In fact, heart disease and stroke kill 31,000 women in Canada every year, but most women are unaware of the risks.
High risk groups are women who have diabetes or are menopausal. Before menopause risk factors are lower because of the protective effect of estrogen. However, this doesn’t necessarily mean you’re in the clear if you haven’t hit menopause yet. For example, pre-menopausal women with diabetes have greater risk because diabetes cancels out the protective effect of estrogen. Certain ethnic backgrounds have higher risks of heart disease as well.
It is important for all women to know about their risk factors so they can recognize the signs for heart disease and stroke and prevent or manage them.
Estrogen and Heart & Stroke Risk
Estrogen is a naturally occurring hormone that is abundant while a woman is in her reproductive years (from about age 12 to 50). During these years, estrogen provides a protective effect on a women’s heart health. This protective effect can change depending on the factors and conditions below.
The Pill (oral contraceptives)
Oral contraceptive use can increase the risk of high blood pressure and blood clots when there are other risk factors present. The risk is greater for women who: smoke, already have high blood pressure, are over the age of 40, have other risk factors for heart disease or stroke, or already have a blood clotting problem. In non-smoking women under the age of 35, taking the pill doesn’t increase the risk of stroke. However, in a small proportion of women, oral contraceptives increase the risk of high blood pressure and blood clots.
During the nine months of pregnancy, there are certain conditions that may develop which put a woman at higher risk of heart disease and stroke. Those conditions include:
- Preeclampsia – typically starts after the 20th week of pregnancy. It is a condition related to increased blood pressure and protein in the mother’s urine (which indicates that there is a problem with the kidneys). There isn’t a way to prevent pre-eclampsia, though you may be prone to develop the condition if you have high blood pressure or are overweight before you become pregnant.
Age is another risk factor – being younger than 20 or older than 40. As is being pregnant with more than one baby, or having diabetes, kidney disease, rheumatoid arthritis, lupus or scleroderma. It’s a good idea for all women to be monitored by their healthcare provider throughout pregnancy. Check your blood pressure checked often to note any signs of Preeclampsia. It is treatable under the supervision of a doctor.
- Gestational diabetes – Extra insulin is produced during pregnancy because increased levels of pregnancy hormones interfere with the body’s ability to use insulin efficiently. In cases where a woman’s body isn’t able to produce enough additional insulin, her blood sugar levels will rise, causing gestational diabetes. Since there are no warning signs, it’s important that women have their glucose levels monitored as part of their prenatal care and throughout their pregnancy. Both the mother and baby have a higher likelihood of developing diabetes later in life if gestational diabetes is present during pregnancy. As mentioned above, diabetes is a risk factor for heart disease and stroke.
- The risk of a pregnancy-related stroke can happen at any stage of pregnancy. A high risk time is during childbirth and the first few months after birth. However, it usually results from an underlying problem like a pre-existing blood vessel malformation or eclampsia.
- Peripartum cardiomyopathy (PPCM) is a rare condition that causes the mother’s heart to become larger around the time of delivery. This enlargement weakens the heart muscle and makes pumping blood more difficult, increasing risk for heart failure.
All women have an increased risk of heart disease and stroke after menopause due to lower estrogen levels. Some signs to look for before and after menopause include:
- An increase in total blood cholesterol, low density lipoprotein cholesterol (LDL or ‘bad’ cholesterol) and triglyceride levels
- A decrease in high density lipoprotein cholesterol (HDL or ‘good’ cholesterol)
- A tendency toward higher blood pressure
- An increase in central body fat, which can increase the likelihood of blood clots and blood sugar problems.
- Severe sweating or sleep disturbances.
Hormone Replacement Therapy:
Risk of stroke and heart attack increases for women taking Hormone Replacement Therapy (HRT) have an increased risk of. If you are on HRT, talk to your doctor about what this means for you and the prevention options available.
After menopause, as natural estrogen levels drop, it’s more common for women to develop high cholesterol. That’s because estrogen helps to keep cholesterol levels in a healthy range. It’s important to talk with your doctor about how often you should have your cholesterol levels checked.
Triglycerides are the most common type of fat in the body. A high triglyceride level is often related to higher levels of total cholesterol and LDL, along with lower levels of HDL (the “good” cholesterol and an increased risk of diabetes. Having high triglycerides may increase the risk of heart disease and stroke for women. Check with your doctor about your risk.
Heart-Healthy Changes You Can Make
A woman’s overall risk of heart disease or stroke is determined by all of her risk factors. The good news is that some of these factors you can control.
Factors you can control are things like smoking, high blood pressure, high blood cholesterol, diabetes, physical inactivity and obesity.
The risk factors that are beyond your control are things like age, gender, family history and ethnicity.
Here are some tips to prevent and reduce your risk of heart disease:
- Stop smoking (if you do)
- Achieve and maintain a healthy body weight
- Include regular physical activity. The recommendation for heart health is 150 minutes of moderate- to vigorous-intensity aerobic physical activity per week (for 10 minutes or more at one time).
- Keep your blood pressure in a healthy range. You can do this though eating a healthy diet, increased physical activity, and when needed, through medication.
- Eat a healthy diet that is low in processed foods and trans-fat, and higher in fibre. It’s also recommended to include leafy greens on a regular basis and foods from each of the food groups.
- When prescribed by your healthcare provider, medication to reduce the risk of heart disease and stroke is also an important part of staying heart-healthy.