Cardiovascular disease

Cardiovascular disease (CVD) includes all the diseases of the heart and
circulation including coronary heart disease, angina, heart attack, congenital
heart disease and stroke.
It's also known as heart and circulatory disease.
Other types of cardiovascular disease include heart valve disease and cardiomyopathy.

How are cardiovascular diseases linked?

Coronary heart disease (angina and heart attack) and stroke may be caused by the
same problem – atherosclerosis. This is when your arteries become narrowed by a
gradual build-up of fatty material (called atheroma) within their walls.

In time, your arteries may become so narrow that they cannot deliver enough oxygen-
rich blood to your heart. This can cause angina – a pain or discomfort in your chest.

If a piece of the atheroma in your arteries breaks away it may cause a blood clot to
form. If the blood clot blocks your coronary artery and cuts off the supply of oxygen-rich
blood to your heart muscle, your heart muscle may become permanently damaged.This
is known as a heart attack.

When a blood clot blocks an artery that carries blood to your brain, it can cut off the
blood supply to part of your brain. This is called a stroke.
What Is Coronary Heart Disease?
Coronary heart disease (CHD) is a disease in which a waxy substance called plaque builds up inside
the coronary arteries. These arteries supply oxygen-rich blood to your heart muscle.

When plaque builds up in the arteries, the condition is called atherosclerosis. The buildup of plaque
occurs over many years.

Atherosclerosis

Figure A shows the location of the heart in the body. Figure B shows a normal coronary artery with normal blood flow. The
inset image shows a cross-section of a normal coronary artery. Figure C shows a coronary artery narrowed by plaque. The
buildup of plaque limits the flow of oxygen-rich blood through the artery. The inset image shows a cross-section of the
plaque-narrowed artery.

Over time, plaque can harden or rupture (break open). Hardened plaque narrows the coronary arteries
and reduces the flow of oxygen-rich blood to the heart.

If the plaque ruptures, a blood clot can form on its surface. A large blood clot can mostly or
completely block blood flow through a coronary artery. Over time, ruptured plaque also hardens and
narrows the coronary arteries.

Overview

If the flow of oxygen-rich blood to your heart muscle is reduced or blocked, angina or a heart
attack can occur.
Angina is chest pain or discomfort. It may feel like pressure or squeezing in your chest. The pain also
can occur in your shoulders, arms, neck, jaw, or back. Angina pain may even feel like indigestion.

A heart attack occurs if the flow of oxygen-rich blood to a section of heart muscle is cut off. If blood
flow isn’t restored quickly, the section of heart muscle begins to die. Without quick treatment, a heart
attack can lead to serious health problems or death.

Over time, CHD can weaken the heart muscle and lead to heart failure and arrhythmias. Heart failure
is a condition in which your heart can't pump enough blood to meet your body’s needs. Arrhythmias
are problems with the rate or rhythm of the heartbeat.

Your heart and circulation

Every part of your body needs a fresh supply of blood in order to work normally.
It's your heart's job to make sure that this is pumped out regularly.

Understanding the cardiovascular system

The movement of blood around the body, pumped by the heart, is called circulation.
Your heart, blood and blood vessels together make up your cardiovascular system (or
heart and circulatory system).
Your body contains about five litres (eight pints) of blood, which your heart is
continuously circulating.

How blood travels around your heart

The two sides of your heart are separate, but they work together.
  The right side of the heart receives dark, de-oxygenated blood which has
circulated around your body.

 It pumps this to your lungs, where it picks up a fresh supply of oxygen and
becomes bright red again.

 The blood then returns to the left side of the heart, ready to be pumped back out
to the rest of your body.

There are four valves in your heart. They act like gates that open and close, making
sure that your blood travels in one direction through your heart – a bit like a one-way
traffic system. They are called the tricuspid valve and the pulmonary valve on the right
side of the heart, and the mitral valve and the aortic valve on the left.
Like every other living tissue, the heart itself needs a continuous supply of fresh blood.
This comes from the coronary arteries which branch off from the main artery (the aorta)
as it leaves the heart. The coronary arteries spread across the outside of the
myocardium, supplying it with blood.

How blood travels around your body

As your heart muscle contracts, it pushes blood through your heart. With each
contraction, or heartbeat:

 Your heart pumps blood from its left side, through the aorta (the main artery
leaving the heart) and into the arteries.

 The blood travels through your arteries, which divide off into smaller and smaller
branches of blood vessels called capillaries. Travelling through this network of
capillaries, blood reaches every part of your body.

 The de-oxygenated blood then travels back to the heart through your veins.
Branches of veins join to form larger veins, which lead back to the right side of
your heart.

 From here, your heart will pump the de-oxygenated blood to your lungs with its
next heartbeat.

As the heart relaxes in between each heartbeat or contraction, blood from your veins
fills the right side of your heart. At the same time, blood that’s freshly full of oxygen from
your lungs fills the left side ready for the entire process to start again.
How a healthy heart works
Your heart is a muscle about the size of a fist. It is in the middle of your chest
tilted slightly to the left.

Each day, your heart beats about 100,000 times. It pumps about 23,000 litres
(5,000 gallons) of blood around your body.
This blood delivers oxygen and nutrients to all parts of your body, and carries away
unwanted carbon dioxide and waste products.

Your heart is a vital part of your cardiovascular system.

Watch our short animated guide to your heart and how it works:

The structure of your heart

Your heart is made up of three tissue layers:

 Pericardium – a thin outer lining that protects your heart

 Myocardium – the thick muscular tissue that contracts and squeezes blood out
of your heart

 Endocardium – a thin inner lining that also provides protection.

Inside the heart there are four chambers – two on the left side and two on the right.

 The two small upper chambers are called the atria.

 The two larger lower chambers are called the ventricles.

The left and right sides of the heart are divided by a muscular wall called the septum.
For your heart to keep pumping regularly, it needs an electrical supply. This is provided
by a special group of heart cells called the sinus node - also known as your heart’s
natural pacemaker.

As your heart beats, it pumps blood to every part of your body. This is called
your circulatory system.

What can go wrong?

Some people are born with hearts that have not developed properly before birth - this is
called congenital heart disease. Sometimes you can inherit a heart condition from your
family.

Some heart conditions may develop later in life, including coronary heart
disease and atrial fibrillation.

People who have coronary heart disease are at risk of having a heart attack. Damage to
the heart muscle because of a heart attack can lead to heart failure which can affect you
for the rest of your life.

However, there's plenty you can do to keep your heart healthy.

What can go wrong?

Problems with your heart and circulation system, including heart attack, angina and
stroke, are forms of cardiovascular disease.

This can occur when your arteries become narrowed by a gradual build-up of fatty
material (called atheroma) within their walls. In time, your arteries may become so
narrow that they cannot deliver enough oxygen-rich blood to your heart. This can
cause angina – a pain or discomfort in your chest.

If the fatty material breaks off (or ruptures), a blood clot will form, which can
cause stroke and heart attack.

Find out more about cardiovascular disease and how you can reduce your risk of
developing it.

Heart disease in women: Understand symptoms

and risk factors
All women face the threat of heart disease. But becoming aware of symptoms and
risks unique to women, as well as eating a heart-healthy diet and exercising, can
help protect you.
By Mayo Clinic Staff
Although heart disease may often be thought of as a problem for men, heart disease is
the most common cause of death for both women and men in the United States. One
challenge is that some heart disease symptoms in women may be different from those
in men. Fortunately, women can take steps to understand their unique symptoms of
heart disease and to begin to reduce their risk of heart disease.

Heart attack symptoms for women

The most common heart attack symptom in women is some type of pain, pressure or
discomfort in the chest. But it is not always severe or even the most prominent
symptom, particularly in women. And, sometimes, women may have a heart attack
without chest pain. Women are more likely than men to have heart attack symptoms
unrelated to chest pain, such as:

 Neck, jaw, shoulder, upper back or abdominal discomfort

 Shortness of breath
 Pain in one or both arms
 Nausea or vomiting
 Sweating
 Lightheadedness or dizziness
 Unusual fatigue
These symptoms can be more subtle than the obvious crushing chest pain often
associated with heart attacks. Women may describe chest pain as pressure or a
tightness. This may be because women tend to have blockages not only in their main
arteries but also in the smaller arteries that supply blood to the heart — a condition
called small vessel heart disease or coronary microvascular disease.
Women's symptoms may occur more often when women are resting, or even when
they're asleep. Mental stress also may trigger heart attack symptoms in women.
Women tend to show up in emergency rooms after heart damage has already occurred
because their symptoms are not those usually associated with a heart attack, and
because women may downplay their symptoms. If you experience these symptoms or
think you're having a heart attack, call for emergency medical help immediately. Don't
drive yourself to the emergency room unless you have no other options.

Heart disease risk factors for women

Although several traditional risk factors for coronary artery disease — such as high
cholesterol, high blood pressure and obesity — affect women and men, other factors
may play a bigger role in the development of heart disease in women. For example, risk
factors may include:

 Diabetes. Women with diabetes are at greater risk of heart disease than are men
with diabetes.
 Mental stress and depression. Women's hearts are affected by stress and
depression more than men's. Depression makes it difficult to maintain a healthy
 lifestyle and follow recommended treatment, so talk to your doctor if you're having
symptoms of depression.
 Smoking. In women, smoking is a greater risk factor for heart disease in women
than it is in men.
 Inactivity. A lack of physical activity is a major risk factor for heart disease, and
some research has found women to be more inactive than men.
 Menopause. Low levels of estrogen after menopause pose a significant risk factor
for developing cardiovascular disease in the smaller blood vessels (coronary
microvascular disease).
 Broken heart syndrome. This condition — often brought on by stressful situations
that can cause severe, but usually temporary, heart muscle failure — occurs more
commonly in women after menopause. This condition may also be called takotsubo
cardiomyopathy, apical ballooning syndrome or stress cardiomyopathy.
 Pregnancy complications. High blood pressure or diabetes during pregnancy can
increase women's long-term risk of high blood pressure and diabetes and increase
the risk of development of heart disease in the mothers.
Some research has found that if you had pregnancy complications such as high
blood pressure or diabetes your children may also have an increased risk of heart
disease in the future.
Women with inflammatory diseases, such as rheumatoid arthritis or lupus, may also
have a higher risk of heart disease. Research is ongoing in other heart disease risk
factors in women.

Is heart disease something only older women should worry about?

No. Women of all ages should take heart disease seriously. Women under the age of
65, and especially those with a family history of heart disease, need to pay close
attention to heart disease risk factors.

What can women do to reduce their risk of heart disease?

Women can make several lifestyle changes to reduce the risk of heart disease,
including:

 Quit or don't start smoking.

 Exercise regularly.
 Maintain a healthy weight.
 Eat a healthy diet that includes whole grains, a variety of fruits and vegetables, low-
fat or fat-free dairy products, and lean meats. Avoid saturated or trans-fat, added
sugars, and high amounts of salt.
Women also need to take prescribed medications appropriately, such as blood pressure
medications, blood thinners and aspirin. And they'll need to better manage other
conditions that are risk factors for heart disease, such as high blood pressure, high
cholesterol and diabetic
What Are the Signs and Symptoms of Heart Disease?
The signs and symptoms of coronary heart disease (CHD) may differ between women and men. Some
women who have CHD have no signs or symptoms. This is called silent CHD.

Silent CHD may not be diagnosed until a woman has signs and symptoms of a heart attack, heart
failure, or an arrhythmia (irregular heartbeat).

Other women who have CHD will have signs and symptoms of the disease.

Heart Disease Signs and Symptoms

The illustration shows the major signs and symptoms of coronary heart disease.

A common symptom of CHD is angina. Angina is chest pain or discomfort that occurs when your heart
muscle doesn't get enough oxygen-rich blood.

In men, angina often feels like pressure or squeezing in the chest. This feeling may extend to the
arms. Women can also have these angina symptoms. But women also tend to describe a sharp,
burning chest pain. Women are more likely to have pain in the neck, jaw, throat, abdomen, or back.

In men, angina tends to worsen with physical activity and go away with rest. Women are more likely
than men to have angina while they're resting or sleeping.

In women who have coronary microvascular disease, angina often occurs during routine daily
activities, such as shopping or cooking, rather than while exercising. Mental stress also is more likely
to trigger angina pain in women than in men.
 The severity of angina varies. The pain may get worse or occur more often as the buildup of plaque
continues to narrow the coronary (heart) arteries.

Signs and Symptoms Coronary Heart Disease Complications

Heart Attack

The most common heart attack symptom in men and women is chest pain or discomfort. However,
only half of women who have heart attacks have chest pain.

Women are more likely than men to report back or neck pain, indigestion, heartburn, nausea (feeling
sick to the stomach), vomiting, extreme fatigue (tiredness), or problems breathing.

Heart attacks also can cause upper body discomfort in one or both arms, the back, neck, jaw, or
upper part of the stomach. Other heart attack symptoms are light-headedness and dizziness, which
occur more often in women than men.

Men are more likely than women to break out in a cold sweat and to report pain in the left arm during
a heart attack.

Heart Failure

Heart failure is a condition in which your heart can't pump enough blood to meet your body's needs.
Heart failure doesn't mean that your heart has stopped or is about to stop working. It means that your
heart can't cope with the demands of everyday activities.

Heart failure causes shortness of breath and fatigue that tends to increase with physical exertion.
Heart failure also can cause swelling in the feet, ankles, legs, abdomen, and veins in the neck.

Arrhythmia

An arrhythmia is a problem with the rate or rhythm of the heartbeat. During an arrhythmia, the heart
can beat too fast, too slow, or with an irregular rhythm.

Some people describe arrhythmias as fluttering or thumping feelings or skipped beats in their chests.
These feelings are called palpitations.

Some arrhythmias can cause your heart to suddenly stop beating. This condition is called sudden
cardiac arrest (SCA). SCA causes loss of consciousness and death if it's not treated right away.

Signs and Symptoms of Broken Heart Syndrome

The most common signs and symptoms of broken heart syndrome are chest pain and shortness of
breath. In this disorder, these symptoms tend to occur suddenly in people who have no history of
heart disease.

Arrhythmias or cardiogenic shock also may occur. Cardiogenic shock is a condition in which a suddenly
weakened heart isn't able to pump enough blood to meet the body's needs.

Some of the signs and symptoms of broken heart syndrome differ from those of heart attack. For
example, in people who have broken heart syndrome:

 Symptoms occur suddenly after having extreme emotional or physical stress.

 EKG (electrocardiogram) results don't look the same as the EKG results for a person having a heart
attack. (An EKG is a test that records the heart's electrical activity.)
 Blood tests show no signs or mild signs of heart damage.
 Tests show no signs of blockages in the coronary arteries.
 Tests show ballooning and unusual movement of the lower left heart chamber (left ventricle).
 Recovery time is quick, usually within days or weeks (compared with the recovery time of a month or
more for a heart attack).

Who Is at Risk for Heart Disease?

Certain traits, conditions, or habits may raise your risk for coronary heart disease (CHD). These
conditions are known as risk factors. Risk factors also increase the chance that existing CHD will
worsen.

Women generally have the same CHD risk factors as men. However, some risk factors may affect
women differently than men. For example, diabetes raises the risk of CHD more in women. Also, some
risk factors, such as birth control pills and menopause, only affect women.

There are many known CHD risk factors. Your risk for CHD and heart attack rises with the number of
risk factors you have and their severity. Risk factors tend to "gang up" and worsen each other's
effects.

Having just one risk factor doubles your risk for CHD. Having two risk factors increases your risk for
CHD fourfold. Having three or more risk factors increases your risk for CHD more than tenfold.

Also, some risk factors, such as smoking and diabetes, put you at greater risk for CHD and heart
attack than others.

More than 75 percent of women aged 40 to 60 have one or more risk factors for CHD. Many risk
factors start during childhood; some even develop within the first 10 years of life. You can control
most risk factors, but some you can't.

For more information about CHD risk factors, go to the Health Topics Coronary Heart Disease Risk
Factors article. To find out whether you're at risk for CHD, talk with your doctor or health care
provider.

Risk Factors You Can Control

Smoking

Smoking is the most powerful risk factor that women can control. Smoking tobacco or long-term
exposure to secondhand smoke raises your risk for CHD and heart attack.

Smoking exposes you to carbon monoxide. This chemical robs your blood of oxygen and triggers a
buildup of plaque in your arteries.

Smoking also increases the risk of blood clots forming in your arteries. Blood clots can block plaque-
narrowed arteries and cause a heart attack. The more you smoke, the greater your risk for a heart
attack.

Even women who smoke fewer than two cigarettes a day are at increased risk for CHD.

High Blood Cholesterol and High Triglyceride Levels

Cholesterol travels in the bloodstream in small packages called lipoproteins (LI-po-pro-teens). The two
major kinds of lipoproteins are low-density lipoprotein (LDL) cholesterol and high-density lipoprotein
(HDL) cholesterol.

LDL cholesterol is sometimes called "bad" cholesterol. This is because it carries cholesterol to tissues,
including your heart arteries. HDL cholesterol is sometimes called "good" cholesterol. This is because it
helps remove cholesterol from your arteries.

A blood test called a lipoprotein panel is used to measure cholesterol levels. This test gives
information about your total cholesterol, LDL cholesterol, HDL cholesterol, and triglycerides (a type of
fat found in the blood).

Cholesterol levels are measured in milligrams (mg) of cholesterol per deciliter (dL) of blood. A
woman's risk for CHD increases if she has a total cholesterol level greater than 200 mg/dL, an LDL
cholesterol level greater than 100 mg/dL, or an HDL cholesterol level less than 50 mg/dL.

A triglyceride level greater than 150 mg/dL also increases a woman's risk for CHD. A woman's HDL
cholesterol and triglyceride levels predict her risk for CHD better than her total cholesterol or LDL
cholesterol levels.

High Blood Pressure

Blood pressure is the force of blood pushing against the walls of the arteries as the heart pumps
blood. If this pressure rises and stays high over time, it can damage the body in many ways.

Women who have blood pressure greater than 120/80 mmHg are at increased risk for CHD. (The
mmHg is millimeters of mercury—the units used to measure blood pressure.)

High blood pressure is defined differently for people who have diabetes or chronic kidney disease. If
you have one of these diseases, work with your doctor to set a healthy blood pressure goal.

Diabetes and Prediabetes

Diabetes is a disease in which the body's blood sugar level is too high. This is because the body
doesn't make enough insulin or doesn't use its insulin properly.

Insulin is a hormone that helps move blood sugar into cells, where it's used for energy. Over time, a
high blood sugar level can lead to increased plaque buildup in your arteries.

Prediabetes is a condition in which your blood sugar level is higher than normal, but not as high as it
is in diabetes. Prediabetes puts you at higher risk for both diabetes and CHD.

Diabetes and prediabetes raise the risk of CHD more in women than in men. In fact, having diabetes
doubles a woman's risk of developing CHD.

Before menopause, estrogen provides women some protection against CHD. However, in women who
have diabetes, the disease counters the protective effects of estrogen.

Overweight and Obesity

The terms "overweight" and "obesity" refer to body weight that's greater than what is considered
healthy for a certain height.
 The most useful measure of overweight and obesity is body mass index (BMI). BMI is calculated from
your height and weight. In adults, a BMI of 18.5 to 24.9 is considered normal. A BMI of 25 to 29.9 is
considered overweight. A BMI of 30 or more is considered obese.

You can use the National Heart, Lung, and Blood Institute's (NHLBI's) online BMI calculator(link is
external)to figure out your BMI, or your doctor can help you.

Studies suggest that where extra weight occurs on the body may predict CHD risk better than BMI.
Women who carry much of their fat around the waist are at greatest risk for CHD. These women have
"apple-shaped" figures.

Women who carry most of their fat on their hips and thighs—that is, those who have "pear-shaped"
figures—are at lower risk for CHD.

To fully know how excess weight affects your CHD risk, you should know your BMI and waist
measurement. If you have a BMI greater than 24.9 and a waist measurement greater than 35 inches,
you're at increased risk for CHD.

If your waist measurement divided by your hip measurement is greater than 0.9, you're also at
increased risk for CHD.

Studies also suggest that women whose weight goes up and down dramatically (typically due to
unhealthy dieting) are at increased risk for CHD. These swings in weight can lower HDL cholesterol
levels.

Metabolic Syndrome

Metabolic syndrome is the name for a group of risk factors that raises your risk for CHD and other
health problems, such as diabetes and stroke. A diagnosis of metabolic syndrome is made if you have
at least three of the following risk factors:

 A large waistline. Having extra fat in the waist area is a greater risk factor for CHD than having extra
fat in other parts of the body, such as on the hips.
 A higher than normal triglyceride level (or you're on medicine to treat high triglycerides).
 A lower than normal HDL cholesterol level (or you're on medicine to treat low HDL cholesterol).
 Higher than normal blood pressure (or you're on medicine to treat high blood pressure).
 Higher than normal fasting blood sugar (or you're on medicine to treat diabetes)

Metabolic syndrome is more common in African American women and Mexican American women than
in men of the same racial groups. The condition affects White women and men about equally.

Birth Control Pills

Women who smoke and take birth control pills are at very high risk for CHD, especially if they're older
than 35. For women who take birth control pills but don't smoke, the risk of CHD isn't fully known.

Lack of Physical Activity

Inactive people are nearly twice as likely to develop CHD as those who are physically active. A lack of
physical activity can worsen other CHD risk factors, such as high blood cholesterol and triglyceride
levels, high blood pressure, diabetes and prediabetes, and overweight and obesity.

Unhealthy Diet
An unhealthy diet can raise your risk for CHD. For example, foods that are high in saturated
and trans fats and cholesterol raise your LDL cholesterol level. A high-sodium (salt) diet can raise your
risk for high blood pressure.

Foods with added sugars will give you extra calories without nutrients, such as vitamins and minerals.
This can cause you to gain weight, which raises your risk for CHD.

Too much alcohol also can cause you to gain weight, and it will raise your blood pressure.

Stress or Depression

Stress may play a role in causing CHD. Stress can trigger your arteries to narrow. This can raise your
blood pressure and your risk for a heart attack.

Getting upset or angry also can trigger a heart attack. Stress also may indirectly raise your risk for
CHD if it makes you more likely to smoke or overeat foods high in fat and sugar.

People who are depressed are two to three times more likely to develop CHD than people who are not.
Depression is twice as common in women as in men.

Anemia

Anemia (uh-NEE-me-eh) is a condition in which your blood has a lower than normal number of red
blood cells.

The condition also can occur if your red blood cells don't contain enough hemoglobin (HEE-muh-glow-
bin). Hemoglobin is an iron-rich protein that carries oxygen from your lungs to the rest of your
organs.

If you have anemia, your organs don't get enough oxygen-rich blood. This causes your heart to work
harder, which may raise your risk for CHD.

Anemia has many causes. For more information, go to the Health Topics Anemia article.

Sleep Apnea

Sleep apnea is a common disorder that causes pauses in breathing or shallow breaths while you sleep.
Breathing pauses can last from a few seconds to minutes. They often occur 5 to 30 times or more an
hour.

Typically, normal breathing starts again after the pause, sometimes with a loud snort or choking
sound. Major signs of sleep apnea are snoring and daytime sleepiness.

When you stop breathing, the lack of oxygen triggers your body's stress hormones. This causes blood
pressure to rise and makes the blood more likely to clot.

Untreated sleep apnea can raise your risk for high blood pressure, diabetes, and even a heart attack
or stroke.

Women are more likely to develop sleep apnea after menopause.

Risk Factors You Can't Control

Age and Menopause

As you get older, your risk for CHD and heart attack rises. This is due in part to the slow buildup of
plaque inside your heart arteries, which can start during childhood.

Before age 55, women have a lower risk for CHD than men. Estrogen provides women with some
protection against CHD before menopause. After age 55, however, the risk of CHD increases in both
women and men.

You may have gone through early menopause, either naturally or because you had your ovaries
removed. If so, you're twice as likely to develop CHD as women of the same age who aren't yet
menopausal.

Another reason why women are at increased risk for CHD after age 55 is that middle age is when you
tend to develop other CHD risk factors.

Women who have gone through menopause also are at increased risk for broken heart syndrome. (For
more information, go to the section on emerging risk factors below.)

Family History

Family history plays a role in CHD risk. Your risk increases if your father or a brother was diagnosed
with CHD before 55 years of age, or if your mother or a sister was diagnosed with CHD before 65
years of age.

Also, a family history of stroke—especially a mother's stroke history—can help predict the risk of heart
attack in women.

Having a family history of CHD or stroke doesn't mean that you'll develop heart disease. This is
especially true if your affected family member smoked or had other risk factors that were not well
treated.

Making lifestyle changes and taking medicines to treat risk factors often can lessen genetic influences
and prevent or delay heart problems.

Preeclampsia

Preeclampsia (pre-e-KLAMP-se-ah) is a condition that develops during pregnancy. The two main signs
of preeclampsia are a rise in blood pressure and excess protein in the urine.

These signs usually occur during the second half of pregnancy and go away after delivery. However,
your risk of developing high blood pressure later in life increases after having preeclampsia.

Preeclampsia also is linked to an increased lifetime risk of heart disease, including CHD, heart attack,
and heart failure. (Likewise, having heart disease risk factors, such as diabetes or obesity, increases
your risk for preeclampsia.)

If you had preeclampsia during pregnancy, you're twice as likely to develop heart disease as women
who haven't had the condition. You're also more likely to develop heart disease earlier in life.

Preeclampsia is a heart disease risk factor that you can't control. However, if you've had the condition,
you should take extra care to try and control other heart disease risk factors.
 The more severe your preeclampsia was, the greater your risk for heart disease. Let your doctor know
that you had preeclampsia so he or she can assess your heart disease risk and how to reduce it.

Emerging Risk Factors

Research suggests that inflammation plays a role in causing CHD. Inflammation is the body's response
to injury or infection. Damage to the arteries' inner walls seems to trigger inflammation and help
plaque grow.

High blood levels of a protein called C-reactive protein (CRP) are a sign of inflammation in the body.
Research suggests that women who have high blood levels of CRP are at increased risk for heart
attack.

Also, some inflammatory diseases, such as lupus and rheumatoid arthritis, may increase the risk for
CHD.

Some studies suggest that women who have migraine headaches may be at greater risk for CHD. This
is especially true for women who have migraines with auras (visual disturbances), such as flashes of
light or zig-zag lines.

Low bone density and low intake of folate and vitamin B6 also may raise a woman's risk for CHD.

More research is needed to find out whether calcium supplements with or without vitamin D affect
CHD risk. You may want to talk with your doctor to find out whether these types of supplements are
right for you.

Researchers are just starting to learn about broken heart syndrome risk factors. Most women who
have this disorder are White and have gone through menopause.

Many of these women have other heart disease risk factors, such as high blood pressure, high blood
cholesterol, diabetes, and smoking. However, these risk factors tend to be less common in women
who have broken heart syndrome than in women who have C

How Is Heart Disease Treated

Treatment for coronary heart disease (CHD) usually is the same for both women and men.
Treatment may include lifestyle changes, medicines, medical and surgical procedures,
and cardiac rehabilitation (rehab).

The goals of treatment are to:

 Relieve symptoms.
 Reduce risk factors in an effort to slow, stop, or reverse the buildup of plaque.
 Lower the risk of blood clots forming. (Blood clots can cause a heart attack.)
 Widen or bypass plaque-clogged coronary (heart) arteries.
 Prevent CHD complications.

Lifestyle Changes
Making lifestyle changes can help prevent or treat CHD. These changes may be the only
treatment that some people need.

Quit Smoking

If you smoke or use tobacco, try to quit. Smoking can raise your risk for CHD and heart attack
and worsen other CHD risk factors. Talk with your doctor about programs and products that can
help you quit. Also, try to avoid secondhand smoke.

If you find it hard to quit smoking on your own, consider joining a support group. Many
hospitals, workplaces, and community groups offer classes to help people quit smoking.

For more information about how to quit smoking, go to the Health Topics Smoking and Your
Heart article and the National Heart, Lung, and Blood Institute's (NHLBI's) "Your Guide to a
Healthy Heart."

Follow a Healthy Diet

A healthy diet is an important part of a healthy lifestyle. A healthy diet includes a variety of
vegetables and fruits. These foods can be fresh, canned, frozen, or dried. A good rule is to try to
fill half of your plate with vegetables and fruits.

A healthy diet also includes whole grains, fat-free or low-fat dairy products, and protein foods,
such as lean meats, poultry without skin, seafood, processed soy products, nuts, seeds, beans, and
peas.

Choose and prepare foods with little sodium (salt). Too much salt can raise your risk for high
blood pressure. Studies show that following the Dietary Approaches to Stop
Hypertension(DASH) eating plan can lower blood pressure.

Try to avoid foods and drinks that are high in added sugars. For example, drink water instead of
sugary drinks, like soda.

Also, try to limit the amount of solid fats and refined grains that you eat. Solid fats are saturated
fat and trans fatty acids. Refined grains come from processing whole grains, which results in a
loss of nutrients (such as dietary fiber).

If you drink alcohol, do so in moderation. Research suggests that regularly drinking small to
moderate amounts of alcohol may lower the risk of CHD. Women should have no more than one
alcoholic drink a day.

One drink a day can lower your CHD risk by raising your HDL cholesterol level. One drink is a
glass of wine, beer, or a small amount of hard liquor.

If you don't drink, this isn't a recommendation to start using alcohol. Also, you shouldn't drink if
you're pregnant, if you're planning to become pregnant, or if you have another health condition
that could make alcohol use harmful.
Too much alcohol can cause you to gain weight and raise your blood pressure and triglyceride
level. In women, even one drink a day may raise the risk of certain types of cancer.

Be Physically Active

Regular physical activity can lower many CHD risk factors, including high LDL
cholesterol, high blood pressure, and excess weight.

Physical activity also can lower your risk for diabetes and raise your HDL cholesterol level.
(HDL cholesterol helps remove cholesterol from your arteries.)

Talk with your doctor before you start a new exercise plan. Ask him or her how much and what
kinds of physical activity are safe for you.

People gain health benefits from as little as 60 minutes of moderate-intensity aerobic activity per
week. Walking is an excellent heart healthy exercise. The more active you are, the more you will
benefit.

Maintain a Healthy Weight

Overweight and obesity are risk factors for CHD. If you're overweight or obese, try to lose
weight. Cut back your calorie intake and do more physical activity. Eat smaller portions and
choose lower calorie foods. Your health care provider may refer you to a dietitian to help you
manage your weight.

A BMI of less than 25 and a waist circumference of 35 inches or less is the goal for preventing
and treating CHD. BMI measures your weight in relation to your height and gives an estimate of
your total body fat. You can use the NHLBI's online BMI calculator to figure out your BMI, or
your doctor can help you.

To measure your waist, stand and place a tape measure around your middle, just above your
hipbones. Measure your waist just after you breathe out. Make sure the tape is snug but doesn't
squeeze the flesh.

Stress and Depression

Research shows that getting upset or angry can trigger a heart attack. Also, some of the ways
people cope with stress—such as drinking, smoking, or overeating—aren't heart healthy.

Learning how to manage stress, relax, and cope with problems can improve your emotional and
physical health.

Having supportive people in your life with whom you can share your feelings or concerns can
help relieve stress. Physical activity, yoga, and relaxation therapy also can help relieve stress.
You may want to consider taking part in a stress management program.
 Depression can double or triple your risk for CHD. Depression also makes it hard to maintain a
heart healthy lifestyle.

Talk with your doctor if you have symptoms of depression, such as feeling hopeless or not taking
interest in daily activities. He or she may recommend counseling or prescribe medicines to help
you manage the condition.

Medicines

You may need medicines to treat CHD if lifestyle changes aren't enough. Medicines can help:

 Reduce your heart's workload and relieve CHD symptoms

 Decrease your chance of having a heart attack or dying suddenly
 Lower your LDL cholesterol, blood pressure, and other CHD risk factors
 Prevent blood clots
 Prevent or delay the need for a procedure or surgery, such as angioplasty (AN-jee-oh-plas-tee) or coronary artery bypass
grafting (CABG)

Women who have coronary microvascular disease and anemia may benefit from taking medicine
to treat the anemia.

Women who have broken heart syndrome also may need medicines. Doctors may prescribe
medicines to relieve fluid buildup, treat blood pressure problems, prevent blood clots, and
manage stress hormones. Most people who have broken heart syndrome make a full recovery
within weeks.

Take all of your medicines as prescribed. If you have side effects or other problems related to
your medicines, tell your doctor. He or she may be able to provide other options.

Ask your doctor about other ways to prevent or treat CHD, including lifestyle changes and
medicines. For more information about MHT, go to the NHLBI's Postmenopausal Hormone
Therapy Web site.

Cardiac Rehabilitation

Your doctor may prescribe cardiac rehab for angina or after angioplasty, CABG, or a heart
attack. Almost everyone who has CHD can benefit from cardiac rehab.

Cardiac rehab is a medically supervised program that can improve the health and well-being of
people who have heart problems.

The cardiac rehab team may include doctors, nurses, exercise specialists, physical and
occupational therapists, dietitians or nutritionists, and psychologists or other mental health
specialists.
 Cardiac rehab has two parts:

 Exercise training. This part of rehab helps you learn how to exercise safely, strengthen your muscles, and improve your stamina.
Your exercise plan will be based on your personal abilities, needs, and interests.
 Education, counseling, and training. This part of rehab helps you understand your heart condition and find ways to lower your
risk for future heart problems. The rehab team will help you learn how to cope with the stress of adjusting to a new lifestyle and
with your fears about the future.

Foods that help prevent heart disease

There is no ‘magic’ food to decrease the risk of developing heart disease. You need to
eat a healthy diet and have plenty of exercise. High-salt diets increase blood pressure
and the risk of heart attack and stroke.

Most of us consume more than ten times the amount of salt we need to meet our
sodiumrequirements (salt contains sodium and chloride). However, there is evidence
that plant foods – especially wholegrain cereals, legumes, nuts, fruits and vegetables –
may decrease the risk of heart disease.

The foods that best protect against heart disease include:

 oily fish – such as mackerel, sardines, tuna and salmon which contain omega-3 fatty
acids. This type of fat has been shown to decrease triglycerides and increase HDL-
cholesterol levels,improves blood vessel elasticity and thins the blood, making it less
likely to clot and block blood flow
 some vegetables oils – such as corn, soy and safflower, which contain omega-6 fatty
acids, and those containing omega-3 fatty acids such as canola and olive oil. All of
these can help to lower LDL cholesterol when used instead of saturated fats such as
butter
 fruit and vegetables – antioxidants in fruit and vegetables offer protection against heart
disease. Fruit and vegetables are also important sources of folate, which helps lower
the blood levels of the amino acid homocysteine, which appears to be linked to an
increased risk of heart disease
 fibre – wholegrain cereals and fruit and vegetables
 unrefined carbohydrate sources with a low glycaemic index – foods such as
wholegrain breads and breakfast cereals, legumes, certain types of rice and pasta are
important for people prone to diabetes because they help keep blood sugar levels in
check
 legumes and soy – soy protein has been shown to lower LDL cholesterol levels,
especially if blood cholesterol levels are high
 nuts and seeds – they should be eaten in small quantities, as they are high in
kilojoules
 tea – some evidence suggests that the antioxidants in tea can help prevent the build-up
of fatty deposits in the arteries. The antioxidants may also act as an anti-blood clotting
agent and improve blood vessel dilation to allow increased blood flow
 alcohol – it is thought that a moderate intake of alcohol may have some potential health
benefits. For example, some types of alcohol (such as red wine) may contain protective
factors like antioxidants, although this is still being researched. Alcohol also increases
the HDL (‘good’) cholesterol and this helps clear cholesterol from the body. However, a
high intake of alcohol increases blood pressure and also tends to increase triglycerides
(a type of fat) in the blood, increasing the risk of heart disease. Current guidelines for
alcohol intake in Australia recommend no more then two standard drinks per day for
men and one for women to reduce the risks of harm related to alcohol
 foods containing vitamin E – some studies indicate that vitamin E acts as an
antioxidant, helping to protect against ‘bad’ cholesterol. Good sources of vitamin E
include avocados, dark green vegetables, vegetable oils and wholegrain products. It is
better to eat foods containing vitamin E rather than take supplements, which do not
have the same protective effects
 garlic – a compound in fresh garlic called allicin has been found in some studies to
lower blood cholesterol
 foods enriched with plant sterols – a daily intake of 2–3 g of phytosterols/stanols
lowers LDL cholesterol levels by approximately ten per cent in healthy people and in
those with high cholesterol and those with diabetes. This intake can be achieved by the
consumption of two to three serves of phytosterol-enriched foods like margarine
spreads, reduced-fat yoghurts, milk and breakfast cereals.

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Help reduce your risk of heart disease

To substantially reduce your risk of developing coronary heart disease:
 Avoid fried fast food and processed foods containing vegetable shortening.
 Choose a variety of oils (extra virgin olive oil, canola, peanut) and foods containing
natural fats (nuts, seeds, avocado, olives, soy, fish).
 Switch to low-fat or non-fat dairy products.
 Increase the amount and variety of plant foods consumed – eat more unrefined
vegetables, fruits and wholegrain cereals. Reduce intake of refined sources of
carbohydrates with higher glycaemic indices.
 Include legumes (like baked beans, soybeans, lentils and tofu) in your diet.
 Have a handful of a variety of raw, unsalted nuts on most days of the week, especially
walnuts and almonds.
 Eat oily fish at least once per week.
 If you drink alcohol, have no more than two drinks per day.
 Trim all visible fat from meat.
 Remove poultry skin and eat only the meat.
 Avoid added salt at the table and cooking and salty foods. Check the sodium content of
foods and choose the lowest sodium products.
 Include physical activity

Exercise is vital to reduce your risk of heart disease. Walking at least 30 minutes each
day at a vigorous pace (at least 4 km per hour) reduces heart disease risk by 30 per
cent. How do you measure how briskly you are walking? Rule of thumb – walk as fast
as you can, so you can still talk but not sing.

If you are over 40, have a heart condition or haven’t exercised for a long time, see your
doctor before you start any exercise program.
Where to get help
 Your doctor
 Dietitians Association of Australia Tel. 1800 812 942
 Things to remember
 Diet is an important risk factor in coronary heart disease.
 Food-related risk factors include obesity, high blood pressure, uncontrolled diabetes
and a diet high in saturated fats.
 A low-saturated fat, high-fibre, high plant food diet can substantially reduce the risk of
developing heart disease