Some Scary Statistics on Heart Disease in Biological* Women

“Breast cancer.”

It gets a lot of attention from healthcare and the media.

It is also one of the most feared diagnoses for most women.

But did you know that is not the number one killer, or even condition, for females?

Heart disease causes the most deaths for all genders, regardless of race and ethnicity.

The World Health Organization (WHO) reports that cardiovascular disease (CVD) takes 17.9 million lives a year.

Four out of five CVD deaths are due to heart attacks and strokes, and one third of these occur prematurely in people under 70 years of age.

This includes for females.

Yet, it gets little notice in women’s health.

Here’s some facts (bold emphasis mine):

• … women have a greater risk of dying from heart disease than from all cancers combined. This is true for women of all races and ethnicities. (Harvard Health 2019)
• Over 60 million women (44%) in the United States are living with some form of heart disease. (CDC 2023)
• In 2020, it [heart disease] was responsible for the deaths of 314,186 women—or about 1 in every 5 female deaths. (CDC 2023)
• Research has shown that only about half (56%) of US women recognize that heart disease is their number 1 killer. (CDC 2023)
• Heart disease – the No. 1 killer of women – can sometimes be a complication of breast cancer treatment. Older women who survive breast cancer are more likely to die of heart disease than a cancer recurrence. (American Heart Association 2020)
• … 5-year survival rates are as high as 93% to 98% when cancer is diagnosed before it spreads beyond the breast. (Healthline 2022, American Cancer Society 2023 revision)

In this article, I dive into the risk factors of heart disease. I also highlight specific differences between genders and which ones are often overlooked in women.

Topics include:

• Traditional risk factors for cardiovascular disease
• The cholesterol and statin controversies
• Underappreciated risk factors for women’s heart health
• The missing links in holistic cardiovascular care

This post is meant to support all genders.

Understanding what you can change regarding cardiovascular health can help to empower you on which choices you make on your wellness journey.

In upcoming posts, we’ll review some more specifics on women and heart health, the heart-brain link, and mind-body, naturopathic, and functional medicine tips to support better heart health for females and males.

*This post refers to gender based on biology versus identity; therefore, “women” and “men” and “females” and “males” are meant to refer to biological women and men.

Why is Heart Disease Overlooked in Women?

Why is heart disease so underrecognized in women?

This is likely for a variety of reasons.

These include:

1. a pronounced fear of cancer
2. many conventional cancer treatments are more involved, expensive, and come with more extreme side effects than drugs for heart disease
3. a desire for early intervention to stop progression of breast cancer (due to numbers 1-2)
4. media attention to promote awareness of breast cancer to support its prevention (likely based on reasons 1-3)
5. symptoms and risk factors for heart problems can be different in women and are not well-known

Deary post so far, huh?

Don’t worry, there’s good news!

… heart disease and breast cancer share many of the same risk factors.

What’s more, there are two big risk categories that we can do something about: exercise and diet. (Harvard Health 2019)

I’d also like to add that we can promote reproductive and cardiovascular health simultaneously in other sectors of wellness, such as by nurturing supportive relationships, balancing emotional health, and stress reduction.

In fact, if you are doing good self-care in general, your risks for most diseases go down!

So, let’s explore what the most common risks are, so we can intervene to optimize our heart and overall wellness.

Risk Factors for Heart Disease

According to WebMD (*mine):

There are risk factors for heart disease that you have control over and others that you don’t.  Uncontrollable risk factors for heart disease include:

• Being male
• Older age
• Family history of heart disease
• Being postmenopausal
• Race (African American, Native American, and Mexican American people are more likely to have heart disease)
• *genetics

Heart disease risk factors that you can control revolve around lifestyle. These include:

• Smoking
• Unhealthy cholesterol numbers (see below)
• Uncontrolled high blood pressure
• Physical inactivity
• Obesity (having a BMI greater than 25) (*this is associative)
• Uncontrolled diabetes
• High C-reactive protein (*inflammatory marker)
• Uncontrolled stress, depression, and anger
• Poor diet
• Alcohol use
• *the missing factor should be in this list, but it isn’t (more on this below)

Recently, the American Heart Association’s checklist to measure cardiovascular health was updated to Life’s Essential 8™. Healthy sleep was added as another controllable factor essential for optimal cardiovascular health. The other lifestyle factors, included in the previous 7-item checklist, are nicotine exposure, physical activity, diet, weight, blood glucose, cholesterol, and blood pressure.

The American College of Cardiology provides the Atherosclerosis Cardiovascular Disease (ACVD) Risk Calculator which determines one’s risk for a cardiovascular event within ten years. It is based on age, sex, race, blood pressure, history of diseases, lifestyle factors, and cholesterol levels.

Speaking of cholesterol, let’s dive into that risk factor.

It is one of the biggest focuses in media and mainstream medicine regarding heart disease and it deserves a spotlight here as well.

The Great Cholesterol Debate

The relevancy of having high cholesterol in relationship to heart disease risk is a contentious debate in medicine; maybe even more so than the treatment of it. The subject is complicated and mortality outcomes for lowering cholesterol has been mixed in the literature.

It’s complicated.

The impact of high cholesterol on heart and overall health is based on many interwoven factors that interplay with it.

The aspects associated with the influence of high cholesterol on CVD from an integrative, naturopathic, and functional medicine perspective include:

• inflammation
• endothelial (blood vessel) health
• one’s microbiome
• lipid particle size and proteins
• blood sugar and insulin levels
• dental health (oral microbiome)
• infections (lipids can bind microbial toxins and neutralize viruses, among other things)
• environmental toxins
• thyroid health (thyroid hormone is needed for cholesterol utilization)
• cholesterol absorption, excretion, and production factors
• liver and digestive health
• dietary cholesterol, yet another subject of debate. It is likely not as impactful as once thought, at least not for everyone. That’s a whole other article!

The fact that cholesterol levels can rise or fall based on so many different biological processes and external triggers has caused many physicians and scientists to have different viewpoints on how to address it, if at all.

Therefore, one of the first things that naturopathic and functional medicine doctors do when someone has high cholesterol is seek to find out why. Unless there are dangerously high levels that must be treated immediately, they will take time to uncover the contributing causes. From there, they will decide on the best treatment course, along with one’s specialist.

Here’s where we enter another major controversy, also related to cholesterol.

It’s the use of statin drugs, cholesterol’s “S” word.

Cholesterol’s “S” Word

Some medical experts, stand by statin therapy as a means to decrease overall mortality from heart disease. This is for a variety of reasons. They argue that if cholesterol is low enough, cardiovascular disease can’t progress on vessel walls. They also feel statins reduce risks by altering different endpoint measurements for heart health other than cholesterol, such as apoB.

Others don’t agree that statins are the answer.

In a recent review of five landmark cholesterol studies, the authors highlight that the benefits of statin drugs may have been overstated by conflating relative risk factors vs. absolute risk. The abstract reads:

The manner in which clinical trial investigators present their findings to healthcare providers and the public can have a substantial influence on their impact. For example, if a heart attack occurs in 2% of those in the placebo group and in 1% of those in the drug-treated group, the benefit to the treated population is only one percentage point better than no treatment. This finding is unlikely to generate much enthusiasm from the study sponsors and in the reporting of the findings to the public. Instead, trial directors can amplify the magnitude of the appearance of the treatment benefit by using the relative risk (RR) value of a 50% reduction of the risk of a heart attack, since one is 50% of two.

By using the RR type of data analysis, clinical trial directors can promote the outcome of their trial in their publication and to the media as highly successful while minimizing or disregarding entirely the absolute risk (AR) reduction of only one percentage point. The practice of expressing the RR without the AR has become routinely deployed in the reporting of findings in many different areas of clinical research.

We have provided a historical perspective on how this form of data presentation has become commonplace in the reporting of findings from randomized controlled trials (RCTs) on coronary heart disease (CHD) event monitoring and prevention over the past four decades.

We assert that the emphasis on RR coupled with insufficient disclosure of AR in the reporting of RCT outcomes has led healthcare providers and the public to overestimate concerns about high cholesterol and to be misled as to the magnitude of the benefits of cholesterol-lowering therapy. The goal of this review is to prompt the scientific community to address this misleading approach to data presentation

The bottom line is that statins may help some, but we must also weigh the benefits with the risks.

Side effects include muscle damage, muscle soreness, blood sugar deregulation, and neurological impact.

The number needed to treat (NNT) and number harmed for those taking statins as primary prevention, without known heart disease, for 5 years are:

• 104 people need to take a statin to prevent one non-fatal heart attack
• 1 in 50 can develop diabetes and 1 in 10 can have damage to muscles as a side effect

For those with known heart disease, the NNT is 1 in 39 for a non-fatal heart attack, and 1 in 83 lives saved. The number harmed remain the same as above.

The Wrong Focus?

Backing up….

It’s disturbing to me that while writing this article and viewing sources, the major risk factor for predicting cardiac mortality is not mentioned in traditional risk factors.

It’s social connection.

Many are not aware that relationships can impact cardiovascular risk more than lifestyle, cholesterol, or any other factor.

Specifically, perceived loneliness increases risk for cardiovascular mortality substantially and healthy relationships buffer it.

For women, this is especially relevant.

Heart Disease Risk Factors for Women

Due to the fact that women tend to be more dependent on emotional connections than men and the role of hormones, especially estrogen, on the heart, it makes sense why they need to pay attention to heart.

Yet, it’s not just a decrease in estrogen in postmenopausal women that would make females take pause, young women are also experiencing an uptick in heart attacks.

According to an article in Health Day:

Sawano said researchers think young women who present with heart attacks have a greater burden of risk factors compared with men.

“In general, young, premenopausal women are protected by their own estrogen hormone to have lower incidence of heart attacks,” he said. “Thus, to overcome this physiological protection, we think a higher accumulation of risk factors, such as obesity, high blood pressure, high cholesterol, cigarette smoking, etc., is needed to cause a ‘breakthrough’ effect.”

The patients had an average age of 47. About 70% were white. More women than men were Black.

The women also had more obesity, congestive heart failure, prior stroke and kidney disease. They were more likely to be low-income, have a history of depression and have significantly worse health status compared to men in the study.

How to Truly Create Heart Health Harmony in Medicine

The last paragraph in the above quote is extremely telling, because low-income and depression are mentioned. These are two factors largely underplayed as connected to heart disease, but very much a part of literature in regards to risk factors for men and women.

For example, a recent study in women found several additional cardiovascular disease (CVD) risk factors associated with heart disease risk. They were not biologically based, rather they were social determinants of health. These included:

• economic stability
• neighborhood safety
• working conditions
• environmental hazards
• education level
• access to healthcare

All of these are upstream precursors that are often being ignored.

They affect the ability to implement lifestyle changes that move the needle on the physiological and psychological risks.

Perhaps socioeconomics and access to wellness, healthy foods, coping skills to handle stress, and social connection need to get as much attention for CVD as cholesterol, not just for women, but for everyone.

Summary on Heart Disease Risks for Women and Men

Heart disease continues to top the list of killers for all genders.

The traditional risk factors, lifestyle choices, and high lipid levels may play a part in cardiovascular disease, but addressing them only partially impacts what makes for truly healthy hearts and lives.

Medicine is missing the mark by ignoring the mind-body-heart connection.

Even though we’ve had incredible advances in medicine, drugs, and research in heart disease, the one thing that our heart needs the most to thrive can’t be biochemically manipulated, is free, and most powerful.

Love is the medicine that can be most effective and boost the impact of all the other things we are doing to optimize cardiovascular and overall health.

We literally need to incorporate love, caring, and giving (more healthcare access) into medicine to change heart disease risk.

After almost 20 years practicing as a naturopathic and functional medicine doctor and exploring biochemical pathways with fervor, I have found that my clients truly heal and transform the most when we fully address the emotional, relational, and mind-body aspects of their dis-eases. I now this to be true.

Fear does not help us heal. Love does.

Do you agree?

In upcoming posts, we’ll explore more about the heart-brain link and overlooked symptoms for heart disease in women.

Naturopathic Medicine and Holistic Resources for Hormonal, Mood, and Digestive Support

• Free resources and more education on essential oils and mind-body wellness are available to you here.
• An Integrative Mental Health and Stress Resource Guide.
• Tools for coping with isolation and separation.

Stay Connected! Sign-up for my weekly newsletter.

Stay tuned for an upcoming opportunity that can support you in holistic mind-body-heart-soul healing. (Join my newsletter to learn more.)

Many blessings.

References:

1. https://www.health.harvard.edu/blog/heart-disease-and-breast-cancer-can-women-cut-risk-for-both-2019010815683
2. https://www.cdc.gov/heartdisease/women.htm
3. https://www.healthline.com/health/breast-cancer/survival-facts-statistics#improving-outlook
4. https://www.cancer.org/cancer/breast-cancer/understanding-a-breast-cancer-diagnosis/breast-cancer-survival-rates.html
5. https://www.who.int/health-topics/cardiovascular-diseases/#tab=tab_1
6. https://www.webmd.com/heart-disease/risk-factors-for-heart-disease
7. https://tools.acc.org/ascvd-risk-estimator-plus/#!/calculate/estimate/https://tools.acc.org/ascvd-risk-estimator-plus/
8. https://pubmed.ncbi.nlm.nih.gov/36361701/
9. https://my.clevelandclinic.org/health/diseases/23230-endothelial-dysfunction
10. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8347163/
11. https://www.healthline.com/health/cholesterol/cholesterol-particle-size-test#testing-options
12. https://www.healthline.com/health/high-cholesterol/sugar-and-cholesterol#Research-Links-Sugar-and-Cardiovascular-Disease
13. https://www.nature.com/articles/s41569-022-00825-3
14. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9143438/
15. https://ji177.keap-link008.com/v2/click/105b7e578964b7efc2ec7186459ba4ef/eJyNkE9rAjEUxL9Lzmr-7Np0cxMRWdZ6KPYsYfPE1JgNyYtFZL97oxRPLfT0DjPzG-bdCILXHltDFPm0XEoyIRF6Gyx4XA4edf8QuWCNqCbEWX9axyEHom6_ZZ_6I8QZkyWE1wDFs3tfLLt2u95v2m1XvEHHUvIvUN1ILudP0upt0W7IOP6JhrPF1aXQE1EYM9xHGVuG4Ud0xX9EDElRqlMCTLM-R8jlDGeagxu0STTCxcLXXke0vQMazIHymr_Ur1QwUbE5E9OqqabccX0Up1nRS60OAbz5eVsHV6IO2iUYvwGW23LU
16. https://www.researchgate.net/scientific-contributions/Mark-C-Houston-38874140
17. https://thennt.com/nnt/statins-for-heart-disease-prevention-without-prior-heart-disease-2/
18. https://www.mayoclinic.org/diseases-conditions/high-blood-cholesterol/in-depth/statin-side-effects/art-20046013
19. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3653260/
20. https://health.clevelandclinic.org/what-does-estrogen-do/
21. https://www.mayoclinic.org/diseases-conditions/heart-disease/in-depth/heart-disease/art-20046167
22. https://www.health.harvard.edu/womens-health/hot-flashes-and-heart-health
23. https://www.rupahealth.com/podcasts/episode-rerun-heart-disease-hormones-and-women-with-dr-doreen-saltiel-executive-director-of-clinical-education-at-precision-analytical
24. https://microbiomeplus.com/blogs/our-blog-posts/4-root-causes-of-high-cholesterol-myths-and-facts
25. https://www.health.harvard.edu/staying-healthy/new-thinking-on-saturated-fat
26. https://peterattiamd.com/why-a-recent-study-hasnt-shaken-my-faith-in-statins/
27. https://www.sciencedaily.com/releases/2022/03/220314120702.htm
28. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4513492/
29. https://www.ncbi.nlm.nih.gov/books/NBK326741/