Heart Disease in Women: A Closer Look

From time immemorial, women have been keepers of the heart. Nurturing and tending the hearts of loved ones is what women do.

But when it comes to our own literal hearts, many women don’t realize the risks associated simply with being female. Women have risk factors that men don’t, including pregnancy-related complications and menopause.

Statistics from the American Heart Association (AHA) reveal that cardiovascular disease is the leading killer of women and responsible for one in three deaths each year.

Common heart issues

Let’s consider some of the most common types of heart disease in women:

Risk Factors

Lifestyle choices and genetics are contributing risk factors for developing heart disease. These include:

“Almost 45% of people in the United States have high blood pressure, and a lot of those are women,” Dr. Baldasare says. “Under the current guidelines, a good normal blood pressure is less than 120/80. It’s now generally accepted that 130/80 is considered stage one hypertension.”

When it comes to LDL, lower is better, as in below 100 mg/dL. However, if you have other risk factors, or already have heart disease, your doctor will probably want to see your LDL at 70 mg/dL or lower.

Dr. Qamar notes that diabetes, hypertension, high cholesterol, smoking and a family history of heart disease continue to be major risk factors.

“Inactivity and elevated body-mass-index (BMI) are risk factors, but a lot of times we take a very simplified approach and just assume that a person who is heavier has a higher risk than a person who is thin,” notes Dr. Qamar.

“We do see a lot of thin people who have extraordinary metabolic propensity for cardiovascular disease, and we do see heavier people who are metabolically healthier than thinner people. Weight alone can never be taken as the ‘be-all’ risk factor,” he adds. 

Dr. Baldasare and Dr. Qamar both emphasize the importance of knowing your family history of heart disease, especially if immediate family members under age 50 have had cardiac events or cardiac disease.

“A family history of a cardiovascular event or a cardiovascular diagnosis, especially coronary artery disease, carotid arterial disease, and other vascular disease such as peripheral arterial disease involving the lower extremities in a first degree relative, and especially at a younger age, which we call ‘premature cardiovascular disease,’ is a very, very strong risk factor,” Qamar says.  

If you have such a family history, aggressive, non-invasive diagnostic testing should be done early on.  

Such testing includes evaluation of lipids (cholesterol), blood sugar and blood pressure. If you smoke, doctors strongly encourage you to stop.

Additional important testing includes having your coronary calcium measured.

“Those calcium scores should then be followed as therapy is delivered to make sure we are headed in the right direction,” Dr. Qamar says. 

Be Proactive

You can’t change genetics, but there are practical things you can do to reduce your risk of heart disease: 

Many of these recommendations seem simple, but following them will make a noticeable difference in your health.

Some patients only go to the doctor when something is wrong, but with routine doctor visits and lab work, risk factors can be identified and steps can be taken to prevent serious heart disease. So keep taking prescribed medication, unless instructed otherwise, for a risk factor like hypertension. 

“The awareness of heart disease in women has gotten a lot better and the majority of women do seek medical attention if they have symptoms,” Dr. Baldasare says.

Breast Cancer & Heart Disease

There can be an overlap of breast cancer and heart disease. The disturbing truth is that older women who are breast cancer survivors have a greater risk of dying from heart disease than from a recurrence of cancer.

Dr. Baldasare explains that both diseases share some of the same risk factors, including smoking, lack of exercise and alcohol consumption, but cancer treatment is also a factor.

“Some of the therapies to treat breast cancer can affect your heart,” she notes. “Some of the drugs used for chemotherapy are cardio-toxic, so the woman may survive breast cancer but end up with cardiac disease in the future.”

Blood clots and high blood pressure are just two of the side effects women may experience after chemotherapy and other cancer treatments.

Radiation, especially to the left breast, can also have repercussions, including hardened or blocked arteries, heart valve problems and irregular heart rhythm.

There’s even a new medical field known as cardio-oncology focused on protecting the heart while treating cancer.

Your mammogram may help identify a higher risk for heart problems. 

Breast arterial calcification is associated with a higher risk of developing cardiovascular disease. These white spots on imaging screens reveal calcium buildup in breast arteries. 

Although breast arterial calcification isn’t considered an indicator of breast cancer, research shows that women whose breasts showed calcification were 51% more likely to develop heart disease or have a stroke than those whose breasts showed no arterial calcification.

Pandemic impact

We’re still feeling the effects of the pandemic. 

Lockdowns, fear and uncertainty caused many people not to forgo diagnostic testing and preventive treatments.

Dr. Qamar says he’s seeing a significant number of patients who developed COVID and post COVID cardiomyopathy, and heart arrhythmias associated with cardiomyopathy. 

“We are also seeing a lot of patients who, just because of COVID and because of the restrictions, which were directly or indirectly imposed because of COVID, were really not worked up and never went to their physicians,” he notes. “They never had their routine cardiovascular testing done and are now being diagnosed with cardiovascular disease.”