Understanding risk for heart attack and stroke in women

Each year, more than 800,000 people in the United States have a heart attack. About 12 percent of them are fatal. Stroke is also a major cause of disability, as well as a top cause of death among women and men.

Despite the frequency of heart attack and stroke, some misconceptions about them endure, particularly the notion that they primarily happen among men. In fact, women are more likely than men to die as a result of a stroke, while heart disease is the top killer of women in the U.S.

The difference between a heart attack and a stroke

In most instances, a heart attack is caused when blood flow to the heart is blocked. A stroke occurs when blood flow to the brain is blocked. Strokes can also occur if a blood vessel bleeds into the brain.

What increases risk for heart disease in women?

Traditional heart-disease risk factors—including high cholesterol, high blood pressure, and obesity—are not specific to either sex. But the certain heart disease risk factors may be more prevalent for women. These include the following.

• Metabolic syndrome, a condition characterized by fat that accumulates around the abdomen, high blood pressure, high blood sugar, low levels of HDL (aka “good” cholesterol), and high triglycerides
• High blood pressure alone (aside from its role in metabolic syndrome)
• Low levels of estrogen after menopause
• A history of pre-eclampsia, or high blood pressure during pregnancy
• Polyendocrine metabolic ovarian syndrome, a hormone disorder that affects how ovaries work
• Autoimmune diseases such as rheumatoid arthritis and lupus
• A history of radiation therapy or some chemotherapies
• Mental health conditions such as anxiety and depression

Heart disease risk can also be influenced by factors that are not related to medical issues, called social determinants of health. They include things like where a person is born, experiences with racism, education access, and exposure to pollution.

Smoking and having a family history of heart disease are also major factors in increasing the risk for cardiovascular issues.

Lifestyle changes can reduce your risk

One thing women can do to prevent heart disease is reduce stress in their lives, says Marianne J. Legato, MD, the founder and director of The Foundation for Gender-Specific Medicine at Columbia University in New York City.

"Deal with your life head-on,” Dr. Legato advises. "If you have a nagging problem you can't solve, it's very important to talk to somebody. Not everything needs a shrink. Talking to a true friend may be the best therapy there is."

How can you tell if stress is becoming a factor? "Look at what you are doing in excess," Legato advises. "Are you overeating or not eating? Shopping? Drinking? Gambling? Any of these are indicators."

She also advises taking care of yourself and knowing your risk factors. She adds, "Trust yourself and take action when needed."

Legato notes that exercise is essential to reducing stress, even if it's just walking. "Walk everywhere, as fast as you can," she says.

You can also increase physical activity in other little ways each day. These could include:

• Using the stairs instead of the elevator
• Walking or riding a bicycle to do errands
• Parking your car a good distance from the entrance of buildings to get some extra steps
• Doing some squats or push-ups while watching TV

Other lifestyle changes you can make to reduce your risk of heart disease include not smoking, maintaining a healthy weight, and eating a heart-healthy diet. Legato suggests keeping a detailed food diary for two weeks. If you would like more guidance, a dietitian or nutritionist can help you find ways to work more of the following foods into your diet:

• Fruits and vegetables
• Whole grains
• Fat-free or low-fat dairy products
• Lean protein, poultry, fish, beans, eggs, and nuts
• Healthy fats
• Foods that are low in saturated fats, trans fats, salt, sodium, and added sugars

Steps to take with a healthcare provider

If you have a medical condition that is a risk factor for heart disease, such as high blood pressure, high cholesterol, or diabetes, follow the advice of your healthcare provider (HCP), including taking your medicines as prescribed.

Keep a close eye on your blood pressure and blood sugar. While it can take some trial and error to get them under control, monitoring your numbers and working with your HCP can help get you on track. Some people at high risk of heart disease might also benefit from supplements, such as omega-3 fatty acids. Check with your HCP before you start any supplements to see if they are right for you.

Until recently, many women were once advised to take a daily aspirin as a preventive measure. But new guidelines from the American Heart Association no longer recommend routinely taking aspirin, based on research suggesting it doesn’t prevent heart attacks in women and can lead to significant bleeding. Because aspirin may still be appropriate for certain groups, ask your HCP about it and other preventive measures to take to help you reduce your risk of heart disease.