Tip Sheet on Womens Risk Factors for Heart Disease and Stroke

American Heart Association: 1-800-AHA-USA-1 (1-800-242-8721), 24 hours a day, 7 days a week Heart Attack Major risk factors you cannot change The risk factors on this list are ones you're born with and cannot be changed. The more of these risk factors you have, the greater your chance of developing coronary heart disease. Since you can't do anything about these risk factors, it's even more important for you to manage the risk factors that can be changed. Increasing Age: About 82 percent of people who die of coronary heart disease are 65 or older. At older ages, women who have heart attacks are more likely than men are to die from them within a few weeks. Male Sex (Gender): Men have a greater risk of heart attack than women do, and they have attacks earlier in life. Even after menopause, when women's death rate from heart disease increases, it's not as great as men's. Heredity (Including Race): Children of parents with heart disease are more likely to develop it themselves. African Americans have more severe high blood pressure than Caucasians and a higher risk of heart disease. Heart disease risk is also higher among Mexican Americans, American Indians, native Hawaiians and some Asian Americans. This is partly due to higher rates of obesity and diabetes. Most people with a strong family history of heart disease have one or more other risk factors. Just as you can't control your age, sex and race, you can't control your family history. Therefore, it's even more important to treat and control any other risk factors you have. Major risk factors you can modify, treat or control by changing your lifestyle or taking medicine Tobacco smoke: Smokers' risk of developing coronary heart disease is 2-4 times that of nonsmokers. People who smoke a pack of cigarettes a day have more than twice the risk of heart attack than people whove never smoked. Cigarette smoking is a powerful independent risk factor for sudden cardiac death in patients with coronary heart disease. Cigarette smoking also acts with other risk factors to greatly increase the risk for coronary heart disease. People who smoke cigars or pipes seem to have a higher risk of death from coronary heart disease (and possibly stroke) but their risk isn't as great as cigarette smokers'. Exposure to other people's smoke increases the risk of heart disease even for nonsmokers. High blood cholesterol: As blood cholesterol rises, so does risk of coronary heart disease. When other risk factors (such as high blood pressure and tobacco smoke) are present, this risk increases even more. A person's cholesterol level is also affected by age, sex, heredity and diet. Here's the lowdown on where those numbers need to be: o Total Cholesterol: Less than 200 mg/dL o LDL (bad) Cholesterol: o If you're at low risk for heart disease: Less than 160 mg/dL o If you're at intermediate risk for heart disease: Less than 130 mg/dL o If you're at high risk for heart disease (including those with existing heart disease or diabetes): Less than 100mg/dL o HDL (good) Cholesterol: 40 mg/dL or higher for men and 50 mg/dL or higher for women o Triglycerides: Less than 150 mg/dL High blood pressure: High blood pressure increases the heart's workload, causing the heart to thicken and become stiffer. This stiffening of the heart muscle is not normal, and causes the heart not to work properly. It also increases your risk of stroke, heart attack, kidney failure and congestive heart failure. When high blood pressure exists with obesity, smoking, high blood cholesterol levels or diabetes, the risk of heart attack or stroke increases several times. Physical inactivity: An inactive lifestyle is a risk factor for coronary heart disease. Regular, moderate-to-vigorous physical activity helps prevent heart and blood vessel disease. The more vigorous the activity, the greater your benefits. However, even moderateintensity activities help if done regularly and long term. Physical activity can help control blood cholesterol, diabetes and obesity, as well as help lower blood pressure in some people. Obesity and overweight: People who have excess body fat especially if a lot of it is at the waist are more likely to develop heart disease and stroke even if they have no other risk factors. Excess weight increases the heart's work. It also raises blood pressure and blood cholesterol and triglyceride levels, and lowers HDL ("good") cholesterol levels. It can also make diabetes more likely to develop. Many obese and overweight people may have difficulty losing weight. But by losing even as few as 10 pounds, you can lower your heart disease risk. Diabetes mellitus: Diabetes seriously increases your risk of developing cardiovascular disease. Even when glucose levels are under control, diabetes increases the risk of heart disease and stroke, but the risks are even greater if blood sugar is not well controlled. At least 65% of people with diabetes die of some form of heart or blood vessel disease. If you have diabetes, it's extremely important to work with your healthcare provider to manage it and control any other risk factors you can. Persons who are obese or overweight should lose weight to keep blood sugar in control. For more information about coronary heart disease and heart attack: American Heart Associations Understand Your Risk of Heart Attack Page: http://www.heart.org/HEARTORG/Conditions/HeartAttack/UnderstandYourRiskofHeartAttack/Understand-Your-Risk-of-HeartAttack_UCM_002040_Article.jsp#

High Cholesterol (no information on the risk factor page) High cholesterol is one of the major controllable risk factors for coronary heart disease, heart attack and stroke. As your blood cholesterol rises, so does your risk of coronary heart disease. If you have other risk factors (such as high blood pressure or diabetes) as well as high cholesterol, this risk increases even more. The more risk factors you have, the greater your chance of developing coronary heart disease. Also, the greater the level of each risk factor, the more that factor affects your overall risk. LDL cholesterol is produced naturally by the body, but many people inherit genes from their mother, father or even grandparents that cause them to make too much. Eating saturated fat, trans fats and dietary cholesterol also increases how much you have. If high blood cholesterol runs in your family, lifestyle modifications may not be enough to help lower your LDL blood cholesterol. Everyone is different, so work with your doctor to find a treatment plan that's best for you. When too much LDL (bad) cholesterol circulates in the blood, it can slowly build up in the inner walls of the arteries that feed the heart and brain. Together with other substances, it can form plaque, a thick, hard deposit that can narrow the arteries and make them less flexible. This condition is known as atherosclerosis. If a clot forms and blocks a narrowed artery, a heart attack or stroke can result. For more information about high cholesterol: American Heart Associations Understand Your Risk for High Cholesterol: http://www.heart.org/HEARTORG/Conditions/Cholesterol/UnderstandYourRiskforHighCholesterol/Understand-Your-Risk-for-HighCholesterol_UCM_001213_Article.jsp High Blood Pressure Family history: Height, hair and eye color runs in families --- so can high blood pressure. If your parents or close blood relatives have had HBP, you are more likely to develop it, too. You might also pass that risk factor on to your children. That's why it's important for children as well as adults to have regular blood pressure checks. You can't control heredity, but you can take steps to live a healthy life and lower your other risk factors. Lifestyle choices have allowed many people with a strong family history of HBP to avoid it themselves. Learn about lifestyle changes you can make to prevent HBP. Advanced age: As we age, we all develop higher risk for high blood pressure and cardiovascular disease. Blood vessels lose flexibility with age which can contribute to increasing pressure throughout the system. Gender-related risk patterns: A higher percentage of men than women have HBP until 45 years of age. From ages 45 to 54 and 55 to 64, the percentages of men and women with HBP are similar. After that, a much higher percentage of women have HBP than men. Lack of physical activity: Physical activity is good for your heart and circulatory system. An inactive lifestyle increases the chance of high blood pressure, heart disease, blood vessel disease and stroke. Inactivity also makes it easier to become overweight or obese. Give yourself the gift of improved health and lower blood pressure with regular, moderate-to-vigorous physical activity. Poor diet, especially one that includes too much salt: To care for our bodies, we all need good nutrition from a variety of food sources. A diet that's high in calories, fats and sugars and low in essential nutrients contributes directly to poor health as well as to obesity. In addition, there are some problems that can happen from eating too much salt. Some people are "salt sensitive," meaning a high-salt (sodium) diet raises their high blood pressure. Salt keeps excess fluid in the body that can add to the burden on the heart. While too much salt can be dangerous, healthy food choices can actually lower blood pressure. Learn about enjoying a heart-healthy diet. Overweight and obesity: Being overweight increases your chances of developing high blood pressure. A body mass index between 25 and 30 is considered overweight. A body mass index over 30 is considered obese. About two-thirds (66.3%) of U.S. adults are overweight or obese (about 144 million adults). Nearly one in three (31.9%) U.S. children (23,500,000) ages 2 to 19 are overweight or obese. Excess weight increases the strain on the heart, raises blood cholesterol and triglyceride levels, and lowers HDL (good) cholesterol levels. It can also make diabetes more likely to develop. Losing as little as 10 to 20 pounds can help lower your blood pressure and your heart disease risk. To successfully and healthfully lose weightand keep it offmost people need to subtract about 500 calories per day from their diet to lose about 1 pound per week. Calculate your body mass index and learn how to manage your weight. Drinking too much alcohol: Heavy and regular use of alcohol can increase blood pressure dramatically. It can also cause heart failure, lead to stroke and produce irregular heartbeats. Too much alcohol can contribute to high triglycerides, cancer and other diseases, obesity, alcoholism, suicide and accidents. If you drink alcohol, do so in moderation. If you drink, limit your alcohol consumption to no more than two drinks per day for men and one drink per day for women. One drink equals a 12-ounce beer, a five-ounce glass of wine, 1.5 ounces of 80-proof liquor, or one ounce of hard liquor (100-proof). If you drink in excess, find out about curbing alcohol intake. Possible contributing factors There is some connection between blood pressure and these factors but science has not proven that they actually cause high blood pressure. Stress: Being in a stressful situation can temporarily increase your blood pressure, but science has not proven that stress causes high blood pressure. Some scientists have noted a relationship between coronary heart disease risk and stress in a person's life, health behaviors and socioeconomic status. How you deal with stress may affect other, established risk factors for high blood pressure or heart disease. For example, people under stress may overeat or eat a less healthy diet, put off physical activity, drink, smoke or misuse drugs.

Smoking and second-hand smoke: Smoking temporarily raises blood pressure and increases your risk of damaged arteries. The use of tobacco can be devastating to your health, especially if you're already at risk for high blood pressure. Secondhand smoke --- exposure to other people's smoke --- increases the risk of heart disease for nonsmokers. Sleep Apnea: Some 12 million Americans have sleep apnea, according to National Heart, Lung, and Blood Institute estimates. Sleep Apnea is a potentially life-threatening sleep disorder in which tissues in the throat collapse and block the airway. The brain forces the sleeper awake enough to cough or gulp air and open the trachea up again. But then, the whole cycle starts all over again. Pauses in breathing can contribute to severe fatigue during the day, increase your safety risks, and make it difficult to perform tasks that require alertness. Sleep apnea is also a risk factor for such medical problems as high blood pressure, heart failure, diabetes and stroke.

Secondary hypertension: HBP caused by a pre-existing problem In 5-10 percent of high blood pressure cases, the HBP is caused by a pre-existing problem. This type of HBP is called secondary hypertension because another problem was present first. Factors that may lead to secondary hypertension include: Kidney abnormality, including a tumor on the adrenal gland, which is located on top of the kidneys A structural abnormality of the aorta (the large blood vessel leaving the heart) that has existed since birth Narrowing of certain arteries The good news is that these pre-existing problems can usually be fixed. For example, doctors can repair a narrowed artery that supplies blood to a kidney. Once the root cause of secondary hypertension is corrected, blood pressure typically returns to normal. For those with HBP, a physical exam and some tests can help your doctor determine whether your high blood pressure is primary or secondary hypertension. For more information about high blood pressure: American Heart Associations Understand Your Risk for High Blood Pressure: http://www.heart.org/HEARTORG/Conditions/HighBloodPressure/UnderstandYourRiskforHighBloodPressure/Understand-Your-Risk-forHigh-Blood-Pressure_UCM_002052_Article.jsp Stroke Major risk factors you cannot change Age: The chance of having a stroke approximately doubles for each decade of life after age 55. While stroke is common among the elderly, a lot of people under 65 also have strokes. Heredity (family history) and race: Your stroke risk is greater if a parent, grandparent, sister or brother has had a stroke. African Americans have a much higher risk of death from a stroke than Caucasians do. This is partly because blacks have higher risks of high blood pressure, diabetes and obesity. Sex (gender): Stroke is more common in men than in women. In most age groups, more men than women will have a stroke in a given year. However, more than half of total stroke deaths occur in women. At all ages, more women than men die of stroke. Use of birth control pills and pregnancy pose special stroke risks for women. Prior stroke, TIA or heart attack: The risk of stroke for someone who has already had one is many times that of a person who has not. Transient ischemic attacks (TIAs) are "warning strokes" that produce stroke-like symptoms but no lasting damage. TIAs are strong predictors of stroke. A person who's had one or more TIAs is almost 10 times more likely to have a stroke than someone of the same age and sex who hasn't. Recognizing and treating TIAs can reduce your risk of a major stroke. If you've had a heart attack, you're at higher risk of having a stroke, too. TIA should be considered a medical emergency and followed up immediately with a healthcare professional. What stroke risk factors can be changed, treated and controlled? High blood pressure: High blood pressure is the leading cause of stroke and the most important controllable risk factor for stroke. Many people believe the effective treatment of high blood pressure is a key reason for the accelerated decline in the death rates for stroke. Cigarette smoking: In recent years, studies have shown cigarette smoking to be an important risk factor for stroke. The nicotine and carbon monoxide in cigarette smoke damage the cardiovascular system in many ways. The use of oral contraceptives combined with cigarette smoking greatly increases stroke risk. Diabetes mellitus: Diabetes is an independent risk factor for stroke. Many people with diabetes also have high blood pressure, high blood cholesterol and are overweight. This increases their risk even more. While diabetes is treatable, the presence of the disease still increases your risk of stroke. Carotid or other artery disease: The carotid arteries in your neck supply blood to your brain. A carotid artery narrowed by fatty deposits from atherosclerosis (plaque buildups in artery walls) may become blocked by a blood clot. Carotid artery disease is also called carotid artery stenosis. Peripheral artery disease is the narrowing of blood vessels carrying blood to leg and arm muscles. It's caused by fatty buildups of plaque in artery walls. People with peripheral artery disease have a higher risk of carotid artery disease, which raises their risk of stroke.

Atrial fibrillation: This heart rhythm disorder raises the risk for stroke. The heart's upper chambers quiver instead of beating effectively, which can let the blood pool and clot. If a clot breaks off, enters the bloodstream and lodges in an artery leading to the brain, a stroke results. Other heart disease: People with coronary heart disease or heart failure have a higher risk of stroke than those with hearts that work normally. Dilated cardiomyopathy (an enlarged heart), heart valve disease and some types of congenital heart defects also raise the risk of stroke. Sickle cell disease (also called sickle cell anemia): This is a genetic disorder that mainly affects African-American and Hispanic children. "Sickled" red blood cells are less able to carry oxygen to the body's tissues and organs. These cells also tend to stick to blood vessel walls, which can block arteries to the brain and cause a stroke. High blood cholesterol: People with high blood cholesterol have an increased risk for stroke. Also, it appears that low HDL (good) cholesterol is a risk factor for stroke in men, but more data are needed to verify its effect in women. Poor diet: Diets high in saturated fat, trans fat and cholesterol can raise blood cholesterol levels. Diets high in sodium (salt) can contribute to increased blood pressure. Diets with excess calories can contribute to obesity. Also, a diet containing five or more servings of fruits and vegetables per day may reduce the risk of stroke. Physical inactivity and obesity: Being inactive, obese or both can increase your risk of high blood pressure, high blood cholesterol, diabetes, heart disease and stroke. So go on a brisk walk, take the stairs, and do whatever you can to make your life more active. Try to get a total of at least 30 minutes of activity on most or all days.

For more information about stroke: American Stroke Associations Understand Your Risk for Stroke: http://www.strokeassociation.org/STROKEORG/AboutStroke/UnderstandingRisk/Understanding-Risk_UCM_308539_SubHomePage.jsp