Top Heart Health Questions Answered

Cardiovascular disease is the number one killer of adults in the United States. However, there is still confusion about heart disease – Who is at risk? How can it be prevented? What are the signs and symptoms?  This article has those answers and more.      

What are the primary risk factors for cardiopulmonary disease?

Cardiopulmonary disease is the medical term describing a range of disorders that affect the heart and lungs The major risk factors for cardiovascular disease include:

• Diabetes
• Hypertension
• Hypercholesterolemia
• Family history
• Smoking

Smoking is also a significant risk factor for the development of emphysema and lung cancer.

How does cardio disease affect women vs. men?

Cardiovascular disease is the leading cause of death among men and women; however, women tend to receive less aggressive diagnostic testing and treatment and have a higher mortality rate after a heart attack than men. Also, women are more susceptible to the effects of smoking than men.

Cardiovascular disease affects men at an earlier age than women since the pre-menopausal years are thought to protect against heart disease. After menopause, the diagnosis of heart disease increases in women.

Are there symptoms that are gender-specific?

The symptoms of emphysema or chronic obstructive lung disease vary slightly between men and women. 

1. Men tend to be diagnosed with emphysema at an earlier stage than women are, in part because of physician bias. Women are diagnosed when their symptoms become prominent.
2. Men complain more of a productive cough while women complain of breathing difficulties.
3. For cardiac disease, symptoms of heart attacks are not as well recognized in women as in men.
4. Women are more likely to have symptoms other than chest pain, such as:
   •    Shortness of breath
   •    Weakness
   •    Fatigue
   •    Nausea
   •    Neck, jaw, or back pain

Does the disease affect demographic groups differently?

1. Race: The rate of heart disease is higher in African American, Mexican American, and Native American women.
2. Age: Chronic lung disease such as emphysema affects mostly smokers in their 50s.
3. Predispositions: Patients with a rare congenital predisposition to the development of emphysema develop disease at an earlier age.

Has the survival rate improved over the years? 

Statistics have shown the number of deaths from heart disease slowly declining between the 1960s and mid ‘90s for both women and men. This decline is smaller in magnitude among African American women and men. 

However, with the growing problem of obesity, these trends may differ from the mid 1990s to now. Despite the improvement in survival rates, heart disease remains the leading cause of death for American men and women. Therefore, it is important to maintain a healthy lifestyle and to reduce risk factors.

What can I do to prevent issues?

Eliminating risk factors is key. 

1. Primary Care:  Having a primary care physician is an important first step.  Women & Infants Hospital now has a primary care practice with expertise in risk modification for cardiovascular disease in women.
2. Identifying Health Issues: Detecting diabetes, hypertension, and hypercholesterolemia and controlling those diseases with lifestyle modifications and medications (as needed) are important steps in the management of any adult.
3. Quit Smoking: Smoking cessation is also crucial for the prevention of both coronary disease and lung disease such as emphysema. Experts recommend smokers be screened for chronic lung disease because the discovery of such disease is good incentive for those patients to quit.
4. Exercise: Aerobic exercises, like walking, swimming, or cycling, also help reduce cardiac risk factors.

Is a daily aspirin still a good way to prevent heart attacks?

The short answer is maybe.  A 2005 study of more than 39,000 looked at the impact of aspirin among different age groups of women:

• 45+: The study found taking a daily aspirin decreases the risk of stroke among women over age 45 (Ridker et al., NEJM, 2005).
• 65+: Among women over 65, taking an aspirin daily also reduced the incidence of heart attack. A daily aspirin.
• 45-65: However, a daily aspirin did not reduce heart attacks in relatively healthy women between the ages of 45 and 65.

Diabetic women should take a daily aspirin to prevent heart attacks in conjunction with other risk modifying steps. 

Will Estrogen Replacement Therapy help reduce the risk for heart disease?

No.  The use of hormone replacement therapy can actually increase the risk of heart disease. 

According to the Women's Health Initiative - a study of more than 19,000 women the risks of oral hormone replacement therapy (HRT) outweighed its benefits -  causing more heart disease and stroke among women using combination (estrogen and progesterone) HRT. 

For women who have undergone a hysterectomy, using oral estrogen replacement therapy was associated with a higher risk of stroke but not heart disease.

Is taking birth control a risk factor?  

Maybe.  This depends on the type of birth control used. Contraceptive methods containing both estrogen and progesterone (most oral contraceptive pills, the skin patch, and the vaginal ring) have been associated with higher rates of heart disease. 

However, because the risk of heart disease among women of reproductive age is relatively low, combination hormonal contraception will only cause a small increase in the number of cases of heart disease. Therefore, these forms of contraception can be used safely in healthy women. 

Women who already have risk factors for heart disease (smoking, diabetes, high blood pressure, high cholesterol, family history of heart attack), however, should ask their primary care doctor which method of birth control is safest for them.

What are signs something is wrong?

1. Chest pain with exertion that resolves with rest is the first sign of coronary disease in many cases.
2. Breathing difficulties with exertion may be an indicator of heart or lung disease.
3. A productive cough is a sign of emphysema or chronic bronchitis but is not specific. 

Development of any of the above symptoms should prompt you to seek help from your primary care physician.

Disclaimer: The content in this blog is for informational and educational purposes only and should not serve as medical advice, consultation, or diagnosis.  If you have a medical concern, please consult your healthcare provider, or seek immediate medical treatment.