Heart Disease

Types and Causes

There are many types of heart disease. Fifteen million people in the United States have coronary heart disease, the most common and widespread form, which is caused by fatty deposits on artery walls. It often [Page 678]leads to angina (chest pain) and heart attack (myocardial infarction). Other common types of heart disease include cardiomyopathy (deterioration of heart muscle function), ischemic heart disease (reduced blood supply to the heart and organs), hypertensive heart disease (caused by high blood pressure), congestive heart failure (insufficient blood supply to body), and congenital heart disease (heart abnormality since birth). Conditions and habits for developing heart disease are wide ranging and include age, culture, lifestyle, menopause, obesity, smoking, and socioeconomic status. The risks of these factors are similar in men and women but gender differences have been recognized, including women-only experiences such as menopause.

Heart disease is most common among older people. Women are generally older than men at the disease's onset. Risk increases gradually following menopause, at around age 50, which is attributed in part to declining levels of the estrogen hormone. Prior to menopause, estrogen benefits cardiovascular health by, for example, maintaining blood vessel function, normal blood pressure, and blood levels of certain lipids and high-density lipoproteins (HDL). However, the level of protection diminishes following menopause. It is still uncertain, based on current medical research, whether replacement estrogen (HRT) reduces the risk of heart disease. The use of oral contraceptives, which contain estrogen, has been linked to heart attack risk, but modern forms are considered to be safer.

Lifestyle contributes to developing heart disease. Risk factors include obesity, sedentary lifestyles, smoking, stress and anxiety, and unhealthy diets. Smoking is a problem because it reduces estrogen and HDL, and can cause early-onset menopause; but the good news is that smoking cessation considerably reduces risk. Obesity increases the likelihood of developing heart disease, largely as a result of associated problems such as hypertension.

Diabetes has been linked to cardiovascular problems. High blood sugar levels play a role in the hardening of arteries. Research suggests that diabetes might pose a greater risk of heart disease among women than men; also, a higher percentage of women have diabetes. The risk is much higher when diabetes is combined with other lifestyle risk factors.

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