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Women

February 2008

Women and cardiovascular diseases

  • Cardiovascular diseases (CVD) cause 8.6 million deaths among women annually.1
  • CVD is the largest single cause of mortality among women, accounting for a third of all women’s deaths worldwide.1
  • In low- and middle-income countries, CVD can be as significant a cause of death and disability in women as it is in men.2
  • There are more deaths in low- and middle-income countries from CVD than those from pregnancy-related causes.2
  • If a woman in the developing world has CVD she is more likely to die from it than comparable women in industrialized nations.2
  • By 2020, coronary heart disease (CHD) will have increased by 120% among women from 1990’s levels.3
  • CHD affects women approximately 10 years later than men, due to the protective effect of estrogen.4
  • Estimates suggest that 70 % of CVD deaths are attributed to modifiable risk factors. i 
  • After menopause, women’s cholesterol levels are, on average, higher than those of men of about the same age.ii
  • Women who smoke are at increased risk of developing hypertension.iii
  • In Europe, the metabolic syndrome is more prevalent in women than in men with CHD.iv

Risk factors

  • The risk factors for CVD are the same for both genders.
  • Being normal weight will not protect against CVD if a woman is physically inactive.5
  • Women who take less than an hour a week of physical activity have 1.58 times the risk of developing CVD compared to women who do more than three hours a week activity. 5
  • Increasing physical inactivity 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.6
  • Women tend to be more physically inactive than men.7
  • Women with high blood pressure have 3.5 times the risk of developing coronary heart disease (CHD) compared to that of women with normal blood pressure.4
  • Smoking is a major risk factor for CVD. While more men than women smoke, in low- and middle- income countries female smoking is increasing rapidly.8
  • 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.9
  • Women who smoke double their risk of stroke. The more cigarettes smoked the higher the risk.10
  • Women who use oral contraceptives do not have an increased risk of heart attack11 but when combined with CV risk factors such as high blood pressure, obesity and smoking, the risk of developing CVD increases.12
  • 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.13
  • High blood pressure, a significant risk factor for the development of CVD, is rare among young women, but increases after the menopause.4
  • In pre-menopausal women, type 2 diabetes cancels out the protective effect of estrogen and the risk of coronary death increases by 3.5 compared with non-diabetic women. The elevation in risk is significantly higher than for men with diabetes.14
  • The relative risk of an obese women dying of CVD is 1.45, compared with normal weight women.15

1 World Health Organization. The world health report, 2004 : changing history. WHO, Geneva, 2004.

2 The Center for Global Health and Economic Development. A race against time: the challenge of cardiovascular disease in developing economies.  The Earth Institute at Columbia University, New York. 2004.

3 Gaziano TA. Reducing The growing burden of cardiovascular disease in the developing world. Health Affairs. 2007;26(1):13-24.

4 Stangl V, Baumann G, Stangl K. Coronary atherogenic risk factors in women. Eur Heart J. 2002;23(22):1738-52.

5 Li TY, Rana JS, Manson JE, Willett WC, Stampfer MJ, Colditz GA, Rexrode KM, Hu FB. Obesity as compared with physical activity in predicting risk of coronary heart disease in women. Circulation. 2006;113(4):499-506.

6 Barlow CE, 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. 2006;163(2):142-50.

7 Riddoch CJ, Bo Andersen L, Wedderkopp N, Harro M, Klasson-Heggebo L, Sardinha LB, Cooper AR, Ekelund U.  Physical activity levels and patterns of 9- and 15-yr-old European children. Med Sci Sports Exerc. 2004;36(1):86-92.

8 Pilote L, Dasgupta K, Guru V, Humphries KH, McGrath J, Norris C, Rabi D, Tremblay J, Alamian A, Barnett T, Cox J, Ghali WA, Grace S, Hamet P, Ho T, Kirkland S, Lambert M, Libersan D, O'Loughlin J, Paradis G, Petrovich M, Tagalakis V. A comprehensive view of sex-specific issues related to cardiovascular disease. CMAJ. 2007 Mar 13;176(6):S1-44.

9 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). 2004;13(8):888-97.

10 Kurth T, Kase CS, Berger K, Gaziano JM, Cook NR, Buring JE. Smoking and risk of hemorrhagic stroke in women. Stroke. 2003;34(12):2792-5.

11 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):11-6.

12 Barton M, Dubey RK, Traupe T. Oral contraceptives and the risk of thrombosis and atherosclerosis. Expert Opin Investig Drugs. 2002;11(3):329-32.

13 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. 1997;56(3):129-40.

14 Pilote L, Dasgupta K, Guru V, Humphries KH, McGrath J, Norris C, Rabi D, Tremblay J, Alamian A, Barnett T, Cox J, Ghali WA, Grace S, Hamet P, Ho T, Kirkland S, Lambert M, Libersan D, O'Loughlin J, Paradis G, Petrovich M, Tagalakis V. A comprehensive view of sex-specific issues related to cardiovascular disease. CMAJ. 2007 Mar 13;176(6):S1-44.

15 Murphy NF, 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. 2006;27(1):96-106.

 i Abegunde DO, Mathers CD, Adam T, et al. The burden and costs of chronic diseases in low-income and middle-income countries. Lancet 2007; 370 (9603):1929-38.

ii American Heart Association. Women, heart disease and stroke.

iii Bowman TS, Gaziano JM, Buring JE, et al. A prospective study of cigarette smoking and risk of incident hypertension in women. J Am Coll Cardiol. 2007;50 (21):2085-92.

iv Stramba-Badiale M, Fox KM, Priori SG, et al. Cardiovascular diseases in women: a statement from the policy conference of the European Society of Cardiology. Eur Heart J. 2006;27:994-1005.