exercise regularly. A sedentary lifestyle is almost as great a risk factor for heart problems as smoking, due to diminished circulation and weight gain. Recommendations abound for heart-healthy exercise options. Just remember that any exercise is better than none.
  • Weigh in. Women who keep their weight at recommended levels have up to 50% less risk for heart disease. Women who are significantly overweight can reduce health risks substantially by losing just 10% of their weight.
  • Reduce stress. A stressful lifestyle increases risk of heart disease as well as other health problems. Many stress-reducing options are available from meditation to relaxation techniques to bubble baths.
  • Control blood pressure. High blood pressure (hypertension) is more common with aging. Over half of all women over age 65 are affected. Even mild elevations in blood pressure can double the risk of stroke or heart attack. Black women are especially susceptible. Regular testing is recommended because high blood pressure rarely causes symptoms. Lifestyle changes can go far in controlling blood pressure: don’t smoke, eat a healthy diet, limit salt and alcohol, exercise, reduce stress, and control weight. If lifestyle changes aren’t enough, several prescription medications are available for addition to the therapeutic plan.
  • Control cholesterol and triglycerides.  Abnormal levels of cholesterol and triglycerides (fats in the blood) can result in clogging plaque deposits along the inner walls of the arteries that supply blood to the heart and the rest of the body. This is called atherosclerosis or hardening of the arteries, and can lead to both heart attack and stroke. Again, lifestyle changes can have a powerful effect. Exercise, control weight, don’t smoke, and reduce intake of animal fat, hydrogenated oil, and trans-fatty acids. If lifestyle changes don’t adequately control cholesterol, add a prescription medication.
  • Prevent diabetes. About two-thirds of people with diabetes die of heart or blood vessel disease. Midlife women should be screened for diabetes if they are at high risk (family history of diabetes, obesity, personal history of gestational diabetes, or member of a high-risk ethnic group). Women who have diabetes are strongly urged to work with their healthcare providers to manage the disease.

Treatment Options

One similarity shared by men and women is the fact that, through lifestyle changes (exercise, healthy diet, and so forth), they can control many risk factors for heart disease.

Nonprescription therapies are also used by many women to lower their risk of heart disease. Consuming soy foods or supplements (25 mg soy protein daily) may improve cholesterol levels. Studies have found that low-dose baby aspirin (81 mg daily) can lower a woman’s risk for heart disease if she is at high risk. More research is needed before aspirin can be recommended for women without risk. Vitamin E, once thought to lower risk, has been proven in many studies to be ineffective. The role of B vitamins (including folic acid) and vitamin C in the prevention of heart disease is still being studied.

When lifestyle changes and nonprescription therapies are not adequate to control blood pressure and cholesterol, a variety of effective prescription therapies (such as diuretics and statins) are available. Your healthcare provider can recommend what is best for you. Although high blood pressure and unhealthy cholesterol levels do not have symptoms, they should not go untreated.

Previously, hormone therapy (either estrogen alone or estrogen-progestogen for women with a uterus) used for menopause symptoms was thought to reduce the risk of heart disease, primarily because of estrogen’s proven beneficial effect on cholesterol. However, recent studies have shown that some types of hormone therapy increase risk for heart disease, blood clots, and stroke. Current recommendations are that hormone therapy should not be used solely to prevent heart disease. Also, women with heart disease should not begin hormone therapy without a careful consideration of the risks.

For both sexes, maintaining heart health is a top priority. Keep these tips in mind and, for more information, visit:

The American Heart Association 

The Heart and Stroke Foundation of Canada

National Heart, Lung, and Blood Institute


Last reviewed: June 2004


Menopause Flashes brings you facts, guidelines and suggestions for a manageable menopause transition. We hope our efforts are making a positive impact on your experience.
-- NAMS Board of Trustees


"Menopause is certainly a ‘life-changing’ experience. And that means body-changing, mind-changing, and more. It affects us most every day -- now and well into the future. At Menopause Flashes, we understand the importance of the menopause experience. From the first signs right through to the years after, it is our goal to provide the knowledge and understanding you need to take charge of the situation. Menopause will change your life. Menopause Flashes will make sure you’re ready."

—Libby Contestabile, RNC, BScN
Menopause Flashes



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