Heart attacks, angina and coronary artery disease are among the many forms of cardiovascular disease – the leading cause of death among American women. The media currently stresses the dangers of breast cancer, but cardiovascular disease claims more than 10 times as many female lives as breast cancer does. To protect themselves, women are urged to learn the facts about heart disease in women, including:

• Alcohol. Some studies have shown that both women and men have better heart health when they drink moderately rather than heavily or not at all. Women’s moderate alcohol use is defined as only one drink per day. Any more alcohol in a woman can be harmful to the heart, stomach and liver, and a few studies have shown that more than two drinks a day may be linked with high blood pressure in women.
  
  
• Aspirin. Taking one low-dose aspirin of 81 milligrams appears to lower women’s risk of having a second stroke, second mini-stroke (TIA) or second heart attack. Some evidence suggests that daily aspirin may even prevent a first stroke, TIA or heart attack. However, women should talk with their physician before taking aspirin because it is not appropriate for everyone. Women are generally advised against taking aspirin if they are pregnant, trying to become pregnant or have certain medical conditions.
  
  
• Birth control pills. Not only are birth control pills designed to prevent unwanted pregnancies, but they have also been associated with significant benefits (e.g., reduced risk of colorectal cancer or ovarian cysts). Unfortunately, they have also been associated with a slightly increased risk of blood clot formation and may be inappropriate for women with a family history of stroke or other conditions. Additionally, women who smoke should avoid birth control pills.
  
  
• Cholesterol. According to the American Heart Association (AHA), over 51 percent of American women had cholesterol levels that were over 200 mg/dL in 2003. Another 18.4 percent of American women had high cholesterol (over 240) as of 2003. Men and women are at greater risk of both heart disease and stroke when cholesterol levels are elevated, but women appear to be more sensitive to low HDL levels than men. Similarly, triglycerides appear to be a better indicator of risk among elderly women than men or younger women. Both men and women at high risk of a heart attack should be treated the same for high cholesterol, especially with cholesterol-reducing medications such as statins. However, studies have shown that women are less likely to be prescribed statins than men.
  
  
• Diabetes. While diabetes is dangerous for everyone’s cardiac health, studies have shown that women die from diabetes-related heart disease at a much greater rate than men. Women are encouraged to work closely with their healthcare provider to develop and follow an appropriate treatment plan.
  
  
• Dieting. Women are strongly urged to choose a heart-healthy diet over unhealthy dieting strategies such as “yo-yo dieting” (alternately losing and gaining weight). Yo-yo dieting has been shown to actually increase weight over time. A heart-healthy diet means low fat, low cholesterol, low carbohydrates and small portion sizes. Aim for 1,200 calories or less daily, and remember that no more than 30 percent of daily calories should be from fat, according to the AHA. Overall, the AHA recommends that women strive for a body mass index (BMI) between 18.5 and 24.9 and a waist circumference of less than 35 inches. As with men, abdominal obesity is a particularly powerful risk factor for heart disease.
  
  
• Exercise. Research has found that women who exercise regularly have a higher chance of living longer and in better health. Women who have been physically active throughout life develop fewer physical disabilities as they age than inactive women. Women who exercise tend to have less heart disease and breast cancer. Aim for 10,000 steps (five miles) a day; buy a pedometer to count your steps.
  
  
• Heart attack. Immediately after menopause, heart attack risk among women begins to rise until it equals men's risk. Women are more likely to die after a heart attack, more likely to become disabled, more likely to have another heart attack and more likely to develop heart failure. Women are also more likely than men to have atypical, non-chest-related symptoms of heart attack. The only way to know if chest-related symptoms are due to a heart attack is to go to the emergency room and get an electrocardiogram and a blood test called cardiac troponin or creatine phosphokinase (CPK-MB). Do not leave the emergency room without them. According to the NHLBI, the typical heart attack victim now is an elderly woman of color.
  
  

• High blood pressure. Although high blood pressure is somewhat less predictive of heart disease in women than in men, it remains an important and controllable risk factor. Studies have shown that up to 80 percent of women over age 70 have elevated blood pressure. High blood pressure among women should be treated similarly to high blood pressure in men.

• Medical treatment. Some research has suggested that, for the same diseases, women often receive different medical treatment than men. For example, women are less likely to be referred for life-saving treatments and cardiac rehabilitation after a heart attack than men are. Immediately upon the diagnosis of a heart attack, all patients should be considered candidates for appropriate therapy, such as clot-busting drugs, balloon angioplasty with stent implantation, aspirin, beta blockers, ACE inhibitors and cholesterol-reducing drugs (e.g., statins).
  
  
• Menopause. Women’s risk of heart disease and stroke increases significantly after menopause until it becomes equal to that of men. Originally, researchers assumed this was because of the protective effects of estrogen, and physicians regularly prescribed hormone replacement therapy for the prevention of heart disease in post-menopausal women. However, results from the Women’s Health Initiative and similar studies have shown that hormone replacement therapy does not reduce – and appears to increase – the risk of blood clots and stroke. Although hormone replacement therapy is still prescribed for relief of the symptoms of menopause, it is no longer prescribed for the primary prevention of heart disease. The exact association between menopause and heart disease is still being studied. Women should discuss with their physician alternate ways (e.g., heart healthy diet, vitamins and minerals) to reduce their cardiac risks.
  
  
• Smoking. Female smokers are at significantly greater risk of having a heart attack and stroke than women who do not smoke. Furthermore, female smokers face very high risks of developing respiratory diseases that have no cure (e.g., chronic obstructive pulmonary disease), lung cancer and other smoking related diseases. In fact, lung cancer claims more female lives than breast cancer does.
  
  
• Stroke. Stroke affects over 3 million women every year in the United States – accounting for more deaths among women than men. In 2003, women accounted for more than 60 percent of stroke deaths. Strokes also tend to affect women at a much younger age than men, often striking women in their 40s or 50s. Among elderly women, it is a leading cause of both mental and physical disability.