What Women Over The Age Of 50 Should Know About Coronary Heart Disease Prevention

Written by: Cameron Rosario
Medically reviewed by: Robert Philibert MD PhD

As you get older, it becomes increasingly more important to take the necessary steps to maintain a healthy heart. Coronary heart disease is a leading cause of mortality and morbidity rates in women. In fact, in high-income countries, coronary heart disease has become one of the major causes of death among women compared to lower respiratory tract infections, neonatal disorders, diarrhea, and malaria in low-income countries.

Learning about common misconceptions, symptoms, and risks specific to women’s heart health is important for reducing your risk for heart disease over time.

What is Coronary Heart Disease (CHD)?

• CHD is the most common type of cardiovascular disease (CVD). It occurs when there is buildup of plaque composed of cholesterol, calcium, fat, cellular waste and other substances within the inner walls of coronary arteries. When nothing is done to reduce and prevent plaque build up, the artery may begin to harden and narrow resulting in a condition called atherosclerosis.

• The plaque build up can block blood flow, leading to heart attacks, the leading cause of death in the United States. The American Heart Association reported that annually, 35 out of 1000  women between the ages of 45-54 years old have been diagnosed with a heart attack or fatal CHD in comparison to 10 out of 1000 women between the ages of 35-44 years old. Unfortunately, the increase in heart attack and CHD diagnosis continues with age and reaches to 110 out of 1000 women over the age of 85. This means that about 1 out of 10 women will be diagnosed with heart attack or fatal CHD. Despite these statistics, it does not mean that CHD is inevitable. Fortunately, there are ways to reduce your risk for CHD and maintain a healthy heart with age.

Not Just a Man’s Disease

• The assumption that CHD is a “man’s disease” is a common misconception that is portrayed in the media. However, cardiovascular disease, including CHD, remains to be the leading cause of death in women.
• The American Heart Association conducted a survey to investigate the reason for this common misconception among women. The results suggested that although about 50% of the women were aware of the high mortality rate of heart disease, 87% would not classify it as their greatest health risk. Further studies suggest that this is a result of higher CHD prevalence among women >50 years old, therefore causing younger women to pay less attention to the threat of, CHD in comparison to diseases that tend to affect younger women such as breast cancer. This disconnect is harmful to a woman’s health as women >50 years old have about a 46% chance of developing CHD in contrast to the 10% chance of developing breast cancer.

Risk Factors Unique to Women

Both men and women share some similar risks for CHD.There are, however, some risks that carry a heavier weight on women than men, contributing to higher CHD risk in women.

These risk factors include, but are not limited to:

• Diabetes:
  • A high blood pressure as a result of diabetes can damage your artery walls due to the high volume of blood flowing through. Diabetes increases the risk of CHD in both men and women. However, diabetic women are at a 1.81-fold risk for CHD related death in relation to non-diabetic women while diabetic men have a lower risk rate at a 1.48-fold in comparison to non-diabetic men.
• Smoking:
  • Smoking can contribute to the buildup of plaque in the blood vessels that affects both men and women. Yet, The Journal of Thoracic Disease published a study that showed that female smokers have a 25% higher risk of developing CHD in comparison to male smokers. The results have been attributed to gender differences in genes that are involved in thrombin signalling.
• Pregnancy Complications:
  • Pregnancy can induce serious damage to the heart and exacerbate underlying CHD. The increase in blood volume, stroke volume, and heart rate demanded by the body during pregnancy makes women more likely to get heart disease.
• Menopause And Estrogen Levels
  • These low rates can be attributed to the decrease in estrogen levels after menopause, a stage women typically go through after the age of 40. The hormone estrogen is a major hormone found in the female body that can protect the body, specifically the cardiovascular system.
  • As the levels of estrogen decrease, its beneficial effects slowly disappear and cause an increase in women’s cardiovascular risk, including coronary artery disease. There are structural and functional problems that occur within the cardiovascular system that result from estrogen depletion that include systemic hypertension, abnormal lipid profiles (possibly leading to atherosclerosis), and insulin resistance.

Non-Traditional Symptoms Women May Experience

For heart attacks the feeling of acute chest pain, discomfort, and pressure is the most common heart attack symptom shared among men and women. Yet, it should be noted that not all women experience these symptoms and may experience other CHD symptoms that are not widely known.

The Cleveland Clinic says that symptoms may include:

• Shortness of breath:The intense feeling of a tight chest or difficulty breathing.
• Lightheadedness: The feeling that you are about to faint. It may be accompanied by a clouded vision and trouble standing straight.
• Back, jaw, neck, arm, or stomach pain: A physical discomfort in one or both arms.

• Nausea: A discomfort in the stomach that may be accompanied with (the feeling of) vomiting.
• Unusual fatigue: The persistent feeling of tiredness or weakness.
• Cold sweat: Sweating that is a result of stress.

If you are experiencing these symptoms, it’s best to bring a list of when and how often they happen to your primary care physician. If you think you or someone else is experiencing a heart attack, call 911 immediately.

Why Are Women Harder To Diagnose Than Men

• CHD is found to be more difficult to diagnose in a clinical setting as a result of a diagnostic imaging test not optimized for women.
• The advanced cardiac evaluation is highly dependent on diagnostic imaging tools that are not catered towards the unique biological composition of women. This is seen through the lack of sensitivity of the golden standard diagnostic device for identifying narrowing and blockages in large arteries, the angiogram.
  • Women have small arteries that are oftentimes where the blockages can be found which cannot be easily detected by the angiogram. Consequently, women may continue to experience CHD symptoms after cardiac catheterization.

What Can You Do To Reduce Your Risk of Coronary Heart Disease?:

Currently, there is no known cure for coronary heart disease. However, a healthy lifestyle can help you reduce your risk.

1. Find Ways To Stay Active:
   • This does not necessarily mean long hours of high-intensity workouts, but rather finding small ways in your daily life that can keep you moving. This can include, but is not limited to, parking farther away from the grocery store to incorporate more walking, talking long walks with friends or pets, and taking the stairs.
   • The Journal of Physiology published a study that discovered that the more often a person exercised, the healthier and more youthful their arteries were. In the cross-sectional examination, 102 participants over the age of 60 with a lifelong history of exercise 2 or 3 times a week had more youthful middle-sized arteries than participants that had little to no exercise. This finding was further reinforced when the data showed that people who exercised 4 to 5 times a week had even more youthful and larger central arteries.
2. Reduce Alcohol Consumption:
   • Drinking alcohol may have negative side effects upon the proteins that participate in blood clot formation and fibrinolysis (the formation of proteins that assist in blood clotting), platelet aggregation, blood pressure, and inflammation. It is advised to avoid binge drinking since this will increase your risk of CHD significantly. The recommended intake of alcohol is 14 units a week spread out over 3 days for both men and women.
3. Quit Smoking:
   • The chemicals inhaled when smoking can increase the buildup and thickening of plaque in the blood vessels that can lead to the narrowing of blood vessels and blockages. Quitting smoking may be difficult at first but can drastically improve your heart and overall health.
4. Eat a Balanced Diet:
   • Dietary modifications are a common and effective way to improve your overall heart health, especially reduce the risk of CHD. This includes healthy fats (monounsaturated and polyunsaturated fats), lean protein, whole grains, and fruits and vegetables. Also getting into the habit of reading food labels can aid in limiting the consumption of unhealthy fat and sodium.
5. Assess Your Risk:
   • Being aware of your risk is important in taking the necessary steps to reduce your CHD risk. Sometimes even when a woman is feeling fine, she is still at risk of having a heart disease where symptoms are dormant. It also should be highlighted that though a family history of CHD increases your risk, it is guaranteed that you will experience CHD. Cardio Diagnostics’ Epi+Gen CHD test is an at-home clinical test for CHD risk assessment.
6. Maintain a Healthy Weight:
   • Though weight is seen as a minor risk factor, taking control over your weight can influence major risk factors such as hypertension, dyslipidemia, and insulin resistance. A healthy weight varies due to a person’s height and build, so consider contacting your primary care physician to determine your ideal weight. Your body mass index (BMI) can also be calculated using a BMI calculator.
7. Find Healthy Ways to Cope with Stress:
   • Constant stress means that your body is releasing harmful levels of the hormone cortisol in response. This can cause an increase in common risk factors for CHD including blood cholesterol, triglycerides, blood sugar, and pressure. Taking a bit of time away from work, picking up a new hobby, and talking to family and friends are some of the best ways to cope with stress. You can even consult your primary care physician to see if they have any recommendations for consults, classes, or programs.
8. Visit Your Primary Care Physician For Checkups:
   • Getting yearly checkups can help with ensuring you are on the right path to optimal heart health. Some numbers that should always be monitored are blood pressure, BMI, cholesterol levels, and glucose levels. From there, recognize areas in which lifestyle improvements need to be made.
9. Following And Being Consistent With Your Treatment Plan:
   • Following your treatment plan is the best way to relieve any symptoms and prevent any potential complications. This goes beyond any CHD prescriptions and includes prescriptions that treat high blood pressure and/or cholesterol levels. Always talk to your primary care physician before you stop taking your medications to avoid putting your health at risk.

References:

1. American Heart Association News. (n.d.). Heart health at any age – 40, 50, 60 and beyond. American Heart Association. https://www.heart.org/en/news/2018/07/20/heart-health-at-any-age-40-50-60-and-beyond
2. Clarke, J. L., Ladapo, J. L., Monane, M., Lansky, A., Skoufalos, A., & Nash, D. B. (2015). The Diagnosis of CAD in Women: Addressing the Unmet Need—A Report from the National Expert Roundtable Meeting. Population Health Management, 18 (2), 86-92. http;//doi.org/10.1089/pop.2015.0006
3. Cleveland Clinic. (2019, October 25). Women: Don’t Ignore These 3 Subtle Heart Attack Symptoms . Health Cleveland Clinic. https://health.clevelandclinic.org/women-dont-ignore-3-subtle-heart-attack-symptoms/
4. Crandall, C. J., Dennis Lee, Marks, J. W., & Lee Kulick, D. (n.d.). Heart Disease in Women . MedicineNet. https://www.medicinenet.com/heart_disease_in_women/views.htm
5. Cuffari, B. (2020, September 7). Gender Differences in Coronary Heart Disease. News Medical Life Sciences. https://www.news-medical.net/health/Gender-Differences-in-Coronary-Heart-Disease.aspx
6. European Society of Cardiology. (2019, Nov 14). Women most affected by vascular complications of diabetes. The European Society of Cardiology (ESC). https://www.escardio.org/The-ESC/Press-Office/Press-releases/Women-most-affected-by-vascular-complications-of-diabetes
7. Gallucci, G., Tartarone, A., Lerose, R., Lalinga, A. V., & Capobianco, A. M. (2020, July). Cardiovascular risk of smoking and benefits of smoking cessation. Journal of Thoracic Disease, 12 (7). https://jtd.amegroups.com/article/view/37685/html
8. Gordon, S., & Cutler, M. (2018, May 11). Women: Heart Health in Your 20s, 30s, 40s, 50s, and 60s. Everyday Health. https://www.everydayhealth.com/heart-health/heart-health-tips-women/
9. Harvard Health Publishing: Harvard Medical School. (2006, September). Gender matters: Heart disease risk in women. Harvard Health Publishing. https://www.health.harvard.edu/heart-health/gender-matters-heart-disease-risk-in-women
10. Higuera, V., & Tinsley, G. (2020, April 1). What Foods Should I Eat and Avoid with Coronary Heart Disease? Healthline. https://www.healthline.com/health/coronary-artery-disease/foods-to-eat-and-avoid
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