Heart disease in women: Understand symptoms and risk factors

The most common heart attack symptom in women is some type of pain, pressure or discomfort in the chest. But it is not always severe or even the most prominent symptom, particularly in women. And, sometimes, women may have a heart attack without chest pain. Women are more likely than men to have heart attack symptoms unrelated to chest pain, such as:

• Neck, jaw, shoulder, upper back or abdominal discomfort
• Shortness of breath
• Pain in one or both arms
• Nausea or vomiting
• Sweating
• Lightheadedness or dizziness
• Unusual fatigue

These symptoms can be more subtle than the obvious crushing chest pain often associated with heart attacks. Women may describe chest pain as pressure or a tightness. This may be because women tend to have blockages not only in their main arteries but also in the smaller arteries that supply blood to the heart — a condition called small vessel heart disease or coronary microvascular disease.

Women's symptoms may occur more often when women are resting, or even when they're asleep. Mental stress also may trigger heart attack symptoms in women.

Women tend to show up in emergency rooms after heart damage has already occurred because their symptoms are not those usually associated with a heart attack, and because women may downplay their symptoms. If you experience these symptoms or think you're having a heart attack, call for emergency medical help immediately. Don't drive yourself to the emergency room unless you have no other options.

Although several traditional risk factors for coronary artery disease — such as high cholesterol, high blood pressure and obesity — affect women and men, other factors may play a bigger role in the development of heart disease in women. For example, risk factors may include:

• Diabetes. Women with diabetes are at greater risk of heart disease than are men with diabetes.
• Mental stress and depression. Women's hearts are affected by stress and depression more than men's. Depression makes it difficult to maintain a healthy lifestyle and follow recommended treatment, so talk to your doctor if you're having symptoms of depression.
• Smoking. In women, smoking is a greater risk factor for heart disease in women than it is in men.
• Inactivity. A lack of physical activity is a major risk factor for heart disease, and some research has found women to be more inactive than men.
• Menopause. Low levels of estrogen after menopause pose a significant risk factor for developing cardiovascular disease in the smaller blood vessels (coronary microvascular disease).
• Broken heart syndrome. This condition — often brought on by stressful situations that can cause severe, but usually temporary, heart muscle failure — occurs more commonly in women after menopause. This condition may also be called takotsubo cardiomyopathy, apical ballooning syndrome or stress cardiomyopathy.
• Certain chemotherapy drugs and radiation therapy for cancer. Some chemotherapy drugs and radiation therapies, such as those used to treat breast cancer, may increase the risk of cardiovascular disease.

• Pregnancy complications. High blood pressure or diabetes during pregnancy can increase women's long-term risk of high blood pressure and diabetes and increase the risk of development of heart disease in the mothers.

  Some research has found that if you had pregnancy complications such as high blood pressure or diabetes your children may also have an increased risk of heart disease in the future.

Women with inflammatory diseases, such as rheumatoid arthritis or lupus, may also have a higher risk of heart disease. Research is ongoing in other heart disease risk factors in women.

No. Women of all ages should take heart disease seriously. Women under the age of 65, and especially those with a family history of heart disease, need to pay close attention to heart disease risk factors.

Women can make several lifestyle changes to reduce the risk of heart disease, including:

• Quit or don't start smoking.
• Exercise regularly.
• Maintain a healthy weight.
• Eat a healthy diet that includes whole grains, a variety of fruits and vegetables, low-fat or fat-free dairy products, and lean meats. Avoid saturated or trans fat, added sugars, and high amounts of salt.

Women also need to take prescribed medications appropriately, such as blood pressure medications, blood thinners and aspirin. And they'll need to better manage other conditions that are risk factors for heart disease, such as high blood pressure, high cholesterol and diabetes.

In general, everybody should do moderate exercise, such as walking at a brisk pace, on most days of the week. The Department of Health and Human Services recommends 150 minutes a week of moderate aerobic activity, 75 minutes of vigorous aerobic activity a week, or a combination of moderate and vigorous activity. That's about 30 minutes a day, five days a week.

For even more health benefits, aim for 300 minutes of moderate aerobic activity or 150 minutes of vigorous aerobic activity a week. That's about 60 minutes a day, five days a week. In addition, aim to do strength training exercises two or more days a week.

If you can't get all of your exercise completed in one session, try breaking up your physical activity into several 10-minute sessions during a day. You'll still get the same heart-health benefits.

Interval training — in which you alternate short bursts of intense activity with intervals of lighter activity — is another exercise alternative you might try. For example, you could incorporate short bursts of jogging or fast walking into your regular walks. Interval training may help you burn more calories than continuous exercise, and it can help you maintain a healthy weight and keep your heart healthy.

You can make other small changes to increase your physical activity throughout the day. For example, try taking the stairs instead of the elevator, walking or riding your bicycle to work or to do errands, or doing situps or pushups while watching television.

What's considered a healthy weight varies from person to person, but having a normal body mass index (BMI) is helpful. BMI is a measurement calculated from height and weight. It helps you see if you have a healthy or unhealthy percentage of body fat. A BMI of 25 or higher can be associated with an increased risk of heart disease.

Waist circumference also is a useful tool to measure whether or not you're overweight. Women are generally considered overweight if their waist measurement is greater than 35 inches (89 centimeters).

Losing even a small amount of weight can help by lowering your blood pressure and reducing your risk of diabetes — both of which increase your risk of heart disease.

Generally, heart disease treatment in women and in men is similar. Treatment may include medications, angioplasty and stenting, or coronary bypass surgery. Angioplasty and stenting, commonly used treatments for heart attack, are effective for both men and women. However, women who don't have typical chest pain are less likely to be offered these potentially lifesaving options.

And, in women, if heart symptoms are mainly caused by coronary microvascular disease, treatment generally includes healthy lifestyle changes and medications.

Doctors may recommend cardiac rehabilitation to improve health and recover from heart disease.

Guidelines from the American Heart Association (AHA) urge women to be more aggressive about cutting their cardiovascular disease risk. For some women, this includes a daily aspirin. But, the routine use of daily aspirin therapy to prevent heart disease in low-risk women younger than 65 years old isn't recommended.

Doctors may recommend that women older than 65 years take a daily 81-milligram aspirin to help prevent heart disease if their blood pressure is controlled and the risk of digestive bleeding is low. Aspirin might also be considered for at-risk women younger than 65 years for stroke prevention.

But, don't start taking aspirin for heart disease prevention on your own. Talk with your doctor about the risks and benefits of taking aspirin based on your individual risk factor.