Heart disease remains the No. 1 killer of women in the U.S.

Approximately one woman dies every minute from heart disease in this country, and the rate of decline in heart disease overall has been less prevalent among women.¹ Every year since 1984 more women have died of heart disease than men, yet many women are still unaware of their biggest health threat. 

The National Heart Lung and Blood Institute's Red Dress/Heart Truth campaign, which began in 2001, and the American Heart Association's Go Red campaign, which began in 2004, were both developed to educate and increase women's awareness of heart disease. 

How well are we doing?  The American Heart Association conducted random surveys in 1997, 2000, and 2003, asking women to identify their leading cause of death.  The percentage answering correctly was 30 percent, 34 percent, and 46 percent, respectively.² 

A Lifetime Women's Pulse Poll released in February 2006 found that only 54 percent of the women surveyed were able to correctly identify heart disease as their leading cause of death.  Among those who correctly identified heart disease as the leading cause of death, the majority still perceived cancer as their greatest health risk. 

Even though awareness overall among women has significantly increased, there is still a large population of women who are unaware of their risk and women who are not personalizing this information.

Lack of Physician Awareness

In February 2004, the American Heart Association published for the first time specific guidelines for cardiovascular disease prevention in women.³  

A random national study of primary care physicians (PCP), OB-GYN physicians, and cardiologists was conducted in November 2004 to evaluate physician awareness and adherence to these gender specific guidelines. 

Approximately 60 percent of the PCPs and ob/gyns, and 80 percent of the cardiologists stated they were aware of the women's heart disease preventative guidelines.⁴  Of the physicians who were aware of the guidelines only about 40 percent of the PCPs and cardiologists, and only 20 percent of the ob/gyns stated they actually utilized the guidelines in the care of their female patients.⁴ 

Another alarming finding from this study was that only 8 percent of PCPs, 13 percent of ob/gyns, and 17 percent of cardiologists knew that heart disease kills more women than men every year.⁴ 

Educating Providers

In order to effectively modify heart disease risk factors and decrease heart disease mortality in women, healthcare providers require additional education. 

In March 2007, updated women's heart disease prevention guidelines were released by the American Heart Association which focus on lowering the lifetime risk of heart disease in women and more aggressive strategies for higher risk women, as indicated in the following table from the prevention guidelines:

1. Smoking cessation, avoid second hand smoke
2. Thirty minutes of moderate-intensity activity all or most days of the week, 60 to 90 minutes of daily activity in women trying to lose weight/sustain weight loss
3. Diet rich in fruits/vegetables, whole-grain, high-fiber foods, fish twice a week, limit alcohol intake to no more than one drink a day, and limit sodium intake to less then 2.3 grams/day (1 teaspoon salt/day).
4. Maintain BMI less than 25 kg/m2, waist circumference less than 35 inches.⁵ 

Evaluating Risk Factors

The majority of the risk factors that can lead to the development of heart disease are similar for both men and women. They include non-modifiable and modifiable risk factors: 

Non-modifiable risk factors:

1. Increased age (menopause)
2. Family history of heart disease

Modifiable risk factors:

1. Dyslipidemia
2. Hypertension
3. Physical inactivity
4. Overweight/Obesity
5. Smoking
6. Emotional stress
7. Diabetes/Metabolic syndrome

One unique risk factor women experience is menopause.  Prior to menopause estrogen protects most women from developing heart disease.⁶  After menopause (and the loss of estrogen) a clustering of heart disease risk factors occurs (including dyslipidemia, hypertension, and weight gain) which dramatically increases a woman's risk for heart attacks and strokes.  

Vital Screenings

As nurses we are on the forefront; we are vital patient advocates and patient educators.  We all need to work towards a common goal of educating women about heart disease risk factors and the optimal values: 

• Total Cholesterol of less than 200 mg/dl.                                                         
• HDL (good) Cholesterol over 50 mg/dl.
• LDL (bad) Cholesterol less than 100 mg/dl (less than 70 mg/dl if high risk).       
• Triglycerides less than 150 mg/dl.
• Fasting Blood Sugar less than 100 mg/dl.
• Hemoglobin A1C less than 7 percent
• Blood pressure: Optimal is less than 120/80mmHg; Normal is 120/80-129/84mmHg.⁵