What women can do to reduce their risk from heart disease

Heart disease is the leading cause of death for women - for about 1 in 5 women - in the United States, according to the US Centers for Disease Control and Prevention. More than 60 million American women are living with some form of heart disease, yet just over half (56%) are aware that heart disease is the No. 1 killer of women.

What are the types of heart disease that women should be aware of? Does heart disease affect women differently than it affects men? What are symptoms that may signify cardiac problems? And what should women do in order to improve their cardiac health?

To guide us through these questions, I spoke with CNN wellness expert Dr. Leana Wen. Wen is an emergency physician and adjunct associate professor at George Washington University. She previously served as Baltimore's health commissioner.

What are the types of heart disease that women should be aware of?

Dr. Leana Wen: Heart disease is an umbrella term that encompasses several cardiovascular conditions.

Coronary artery disease is the most common kind of heart disease. This occurs when the arteries in the heart are narrowed or become blocked by plaques made of cholesterol deposits. Coronary artery disease and vascular disease, or disease in blood vessels, are the leading cause of heart attacks and strokes. Risk factors for coronary artery disease include medical problems such as hypertension, high cholesterol and diabetes; obesity; and smoking.

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Another type of heart disease is heart rhythm abnormalities. Atrial fibrillation, for instance, occurs when the heart beats irregularly. This can lead to blood clots and complications like stroke and heart failure.

Heart failure itself is another form of heart disease. This occurs when the heart is damaged or weakened in some way. Causes of heart failure include heart attacks; chronic conditions such as high blood pressure and excessive alcohol use; and some viral or bacterial infections.

There are also abnormalities with the structure of the heart itself, for example, if there are defects with the valves in the heart or a hole in the wall of the heart. Some of these are congenital, meaning they are there at birth; or they could develop over time due to infection, disease or other factors.

Does heart disease affect women differently than it affects men?

Wen: In some ways, yes. This begins at birth, because the size and structure of the heart is different in men and women, with women generally having smaller hearts and blood vessels compared with men. Studies have shown that women have a higher likelihood of developing heart disease in the smaller arteries of their heart. This is harder to diagnose compared with problems with the larger arteries and contributes in part to the higher rates of missed diagnoses in women.

Furthermore, there are hormonal changes, such as changes in estrogen levels, that occur in women during their lifetime that may also affect their risk of coronary artery disease. And women are more likely than men to have certain conditions that increase their risk of heart conditions, including anemia and endometriosis.

Are there cardiac problems that occur specifically during pregnancy?

Wen: There are medical conditions that can manifest during pregnancy that could influence heart health both while the patient is pregnant and later in life. These include common conditions such as gestational diabetes and high blood pressure, and less common but very serious problems such as enlarged heart resulting in heart failure.

There may also be preexisting heart conditions that don't manifest until the body is stressed during pregnancy and labor and delivery. For instance, someone may have had long-standing blood pressure but not known it until pregnancy. Women of child-bearing age need to be aware of these conditions and pay attention to heart health before, during and after delivery.

What are symptoms that mean women should seek prompt urgent medical attention?

Wen: The classic symptoms of heart attack are chest pain, pain in the jaw and neck extending to left arm, shortness of breath, feeling lightheaded and nausea. These symptoms may not all be there, or there may be variations. For instance, someone may not say they have chest pain, but they could be having a heavy sensation or dull ache in their chest. They could have pain in their upper abdomen, back or shoulders.

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Women are more likely than men to have vague, non-classic symptoms, including fatigue, nausea, and upper abdomen discomfort. Multiple studies have reported that women are misdiagnosed more than men; their symptoms of heart attack end up being attributed to heartburn or even psychiatric manifestations. In one study, nearly half of women didn't have the classic signs of heart attack.

What about other heart problems that aren't heart attacks? What might be some warning signs?

Wen: Someone with heart rhythm abnormalities might experience palpitations and feel like their heart is suddenly beating quickly and irregularly. They might experience lightheadedness and feeling faint. People with congestive heart failure could have gradual worsening of their ability to exercise and start feeling winded after a short walk. They might notice swelling in their legs and require more pillows to be comfortable sleeping at night.

These can all be somewhat subtle symptoms. My key takeaway here is listen to your body and don't to wait to seek care. If you don't feel right, make sure to advocate for yourself. Discuss how the symptoms you are feeling aren't usual for you. Put it in the context of your life to make the point clearer for your clinician. For instance, if you used to speed-walk for 30 minutes every day but now can't make it down the block without getting winded, that's all important information to convey.

What should women do to improve their cardiac health?

Wen: The most important thing is to be aware of and manage existing medical conditions that increase your risk of heart disease. High blood pressure is one such risk factor. More than 56 million American women have high blood pressure. That's 44% of adult women in the United States. While the incidence of high blood pressure increases with age, many younger women have this condition, too; according to the US Centers for Disease Control and Prevention, nearly 1 in 5 women of reproductive age have high blood pressure.

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Fewer than 1 in 4 women with high blood pressure have this condition under control, according to the CDC. Keeping on top of your blood pressure and optimizing it with lifestyle changes and medications, if needed, is key to reducing the risk of heart attack, stroke, and other cardiovascular complications.

The same goes for women with diabetes and high cholesterol. Obesity is also a major risk factor, as is smoking, excessive alcohol intake, unhealthy diet and lack of exercise. Women should also not discount the role of stress, sleep, and mental well-being, which can also influence heart health.

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