Women and Risk factors
- The risk factors for CVD (cardiovascular disease) are the same for both genders but significant changes occur after menopause. Estimates suggest that 70% of CVD deaths are attributed to modifiable risk factors.1
- Young women are normally at a very low risk of CVD, but they increase their risk if they smoke or have high blood pressure, diabetes, high cholesterol levels or a family history of CVD.2
- If women avoid CVD risk factors up to the menopause, they will have a very low lifetime risk for CVD and markedly longer survival.3
- High blood pressure, a significant risk factor for the development of CVD, is rare among young women, but increases after the menopause.4 Women with high blood pressure have 3.5 times the risk of developing CAD compared to that of women with normal blood pressure.4
- After menopause, women’s cholesterol levels are on average higher than those of men of about the same age.5 After the age of 60, women’s blood pressure is on average higher than men’s.6
- An obese woman increases her risk of dying of CVD by 45% compared with a normal weight woman.7 Being normal weight will not protect against CVD if a woman is physically inactive.8
- Abdominal obesity (waist size more than 31 inches or 80cm among South Asian women) is a stronger predictor of CVD risk than high body mass index (BMI). Another rule of thumb for obesity is having waist girth more than 50% of the height. A 1 cm increase in a woman’s waist measurement increases the risk of a CVD event by 2%.9
- Women tend to be more physically inactive than men.10 If a woman is physically inactive it increases the risk of heart disease by 60% compared to women who are physically active.11 Women who take less than an hour a week of physical activity have 60% higher risk of developing CVD compared to women who do more than three hours a week activity.8
- Decrease in physical activity raises the risk of high blood pressure; unfit women have up to a 55% greater chance of developing high blood pressure than a moderately fit woman of the same age.12
- Smoking is a major risk factor for CVD with double the risk among smoking women. The more cigarettes smoked the higher the risk.13 While more men than women smoke, female smoking is increasing rapidly in low- and middle- income countries.6
- Exposure to second hand smoke increases the risk of dying from heart disease by 15% in women compared to women not subjected to passive smoking.14
- Women who use new generation of oral contraceptives do not have an increased risk of heart attack but when combined with CVD risk factors such as high blood pressure, obesity and smoking, CVD risk increases.15, 16
- Depending on the type of contraceptive used, the risk of heart attack in a smoker can be nearly 10 times that of a non smoker although the latest formulations of oral contraceptives are not associated with risks as high as this.17
- The role of non-biological, psychologicaland behavioral risk factors such as depression, family/workstress, socioeconomic deprivation, and early life adversities are currently under intense research.18
1. Mosca L, Benjamin EJ, Berra K, et al. Effectiveness-based guidelines for the prevention of cardiovascular disease in women-2011 update a guideline from the american heart association. J Am Coll Cardiol. Mar 22 2011;57(12):1404-1423.
2. Daviglus ML, Stamler J, Pirzada A, et al. Favorable cardiovascular risk profile in young women and long-term risk of cardiovascular and all-cause mortality. Jama. Oct 6 2004;292(13):1588-1592.
3. Lloyd-Jones DM, Leip EP, Larson MG, et al. Prediction of lifetime risk for cardiovascular disease by risk factor burden at 50 years of age. Circulation. Feb 14 2006;113(6):791-798.
4. Stangl V, Baumann G, Stangl K. Coronary atherogenic risk factors in women. Eur Heart J. Nov 2002;23(22):1738-1752.
5. Bittner V. Perspectives on dyslipidemia and coronary heart disease in women. J Am Coll Cardiol. Nov 1 2005;46(9):1628-1635.
6. Pilote L, Dasgupta K, Guru V, et al. A comprehensive view of sex-specific issues related to cardiovascular disease. CMAJ. Mar 13 2007;176(6):S1-44.
7. Murphy N F, MacIntyre K, Stewart S, Hart CL, Hole D, McMurray JJ. Long-term cardiovascular consequences of obesity: 20-year follow-up of more than 15 000 middle-aged men and women (the Renfrew-Paisley study). Eur Heart J. Jan 2006;27(1):96-106.
8. Li TY, Rana JS, Manson JE, et al. Obesity as compared with physical activity in predicting risk of coronary heart disease in women. Circulation. Jan 31 2006;113(4):499-506.
9. de Koning L, Merchant AT, Pogue J, Anand SS. Waist circumference and waist-to-hip ratio as predictors of cardiovascular events: meta-regression analysis of prospective studies. Eur Heart J. Apr 2007;28(7):850-856.
10. Riddoch CJ, Bo Andersen L, Wedderkopp N, et al. Physical activity levels and patterns of 9- and 15-yr-old European children. Med Sci Sports Exerc. Jan 2004;36(1):86-92.
11. LiTY, Rana JS, Manson JE, et al. Obesity as compared with physical activity in predicting risk of coronary heart disease in women. Circulation. Jan 31 2006;113(4):499-506.
12. Barlow C E, LaMonte MJ, Fitzgerald SJ, Kampert JB, Perrin JL, Blair SN. Cardiorespiratory fitness is an independent predictor of hypertension incidence among initially normotensive healthy women. Am J Epidemiol. Jan 15 2006;163(2):142-150.
13. Kurth T, Kase CS, Berger K, Schaeffner ES, Buring JE, Gaziano JM. Smoking and the risk of hemorrhagic stroke in men. Stroke. May 2003;34(5):1151-1155.
14. Kaur S, Cohen A, Dolor R, Coffman CJ, Bastian LA. The impact of environmental tobacco smoke on women’s risk of dying from heart disease: a meta-analysis. J Womens Health (Larchmt). Oct 2004;13(8):888-897.
15. Graff-Iversen S, Hammar N, Thelle DS, Tonstad S. Use of oral contraceptives and mortality during 14 years’ follow-up of Norwegian women. Scand J Public Health. 2006;34(1):11-16.
16. Barton M, Dubey RK, Traupe T. Oral contraceptives and the risk of thrombosis and atherosclerosis. Expert Opin Investig Drugs. Mar 2002;11(3):329-332.
17. Lewis MA, Heinemann LA, Spitzer WO, MacRae KD, Bruppacher R. The use of oral contraceptives and the occurrence of acute myocardial infarction in young women. Results from the Transnational Study on Oral Contraceptives and the Health of Young Women. Contraception. Sep 1997;56(3):129-140.
18. Vaccarino V. Ischemic heart disease in women: many questions, few facts. Circ Cardiovasc Qual Outcomes. Mar 2010;3(2):111-115.