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Stress / Menopause and Other Factors Linked To Heart Disease In Women

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Stress Linked To Heart Disease In Women

 An American Heart Association Article


Women, Heart Disease and Stroke

Heart disease isn't just a man's disease. Heart attack, stroke and other cardiovascular diseases are devastating to women, too. In fact, coronary heart disease, which causes heart attack, is the leading cause of death for American women.

Many women believe that cancer is more of a threat, but they're wrong. Nearly twice as many women in the United States die of heart disease and stroke as from all forms of cancer, including breast cancer.

The American Heart Association has identified several factors that increase the risk of heart disease and stroke. The more risk factors a woman has, the greater her risk of a heart attack or stroke.

Some of these risk factors you can't control, such as increasing age, family health history, and race and gender. But you can modify, treat or control most risk factors to lower your risk.

What are the risk factors for heart disease and stroke that you can't control?

  • Increasing age — As women grow older, their risk of heart disease and stroke begins to rise and keeps rising with age.

 

  • Sex (Gender) — Men have a greater risk of heart attack than women, and they have attacks earlier in life. Each year about 40,000 more women than men have strokes, and more than 60 percent of total stroke deaths occur in women.

 

  • Heredity (family history) — Both women and men are more likely to develop heart disease or stroke if their close blood relatives have had them. Race is also a factor. Black women have a greater risk of heart disease and stroke than white women. Compared with whites, African-American men and women are more likely to die of stroke.

 

  • Previous heart attack or stroke or TIA — Women who've had a heart attack are at higher risk of having a second heart attack. 14 percent of persons who survive a first stroke or heart attack will have another within a year. A transient ischemic attack (TIA or "mini-stroke") also is a risk factor and predictor of stroke.

What risk factors can be modified, treated or controlled by focusing on lifestyle habits and taking medicine, if needed?

  • Tobacco smoke — Smoking is the single most preventable cause of death in the United States. Smoking is a major cause of cardiovascular heart disease among women.

 

  • Women who smoke have an increased risk for ischemic stroke and subarachnoid hemorrhage. Constant exposure to others' tobacco smoke (secondhand smoke) at work or at home also increases the risk, even for nonsmokers.

 

  • Women smokers who use birth control pills have a higher risk of heart attack and stroke than nonsmokers who use them.
  • High blood cholesterol — High blood cholesterol is a major risk factor for heart disease and also increases the risk of stroke. Studies show that women's cholesterol is higher than men's from age 45 on. High levels of LDL (low-density lipoprotein) cholesterol (the "bad" cholesterol) raise the risk of heart disease and heart attack.

 

  • High levels of HDL (high-density lipoprotein) cholesterol (the "good" cholesterol) lower the risk of heart disease. Research has shown that low levels of HDL cholesterol seem to be a stronger risk factor for women than for men.
  • High blood pressure — High blood pressure is a major risk factor for heart attack and the most important risk factor for stroke. Women have an increased risk of developing high blood pressure if they are obese, have a family history of high blood pressure, are pregnant, take certain types of birth control pills or have reached menopause. African-American women have higher average blood pressure levels compared to Caucasian women.

 

  • Physical inactivity — Various studies have shown that lack of physical activity is a risk factor for heart disease and indirectly increases the risk of stroke.

 

  • Overall, they found that heart disease is almost twice as likely to develop in inactive people than in those who are more active. When you're inactive and eat too much, you can gain excess weight. In many people overweight can lead to high blood cholesterol levels, high blood pressure, diabetes and increased risk of heart disease and stroke. The American Heart Association recommends accumulating at least 30 minutes of physical activity on most or all days of the week.

 

  • Obesity and overweight — If you have too much fat — especially if a lot of it is located in your waist area — you're at higher risk for health problems, including high blood pressure, high blood cholesterol, high triglycerides, diabetes, heart disease and stroke.

 

  • Diabetes mellitus — Compared to women without diabetes, women with diabetes have from two to six times the risk of heart disease and heart attack and are at much greater risk of having a stroke. People with diabetes often have high blood pressure and high cholesterol and are overweight, increasing their risk even more. 

What other factors contribute to the risk of heart disease and stroke in women?

  • High triglyceride levels — Triglyceride is the most common type of fat in the body. A high triglyceride level often goes with higher levels of total cholesterol and LDL, lower levels of HDL and increased risk of diabetes. But scientists don't agree that it's a risk factor for heart disease by itself. Research suggests that having high triglycerides may increase the risk for women more than for men.

 

  • Excessive alcohol intake — The risk of heart disease in people who drink moderate amounts of alcohol (an average of one drink for women per day) is lower than in nondrinkers. However, it's not recommended that nondrinkers start using alcohol or increase the amount they drink.

 

  • Excessive drinking and binge drinking can contribute to obesity, high triglycerides, cancer and other diseases, raise blood pressure, cause heart failure and lead to stroke. Pregnant women should not drink alcohol in any form.

 

  • Individual response to stress — Research hasn't yet defined the role stress plays in the development of heart disease. People respond differently to situations they find stressful. Unhealthy responses to stress may lead to other risk behaviors like smoking and overeating.

Related AHA publications:

  • Heart and Stroke Facts
  • Fact Sheet on Heart Attack, Stroke and Risk Factors
  • High Blood Pressure Fact Sheet
  • We're Talking About Women and Heart Attack (Quick and Easy Reading) (also in Spanish)
  • Women, Heart Disease and Stroke
  • We're Talking About Women and Stroke (Quick and Easy Reading) (also in Spanish)
  • Heart Disease and Stroke Statistics Update


Menopause and the risk of heart disease and stroke

Compared to men, many women before the age of menopause seem to be partly protected from coronary heart disease, heart attack and stroke. As women age, their risk of heart disease and stroke rises. Coronary heart disease rates in women after menopause are 2–3 times higher than in women of the same age before menopause.  

AHA Recommendation 

The reasons for the lower incidence of coronary heart disease and stroke in younger women aren't clear. The loss of natural estrogen as women age may contribute to the higher risk of heart disease after menopause. However, in light of recent results from clinical trials, the American Heart Association does not advise women to take postmenopausal hormone therapy (PHT, formerly called hormone replacement therapy or HRT) to reduce the risk of coronary heart disease or stroke.

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Japanese Health Study

The Issue:

An extensive Japanese study and research proves that women under high levels of day-to-day stress are more likely to die of heart disease than women who lead a more relaxed lifestyle, even if they do not have any other risk factors.

Participants:

Researchers at the University of Tsukuba analyzed the medical records of more than 73,000 people between the ages of 40 and 79 who did not have previous signs of heart disease.

At the start of the study, the researchers asked the participants to rate the level of stress in their lives.

Results:

(The findings appear in the Aug. 13 issue of Circulation: Journal of the American Heart Association.)

The researchers found that Japanese women who reported high levels of stress at the beginning of the study were more than twice as likely to suffer a stroke and more than 1.5 times more likely to die of a heart attack. 

The women with more stress were mostly young women who were educated, less active, thin, and more likely to have a history of high blood pressure and diabetes.  They also smoked more often and were more likely to have a full-time job compared with more relaxed women, according to Dr. Hiroyaso Iso, from the University of Tsukuba, and colleagues.

Analysis:

Stress can raise blood pressure and heart rate, increase the risk of developing blood clots, cause blood vessels to constrict, and make a person more susceptible to chronic disease.  Because of this, women with high stress should be regarded as high-risk for stroke, and they should look for ways to relax and minimize their stress.

 

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