Heart Disease and Stroke

Steps to Healthier Women:  Heart Disease and Stroke  Women aged 40 to 60 years should begin right away to lower their risk of heart disease. That's the time when a woman's risk starts to rise. Younger and older women also need to act now. Heart disease can begin early, even in the teen years. It's never too late to improve heart health—even for those who have already had a heart attack. Some key steps women can take to reduce their risk factors for heart disease and stroke: Be physically active. Quit smoking. Reduce stress. Maintain a healthy weight. Control blood pressure and cholesterol levels.

Healthy People 2010 Objectives Heart Disease and Stroke Of the 16 heart disease and stroke objectives, the following have been targeted for women: 12-1.  Coronary heart disease deaths 12-6.  Heart failure hospitalizations 12-7.  Stroke deaths 12-9.  High blood pressure 12-10.  High blood pressure control 12-12.  Blood pressure monitoring 12-13.  Mean total blood cholesterol levels 12-14.  High blood cholesterol levels 12-15.  Blood cholesterol screening *Link to the complete Healthy People 2010 chapter.

	Asian/Pacific Islander women have a lower rate of heart disease than women of other minority groups, but heart disease is the second leading cause of death within that group.
	High blood pressure and smoking rates are more severe among African American women than all other groups of women.
	A significant number of Hispanic women also are affected by the problems of smoking and obesity.

What Women Should Know: The Warning Signs of a Heart Attack Women's most common heart attack symptom is chest pain or discomfort.  BUT, women are somewhat more likely than men to have other warning signs, particularly shortness of breath, nausea, vomiting, and back pain or jaw pain. Listen to your body. Don't ignore your symptoms. Don’t wait. Call 911.

Stroke

An obstruction, rupture, or other disorder in the blood vessels leading to the brain restricts the supply of oxygen to the brain. Insufficient oxygen to the brain usually results in a stroke. Cerebrovascular diseases can result in weakness, paralysis of some parts of the body, difficulties with speech, loss of consciousness, or death.

Major risk factors for stroke are similar to those for heart disease, including smoking, high blood pressure, and high blood cholesterol.

Stroke and other cerebrovascular diseases (which refer to the blood supply to the brain) are leading cause of death for minority women in the United States:²

	As shown in the chart Stroke Deaths for Women, African American women have the highest death rate from stroke of all women, at 79.1 deaths per 100,000 (in contrast to 59.7 for Caucasian women).
	While 40.4 per 100,000 American Indian/Alaska Native women are reported to die from stroke, the proportion increases to 25.1 when adjusted to compensate for the miscoding of Indian race on death certificates.
	Asian American/Pacific Islander women have a death rate from stroke of 49.2.
	Hispanic women have the lowest death rate from stroke (37.6) of all women.

 

 

Making the Connection:  Heart Disease and Stroke and Steps to a Healthier US All three lifestyle choices promoted through the Steps to a HealthierUS are critical to reducing illness, disability, and death from heart disease and stroke: Nutrition Physical activity Tobacco use

High Blood Pressure

High blood pressure, also called hypertension, is a serious health condition that can lead to stroke, heart disease, kidney failure, and other health problems. As blood flows from the heart out to the blood vessels, it creates pressure against the blood vessel walls. A person’s blood pressure reading is a measure of this pressure. When that reading goes above a certain point, it is called high blood pressure. People are classified as hypertensive if:  

	Their average systolic blood pressure is greater than 140 mm mercury.
	Their average diastolic blood pressure is greater than 90 mm mercury.
	Or they report taking medicine for high blood pressure.

Doctors believe many factors may cause high blood pressure, such as being overweight, drinking too much alcohol, and eating too much salt. Sometimes high blood pressure may be caused by other illnesses. Once the illness goes away, the person’s high blood pressure should go down. 

Black (non-Hispanic) or African American and Alaska Native women 20 years of age and older have higher blood pressure levels (36.4 and 36.0, respectively) than white non-Hispanic women (19.7 percent).³ African American women also are more likely to have serious problems as a result of their high blood pressure than white women are. These serious problems include stroke, heart disease, and kidney failure.

Among all women, American Indian/Alaska Native women are the least likely to have had a blood pressure screening.  A staggering 73 percent of American Indian/Alaska Native women had not had a blood pressure screening in the past 12 months.  Of Hispanic and Asian American women, 26 percent and 27 percent, respectively, had not had a blood pressure screening in the past 12 months. In contrast, 20 percent of white women and 18 percent of African American women reported that they had not had a blood pressure screening.⁴ 

In terms of whether they have been told by a doctor, nurse, or other health professional that they have high blood pressure, Hispanic women experience significantly different regional hypertension rates. For example, as shown on the map Hispanic Women With Hypertension, the proportion of Hispanic women in Virginia is a low of 12.5 percent, compared to a high of 42.9 in Maine.

The best treatments for high blood pressure are living a healthy life and taking medication as directed by a woman’s doctor. A woman can live a healthy life and control her blood pressure by:

	Eating a low-salt diet (talk with your doctor or dietitian for help on what foods to buy and eat).
	Eating less fat and cholesterol.
	Limiting the amount of alcohol consumed.
	Getting lots of exercise (a woman should check with her doctor to find out what kinds of exercise are best for her).
	Losing weight if her doctor says that it will help to lower her blood pressure.
	Taking her blood pressure medication(s).
	Taking only medications suggested by her doctor.
	Finding out from her doctor what is a healthy blood pressure level for her. Then, if possible, buying a blood pressure cuff and measuring her blood pressure at home. The doctor or nurse can demonstrate how to use the cuff. The woman should keep a record of these measurements and take it each time she visits her doctor.

The Sixth Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure was developed using evidence-based medicine and consensus to make recommendations to clinicians. It provided a contemporary approach to hypertension prevention and control and included a discussion of drug therapies and a guide to help clinicians individualize treatment by stratifying patients’ risks. The report included a section on racial and ethnic minorities.⁴

After that report was released in 1997, many large-scale clinical trials were published.  Work thus began on a seventh report that would include a practical guide and a more comprehensive report.  The express volume now is available for primary care physicians, and the other volume is in progress.  Of particular importance to women concerned about heart health is the new guideline for hypertension prevention and management.  The classification “prehypertension” recognizes the relationship of blood pressure and heart disease and stroke.  Women have even more reasons to make healthy choices for their hearts.

High Blood Cholesterol

Cholesterol is a fatty substance made by the liver and found in all parts of the body. The body uses cholesterol to produce hormones, vitamin D, and the bile acids that help to digest fat. It takes only a small amount of cholesterol in the blood to meet these needs; the liver makes all the cholesterol a person’s body needs.

High blood cholesterol means that there is too much cholesterol (a fat-like substance) in a person’s blood. The risk for getting heart disease or having a heart attack goes up when the cholesterol level is too high.
 

If a person has high blood cholesterol, fatty deposits called plaque can build up on the walls of the arteries and cause atherosclerosis. If the arteries that carry blood to the heart (the coronary arteries) are affected, less blood and oxygen can get to the heart. This condition can cause chest pain (angina) and heart attacks.  

Heart disease is the number one cause of death for both women and men in the United States. High blood cholesterol levels raise a person’s chances of getting heart disease. Blood cholesterol levels in both men and women begin to go up around age 20. Before menopause, women have lower cholesterol levels than men of the same age. After menopause, a woman’s cholesterol level can go up.

High blood cholesterol was found in roughly equal proportions of the subpopulations of women of color between the ages of 20 and 74 years in 1988-1994.  About a fifth of white non-Hispanic (21 percent) and black non-Hispanic (20 percent) women reported having high blood cholesterol as did 19 percent of Mexican American females.⁵

As with other heart disease risk factors, regional differences are noted. For example, as shown on the map Black, Non-Hispanic Women Who Have Been Told They Have High Cholesterol, the proportion of black, non-Hispanic women who have been told they have high cholesterol ranges from a high of 42.5 in Nevada to 13.8 percent in Kansas. 

The Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults provides updated evidence-based clinical guidelines for cholesterol testing and management.  Recommendations are included for women and racial/ethnic groups.⁶

Select Federal Resources on Heart Disease and Stroke Office on Women’s Health Centers for Disease Control and Prevention Wise Woman: Facts and Tools Every Woman Can Use National Heart, Lung, and Blood Institute The Heart Truth Healthy Heart Handbook for Women