Signs & Symptoms of Coronary Artery Disease in Women

Coronary artery disease (CAD) is a leading cause of death in women, yet the symptoms often go unrecognized. Although women may experience the classic symptoms of pain in the chest and arm, shortness of breath and indigestion or heartburn, they are more likely to experience unusual fatigue or sleep disturbances. Treatments also differ in women compared with men. Women respond better to thrombolytic medications, whereas angioplasty is more effective in men.

What Is Coronary Artery Disease?

• CAD, also called coronary arteriosclerosis or coronary atherosclerosis, is the most common type of heart disease among men and women. It occurs when plaque forms on the inside walls of arteries, supplying blood and oxygen to the heart. The plaque narrows the arteries and restricts blood flow to the heart, which can lead to chest pain and heart attack. Over time, the heart muscle weakens and can fail. Although heart disease of all types is under-recognized among women, more women die from CAD than die from cancer, chronic obstructive pulmonary disorder, Alzheimer's disease, diabetes and car accidents combined.

Symptoms in Women

• Characteristic symptoms of CAD include chest pain (angina) or pain in other upper body areas, such as arms, shoulder or back; sweating, indigestion or heartburn; nausea or vomiting; dizziness and rapid or irregular heartbeat. Women with CAD may experience the classic symptoms, but they are also likely to experience less commonly recognized symptoms such as unusual fatigue, sleep disturbances, shortness of breath, indigestion and anxiety.

Risk Factors

• Women tend to be 10 years older than men when they first experience CAD symptoms. A woman's risk of CAD triples after menopause. High blood pressure, high cholesterol levels and high abdominal fat raise the risk of CAD, and all of these factors increase after menopause. Stress and anxiety tend to initiate heart attacks in women, whereas in men, exercise or exertion tend to be the precipitating factors. Other risk factors for women include smoking, family history of CAD, age older than 65 years and early menopause. Women often fail to seek proper care because they fail to recognize the symptoms as related to heart disease.

Prevention

• Women can prevent CAD by making a few lifestyle changes. Women should stop smoking, drink alcohol in moderation (maximum one drink per day), and exercise regularly, at least two and a half hours of moderate activity twice a week Additional suggestions to prevent heart disease include following a heart healthy diet, limiting saturated fats and cholesterol and maintaining a body mass index between 18.5 and 24.9 and a waist circumference less than 35 inches.

Treatment

• CAD treatment for women differs from treatments for men. Arterial plaque tends to build up in an even layer in women rather than the bulky, irregular plaque formation in men . Angioplasty and stents are ineffective for the smooth plaque in the arteries of women and medications produce a better result. Thrombolytics (drugs that breaks apart clots) are more effective in women than in men. Aspirin is more effective in preventing stroke in women compared with men, but it reduces the risk of heart attack more in men than in women. Other treatments include blood pressure medications, statins to reduce cholesterol levels, angiotensin converting enzymes and angiotensin receptor blockers. Estrogen replacement therapy does not prevent CAD and may even raise a woman's risk if she is 10 or more years past menopause.