Treatment Options for Women

Women* (assigned female at birth) benefit from the same types of treatment for heart disease as men* (assigned male at birth) when appropriately applied. This isn’t to say that treatment should be “one size fits all” for everyone, but that the same kinds of treatment are effective. In fact, every patient with heart disease is an individual, and the treating doctor will use professional practice guidelines and experience to create a treatment plan that meets that patient’s medical needs and quality-of-life expectations.

The range of treatment options includes the following:

• Lifestyle changes such as eating a heart-healthy diet, exercising, and quitting smoking
• Medications such as aspirin, antiplatelets, beta-blockers, and statins
• Interventional procedures such as angioplasty and stenting
• Surgery such as coronary artery bypass graft surgery (CABG)

As more females enroll in clinical trials and other studies, more information should emerge about how to treat females with heart disease best.

Lifestyle

You can take control of your heart health by making some lifestyle changes. Don't wait until you have a heart attack. If you think changing aspects of your lifestyle is inconvenient, remember the alternative—the potentially devastating consequences of a heart attack or stroke.

1. Stop smoking!

If you smoke, the good news is you can do something right now to reduce your risk for heart disease: Stop smoking! Individuals who smoke, especially those who are overweight and those who take birth control pills and other hormone-based contraceptives, are at the highest risk.

Females who smoke have a 25% higher risk of developing heart disease than males who smoke. And continuing to smoke throughout your life shaves 13–14 years off of it.¹

Talk to your doctor about tools and techniques to help you stop smoking, or look online for a support group.

2. Lose weight based on your diagnosis

Depending on your diagnosis, your doctor may recommend you try to lose weight to improve your cardiovascular health. Maintaining a healthy weight for cardiovascular health is especially critical if your father had a heart attack before age 50 or your mother before age 60.

If you’re struggling to maintain a healthy weight, your doctor can help. You can also visit your local library or search the internet for free information, tools, and support.

3. Lower your cholesterol levels

High LDL cholesterol—the so-called “bad” cholesterol—can increase plaque buildup in the heart's arteries (atherosclerosis). Having low HDL or "good" cholesterol levels is also unhealthy. Your ideal blood cholesterol level depends on age, biological sex, and history of heart disease. Lowering LDL is usually the primary goal of reducing cardiovascular risk. This is primarily done with a very important class of medications called statins, although alternative medications can be used in some patients. Despite the fact that low HDL is a marker for heart disease, there have been no studies that have shown that using medications to raise HDL results in a decrease in heart attack risk.

4. Learn more about menopause

If you’re a younger, premenopausal individual, you’re not immune to heart disease, especially if you smoke or have diabetes, but you have a lower risk of heart disease than males. But, unfortunately, that advantage doesn't extend beyond menopause. Your LDL or “bad” cholesterol can rise as much as 10% in the years before and after menopause begins—the time period that coincides with a significant drop in levels of estrogen.

• Estrogen replacement – Given the previous statement about menopause, it may seem logical that estrogen replacement therapies would offer some protection against heart disease. Still, large studies have found that's not the case. Estrogen replacement therapies don’t seem to lower the risk of heart disease after menopause and may cause other problems. The Women's Health Initiative, a study by the National Institutes of Health (NIH), has raised serious concerns about the risks of hormones for postmenopausal individuals. Because of these findings, the U.S. Food and Drug Administration (FDA) requires a warning on estrogen-containing products for postmenopausal individuals.
• Iron after menopause – Another reason researchers believe the risk of heart disease is lower in younger individuals is that they lose iron when they menstruate. That may initially seem bad, but after menopause, when individuals no longer lose that iron, it builds up in organs such as the heart and increases the risk of heart disease. If you’re taking iron supplements, check with your doctor to make sure you should continue to take iron after menopause.
• Blood pressure after menopause – You should watch for increases in blood pressure after menopause.
• Early menopause – Whether it occurs naturally or as a result of surgery, menopause before age 40 is associated with an increased risk for heart disease, according to the American Heart Foundation.

5. Control your diabetes

Females with diabetes are at greater risk for developing heart disease than males. In fact, it’s such a serious risk factor that before menopause, females with diabetes have the same risk for heart disease as males.

6. Ask about your birth control pills

Birth control pills may place some individuals at a higher risk of high blood pressure and blood clots that can cause a stroke or heart attack. Individuals over age 35; smokers; and individuals with high blood pressure, diabetes, or unhealthy cholesterol levels are most at risk. The birth control patch may pose a greater risk because of its higher estrogen levels. The connection between birth control pills and the risk of heart disease remains unclear. If you have other risk factors, such as a history of heart disease in your family or if you’re a smoker, talk to your physician about your concerns and options.

7. Know the link between pregnancy complications and heart disease

New evidence suggests that individuals who developed certain pregnancy complications such as preeclampsia (a condition in which the mother develops hypertension and significant amounts of protein in the urine during pregnancy) or gestational diabetes, or those who deliver low-birth-weight babies are at greater risk of developing heart disease.

A 2007 study published in the British Medical Journal found that individuals with preeclampsia have double the risk of developing heart disease later in life. As for those with gestational diabetes, 20–60% will develop type 2 diabetes within five years of their pregnancy, according to the American Diabetes Association, putting them at a six times greater risk of heart disease.

If you’ve experienced pregnancy complications, you must work closely with your doctor to aggressively manage these risk factors for the rest of your life.

8. Monitor C-reactive protein (CRP)

Studies have suggested that CRP, a protein in the blood that indicates inflammation in the body, may indicate a greater risk of heart disease. Evidence suggests CRP may be a stronger marker of heart disease in females than males. CRP levels can be monitored through a simple blood test. Ask your doctor if you should have this test.

9. Calcium scoring

A recent technology in preventive cardiology, called calcium scoring, may be performed in some patients to assess the presence of plaque (atherosclerosis) in the coronary arteries. This is a quick, simple test involving a low-resolution (low-radiation dose) computerized tomography (CT) scan of the heart, which shows “specks” of plaque in the coronary arteries of the heart. If plaque is present on a calcium score, your doctor may recommend medications, such as statins, to reduce your future risk of a heart attack.
 

*The term “women” in the context of “women’s cardiovascular health” applies to individuals assigned female at birth (AFAB) who have a female biological reproductive system, which includes a vagina, uterus, ovaries, Fallopian tubes, accessory glands, and external genital organs.

*The term “men” in the context of “cardiovascular health” applies to individuals assigned male at birth (AMAB) who have a male biological reproductive system, which includes a penis, scrotum, testes, epididymis, vas deferens, prostate, and seminal vesicles.