• Cardiovascular

    Tuesday Q and A: Differences between men and women can impact risk of heart disease

DEAR MAYO CLINIC: I know that heart disease is the leading killer among men and women, but is it true that men and women have different risk factors for heart disease?red heart in woman and man hands

ANSWER: You are correct that heart disease is the leading cause of death in men and women in the United States. Many risk factors are the same for both genders. But there are some differences between men and women that can have an impact on an individual’s risk of heart disease.

One of most significant heart disease risk factors for both men and women is smoking. Nicotine can narrow your arteries, and carbon monoxide can damage their inner lining. That makes the vessels more likely to become thick and stiff, a condition known as arteriosclerosis. Eventually arteriosclerosis limits blood flow, increasing the risk of a heart attack. Because of this, heart attacks are more common in smokers than in nonsmokers.

Studies have shown that smoking is a more dangerous risk factor in women compared to men. A woman who smokes is twice as likely to have a heart attack as one who does not. Quitting smoking is one of the best ways you can lower your heart disease risk.

People of both genders who are obese also have a higher risk of developing heart disease. Excess weight is particularly dangerous because it often triggers other medical conditions, such as diabetes, high blood pressure and high cholesterol. Each of those disorders on its own can make a person more susceptible to heart disease, as well.

Again, women with these three medical complications of obesity have even higher heart disease risk than men. A large study showed that women who are obese experience heart attacks eleven years earlier, on average, than similar women who are not obese.

Research suggests that individuals who have conditions that cause inflammation are more likely to develop heart disease, too. Certain inflammatory conditions such as rheumatoid arthritis and lupus are more common in women. Both increase heart disease risk by at least two to three times. Some rheumatologic disorders that cause inflammation more often in men, such as psoriatic arthritis and ankylosing spondylitis, can also raise heart disease risk.

Several factors unique to women affect the likelihood of developing heart disease. First, women who have high blood pressure during pregnancy, specifically preeclampsia or toxemia, have a higher tendency to develop heart disease later in life.

Second, the female hormone estrogen appears to have a protective effect on women, lowering their risk of heart disease. After menopause, that protection decreases as the level of estrogen in a woman’s body goes down, making postmenopausal women more vulnerable to heart disease. Women who have premature menopause — at age 40 or younger — and who do not receive hormone therapy are significantly more likely to develop heart disease than other women.

All the factors mentioned so far can be prevented, treated or managed in some way. But a significant risk factor for heart disease that cannot be controlled is family history. If you have a parent or a sibling who had a heart attack at the age of 55 and younger for men or 65 and younger for women, then your risk goes up.

Fortunately, more than 80 percent of heart disease is preventable by living a heart healthy lifestyle. That lifestyle includes: eating a diet rich in fruits and vegetables and low in saturated fats getting regular physical activity, being at a healthy body weight and not smoking.

Everyone can look at their individual situation and make positive changes based on their circumstances. In many cases, those changes are likely to lower the risk for developing heart disease and increase the possibilities for a long and heart-healthy life. Sharon L. Mulvagh, M.D., Women’s Heart Clinic, Mayo Clinic, Rochester, Minn.