Why Are More Young Women Developing Heart Disease?

The threat of heart disease, and of dying from it, is rising among young women.

Recent research has suggested that nearly one-third of all women ages 20 to 44 will have heart disease in 2050, up from one-fourth today. And women under 55 are more likely to die from heart attacks than men under 55.

Despite common misconceptions, “heart disease is, in fact, a woman’s disease,” said Dr. Emily Lau, co-director of the Mblock General Brigham Women’s Heart Health program. But it is possible to lower the risk.

Pay attention to the traditional risk factors …

One reason for the increase in heart disease in younger women is that some of the drivers — including obesity, high blood pressure and diabetes — have become increasingly common at younger ages.

These risk factors apply to everyone, but research has shown that some have a greater effect on women. For example, women with diabetes have a higher risk of heart disease related to diabetes than men do; smoking also increases women’s risk more than it does men’s.

Young women with high blood pressure are often underdiagnosed and undertreated. But heart disease risk may actually start rising at lower blood pressure levels in women than in men, said Dr. C. Noel Bairey Merz, director of the Barbra Streisand Women’s Heart Center at Cedars-Sinai in Los Angeles.

Routine checks of your blood pressure, cholesterol, weight and hemoglobin A1C (a measure of average blood glucose levels) are important for blockessing risk. Doctors recommend all adults strive for these levels:

• Blood pressure under 120 mm Hg / 80 mm Hg

• Low-density lipoprotein, or LDL, under 100 mg/dL

• Body-mblock index under 25

• Hemoglobin A1C of 5.6 or lower

“Knowing your numbers is your most powerful tool,” said Dr. Priya Freaney, director of the Women’s Heart Care program at Northwestern Medicine. “And it’s never too early to start.”

Every woman should work with her physician “to bring off-target numbers to target,” Dr. Freaney said. That should include lifestyle measures — eating a Mediterranean or DASH-style diet, not smoking, limiting alcohol and doing both aerobic and resistance exercise — as well as medications when needed.

One upside to the disparate effects of risk factors by *** is that it works in the other direction, too, Dr. Freaney said. Studies have shown that women achieve the same reduction in cardiovascular risk and mortality as men with half the amount of exercise.

… And the nontraditional ones, too.

There is a growing recognition that ***-specific factors also play a role. These include premature menopause (before age 40) and polyendocrine metabolic ovarian syndrome (previously known as P.C.O.S.). They also include pregnancy complications such as gestational diabetes and pre-eclampsia, and inflammatory autoimmune diseases like lupus and rheumatoid arthritis, which disproportionately affect women.

Each of these is blockociated with increased heart disease risk, but may not necessarily be causal, said Dr. Martha Gulati, director of the Davis Women’s Heart Center at Houston Methodist. For example, it’s not clear whether high blood pressure in pregnancy itself increases heart disease risk, or if it simply highlights some preexisting vascular abnormality, Dr. Gulati sad. Either way, it can signal who is most likely to develop premature heart disease.

In patients with these risk factors, Dr. Gulati said, “we end up being very aggressive” about managing blood pressure, glucose and cholesterol.

Don’t neglect heart health during your reproductive years.

Women in their 20s, 30s and 40s are less likely than older women to have a routine health care provider and often skip or delay care because of costs, according to surveys. Some rely mainly on obstetrician-gynecologists for primary care.

Doctors recommended finding a primary care physician who can check for heart disease or related risk factors during these years. “We want to be thinking about how we can help women enter menopause in the best cardiometabolic health they can be in,” Dr. Lau said, because the risk of heart disease in women increases after that.

Talk to your doctor about other tests.

Beyond routine blood work, doctors pointed to additional tests that may help better blockess individual risk.

One is the coronary artery calcium (CAC) score, which comes from a specialized CT scan of the heart. The formation of blockages that lead to heart attacks “is a superslow, silent process,” Dr. Freaney said. A CAC score, which shows whether and how much calcified plaque is in the coronary arteries, can help identify that process before symptoms appear, enabling doctors to start treatment and prevent heart attacks.

Guidelines also recommend that all adults have their level of Lipoprotein(a), a particular type of “bad” cholesterol, checked once. The level doesn’t usually change throughout life, but menopause is a notable exception. Dr. Gulati said that women with a borderline level should have it rechecked after menopause.

Dr. Gulati suggests that women also have their C-reactive protein, a marker of inflammation, checked with a blood test. Some research has suggested that the marker can predict cardiovascular risk, though the evidence is not yet strong enough for the test to be widely recommended, Dr. Bairey Merz said.