When doctors assess a patient’s risk of heart disease, they typically ask about their diet and family medical history, while also taking their blood pressure and cholesterol into consideration. This information provides some insight into women’s heart health, but it only tells part of the story, according to a recent statement from the American Heart Association (AHA), published in the journal Circulation in April 2023.
“Risk assessment is the first step in preventing heart disease, yet there are many limitations to traditional risk factors and their ability to comprehensively estimate a woman’s risk for cardiovascular disease,” Jennifer H. Mieres, M.D., a professor of cardiology at Hofstra Northwell, and co-author of the report said in the AHA statement.
The hazards surrounding women’s heart health have remained poorly understood for decades. Through the 1990s, research on risk factors and treatments for heart disease was conducted almost exclusively on white men. When women could finally take part in these studies, most were postmenopausal —leaving doctors with a limited understanding of cardiovascular health in younger women.
Another issue is the lack of reliable data for people of color. When researchers use data from large patient registries to create heart disease risk assessment formulas, they often exclude women of color. As a result, most registries are in need of more racial and ethnic health information.
Though there has been some progress in understanding women’s heart health. Scientists have recognized that the signs of an upcoming heart attack look different in women than men. Additionally, the current methods for assessing a woman’s risk of cardiovascular disease need improvement. In fact, according to the American Heart Association’s recent scientific statement, the following risk factors aren’t taken into account:
The expecting mother’s blood volume rises by 45 percent and even up to 50 to 60 percent in the late third trimester to feed the growing fetus. The drawback is that the heart is working harder than usual to pump the extra blood. Labor and delivery can also put a strain on the heart as it causes drastic changes to blood flow and pressure. Pregnancy-related conditions such as preeclampsia, gestational diabetes, preterm delivery, gestational high blood pressure, and miscarriage are also associated with heart problems.
Menstrual cycle history
Research suggests the timing of a girl’s first period can somewhat predict their risk of heart problems. Compared to women who menstruated at 13 years old, those who had their period before 10 or after 17 were 27 percent more likely to die or need hospitalization for heart disease in the future. Additionally, they were 16 percent more likely to die or need urgent medical care because of a stroke. Having irregular periods — those that fall outside the standard 22- to 34-day range — also increased the risk of heart disease and heart attack.
Use of hormonal contraceptives
Birth control containing estrogen makes it easier for blood clots to form. If there are enough blood clots, it can block blood from flowing to your heart muscle. If the clot blocks an artery in charge of circulating blood to the brain, it may cause a stroke. This risk applies to pills, patches, implants, vaginal rings, and injections.
Hormone replacement therapy
Estrogen protects the heart by maintaining blood pressure, allowing blood vessels to relax, and lowering cholesterol levels. With this reasoning, adding estrogen back to the body through hormone replacement therapy would provide cardioprotective effects. However, clinical trials studying hormone replacement therapy and heart risks suggest the opposite is true. Although the worsening effects may be due to other outside factors such as age, preexisting heart condition, type of estrogen used, and using progestin in the therapy regimen.
Chemotherapy or radiation
Chemotherapy and radiation therapy have a number of side effects that damage the heart. Certain types of cancer treatments increase high blood pressure, cause irregular heartbeats, and heart failure. The treatments can also target the heart directly. According to the University of Rochester Medical Center, some chemotherapies weaken the heart because they cause chemical reactions resulting in free radicals — unstable atoms that damage cells — along with an increase in calcium buildups in the arteries.
Polycystic ovarian syndrome
Women with polycystic ovarian syndrome (PCOS) are at a 19 percent higher risk for heart disease than women without the condition. This likely stems from the other risk factors associated with the condition, such as being overweight, having diabetes, and elevated blood pressure.
Autoimmune conditions like rheumatoid arthritis and lupus are associated with faster build-up of plaque in the arteries. Women are twice as likely as men to develop these disorders because of the second X chromosome, which contains most genes involved in regulating the immune system.
Depression and post-traumatic stress disorder
Both conditions are more common among women, and over time can lead to reduced blood flow to the heart. This is because mental stress raises your heart rate and blood pressure from constantly pumping out the stress hormone cortisol. The increased stress may also encourage calcium plaques to build up in the arteries.
Because health professionals are still learning about heart disease in women, it is important for women to recognize warning signs. Additionally, the other issue is that women — especially women of colo r—have historically been dismissed or medically gaslighted. Waiting on your doctor to point out the risk factors will take longer for women to receive the care they need.
The bottom line: Learning about these risk factors, and discussing them with your doctor, is an important way to take control of your own health.