Ask a Health Care Professional – Coronary Artery Disease

By Diana Weber, M.D., Medical Director, Blue Cross and Blue Shield of New Mexico

February is American Heart Month, which is an opportunity to direct our focus toward recognizing and preventing heart disease. Heart disease causes one in three deaths each year, but most people do not realize that heart disease is the number one killer of women, and more than 40 percent of women are affected. African American women have the highest incidence of heart disease.  While past heart disease studies have focused on male subjects, more research is now focused on women, and doctors are identifying differences in heart disease between men and women.

What is Coronary Artery Disease?

Your heart is a muscle, and like any other muscle, it requires blood vessels (the coronary arteries) to provide oxygen so the muscles can function. Plaque, a buildup of fat, can block the coronary arteries. As plaque increases in the wall of the blood vessel, blood flow decreases, and the heart muscle doesn’t get the oxygen required to contract and pump blood to the rest of your body.  When you are at rest, your heart may receive enough blood flow despite the plaque. But as you exercise, the demand for oxygen increases. Lack of oxygen causes symptoms such as pain. The symptoms may resolve with rest. However, as coronary artery disease progresses, the pain may start to occur even when you are not exercising.

What are the symptoms?

Inadequate blood flow to the heart muscle causes chest pain, also known as angina, which can feel like pressure, tightness, or discomfort in the chest. Women may experience pain in areas other than the chest, including the neck, jaw, throat, back, arms or abdomen. Other heart attack symptoms in women include lightheadedness, dizziness, nausea, vomiting, and shortness of breath.  Since these symptoms seem atypical for cardiac pain, the diagnoses of heart disease may be delayed in women. Heart disease symptoms are different in women because coronary artery disease is different. In men, most of the plaque buildup and blockages are in major blood vessels of the heart, while in women, these blockages are more common in the smaller blood vessels that are branches of the main coronary arteries.

What are the risk factors?

Major risk factors include cigarette smoking, high blood pressure, diabetes, high cholesterol, and obesity. Your family history can also significantly impact your risk for heart disease. Make sure you know if your parents, grandparents, and siblings have experienced heart attacks or strokes, and share this information with your doctor. A family history of heart disease increases your risk, but it does not guarantee that you will be affected. There are actions you can take to lower your risk.

Are there specific risk factors for women?

Researchers have determined that estrogen benefits your blood vessels by decreasing the risk of plaque buildup, which may explain why heart disease is less common in younger women.  After menopause, which is confirmed after 12 consecutive months without a period, women produce less estrogen. Women who have early menopause, before age 45, are at higher risk of heart disease. Studies suggest that early in menopause, estrogen replacement therapy may be beneficial in decreasing the risk of heart disease. However, the benefit appears to diminish in later menopause, so the American Heart Association recommends against using hormone replacement therapy in late menopause.

How can women reduce their risk for heart disease?

  1. Have regular checkups with your doctor and stay current on cholesterol, blood pressure, blood glucose, body mass index, and waist circumference screenings.
  2. Exercise regularly
  3. Eat a healthful diet.
  4. Stay mentally healthy, as depression can increase your risk of cardiovascular disease.
  5. Find supportive people to help you stay healthy.

For more information on women and heart disease, go to the American Heart Association’s Go Red for Women website,

If you have a health question that you would like to be considered in Ask a Health Care Professional, please email [email protected]. BCBSNM will select questions that may appear. Questions will not be personally answered. The opinions expressed in this column are solely those of the author and not necessarily those of BCBSNM. This column is not intended to be a substitute for professional medical care.

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