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Coronary Heart Disease - CHD is the leading cause of death for women in the USA. According to the CDC (Centers for Disease Control and Prevention) report, the leading cause of death for Women in the US, heart disease (23.5 %) tops the chart followed by Cancer (22.1%), Stroke (6.2%), Chronic Respiratory diseases (5.9%) and Alzheimer's disease (4.7%) to name the top 5 causes. CHD accounts for about half a million death of women every year.
In the recent years, considerable volumes of research studies have been published outlining evidence-based
preventive guidelines especially for women. Framingham Heart Study is the first long term study that probed the CHD risk factors in greater detail. Coronary Heart Diseases include - Congestive Heart Failure, Myocardial Infarction (MI), Cardiac Ischemia without infarction and angina pectoris.
Briefly, Framingham heart study, a longitudinal epidemiological study of cardiovascular factors of 5209 subjects based in Framingham, Massachusetts was initiated in the year 1948.
You can read more about this study here. If you want to delve straight to the Risk Calculator and come back for information on risk mitigation later - click here. The results page which comes up after you complete the form, will contain tips to reduce your risk level based on the data you provided.
Major CHD risk factors: The risk factors are grouped under 2 sections based on factors under the control of the woman or factors beyond her control (modifiable risk factors, non-modifiable risk factors).
Non-modifiable CHD Risk Factors are age, family history, race and socioeconomic status. Age tops the list of risk factors for both genders.
Modifiable risk factors are:
- Hypertension : The number of Women affected by hypertension - elevated levels of blood pressure, begins to exceed men during the Peri / Postmenopausal period. Every 20 mm/Hg rise in systolic pressure or 10 mm/Hg rise in diastolic rise in pressure results in doubling of mortality rate from CHD or stroke. Normal Blood pressure is about 120/80 mm/Hg which tends to rise as we age. The first value 120 represents the systolic pressure and the latter is the diastolic pressure. For this calculation we use the systolic pressure.
- Hypercholesterolemia : Framingham study established the link of cholesterol with higher risk levels of dying due to Cardio vascular disease. 85 % of the subjects with serum cholesterol levels of less than 180 mg/dL were still alive while one third of those whose levels were higher than 260 mg/dL had died.
A woman having a serum cholesterol level > =260 mg/dL has a 40% higher risk compared to a woman with a cholesterol of less than 200 mg/dL .
- Cholesterol : Elevated levels of low density lipoprotein (LDL) or low levels of high density lipoprotein (HDL) can signal high level risk. Dyslipidemia - high levels of LDL, triglycerides combined with low levels HDL is a major risk factor for both genders. HDL cholesterol is a strong predictor of CHD risks in Women. Equally a HDL level of >= 60 mg/dL can be regarded as a protective factor.
- Smoking : Other things being equal, a woman who smokes about 4 cigarettes a day is 2 times likely to have a CHD than a woman who is not a smoker. In addition, smoking is implicated in other health issues - Cancer and respiratory diseases, thus raising mortality risk.
- Frailty - thy name is Woman : Women tend to experience more upper abdominal pain, nausea, dyspnea (shortness of breath) and chronic fatigue. Women have comparatively smaller coronary artery lumens regardless of their body size which can result in higher incidence of ischemia - more so in times of stress. As if this is not enough, Women suffer 3 times more of depression than men. Depression can accentuate angina pectoris - chest pain. These reasons highlight the considerable disadvantages women suffer with respect to CHD and the final prognosis.
CHD risk Reduction : There are many ways to manage the risks. The following is only a summary of the many steps required to mitigate the risks.
- Trans fatty Acid - A meta analysis of 4 prospective cohort studies showed a 23 % increase in CHF (Congestive Heart Failure) incidence when the intake of trans fatty acid increased by 2 %. Eliminating food containing trans fatty acid is a significant step.
- If you have a family history of heart disease, it is imperative that a lipid screen test is done at regular intervals and watch your risk factors. Proper diet combined with adequate exercise and backed with the use of effective drugs can reduce the serum cholesterol levels. Aerobic exercise is known to reduce serum lipid levels - if done regularly. Remember - every one percent reduction in Cholesterol level reduces the risk of CHD by 2 %.
- The Nurses Health Study (NHS) which began in 1976 with 121700 women nurses contributed to better understanding of heart diseases for women. As the subjects are associated with medical fraternity, it was relatively easier to establish path-breaking causative relationships with a number of factors specific to women - hormone, nutrition, exercise and diseases. This study indicates that moderate intensity physical activity of adequate duration done 3 days a week can reduce the CHD risk by a whopping 50 %.
- Your physician may determine other medications to control some of the risk factors. Low dose Aspirin, in one study lowered the risk of stroke up to 19 %. Vitamin and mineral supplements may also lower the risks in some studies. At least 100 IU of Vitamin E per day showed lower risk in NHS study.
Framingham Point Score Estimate of 10-year risk for Women
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