Heart Disease

Heart Disease

Listen to your heart. Many women don't recognize the warning signs of coronary heart disease (CHD) until their health—and their lives—are in jeopardy. According to the American Heart Association, every year more than half a million women die of cardiovascular diseases, which includes diseases of the heart and blood vessels, and stroke? Since 1984, more women have died of cardiovascular diseases than men.

Coronary heart disease (CHD), also known as coronary artery disease (CAD) and ischemic heart disease, is a disease of the heart's blood vessels that, if untreated, can cause heart attacks. Like any muscle, the heart needs a constant supply of oxygen and nutrients that are carried to it by the blood in the coronary arteries. When the coronary arteries become narrowed or clogged and cannot supply enough blood to the heart, the result is CHD.

Heart attack and stroke are common results of conditions that restrict or stop the blood flow to the heart or brain. At any given age, men have a greater risk of heart attack than women, but women are only half as likely as men to survive a heart attack, and more likely to have a second attack.

African-American women are more likely to die of CHD than Caucasian women, perhaps because they are more likely to have more risk factors, including high blood pressure (hypertension), diabetes, obesity and smoking, and are more likely to receive poorer health care than Caucasian women. For example, in 2001, the overall CHD death rate (per 100,000 women) was 176.7 for black women compared to 137.4 for white women and 138.4 for Hispanic women. Heart disease risk is also higher among Mexican Americans, Native Americans and native Hawaiians. This may be partly due to higher rates of obesity and diabetes in these groups.

Coronary heart disease starts with atherosclerosis, a process in which fatty substances build up inside the walls of blood vessels. Blood components also stick on the surface inside vessel walls making the vessels narrower and "hardened," and eventually less flexible. The buildup, or "plaque," may also break apart, which can further limit blood flow. The buildup and narrowing proceed gradually and result in decreasing blood flow, followed by CHD symptoms.

When blood flows more slowly at the site of narrowing, it can be come "sticky" and eventually form a clot. This blood clot can narrow the opening of the artery even further, which can reduce blood flow to the heart, leading to chest pain, or angina. If blood flow is nearly or completely blocked, a heart attack can occur, leading to the death of muscle cells in the heart. Because the cells cannot be replaced, the result is permanent heart damage. Each year, up to half a million American women suffer heart attacks, an all-too-frequent outcome of CHD.

Your risk of developing heart disease increases as you grow older. Prior to menopause, estrogen is thought to provide some protection to women against heart disease. (Premenopausal women who have diabetes or who smoke are not adequately protected by estrogen, as diabetes and smoking are major risk factors for heart disease.)

Estrogen works to keep a woman's arteries free from atherosclerotic plaque (the buildup of fatty substances cholesterol, cellular waste and other material) partly by improving the ratio of LDL (low-density lipoprotein) and HDL (high-density lipoprotein) cholesterol. Estrogen increases the amount of HDL cholesterol, which helps clear LDL cholesterol from the bloodstream, the type of cholesterol that contributes to plaque buildup in the arteries. LDL cholesterol is a major cause of CHD, according to the National Cholesterol Education Program (NCEP) of the National Heart, Lung, and Blood Institute (NHLBI).

However, taking supplemental estrogen after menopause won't reduce your risk of cardiovascular events. To the contrary, research shows that certain forms of hormone therapy slightly increase a postmenopausal woman's risk of heart attack and stroke.