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Coronary Artery Disease in Women

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

Many women underestimate the threat coronary artery disease (CAD) poses to their health. Coronary artery disease is the number one killer of women in the United States. Yet in a recent survey, 50% of women replied that they still considered cancer their biggest health threat. Only 13% cited coronary artery disease as their biggest concern.

Health campaigns over the past decade have promoted heart disease prevention by encouraging people to lower their blood pressure and cholesterol, change their diet and exercise habits, quit smoking, and improve their medical care. However, many women are missing this message. In a study of 1,820 people hospitalized for heart attacks from 1979 to 1994, heart attack rates for men dropped by 8%, while heart attacks in women increased by 36%.

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 an artery's inside channel, decreasing blood flow to the 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.

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. 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.

In the past, medical research on heart disease was primarily focused on men. Now, researchers recognize that there are significant differences in coronary artery disease in women and men. For example, men usually have typical heart attack symptoms: chest pain that grips the chest and spreads to the shoulders, neck, and arms. Although women can have these symptoms too, women are more likely to have less typical symptoms such as breathlessness, heartburn, nausea, or fatigue. Heart attacks in women are often brought on by anxiety or mental stress, and even sleep, while heart attacks in men more often come on with exercise or exertion.

Because women do not always have the classic heart attack symptoms or typical onset of heart attacks, they may delay seeking care or, when seeking care, may not be treated as aggressively as men.

What can women do to prevent coronary artery disease?

In response to these concerns, the American Heart Association recently published specific guidelines for preventing and treating coronary artery disease in women. These guidelines address lifestyle changes, medications 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.
  • Do at least 30 minutes of moderate-intensity activity, such as brisk walking, on most days of the week.
  • Eat a heart-healthy diet and limit saturated fat to less than 10% of calories, limit cholesterol intake to less than 300 mg per day, and avoid trans fatty acids.
  • Keep your body mass index (BMI) between 18.5 and 24.9 kg/m2 and your waist circumference less than 35 in.(89 cm).
  • If you have coronary artery disease, be evaluated for depression.
  • If you drink, do so in moderation (an average of 1 drink per day for women). If you do not drink, do not start.
  • Adopt the DASH (Dietary Approaches to Stop Hypertension) eating plan, and reduce daily salt intake if you have high blood pressure.


  • When high blood pressure (140/90 mm Hg or higher) cannot be controlled with lifestyle approaches, consider medications to control it.
  • Lipid-lowering medication (usually statins) and lifestyle changes are recommended for women at intermediate to high risk of coronary artery disease or when cholesterol levels cannot be controlled with other medications.
  • If you have diabetes, keep your hemoglobin A1c (HbA1c) level at less than 7%. HbA1c is a blood test that measures how well blood sugar levels have remained within a safe range over the previous 2 to 3 months.
  • Daily, low-dose aspirin is recommended for most women who are at intermediate to high risk of coronary artery disease. The routine use of low-dose aspirin in women at low risk of coronary artery disease is not recommended.
  • Beta-blocker medications, which slow heart rate and reduce the workload on the heart, are recommended for women who have had a heart attack or those who have chronic chest pain (angina).
  • Most women at high risk for coronary artery disease or those with heart failure or diabetes should take an angiotensin-converting enzyme (ACE) inhibitor. ACE inhibitors lower blood pressure and reduce the workload on the heart.
  • Angiotensin II receptor blocker (ARB) medications, which also lower blood pressure and reduce the workload on the heart, should be used by high-risk women with heart failure who cannot take ACE inhibitors.

Hormone therapy

  • Combined estrogen plus progestin or estrogen-only hormone therapy should not be taken to prevent coronary artery disease in postmenopausal women. Although hormone therapy is not recommended for coronary artery disease prevention, some women may take it for relief from menopausal symptoms. Most doctors recommend that you carefully weigh the benefits against the risks of taking hormone therapy before considering it.

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); cigarette smoking; high blood pressure (140/90 mm Hg or greater) or taking medication to treat high blood pressure; low HDL cholesterol (less than 40 mg/dL); family history of early coronary artery disease in father or brother before age 55; heart disease in mother or sister before age 65; and being older than 55 or having gone through early menopause.