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Women and heart disease and stroke

Women today are living longer, but that doesn’t mean that they still don’t face major health challenges. Cardiovascular disease (heart disease and stroke) is a leading cause of death for Canadian women, and yet many are not aware of this threat.

In fact, most Canadian women have at least one risk factor for cardiovascular disease (heart disease and stroke). Women who have diabetes, come from certain ethnic backgrounds or are menopausal are even more at risk.

It is important for every woman to know about their risk factors and recognize the warning signs for heart disease and stroke so that you can prevent and manage them.

Women and heart attack
Women’s unique conditions related to heart disease and stroke
Making heart-healthy changes in your life

Women and heart attack

Are the warning signs of heart attack the same for women?
In the past, it was believed that women and men had different warning signs of heart attack. This may not be the case. Both women and men may experience typical or non-typical symptoms such as nausea, sweating, pain in the arm, throat, jaw or pain that is unusual. However, women may describe their pain differently than men. Nevertheless, the most common symptom in women and men is still chest pain.

Cardiovascular disease (heart disease and stroke) is a leading cause of death for Canadian women. Women tend to be safeguarded from heart disease prior to menopause because of the protective effect of estrogen.  However, this is not always the case. For example, pre-menopausal women with diabetes have similar risk to men of the same age because diabetes cancels out the protective effect of estrogen. Read more about heart attack warning signs.

Women’s unique conditions related to heart disease and stroke
Women are living longer, healthier lives than ever before. While most of the risk factors and signs are the same in women as they are in men, there are unique aspects to women's heart health that you should know.

The role of estrogen
Birth control pills (oral contraceptives)
Pregnancy
Menopause and hormone therapy
Cholesterol
Triglycerides

The role of Estrogen
During a woman's reproductive life cycle, from about age 12 to 50, the naturally occurring hormone, estrogen, provides a protective effect on women's cardiovascular health. However, estrogen's protective effect can change depending on a variety of factors and conditions.   

Birth control pills (oral contraceptives)
Modern oral contraceptives are much safer than the forms used decades ago. In women under the age of 35 who don't smoke, contraceptive use does not increase the risk of stroke. However, in a small proportion of women, oral contraceptives increase the risk of high blood pressure and blood clots. The risk is greater if you: smoke, already have high blood pressure (especially if you are over the age of 35), have other risk factors for heart disease or stroke, or already have a blood clotting problem. 

Pregnancy
Over the nine months of gestation, women may develop certain conditions that put them at higher risk of heart disease.

  • Pre-eclampsia is a condition that typically starts after the 20th week of pregnancy. It is related to increased blood pressure and protein in the mother's urine (the protein indicates that there is a problem with the kidneys). Although there is no proven way to prevent pre-eclampsia, you may be prone to the condition if you have high blood pressure or are obese prior to becoming pregnant. Other risk factors include being younger than 20 or older than 40, are pregnant with more than one baby, or have diabetes, kidney disease, rheumatoid arthritis, lupus or scleroderma. All women should be monitored by their healthcare provider throughout their pregnancy. Have your blood pressure checked often. Pre-eclampsia is treatable under the supervision of a doctor.
  • Gestational diabetes While pregnant, a woman's body must produce extra insulin because increasing levels of pregnancy hormones interfere with the body's ability to use insulin efficiently. If the woman's body can't produce the additional insulin sufficiently, her blood sugar levels may rise, causing gestational diabetes. There are no warning signs so it is important that women get tested for diabetes as part of their prenatal care and continue to be monitored throughout their pregnancy. Although gestational diabetes usually disappears after the baby is delivered, it can increase the risk of the mother and baby developing diabetes later in life. Diabetes is a risk factor for heart disease and stroke.
  • Stroke occurs rarely in young women of childbearing years. Strokes associated with pregnancy and childbirth are usually the result of an underlying problem such as a pre-existing blood vessel malformation or eclampsia. The risk of a pregnancy-related stroke is greatest in the six weeks following childbirth. Read about the warning signs of stroke.

You may want to be assessed for heart disease by your doctor before you conceive and be followed closely throughout your pregnancy and after childbirth. Heart disease can complicate pregnancy. Visit The Hospital for Sick Children and learn more about Heart Disease and Pregnancy. The Heart Disease and Pregnancy website also provides information about the risks associated with pregnancy and strategies for the management of pregnant women with heart disease. The website was developed by an international panel of physicians including internists, cardiologists, obstetricians and other medical specialists with expertise in pregnancy and heart disease.

Menopause
Menopause is a time when a woman stops having menstrual cycles. If you have reached menopause, your overall risk of heart disease may increase due to the reduction in the hormones estrogen and progesterone produced by your body. Before and after menopause, you may experience:

  • An increase in total blood cholesterol, low density lipoprotein cholesterol (LDL or ‘bad’ cholesterol) and triglyceride levels
  • A decrease in high density lipoprotein cholesterol (HDL or ‘good’ cholesterol)
  • A tendency toward higher blood pressure
  • An increase in central body fat, which can be harmful to your body because you may be more prone to  blood clots and blood sugar problems Symptoms such as severe sweating or sleep disturbances

Hormone Therapy (HT) refers to different types of estrogen and progestin that a woman may take to ease some of the symptoms related to menopause. Randomized controlled trials have shown that HT does not reduce the risk of heart disease or stroke, or prevent future heart disease or stroke. It is not recommended to begin or continue to use HT, either estrogen alone or combined estrogen-progestin, for the sole purpose of preventing heart disease and stroke. Discuss all health risks and benefits of HT with your healthcare provider.

Cholesterol
You may have heard or read that natural estrogen helps to keep cholesterol levels in a healthy range. After menopause, as natural estrogen levels drop, more and more women tend to develop high cholesterol. Talk with your doctor about how often you should have your cholesterol checked. Read Living with Cholesterol.

Triglycerides
Triglycerides are the most common type of fat in the body. A high triglyceride level often goes with higher levels of total cholesterol and LDL, lower levels of HDL and an increased risk of diabetes. Research suggests that having high triglycerides may increase the risk of heart disease and stroke for women. Talk to your doctor about your risk.

Making heart-healthy changes in your life
A woman’s overall risk of heart disease or stroke is determined by all of her risk factors. You can control some of these risk factors, but not all of them. 

Women can prevent and reduce their risk of heart disease by:

  • Becoming and remaining smoke free.
  • Achieving and maintaining a healthy body weight.
  • Being physically active for at least 150 minutes of moderate- to vigorous-intensity aerobic physical activity per week, in bouts of 10 minutes or more. Maintaining a blood pressure through lifestyle changes (such as increased physical activity) and when needed through medication.
  • Eating a healthy diet that is lower in fat, higher in fibre and includes foods from each of the four food groups in Canada’s Food Guide.
  • Using medications to reduce the risk of heart disease and stroke as prescribed by your healthcare provider, for example medications for high blood pressure, high blood cholesterol and diabetes, or other medications like acetylsalicylic acid (ASA commonly known as AspirinTM)

Go to our section on Healthy Living to reduce your risk of heart disease and stroke.

For more information on women and heart disease, please read our brochure HeartSmart™ Women: A guide to living with and preventing heart disease and stroke.

To be more aware of women and heart disease, visit our Heart Truth campaign

For more information on women and health and lifestyle trends, visit womenshealthmatters.ca. You can also join Le Club and share your stories and experiences with other women or talk to health experts at the Women's College Hospital.

Last reviewed: March 2011

Last modified: June 2012