Heart Attack and Stroke Prevention in Women

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Cardiology Patient Pages

Heart Attack and Stroke Prevention in Women

C. Becker

Circulation 2005;112 e273-e275

Introduction

Each year, more than one million Americans experience a heart attack, and nearly

half of them are fatal. Stroke is the leading cause of disability and the third

leading cause of death for women and men.1–3

Heart Attack and Stroke in Women

Many people continue to believe that heart attacks represent a problem targeting

solely older men, yet heart disease is the number one killer of both women and

men

in the United States. The difference is that among men, the risk for heart

attack

increases steadily after 45 years of age. In women, the risk increases after 50

years of age. However, younger women and men can also have heart attacks, and

the

current epidemic of obesity and inactivity among our nation’s youth will likely

shift the risk toward occurrence at younger ages over the next one to two

decades.

Each year, nearly 700 000 Americans experience either their first or second

stroke,

and more than 20% of them are fatal. More women than men have strokes, and they

are

more likely to die as a result. The problem is particularly serious in black

Americans.4–8

Who Is at Risk?

Being familiar with factors that increase the risk for either a heart attack or

stroke is the first step toward prevention. If you have one or more of these

factors, please contact your healthcare provider to discuss the available means

to

reduce the risk.

What Are the Signs and Symptoms?

In most instances, a heart attack or stroke is caused by a small blood clot

lodged

within a blood vessel leading to either the heart or brain (see the Figure). The

lack of blood (and oxygen) causes injury, which increases steadily over time;

therefore, prompt recognition and medical treatment are of utmost importance.

Fig: Blood clots forming in the blood vessels serving the heart cause heart

attacks; those that develop in or travel to the blood vessels in the brain are

responsible for strokes.

The signs and symptoms of heart attack and stroke are listed in the boxes. It is

important to remember that they can differ from one person to another and may

" wax

and wane " with time. If you are not sure, it is better to seek medical advice

than

to wait.

Warning Signs for Stroke

Sudden weakness or numbness of face or limb on one side.

Sudden, severe headache.

Difficulty talking or understanding speech.

Unexplained dizziness.

Sudden dimness/loss of vision, often in one eye.

Warning Signs for Heart Attack

Chest discomfort: uncomfortable pressure, squeezing or fullness.

Discomfort in other areas of the upper body: one or both arms or in the back,

neck,

jaw, or stomach.

Shortness of breath, either with chest discomfort or alone.

Other signs, including nausea, lightheadedness, or breaking out in a cold sweat.

Risk Factors for Stroke

High blood pressure.

Diabetes.

High cholesterol.

Age (risk doubles for each decade over 55 years of age).

Family history of stroke.

Smoking.

Birth control pills.

Atrial fibrillation.

Heart failure.

Excess alcohol.

Prior stroke or heart attack.

Black race.

Gender (women are at greater risk than men).

Risk Factors for Heart Attack

High blood pressure.

Diabetes.

Smoking.

High cholesterol.

Age.

Hormone replacement therapy.

Physical inactivity.

Gender (men are at greater risk than women).

Prevention of Heart Attack and Stroke

Stop smoking.

Engage in physical activity.

Use diet therapy.

Maintain/reduce weight.

Control blood pressure.

Undergo cholesterol control/statin therapy.

Control blood sugar.

Limit alcohol intake.

Take aspirin as advised.*

=========================

*For women who have at least a 20% chance of a heart attack or stroke over the

next

10 years.

How Aware Are You?

A recent American Heart Association–sponsored telephone survey of more than 1000

women who were over 25 years of age found that only 1 of every 3 women correctly

identified the warning signs of stroke. Awareness of heart attack risk is low

nationwide but was particularly low among Hispanic and black women.

There has been an overall improvement in the level of awareness among American

women

over the past decade. Both a clear need and a large margin for improvement

exist,

however, for national and community prevention programs to develop educational

programs directed toward those at greatest risk.9

How Can I Reduce My Chances of Having a Heart Attack or Stroke?

Rather than consider heart and blood vessel disease as a " have-or-have-not "

condition, the medical community now looks at a " continuum of risk " that

requires

intermittent appraisal by healthcare providers. Your physician can assess the

chance

of your having a heart attack or stroke according to risk prediction charts and

can

optimize strategies of preventive care.10,11 It is important for all women to

recognize the important role that they themselves play in preventing heart

attack

and stroke by following a healthy lifestyle.12

Is Aspirin for Everyone?

In low doses, aspirin reduces " sticking " of blood platelets to one another,

preventing blood clots. A study of nearly 40 000 initially healthy women 45

years of

age or older13 found that aspirin (100 milligrams every other day) reduced the

risk

of a first stroke by nearly 25%, and in women over 65 years of age, it decreased

the

likelihood of both heart attack and stroke. On the flip side, aspirin increased

by

40% the risk of bleeding within the stomach and intestines, a known side effect.

What is the take-home message for women? Low-dose aspirin reduces heart attack

and

stroke for women at high risk and for those over 65 years of age. The balance of

benefit with the risk of bleeding must be weighed carefully for each individual

and

discussed with a healthcare professional.

It must be emphasized that women with a prior heart attack or stroke are known

to

benefit from daily aspirin.

Are All the Answers About Aspirin in?

The wide-scale availability, low cost, and proven benefits of aspirin make it a

topic of great interest and importance in public health. Women at low risk for a

heart attack or stroke do not benefit from regular aspirin use. Similarly, it

has

been established that women at high risk benefit considerably. The questions

that

remain unanswered are as follows:

What is the role of aspirin among women at intermediate risk (10% to 20% risk

over a

10-year period) for a stroke or heart attack?

What is the safest and most effective dose of aspirin?

Does the optimal dose of aspirin differ from one person to another?

Do the protective effects of aspirin differ between women and men? If so, how

can

the difference be explained and translated to health care?

Can a simple blood test like C-reactive protein identify healthy people who are

likely to benefit from aspirin?

Answers to these questions require additional research.

What Should I Do if I Experience Signs or Symptoms of a Heart Attack or Stroke?

Time is of the essence. Treatments to restore the flow of blood (and oxygen) to

the

brain and heart are available but are most beneficial when used in the first

several

hours. Call 9-1-1. By calling 9-1-1 and taking an ambulance to the hospital

where

heart attack and stroke care is available, you substantially increase your

chances

of recovery. Remember, you should never drive yourself to the hospital unless

there

is absolutely no other choice.

Knowing how to prevent a heart attack or stroke, and being prepared to act

immediately if you experience the signs or symptoms of either one, could save

your

life.

Footnotes

The information contained in this Circulation Cardiology Patient Page is not a

substitute for medical advice or treatment, and the American Heart Association

recommends consultation with your doctor or healthcare professional.

Al Pater, PhD; email: old542000@...

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