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Heart disease fact sheet

African American woman Angela's story

In 1991, I went to the ER with chest pains twice in one week. They said it was ulcers (bleeding in the stomach). Then the pain became very intense. Again, the ER said there was nothing they could do. I refused to leave and was admitted for observation. Later, the doctor on duty saw my EKG and asked, "Where's the 34-year-old who had the massive heart attack?" I had emergency surgery. But the damage was done; only part of my heart muscle functions. I had to quit a job I loved, and my life is completely changed. They thought I was too young to have a heart attack.

What is heart disease?

Heart disease includes a number of problems affecting the heart and the blood vessels in the heart. Types of heart disease include:

  • Coronary artery disease (CAD) is the most common type and is the leading cause of heart attacks. When you have CAD, your arteries become hard and narrow. Blood has a hard time getting to the heart, so the heart does not get all the blood it needs. CAD can lead to:
    • Angina (an-JEYE-nuh). Angina is chest pain or discomfort that happens when the heart does not get enough blood. It may feel like a pressing or squeezing pain, often in the chest, but sometimes the pain is in the shoulders, arms, neck, jaw, or back. It can also feel like indigestion (upset stomach). Angina is not a heart attack, but having angina means you are more likely to have a heart attack.
    • Heart attack. A heart attack occurs when an artery is severely or completely blocked, and the heart does not get the blood it needs for more than 20 minutes.
  • Heart failure occurs when the heart is not able to pump blood through the body as well as it should. This means that other organs, which normally get blood from the heart, do not get enough blood. It does not mean that the heart stops. Signs of heart failure include:
    • Shortness of breath (feeling like you can't get enough air)
    • Swelling in feet, ankles, and legs
    • Extreme tiredness
  • Heart arrhythmias (uh-RITH-mee-uhz) are changes in the beat of the heart. Most people have felt dizzy, faint, out of breath or had chest pains at one time. These changes in heartbeat are harmless for most people. As you get older, you are more likely to have arrhythmias. Don't panic if you have a few flutters or if your heart races once in a while. If you have flutters and other symptoms such as dizziness or shortness of breath, call 911 right away.

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Do women need to worry about heart disease?

Yes. Among all U.S. women who die each year, one in four dies of heart disease. In 2004, nearly 60 percent more women died of cardiovascular disease (both heart disease and stroke) than from all cancers combined. The older a woman gets, the more likely she is to get heart disease. But women of all ages should be concerned about heart disease. All women should take steps to prevent heart disease.

Both men and women have heart attacks, but more women who have heart attacks die from them. Treatments can limit heart damage but they must be given as soon as possible after a heart attack starts. Ideally, treatment should start within one hour of the first symptoms.

If you think you're having a heart attack, call 911 right away. Tell the operator your symptoms and that you think you're having a heart attack.

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Do women of color need to worry about heart disease?

Yes. African American and Hispanic American/Latina women should be concerned about getting heart disease because they tend to have more risk factors than white women. These risk factors include obesity, lack of physical activity, high blood pressure, and diabetes. If you're a woman of color, take steps to reduce your risk factors.

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What can I do to prevent heart disease?

Take action to reduce heart disease risk:

  1. Be physically active
  2. Don't smoke
  3. Eat healthy
  4. Maintain a normal weight
  5. Know your numbers (blood pressure, cholesterol, and triglycerides)

You can reduce your chances of getting heart disease by taking these steps:

  • Know your blood pressure. Years of high blood pressure can lead to heart disease. People with high blood pressure often have no symptoms, so have your blood pressure checked every 1 to 2 years and get treatment if you need it.
  • Don't smoke. If you smoke, try to quit. If you're having trouble quitting, there are products and programs that can help:
    • Nicotine patches and gums
    • Support groups
    • Programs to help you stop smoking
    Ask your doctor or nurse for help. For more information on quitting, visit our section on Smoking and how to quit.
  • Get tested for diabetes. People with diabetes have high blood glucose (often called blood sugar). People with high blood glucose often have no symptoms, so have your blood glucose checked regularly. Having diabetes raises your chances of getting heart disease. If you have diabetes, your doctor will decide if you need diabetes pills or insulin shots. Your doctor can also help you make a healthy eating and exercise plan.
  • Get your cholesterol and triglyceride levels tested. High blood cholesterol (koh-LESS-tur-ol) can clog your arteries and keep your heart from getting the blood it needs. This can cause a heart attack. Triglycerides (treye-GLIH-suh-ryds) are a form of fat in your blood stream. High levels of triglycerides are linked to heart disease in some people. People with high blood cholesterol or high blood triglycerides often have no symptoms, so have both levels checked regularly. If your levels are high, talk to your doctor about what you can do to lower them. You may be able to lower your both levels by eating better and exercising more. Your doctor may prescribe medication to help lower your cholesterol.
  • Maintain a healthy weight. Being overweight raises your risk for heart disease. Calculate your Body Mass Index (BMI) to see if you are at a healthy weight. Healthy food choices and physical activity are important to staying at a healthy weight:
    • Start by adding more fruits, vegetables, and whole grains to your diet.
    • Each week, aim to get at least 2 hours and 30 minutes of moderate physical activity, 1 hour and 15 minutes of vigorous physical activity, or a combination of moderate and vigorous activity.
  • If you drink alcohol, limit it to no more than one drink (one 12 ounce beer, one 5 ounce glass of wine, or one 1.5 ounce shot of hard liquor) a day.
  • Find healthy ways to cope with stress. Lower your stress level by talking to your friends, exercising, or writing in a journal.

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What does high blood pressure have to do with heart disease?

Blood pressure is the force your blood makes against the walls of your arteries. The pressure is highest when your heart pumps blood into your arteries – when it beats. It is lowest between heart beats, when your heart relaxes. A doctor or nurse will write down your blood pressure as the higher number over the lower number. For instance, you could have a blood pressure of 110/70 (read as "110 over 70"). A blood pressure reading below 120/80 is usually considered normal. Very low blood pressure (lower than 90/60) can sometimes be a cause of concern and should be checked out by a doctor.

High blood pressure, or hypertension, is a blood pressure reading of 140/90 or higher. Years of high blood pressure can damage artery walls, causing them to become stiff and narrow. This includes the arteries carrying blood to the heart. As a result, your heart cannot get the blood it needs to work well. This can cause a heart attack.

A blood pressure reading of 120/80 to 139/89 is considered prehypertension. This means that you don't have high blood pressure now but are likely to develop it in the future.

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How can I lower my blood pressure?

If you have hypertension or prehypertension, you may be able to lower your
blood pressure by:

  • Losing weight if you are overweight or obese
  • Getting at least 2 hours and 30 minutes of moderate physical activity or 1 hour and 15 minutes of vigorous activity each week.
  • Limiting alcohol to one drink per day
  • Quitting smoking if you smoke
  • Reducing stress
  • Following the DASH (Dietary Approaches to Stop Hypertension) Eating Plan, which includes cutting down on salt and sodium and eating healthy foods, such as fruits, vegetables, and low-fat dairy products

If lifestyle changes do not lower your blood pressure, your doctor may prescribe medicine.

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What does high cholesterol have to do with heart disease?

Cholesterol is a waxy substance found in cells in all parts of the body. When there is too much cholesterol in your blood, cholesterol can build up on the walls of your arteries and cause blood clots. Cholesterol can clog your arteries and keep your heart from getting the blood it needs. This can cause a heart attack.

There are two types of cholesterol:

  • Low-density lipoprotein (LDL) is often called the "bad" type of cholesterol because it can clog the arteries that carry blood to your heart. For LDL, lower numbers are better.
  • High-density lipoprotein (HDL) is known as "good" cholesterol because it takes the bad cholesterol out of your blood and keeps it from building up in your arteries. For HDL, higher numbers are better.

All women age 20 and older should have their blood cholesterol and triglyceride levels checked at least once every 5 years.

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What do my cholesterol and triglyceride numbers mean?

Total cholesterol level – Lower is better. Less than 200 mg/dL is best.
Total cholesterol levelCategory
Less than 200 mg/dLDesirable
200 - 239 mg/dLBorderline high
240 mg/dL and aboveHigh
LDL (bad) cholesterol – Lower is better. Less than 100 mg/dL is best.
LDL cholesterol levelCategory
Less than 100 mg/dLOptimal
100-129 mg/dLNear optimal/above optimal
130-159 mg/dLBorderline high
160-189 mg/dLHigh
190 mg/dL and aboveVery high

HDL (good) cholesterol - Higher is better. More than 60 mg/dL is best.

Triglyceride levels - Lower is better. Less than 150mg/dL is best.

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How can I lower my cholesterol?

You can lower your cholesterol by taking these steps:

  • Maintain a healthy weight. If you are overweight, losing weight can help lower your total cholesterol and LDL ("bad cholesterol") levels. Calculate your Body Mass Index (BMI) to see if you are at a healthy weight. If not, try making small changes like eating an apple instead of potato chips, taking the stairs instead of the elevator, or parking farther away from the entrance to your office, the grocery store, or the mall. (But be sure to park in a safe, well-lit spot.)
  • Eat better. Eat foods low in saturated fats, trans fats, and cholesterol.
  • Eat more:
    • Fish, poultry (chicken, turkey--breast meat or drumstick is best), and lean meats (round, sirloin, tenderloin). Broil, bake, roast, or poach foods. Remove the fat and skin before eating.
    • Skim (fat-free) or low-fat (1%) milk and cheeses, and low-fat or nonfat yogurt
    • Fruits and vegetables (try for 5 a day)
    • Cereals, breads, rice, and pasta made from whole grains (such as "whole-wheat" or "whole-grain" bread and pasta, rye bread, brown rice, and oatmeal)
  • Eat less:
    • Organ meats (liver, kidney, brains)
    • Egg yolks
    • Fats (butter, lard) and oils
    • Packaged and processed foods

There are two diets that may help lower your cholesterol:

Get moving. Exercise can help lower LDL ("bad cholesterol") and raise HDL ("good cholesterol"). Exercise at a moderate intensity for at least 2 hours and 30 minutes each week, or get 1 hour and 15 minutes of vigorous intensity physical activity each week.

  • Take your medicine. If your doctor has prescribed medicine to lower your cholesterol, take it exactly as you have been told to.

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How do I know if I have heart disease?

Heart disease often has no symptoms. But, there are some signs to watch for. Chest or arm pain or discomfort can be a symptom of heart disease and a warning sign of a heart attack. Shortness of breath (feeling like you can't get enough air), dizziness, nausea (feeling sick to your stomach), abnormal heartbeats, or feeling very tired also are signs. Talk with your doctor if you're having any of these symptoms. Tell your doctor that you are concerned about your heart. Your doctor will take a medical history, do a physical exam, and may order tests.

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What are the signs of a heart attack?

For both women and men, the most common sign of a heart attack is:

  • Pain or discomfort in the center of the chest. The pain or discomfort can be mild or strong. It can last more than a few minutes, or it can go away and come back.

Other common signs of a heart attack include:

  • Pain or discomfort in one or both arms, back, neck, jaw, or stomach
  • Shortness of breath (feeling like you can't get enough air). The shortness of breath often occurs before or along with the chest pain or discomfort.
  • Nausea (feeling sick to your stomach) or vomiting
  • Feeling faint or woozy
  • Breaking out in a cold sweat

Women are more likely than men to have these other common signs of a heart attack, particularly shortness of breath, nausea or vomiting, and pain in the back, neck, or jaw. Women are also more likely to have less common signs of a heart attack, including:

  • Heartburn
  • Loss of appetite
  • Feeling tired or weak
  • Coughing
  • Heart flutters

Sometimes the signs of a heart attack happen suddenly, but they can also develop slowly, over hours, days, and even weeks before a heart attack occurs.

The more heart attack signs that you have, the more likely it is that you are having a heart attack. Also, if you've already had a heart attack, your symptoms may not be the same for another one. Even if you're not sure you're having a heart attack, you should still have it checked out.

If you think you, or someone else, may be having a heart attack, wait no more than a few minutes—five at most—before calling 911.

illustration of a woman's body showing how a heart attack affects the body, inside and out

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One of my family members had a heart attack. Does that mean I'll have one too?

If your dad or brother had a heart attack before age 55, or if your mom or sister had one before age 65, you're more likely to develop heart disease. This does not mean you will have a heart attack. It means you should take extra good care of your heart to keep it healthy.

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Sometimes my heart beats really fast and other times it feels like my heart skips a beat. Am I having a heart attack?

Most people have changes in their heartbeat from time to time. These changes in heartbeat are, for most people, harmless. As you get older, you're more likely to have heartbeats that feel different. Don't panic if you have a few flutters or if your heart races once in a while. If you have flutters and other symptoms such as dizziness or shortness of breath (feeling like you can't get enough air), call 911.

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Should I take a daily aspirin to prevent heart attack?

Aspirin may be helpful for women at high risk, such as women who have already had a heart attack. Aspirin can have serious side effects and may be harmful when mixed with certain medicines. If you're thinking about taking aspirin, talk to your doctor first. If your doctor thinks aspirin is a good choice for you, be sure to take it exactly as your doctor tells you to.

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Does taking birth control pills increase my risk for heart disease?

Taking birth control pills is generally safe for young, healthy women if they do not smoke. But birth control pills can pose heart disease risks for some women, especially women older than 35; women with high blood pressure, diabetes, or high cholesterol; and women who smoke. Talk with your doctor if you have questions about the pill.

If you're taking birth control pills, watch for signs of trouble, including:

  • Eye problems such as blurred or double vision
  • Pain in the upper body or arm
  • Bad headaches
  • Problems breathing
  • Spitting up blood
  • Swelling or pain in the leg
  • Yellowing of the skin or eyes
  • Breast lumps
  • Unusual (not normal) heavy bleeding from your vagina

If you have any of these symptoms, call 911.

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Does using the birth control patch increase my risk for heart disease?

The patch is generally safe for young, healthy women. The patch can pose heart disease risks for some women, especially women older than 35; women with high blood pressure, diabetes, or high cholesterol; and women who smoke.

Recent studies show that women who use the patch may be exposed to more estrogen than women who use the birth control pill. Estrogen is the female hormone in birth control pills and the patch that keeps you from getting pregnant. Research is underway to see if the risk for blood clots is higher in patch users. Blood clots can lead to heart attack or stroke. Talk with your doctor if you have questions about the patch.

If you're using the patch, watch for signs of trouble, including:

  • Eye problems such as blurred or double vision
  • Pain in the upper body or arm
  • Bad headaches
  • Problems breathing
  • Spitting up blood
  • Swelling or pain in the leg
  • Yellowing of the skin or eyes
  • Breast lumps
  • Unusual (not normal) heavy bleeding from your vagina

If you have any of these symptoms, call 911.

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Does menopausal hormone therapy (MHT) increase a woman's risk for heart disease?

Menopausal hormone therapy (MHT) can help with some symptoms of menopause, including hot flashes, vaginal dryness, mood swings, and bone loss, but there are risks, too. For some women, taking hormones can increase their chances of having a heart attack or stroke. If you decide to use hormones, use them at the lowest dose that helps for the shortest time needed. Talk with your doctor if you have questions about MHT.

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More information on heart disease

For more information about heart disease, call womenshealth.gov at 800-994-9662 (TDD: 888-220-5446) or contact the following organizations:

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The information on our website is provided by the U.S. federal government and is in the public domain. This public information is not copyrighted and may be reproduced without permission, though citation of each source is appreciated.

Heart disease fact sheet was reviewed by:

Patrice Desvigne-Nickens, M.D.
Program Director
Heart Failure & Arrhythmias Branch
Division of Cardiovascular Diseases
National Heart, Lung, and Blood Institute

Content last updated: July 16, 2012.

Resources last updated: February 02, 2009.

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