All women face the threat of heart disease. But becoming aware of symptoms and risks unique to women, as well as eating a heart-healthy diet and exercising, can help protect you.

By Mayo Clinic Staff

Although heart disease is often thought of as a problem for men, more women than men die of heart disease each year. One challenge is that some heart disease symptoms in women may be different from those in men. Fortunately, women can take steps to understand their unique symptoms of heart disease and to begin to reduce their risk of heart disease.

The most common heart attack symptom in women is some type of pain, pressure or discomfort in the chest. But it's not always severe or even the most prominent symptom, particularly in women. And, sometimes, women may have a heart attack without chest pains. 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
  • Right arm pain
  • 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 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 typically 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 the 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:

  • Diabetes increases the risk of heart disease significantly more in women than in men.
  • Metabolic syndrome — a combination of fat around your abdomen, high blood pressure, high blood sugar and high triglycerides — has a greater impact on women than on men.
  • Mental stress and depression affect women's hearts 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 is a greater risk factor for heart disease in women than in men.
  • A lack of physical activity is a major risk factor for heart disease, and as a group, women tend to be less active than men.
  • Low levels of estrogen after menopause pose a significant risk factor for developing cardiovascular disease in the smaller blood vessels (microvascular disease).
  • Pregnancy complications such as high blood pressure or diabetes during pregnancy can increase a woman's long-term risk of high blood pressure and diabetes and increase the risk of development of heart disease in both the mother and in her children.

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

There are several lifestyle changes you can make to reduce your risk of heart disease:

  • Quit or don't start smoking.
  • Exercise 30 to 60 minutes a day on most days of the week, or 60 to 90 minutes if you need to lose weight.
  • Maintain a healthy weight.
  • Eat a diet that's low in saturated fat, cholesterol and salt.

You'll also need to take prescribed medications appropriately, such as blood pressure medications, blood thinners and aspirin. And you'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, you should do moderate exercise, such as walking at a brisk pace, for 30 to 60 minutes most days of the week. If you can't get all of your exercise completed in one session, it's fine to break up your physical activity into several 10- to 15-minute sessions. You'll still get the same heart-health benefits. Some research has even shown that short bursts of very intensive exercise, such as a short run in the middle of a walk, may be an effective way to boost your metabolism. This may help you keep your weight down, which in turn, helps keep your heart healthy.

There are other small changes you can make to increase your physical activity throughout the day. You can take the stairs instead of the elevator, walk or ride your bicycle to do errands, or try some 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. This calculation 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 overweight if their waist measurement is greater than 35 inches (89 cm).

Losing even small amounts 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. 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, if a woman's heart symptoms are mainly caused by microvascular disease, angioplasty and stenting may not be the most effective treatment choice.

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.

The AHA guidelines do recommend that women of any age consider taking between 75 and 325 milligrams of aspirin daily if they have diabetes or if they already have heart disease. The AHA also recommends that women over 65 years can benefit from a daily 81-milligram aspirin 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.

Feb. 13, 2014