Women's heart health starts with understanding risk factors

cardiologist dr. polonsky
More women are getting the message that cardiovascular disease isn’t just for men. While women tend to develop heart disease about 10 years later than men do, it’s still the leading cause of death for both sexes.

“For many years women were significantly less likely than men to seek care for symptoms of a heart attack,” says UChicago Medicine cardiologist Tamar Polonsky, MD, MSCI. “Public health initiatives such as the American Heart Association’s Go Red for Women have made a huge difference in raising women’s awareness of heart disease.”

Women benefit just as much as men do from a heart-healthy lifestyle. But there also are some risk factors that are specific to women, such as a history of high blood pressure or diabetes during pregnancy.

Three UChicago Medicine cardiologists explain how an understanding of cardiovascular risk factors can help women ask the right questions about their heart health.

Take cholesterol-lowering drugs called statins, for example. In general, patients are eligible for statin therapy if they have a 7.5 percent or higher risk of having a heart attack or stroke in the next 10 years. Women are less likely to reach that cutoff because being male is weighted so heavily in the algorithm. But studies have shown that some women with a lower risk score already have signs of atherosclerosis, or fatty deposits that build in the arteries.

“We know there is a subset of women who would benefit from statin therapy at a risk score lower than 7.5 percent,” Polonsky says.

What women can do: Know your numbers, including blood pressure, glucose level, total and HDL cholesterol, and ACC/AHA risk score.

“And have a conversation with your doctor about whether there is anything else in your history that could put you at greater risk than we’d expect based on risk factors alone,” Polonsky says.

Metabolic syndrome is one condition that raises cardiovascular risk. A patient is considered to have metabolic syndrome if she has three of the following five: blood pressure above 130/85, low HDL, high triglycerides, elevated fasting blood sugar and a waist bigger than 35 inches.

A history of pregnancy complications can also raise a woman’s cardiovascular risk later in life. A recent study shows women with a history of preeclampsia have an increased risk for early stroke. Development of high blood pressure or diabetes during pregnancy also raises a woman’s risk of high blood pressure as she ages.

What women can do: “Sometimes the hypertension doesn’t develop until years after the pregnancy, so it’s important that women who develop those complications continue to see their doctor every year to have their blood pressure checked,” Polonsky says. “It’s especially important that these women develop or maintain a healthy lifestyle after pregnancy to try to prevent cardiovascular complications from developing later in life.”

Women are more likely than men to develop heart failure with preserved ejection fraction (HFpEF), a form of heart failure that impairs the relaxation of the heart, but not its ability to contract. It is a very common reason for being breathless with mild activity, such as walking up stairs. This kind of heart failure is often a consequence of hypertension, since increased blood pressure might lead to hypertrophy of the heart muscle with increased stiffness.

“The American Heart Association’s new guidelines state clearly that blood pressure measurements above 120/80 need to be taken seriously,” Hofmann-Bowman says. Lifestyle changes such as weight loss and exercise are often recommended first for early hypertension.

What women can do: Advice for women is to get your blood pressure checked during February Heart Month, and if it is above 120/80, have a conversation with your physician. And get a new pair of sneakers.

Women are less likely than men to develop atrial fibrillation, a common form of arrhythmia, but at greater risk of a stroke when they do.

“Heart rhythm problems are very common among women, such as too fast or slow heart beats, or irregular rhythm or skipped beats," says cardiologist Cevher Ozcan, MD, who specializes in heart rhythm disorders. “Palpitations, chest pressure, fainting, nearly fainting, shortness of breath or anxiety can be signs or symptoms of rhythm problems.

“There are significant differences in men and women regarding the nature of the rhythm problems, symptoms, prognosis and the treatment strategy,” she says. “For example, atrial fibrillation causes higher risk of stroke in women.”

What women can do: Early diagnosis and treatment of heart rhythm disorders in women is particularly important, Ozcan says. Many patients with arrhythmias live normal lives with treatment, such as medication or a procedure.
Tamar Polonsky, MD

Tammy Polonsky, MD

Tamar Polonsky, MD, MSCI, is a general cardiologist. She treats a wide range of cardiac conditions, including coronary artery disease, hypertension, hyperlipidemia (high cholesterol) and valve disease.

Learn more about Dr. Polonsky

Cevher Ozcan, MD

Cevher Ozcan, MD, is a highly skilled cardiologist with an expertise in heart rhythm disorders. Dr. Ozcan has a primary focus in pharmacological and non-pharmacological treatment of arrhythmias and conduction disease.

Learn more about Dr. Ozcan