Probably the most important risk factor for coronary artery disease (CAD) in women is the misconception that CAD is not a women’s problem but somehow a men’s disease. Risk factors associated with a higher cardiac risk in both men and women include: older age, family history, smoking, high blood pressure, high cholesterol, and diabetes. Moreover, hormonal status in women is an equally powerful predictor for CAD. At the time of menopause when the ovary gradually decreases the production of hormones, the risk of CAD rises thereafter until it equals that of men by the age of 75 years. In the light of more recent data, it is hard to recommend initiating estrogen replacement therapy after a woman has had a cardiac event or to prevent a cardiac event if one has not occurred, but women who are already on estrogen therapy for other indications should probably continue. Many questions remain. The potential benefits of estrogen therapy must always be weighed against the small but definite risk for breast and endometrial cancer, and careful consultation is always warranted. Finally, exercise can prevent CAD.
Moderate exercise such as brisk walking is as effective as vigorous exercise and sedentary women who become active reap similar benefits as those who have remained active throughout their lives. As always, please consult your primary care physician to identify the best prevention and treatment options that are right for you.