Cardiovascular Disease: The Number 1 Killer of Women

So you think that cardiovascular disease is primarily a problem for men. Think again: More than 500,000 women in the U.S. die each year of cardiovascular disease, making it their No. 1 killer.

In fact, for a variety of complex reasons, the condition is more often fatal in women than in men and is more likely to leave women severely disabled by a stroke or congestive heart failure.

True, women don't usually start showing signs until their 60s--about 10 years after men first develop symptoms. And hormones seem to play a protective role in women before menopause.

But the common belief that premenopausal women are immune to heart problems is just plain wrong. Heart attacks strike 9,000 women younger than 45 each year.

The more scientists learn about a woman's heart and what can go wrong with it, the more they realize that females aren't just small males. There are subtle but important differences in how women's cardiovascular systems respond to stress, hormones, excess saturated fat and toxins like tobacco. There are also some pretty big differences in how aggressively doctors treat women with heart trouble--even in the emergency room when they are in most desperate need of help.

"The vast majority of heart attacks in women could be prevented with a combination of lifestyle modifications and medication," says Dr. JoAnn Manson at the Brigham and Women's Hospital in Boston. "Just making use of existing information could nearly eradicate the disease."

Of course, neither men nor women can do anything about their age or the genes they were born with. (If your father had a heart attack before 55 or your mother had a heart attack before 65, you should pay special attention to your heart health.) And it's still unclear why heart disease seems to strike men and women so differently. Structurally, their hearts and arteries are basically the same; women's hearts are smaller, but in proportion to their bodies. So doctors are pretty sure that any differences are matters of degree rather than kind.

Cardiologists are confident that they understand how heart attacks occur in men. The trouble usually begins when a fatty deposit or plaque, which has taken decades to build up on the inside of a coronary artery, becomes unstable and bursts, triggering a clot that blocks a blood vessel. Doctors can see these plaques during a fairly invasive procedure called an angiogram, in which a catheter is threaded through an artery in the groin or leg up to the arteries of the heart and a dye is then released to make any blockages easier to spot.

Although the research is controversial, some evidence suggests that bursting plaques may not be as important for women as for men. Doctors have long puzzled over the fact that some of their female heart-attack patients--usually those who have not yet gone through menopause--show few signs of artery-clogging plaques on their angiograms. Perhaps their blockages don't occur in the major arteries of the heart, where angiograms are performed and bypasses are most effective. Perhaps blood flow is restricted in the smaller vessels that branch off the coronary arteries. And perhaps the problem isn't plaques at all but the fact that these smaller blood vessels are somehow more prone to spasm, snapping shut at the slightest stress or trigger, cutting off the flow of blood to parts of the heart.

It's also possible that plaques--whether in the main coronary arteries or the smaller vessels--behave differently in women. Unlike men, women tend to distribute all the "garbage" associated with atherosclerosis--such as saturated fat and oxidized waste products--more evenly throughout the arteries. The process is analogous to the way men and women gain weight, says Dr. Noel Bairey Merz of the Cedars-Sinai Medical Center in Los Angeles. "When men get fat, it all goes to their belly," she says. "When women get fat, they tend to get fat all over--fat at the ankles, fat in the sides, fat in the upper arms." So although women generally avoid the monster plaques that kill so many men in early middle age, the continuing buildup in women's arteries may come back to haunt them in their 50s, 60s, 70s and 80s.

Plaques are another reason for women to throw away their cigarettes, as smoking seems to turn stable plaques into unstable ones. "If you look at the plaque under a microscope, it doesn't appear to be the kind of plaque that can become unstable and rupture," says Dr. Robert Bonow of the American Heart Association. "But the surface has become eroded, exposing the material beneath the surface to the blood, which causes blood clots. And it turns out that the women who have this plaque erosion tend to be women who smoked." Those clots can travel through the bloodstream, wreaking havoc in the heart or the brain.

Kardea Nutrition--Delivering Therapeutic Nutrition for Cardiovascular Health, Naturally.