by Julie Snyder
Cardiovascular disease (CVD) causes 8.6 million deaths among women annually. It is the largest single cause of mortality among women, accounting for a third of all deaths in women worldwide.(1)
In developing countries, half of all deaths of women over 50 are due to heart disease and stroke.
- Stroke accounts for a higher proportion of deaths among women than men (11% vs 8.4%). Among women, nearly 3 million of deaths by stroke occur each year.
- Coronary Heart Disease affects women approximately 10 years later than men, possibly because of the protective effect of estrogen prior to the onset of menopause.(2)
- Smoking is a major risk factor for CHD and stroke. Among women, the myocardial infraction risk is elevated by 1-7 fold in the case of moderate nicotine abuse and by 4 fold in the case of heavy smokers.(3) Among women, stroke is more likely to occur in smokers than non smokers.
- Passive smoking is also a coronary risk factor for women. It is associated with a 30% excess risk.(4)
- Women have additional risk factor for CHD and stroke; oral contraceptive use in combination with smoking.
The combination of oral contraception and consumption of up to 15 cigarettes per day is associated with a 3-5 fold increase in coronary risk, for women who smoke more than 15 cigarettes per day the increase rises to 20 fold.(5)
The state of health begins to improve immediately after quitting as the risk of heart attack reduces considerably already during the first 1-2 years. According to the WHO, one year after quitting the risk of CHD decreases by 50 percent, and within 15 years the relative risk of dying from CHD for an ex-smoker approaches that of a long-time non-smoker. According to several studies five years after quitting, the former smoker has no higher risk of stroke than the non-smoker.
- Women with hypertension experience a risk of developing CHD that is 3.5 times that of female with normal blood pressure.(7)
- Diabetes (Type II) is a first degree cardiovascular risk factor and it is a more serious risk factor among women. Diabetic women suffer from CHD risk 8 fold more than non diabetic (just 3 fold more among diabetic men).(8)
- Physical inactivity has been established as a major risk factor for CVD. Physical inactivity doubles the risk of developing heart disease and increases the risk of hypertension by 30%. It also doubles the risk of dying from cardiovascular disease and stroke.(9)
An important part of the world population, 60% to 85%, -- from both developed and developing countries -- is not physically active enough to gain health benefits, especially among girls and women. A WHO cross-national study (HBSC) shows that in all EU members states, boys are more physically active than girls. Even slight to moderate physical activity among women can achieve favorable preventive effects.(10)
- Obesity leads to an increased risk of premature death due to cardiovascular problems like hypertension, stroke and coronary heart disease. Hypertension, diabetes and raised serum cholesterol are between two and six times more prevalent among heavier women. Current prevalence data from individual national studies suggests that the range of obesity prevalence in a majority of countries is higher among women.(11)
- There is an association of psychosocial stress with CHD among women.(12) Marital stress worsens prognosis in women with coronary heart disease.(13)
1) WHO, World Health Report 2002
2) Stangl V et al. Coronary atherogenic risk factors in women. European Heart Journal (2002) 23, 1738-1752.
3) Doll R et all. Mortality in relation to smoking: 20 years' observation on female British doctors. BMJ 1980; 2: 967-71.
4) Law MR et al. Environmental tobacco smoke exposure and ischaemic heart disease: an evaluation of the evidence. BMJ 1997; 315:973-80.
5) Stampfer MJ et al. Primary prevention of coronary heart disease in women through diet and lifestyles. N Engl J Med 2000;343: 16-22.
6) Smoking and stroke : a causative role by Aldoori MI, Rahman SH. BMJ 1998; 317: 962-3.
7) Corrao JM et al. Coronary heart disease risk factors in women. Cardiology 1990; 77:8-12.
Laakso M et al. Does NIDDM increase the risk for coronary heart disease similarly in both low and high risk populations? Diabetologia 1995; 38: 487-93.
9) CDC collaboration center on Physical Activity and Health Promotion, 2000
10) Lee IM et al. Physical activity and coronary heart disease in women : Is "no pain, no gain" passé? JAMA 2001; 285: 1447-54.
11) IOTF, The global epidemic of obesity. 2002
12) Eaker ED. Psychosocial risk factors for coronary heart disease in women. Cardiol Clin 1998; 16 : 103-11.
13) Orth-Gomer K et al. The Stockholm Female Coronary Risk Study. JAMA 2000; 284: 3008-14
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