Women and heart disease and stroke

Women and heart attack
Women’s unique conditions related to heart disease and stroke

Women and heart attack

Are the warning signals of heart attack the same for women?
In the past, it was believed that women and men had different warning signals 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 is still chest pain.

Heart disease is the leading cause of death in 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.

Women’s unique conditions related to heart disease and stroke
Women are living longer, healthier lives than ever before. That's why it's even more important to prevent the leading causes of death among Canadian women: heart disease and stroke.

While most of the risk factors, signs and symptoms are the same in women as they are in men, there are unique aspects to women's heart health that you should know.

Estrogen
Birth control pills
Pregnancy
Menopause
Cholesterol
Triglycerides
Heart attack

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 occurs in about 7% of pregnant women. 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 occurs in about 2 to 4% of pregnant women. 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 process 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. However, pregnancy and childbirth increase the risk of stroke as much as 3 to 13 times. 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. 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. Read about the warning signs of stroke.

Menopause
During the transition to menopause, which usually occurs at about age 51, a woman's risk of heart disease and stroke increases. This is because the ovaries slowly stop producing the hormone estrogen, which has a protective effect on the heart. A menopausal woman may experience an increase in LDL or bad cholesterol, increased triglyceride levels, and may experience a decrease in HDL or good cholesterol. She may also show a tendency toward higher blood pressure. Reduced estrogen levels may also increase body fat above the waist; have harmful effects on the way blood clots; and affect the way the body handles sugar, a precursor condition to diabetes.

Read the Heart and Stroke Foundation's Position Statement on Hormone Replacement Therapy.

Cholesterol
You may have heard or read that natural estrogen helps to keep cholesterol levels in a healthy range. However, despite the presence of natural estrogen in women, 45% women between the ages of 18 to 74 have cholesterol levels that are too high. After menopause, as natural estrogen levels drop, more and more women develop high cholesterol. Among women between the ages of 65 to 74, an alarming 80% have cholesterol levels that are unhealthy. 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.

Heart attack
In the past, it was believed that women and men had had different heart attack warning signals. 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 and men may describe their pain differently. Nevertheless, the most common symptom in women is still chest pain. Women tend to be safeguarded from heart disease prior to menopause because of the protective effect of estrogen, but not always. For example, pre-menopausal women with diabetes have similar risk to men of the same age because diabetes cancels out the protective effect that estrogen provides to pre-menopausal women.  Heart disease is the leading cause of death in women. Read about the warning signals of heart attack.

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. 

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

Last reviewed March 2010.