Hypertension and other cardiovascular risk factors in women

Coronary heart disease (CHD) is the leading cause of death in U.S. women, causing about 250,000 deaths annually. More than one-third of women aged 55 to 64 with CHD are disabled by their disease, and this increases to 55% in women 75 years and older. Risk factors are highly prevalent in U.S. women aged 20 to 74 years: > 1/3 have hypertension, > 1/4 have hypercholesterolemia, > 1/4 are overweight, and > 1/4 are sedentary. Additionally, diabetes mellitus imparts greater risk for women than for men. Risk factor prevalence is greater in women of lower socioeconomic status and lower educational level. The decrease in coronary risk factors has been less pronounced in women than in men in the past 2 to 3 decades; the decrease in coronary and cardiovascular mortality has also been less pronounced for women than for men. For example, 51% of white women and 79% of black women > 45 years of age have hypertension; 71% of women > 65 years of age have hypertension. Systolic blood pressure peaks in middle age for men but continues to increase in women until beyond age 80. Hypertension is more prevalent in women than men after age 65, and women incur more complications than men from hypertension. There is an equal current prevalence of cigarette smoking in both genders due to increased smoking cessation in men. Cigarette smoking doubles to triples the risk of myocardial infarction, even in premenopausal women. Young to middle aged women have higher HDL cholesterol and lower LDL cholesterol levels than men. Total cholesterol levels in white women increase with age at least to age 70; LDL cholesterol levels rise progressively to exceed those in men. The postmenopausal increase in total cholesterol is far less in black women. The association of physical fitness with a more favorable coronary risk profile is more pronounced for women than men. Education is important; unless women consider CHD as part of their illness experience, they are unlikely to heed preventive messages.