H EAR T D ISEASE AND W OMEN :

Heart disease is a woman's concern. Every

woman's concern. One in ten American

women 45 to 64 years of age has some form

of heart disease, and this increases to one in

four women over 65. Heart disease is the

number one killer of American women. 

In addition, 2 million women have had 

a stroke, and 93,000 women die of stroke

each year. 

This fact sheet tells you what kinds of

habits and health conditions increase the

chances of developing these diseases--and

what you can do to keep your heart healthy. 

What Are These Diseases?

Both heart disease and stroke are known as

cardiovascular diseases, which are disorders of

the heart and blood vessel system. Coronary

heart disease—the main subject of this fact

sheet—is a disease of the blood vessels of

the heart, known as “coronary arteries.”

Coronary heart disease causes chest pain

(angina) and heart attacks. Blood brings

oxygen and nutrients to the heart. When

too little blood flows to the heart, angina

results. When the blood flow is critically

reduced, a heart attack occurs. A lack of

blood flow to the brain or, in some cases,

bleeding in the brain causes a stroke. Some

other cardiovascular diseases are high blood

pressure and rheumatic heart disease. 

F ACTS ABOUT

Are You At Risk?

Who Gets Cardiovascular Diseases?

Some women have more "risk factors" for

cardiovascular diseases than others. Risk

factors are habits or traits that make a person more likely to develop a disease. Some

risk factors for heart-related problems cannot be changed, but many others can be.

The major risk factors for cardiovascular

disease that you can do something about 

are cigarette smoking, high blood pressure,

high blood cholesterol, overweight, and

physical inactivity. Other risk factors, such

as diabetes, also are conditions you have

some control over. Even just one risk factor

will raise your chances of having heartrelated problems. But the more risk factors

you have, the more likely you are to develop cardiovascular diseases—and the more

concerned you should be about protecting

your heart health.

N A TIONAL INSTITUTES OF HEAL T H

N A TIONAL HEAR T , LUNG, AND BLOOD INSTITUTE

HEART DISEASE RISK FACTORS

Risk factors are habits or traits that make 

a person more likely to develop a disease.

Many of those for heart disease can be 

controlled. These include:

■ Cigarette smoking

■ High blood pressure

■ High blood cholesterol

■ Overweight

■ Physical inactivity

■ Diabetes

The more risk factors you have, the greater

your risk. So take action—take control!
However, the harmful effects of 

elevated blood pressure do not begin

at the 140/90 mmHg mark—even

blood pressures slightly under that

can increase your risk of heart 

disease and stroke. Also, both numbers are important to your health.

Many older Americans, for example,

have a form of high blood pressure

known as “isolated systolic hypertension” (ISH). This occurs when

the systolic pressure (the top number) is high but the diastolic pressure (the bottom number) is normal.

This too, if not controlled, increases

the risk of heart attack and stroke.

High blood pressure is called the

"silent killer" because most people

who have it do not feel sick. That

means it is important to have it

checked regularly. Because blood

pressure changes often, your doctor

or other health professional should

check it on several different 

days before deciding if your blood

pressure is too high.

Although high blood pressure can

rarely be cured, it can be controlled

with proper treatment. If your blood

2

MAJOR RISK FACTORS

Smoking

Smoking by women in the United

States causes one and a half times as

many deaths from heart disease as

from lung cancer. If you smoke, 

you are two to six times more likely

to suffer a heart attack than a 

nonsmoking woman, and the risk

increases with the number of cigarettes you smoke each day. Smoking

also boosts the risk of stroke. 

Cardiovascular diseases are not the

only health risks connected to smoking. Women who smoke are much

more likely to develop lung cancer

than nonsmoking women. Cigarette

smoking is also linked with cancers

of the mouth, larynx, esophagus, 

urinary tract, kidney, pancreas, 

and cervix. Smokers also are more

likely to develop other kinds of 

lung problems, including bronchitis 

and emphysema. 

Smoking during pregnancy is also

linked to a number of problems.

They include bleeding, miscarriage,

premature delivery, lower birth

weight, stillbirth, and sudden infant

death syndrome, or "crib death."

Also, young children who breathe 

in a parent’s cigarette smoke have

more lung and ear infections.

There is simply no safe way to

smoke. Although low-tar and lownicotine cigarettes may reduce the

lung cancer risk somewhat, they do

not lessen the risks of heart diseases

or other smoking-related diseases.

The only safe and healthful course 

is not to smoke at all. 

High Blood Pressure

High blood pressure, also known as

hypertension, is another major risk

factor for coronary heart disease and

the most important risk factor for

stroke and heart failure. Heart failure

is a severe condition in which the

heart cannot adequately supply the

body with blood. High blood 

pressure causes three of every five

cases of heart failure in women. 

High blood pressure also boosts the

chances of developing kidney disease

and blindness.

Older women have a higher risk of

high blood pressure, with more than

half of all women over age 55 suffering from this condition. High blood

pressure is more common and more

severe in African-American women

than it is in white women. Using

birth control pills can contribute to

high blood pressure in some women.

While all women can and should take

steps to prevent or control high blood

pressure, it is especially important for

women who have heart disease to do

so. When blood pressure is lowered,

the heart does not work as hard.

Women who have had a heart attack

are less likely to have another if they

reduce their high blood pressure.

What is blood pressure—and when 

is it high? Blood pressure is the

amount of force exerted by the blood

against the walls of the arteries.

Everyone has to have some blood

pressure, so that blood can get to the

body's organs and muscles. Usually,

blood pressure is expressed as two

numbers, such as 120/80 mmHg

(millimeters of mercury). Depending

on your activities, blood pressure may

rise or fall in the course of a day. 

Blood pressure is considered high when it

stays above 140/90 mmHg over a period

of time.

REMEMBER: GET YOUR

BLOOD PRESSURE

CHECKED

The higher your blood pressure, 

the greater your risk for coronary

heart disease. If your blood 

pressure is above 140/90 mmHg,

you should consult your doctor at

once. Even if your blood pressure

is normal, you can lower it—and

reduce your risk for coronary artery

disease.

Talk to your doctor to discuss the

steps you should take to keep your

blood pressure at a healthy level.
3

pressure is not too high, you may be

able to control it entirely through

weight loss if you are overweight,

regular physical activity, and cutting

down on alcohol and salt and sodium. (Sodium is an ingredient in salt

that is found in many packaged

foods, carbonated beverages, baking

soda, and some antacids.)

It may also help to eat more fruits

and vegetables and low fat or nonfat dairy products that supply plenty of potassium, magnesium, fiber,

and calcium. Eating foods rich in

potassium, in particular, seems to

prevent high blood pressure.

However, if your blood pressure

remains high, your doctor may prescribe medicine in addition to the

above changes, especially if you

already have heart disease. The

amount of medicine you take may

be gradually reduced, especially if

you are successful with the changes

you make in your lifestyle. 

A reminder: Be sure to take a blood

pressure medication exactly as your

doctor has prescribed it. Blood pressure medicine must be taken in the

right amounts and at the right times

in order to work properly.

During pregnancy, some women

develop high blood pressure for the

first time. Other women who already

have high blood pressure may find

that it gets worse during pregnancy.

If untreated, these conditions can be

life-threatening to both mother and

baby. Since you can feel perfectly

normal and still have one of these

conditions, be sure to get regular

prenatal checkups so your doctor 

can find and control a possible high

blood pressure problem. 

BLOOD PRESSURE CATEGORIES IN WOMEN 

(18 YEARS AND OLDER)*

Blood pressure is shown as two numbers—the systolic pressure as the heart 

is beating and the diastolic pressure between heartbeats. Both numbers are

important.

Blood Pr essur e Level in mmHg

Category Systolic Diastolic

Optimal** <120 and <80

Normal <130 and <85

High-normal 130-139 or 85-89

Hypertension

Stage 1 140-159 or 90-99

Stage 2 160-179 or 100-109

Stage 3 ≥180 or ≥110

* Not taking antihypertensive drugs and not acutely ill. When systolic and diastolic blood 

pressures fall into different categories, the higher category determines blood pressure status.

**Optimal blood pressure with respect to cardiovascular risk is <120/<80 mmHg. Unusually 

low readings should be evaluated for clinical significance.

Source: The Sixth Report of the Joint National Committee on Detection, Evaluation, and

Treatment of High Blood Pressure, NIH, NHLBI, 1997.

Blood pressure tends to get higher

as you age. So, even if your blood

pressure is normal now, it makes

sense to take steps to prevent high

blood pressure in the years to come.

You will be less likely to develop

high blood pressure if you are physically active, maintain a healthy

weight, limit your alcohol intake,

and cut down on salt and sodium.

High Blood Cholesterol

High blood cholesterol is another

very important risk factor for coronary heart disease that you can do

something about. Blood cholesterol

levels among women in the United

States tend to rise from about the age

of 20. But they rise sharply beginning at about age 40 and continue 

to increase until about age 60. The

higher your blood cholesterol level,

the higher your heart disease risk.

Today, about a quarter of all

American women have blood cholesterol levels high enough to pose a

serious risk for heart disease. More

than half of the women over age 55

need to lower their blood cholesterol.

While the body needs cholesterol to

function normally, it makes enough

to meet all of its needs. But too

much saturated fat and cholesterol

in the food one eats raise the level 

of cholesterol in the blood. Over a

period of years, extra cholesterol 

and fat in the blood are deposited in

the inner walls of the arteries that

supply blood to the heart. These

deposits make the arteries narrower

and narrower. As a result, less blood

gets to the heart and the risk of

coronary heart disease increases. 

Cholesterol travels in the blood in

packages called lipoproteins.

Cholesterol packaged in low density

lipoprotein (LDL) is often called
4

“bad” cholesterol, because too 

much LDL in the blood can lead 

to cholesterol buildup and blockage

in the arteries.

Another type of cholesterol, which

is packaged in high density lipoprotein (HDL), is known as “good”

cholesterol. That is because HDL

helps remove cholesterol from the

blood, preventing it from piling up

in the arteries. 

All women age 20 and older should

have their blood cholesterol

checked. The following sections

describe the steps for managing

cholesterol levels for two types of

women: those who do not have

coronary heart disease, and those

who do have coronary heart disease.

If You Do Not Have Heart Disease

Getting Your Cholesterol Checked.

Blood cholesterol levels are measured by means of a small blood

sample. The blood should be tested

for total cholesterol and, if an accurate measurement is available, for

HDL cholesterol as well. 

Understanding the Numbers. A desirable total cholesterol level for adults

without heart disease is less than

200 mg/dL (or 200 milligrams per

deciliter of blood). A level of 240

mg/dL or above is considered “high”

blood cholesterol. But even levels 

in the “borderline-high” category

(200-239 mg/dL) increase the risk

of heart disease.

HDL levels are interpreted differently than total cholesterol levels. The

lower your HDL level, the higher

your heart disease risk. An HDL level

of under 35 is a major risk factor for

heart disease. A level of 60 or higher

is considered protective. 

Total and HDL cholesterol are measured first. If these tests show any of

the following, your doctor will want

to measure your LDL level as well:

total cholesterol of 240 mg/dL or

above; total cholesterol of 200-239

mg/dL with two or more other risk

factors for heart disease; or HDL

cholesterol of less than 35 mg/dL.

An LDL level below 130 mg/dL is

desirable. LDL levels of 130-159

mg/dL are borderline-high. Levels 

of 160 mg/dL or above are high. 

As with total cholesterol, the higher your LDL number, the higher 

the risk.

Prevention and Treatment. If your tests

show that your blood cholesterol

levels are in the desirable range,

keep up the good work! To help

keep your levels healthy, it will be

important to eat a low saturated fat,

low cholesterol diet, engage in regular physical activity, and control

your weight. 

If your blood cholesterol levels are

too high, your doctor may recommend a specific treatment program

for you. For most people, cutting back

on foods high in saturated fat and

cholesterol will lower LDL cholesterol,

which is the main goal of treatment.

Regular physical activity and weight

loss for overweight persons also will

lower blood cholesterol levels.

Losing extra weight, as well as quitting smoking and becoming more

physically active, also may help

boost your HDL cholesterol level. 

If your new diet and other lifestyle

changes do not lower your blood

cholesterol level enough, your 

doctor may suggest that you take

cholesterol-lowering medications. 

If you have other risk factors for

heart disease, you will need to lower

your cholesterol more than someone

without risk factors. 

If You Have Heart Disease

Women who have coronary (or

“ischemic”) heart disease should pay

even more attention to their cholesterol levels. An individual with 

coronary heart disease has a much

greater risk of having a future heart

attack than a person without heart

disease. Whether or not your cholesterol level is elevated, lowering it

will greatly reduce your risk of a

future heart attack and can actually

prolong your life.

Getting Your Cholesterol Checked. Since

you have heart disease, you will

need to have a blood test called a

lipoprotein profile. This test will

determine not only your total 

BLOOD CHOLESTEROL LEVELS

FOR WOMEN WITHOUT HEART DISEASE

Desirable Bor derline-High High

Total cholesterol Less than 200 200-239 240 and above

LDL cholesterol Less than 130 130-159 160 and above

An HDL cholesterol level of less than 35 is a major risk factor for heart 

disease. An HDL level of 60 or higher is protective.

Source: Second Report of the Expert Panel on Detection, Evaluation, and Treatment of High Blood

Cholesterol In Adults, NIH, NHLBI, 1993.
cholesterol and HDL cholesterol 

levels, but also your levels of LDL

cholesterol and another fatty 

substance called triglycerides. 

Understanding the Numbers. Your goal

should be to have an LDL cholesterol

of about 100 mg/dL or less, which is

lower than for people who do not

have heart disease. Depending on

what your LDL level is, your next

steps will be the following: 

■ If your LDL level is 100 mg/dL

or less, you do not need to take

specific steps to lower your LDL.

But you will need to have your

level tested again in 1 year. In

the meantime, you should closely

follow a diet low in saturated fat

and cholesterol, maintain a

healthy weight, be physically

active, and not smoke. You

should also follow the specific

recommendations of your doctor. 

■ If your LDL level is higher than

100 mg/dL, you will need a complete physical examination to

find out if you have a disease or

condition that is raising your

cholesterol levels. Then you

should take steps to lower your

LDL to 100 mg/dL or less: closely follow a low saturated fat, low

cholesterol diet, be physically

active, lose excess weight, and

take cholesterol-lowering medicine, if prescribed. Of course,

you also should avoid smoking. 

If, in your doctor’s judgment,

your LDL level starts out too

much higher than the LDL goal

of 100 mg/dL or if your LDL

level stays too high after lifestyle

changes, you will need to take

medicine. 

Overweight

Overweight women are much more

likely to develop heart-related problems, even if they have no other risk

factors. Excess body weight in women

is linked with coronary heart disease,

stroke, congestive heart failure, and

death from heart-related causes. The

more overweight you are, the higher

your risk for heart disease. 

Overweight contributes not only to

cardiovascular diseases, but also to

other risk factors, including high blood

pressure, high blood cholesterol, and

diabetes. Fortunately, these conditions

often can be controlled with weight

loss and regular physical activity. 

What is a healthy weight for you?

There is no exact answer. Check the

"Are You Overweight?" chart to find

out if your weight is within the

healthy weight range suggested for

women of your height. Weights above

the suggested ranges are believed to

be unhealthy for most people. 

Body shape as well as weight may

affect heart health. "Apple-shaped"

individuals with extra fat at the

waistline may have a higher risk than

"pear-shaped" people with heavy hips

and thighs. If your waist is nearly as

large as, or larger than, the size of

your hips, you may have a higher

risk for coronary heart disease.

For lasting weight loss, engage in

regular, brisk physical activity and

eat foods that are low in calories and

fat. Do not try to lose more than 

1/2 to 1 pound a week.

5

Physical Inactivity

Physical inactivity increases the risk

of heart disease. It both contributes

directly to heart-related problems

and increases the chances of developing other risk factors, such as

high blood pressure and diabetes.

Physical inactivity is increasing

among Americans—especially

among women. According to the

first-ever Surgeon General’s Report 

on Physical Activity and Health, 

60 percent of American women do

not get the recommended amount

of physical activity, while more than

25 percent are not active at all. 

Fortunately, it doesn’t take a lot of

effort to become physically active.

The Surgeon General’s report and

other research conclude that as little

as 30 minutes of moderate activity

on most, and preferably all, days of

the week help protect heart health.

Examples of moderate activity are

brisk walking or bicycling, raking

leaves, or gardening. 

If you prefer, you can divide the 

30-minute activity into shorter periods of at least 10 minutes each. If

you already engage in this level of

activity, you can get added benefits

by doing even more. 

Diabetes

Diabetes, or high blood sugar, is a

serious disorder that raises the risk

of coronary heart disease. The risk 

of death from heart disease is about

three times higher in women with

diabetes. Diabetic women also are

more apt to have high blood pressure and high blood cholesterol. 

Diabetes is often called a "woman's

disease" because after age 45 about

twice as many women as men 
6

develop diabetes. While there is no

cure for this disorder, there are steps a

person can take to control it. In certain people, being overweight and

growing older are linked with the

development of the most common

type of diabetes. Losing excess weight

and boosting physical activity may

help postpone or prevent the disease.

Other Factors

Stress

In recent years, we have heard a lot

about the connection between stress

and heart disease. For example,

studies have found that the most

commonly reported incident preceding a heart attack is an emotionally

upsetting event, particularly one

that involves anger. Also, some

common ways of coping with stress,

such as overeating, heavy drinking,

and smoking, are clearly bad for

your heart.

The good news is that sensible

health habits can have a protective

effect. Regular physical activity not

only relieves stress, but can directly

lower your risk of heart disease.

Also, participating in a stress management program following a heart

attack lowers the chances of further

heart-related problems.

Studies also suggest that having

emotionally supportive relationships

lessens the chances of developing

heart disease and prolongs life following a heart attack. While these

findings are promising, researchers

will need to conduct further studies

to find out more about the links

among certain behaviors, stress, and

coronary heart disease in women. 

Birth Control Pills

Birth control pills (oral contraceptives) used to have much higher

doses of estrogen than they do

today. Such pills increased the risk

of vascular and heart disease, especially among women who smoked.

Today, “high-dose” refers to pills

containing about 50 micrograms 

of estrogen. However, American

women much more commonly use

“low-dose” pills that have 35 micrograms of estrogen or less. There is

little, if any, additional risk of heart

disease for premenopausal women

using a pill that has up to 50 micrograms of estrogen.

However, taking a birth control pill

does pose risks for some women. 

If you are now taking any kind of

birth control pill or are considering

using one, keep these guidelines 

in mind: 

■ If you smoke cigarettes, stop

smoking or consider a different

form of birth control. Smoking

boosts the risks of serious cardiovascular problems from birth

control pill use, especially the risk

of blood clots, and particularly in

women over 35. 

■ Use of birth control pills may

increase blood pressure. If you

take oral contraceptives, you

should get your blood pressure

checked regularly. If you develop

hypertension, you should ask

your doctor about changing pills

or switching to another form of

birth control.

■ If you take birth control pills 

and are diabetic or prediabetic,

you should have regular blood

sugar tests. 

■ If you have had problems with

blood clots, a heart attack, or a

stroke, or if you have any other

kind of cardiovascular disease,

oral contraceptives may not be a

safe choice. Be sure your doctor

knows about your condition

before prescribing birth control

pills for you.

Height*

Are You Overweight?

Pounds†

* Without shoes

† Without clothes. The higher weights apply to people with more muscle and bone, such as many men.

Source: Report of the Dietary Guidelines Advisory Committee on the Dietary Guidelines for Americans, 1995.

50 75 100 125 150 175 200 225 250

6'6"

6'5"

6'4"

6'3"

6'2"

6'1"

6'0"

5'11"

5'10"

5'9"

5'8"

5'7"

5'6"

5'5"

5'4"

5'3"

5'2"

5'1"

5'0"

4'11"

4'10"

Healthy Weight

Moderate 

Overweight

Severe Overweight
7

Of course, this addresses only 

cardiovascular points. For a more

complete discussion about birth

control pills, talk with your doctor.

Homocysteine

Homocysteine (pronounced homoSIS-teen) is an amino acid that is

found normally in the body.

Recent studies suggest that high

blood levels of this substance may

increase a person’s chances of

developing heart disease, stroke,

and reduced blood flow to the

hands and feet. It is believed that

high levels of homocysteine may

damage the arteries, make the

blood more likely to clot, and/or

make blood vessels less flexible.

Recent research also shows that

the level of homocysteine in the

blood is affected by the consumption of three vitamins—folic acid

and vitamins B6 and B12. People

who consume less than the recommended daily amounts of these

vitamins are more likely to have

higher homocysteine levels.

Recommended daily amounts 

are as follows: 400 micrograms 

of folic acid, 2 milligrams of B6,

and 6 micrograms of B12. 

It has not yet been proven that 

lowering homocysteine levels will

actually help to prevent heart or

blood vessel disease. But, until

more research is done, women 

can help protect their health by

getting enough folic acid, B6, 

and B12 in their diets. 

Good sources of folic acid include

citrus fruits, tomatoes, vegetables,

whole-grain and fortified-grain

products, beans, and lentils. Foods

high in B6 include meat, poultry,

fish, fruits, vegetables, and grain

products. Major sources of B12 

are meat, poultry, fish, and milk 

and other dairy products. 

Alcohol

Several recent studies have reported

that moderate drinkers—those who

have one or two drinks per day—are

less likely to develop heart disease

than people who don't drink any

alcohol. If you are a nondrinker, this

is not a recommendation to start

using alcohol. And certainly, if you

are pregnant or have another health

condition that could make alcohol

use harmful, you should not drink.

But if you are already a moderate

drinker, you may be less likely to

have a heart attack. 

But remember, moderation is the

key. More than three drinks per day

can raise blood pressure, and binge

drinking can lead to stroke. People

who drink heavily on a regular basis

have higher rates of heart disease

than either moderate drinkers or

nondrinkers.

The “Dietary Guidelines for

Americans” recommend that for 

overall health, women should have 

no more than one drink per day. 

One drink equals 12 ounces of beer, 

or 5 ounces of wine, or 11/2 ounces 

of 80-proof liquor. 

Keep in mind, too, that alcohol provides no nutrients—only extra calories. If you are trying to control your

weight, you may want to cut down

on alcohol and substitute calorie-free

iced tea, mineral water, or seltzer. 

Hormones and Menopause

Should menopausal women use 

hormone pills? There is no simple

answer to this question. 

Menopause is caused by a decrease

in estrogen produced by a woman's

ovaries. As estrogen levels begin to

drop, some women develop uncomfortable symptoms such as “hot

flashes” and mood changes.

Hormone replacement therapy

(HRT)—a term for prescription 

hormone medications—can be used

to relieve these symptoms. Some

women are prescribed medication

that contains only estrogen. Others

take estrogen combined with a 

second hormone, called progestin.

Hormone Therapy and 

Heart Health

The latest research indicates that

HRT may have important heart

benefits for women after menopause.

The National Institutes of Health

(NIH) supported a major study on

HRT called the Postmenopausal

Estrogen/Progestin Interventions

(PEPI) Trial. It found that HRT

raised levels of HDL and decreased

those of LDL. This was true for

both HRT with estrogen alone or 

in combination with progestin.

Further, HRT slowed the bone loss

that occurs with menopause and 

significantly increased bone mass.

These effects on bone were strongest

among older women and those who

had not recently used hormones.

Smokers, who generally lose bone

mass more quickly than nonsmokers, gained as much bone on average

as nonsmokers.

HRT did not increase blood pressure

or cause weight gain.

There was a key difference between

the estrogen-only and estrogenprogestin forms of HRT and their

effects on the uterine lining, called

the endometrium. HRT using estrogen plus progestin prevented over-
U.S. DEPARTMENT OF HEALTH 

AND HUMAN SERVICES

Public Health Service 

National Institutes of Health 

National Heart, Lung, and Blood Institute

NIH Publication No. 98-3654

Originally printed 1995

Revised August 1998

FOR MORE 

INFORM A TION 

If you would like to know

more about keeping your

heart healthy, the National

Heart, Lung, and Blood

Institute (NHLBI) has available free fact sheets on

these subjects: preventing

and controlling high blood

pressure, preventing and

controlling high blood cholesterol, quitting smoking,

the heart benefits of physical activity, and HRT. 

CONTACT: 

NHLBI Information Center

P.O. Box 30105 

Bethesda, MD 20824-0105

Phone: (301) 251-1222

Fax: (301) 251-1223

Or check out the NHLBI

web site at

http://www.nhlbi.nih.gov/

nhlbi/nhlbi.htm.

8

growth of the uterine lining, while

HRT with estrogen-only increased

the risk of such overgrowth.

Deciding on HRT

Some questions about HRT remain.

For example, PEPI was not large

enough and did not last long

enough to examine breast cancer

issues. However, other research 

suggests HRT slightly increases that

risk, perhaps only in women who

take it for 5 or more years.

To decide whether or not to use

HRT, talk with your doctor or

health professional about your 

risk of heart disease, osteoporosis 

(a severe thinning of the bones that

makes them more likely to break),

cancer, your family medical history,

and quality of life issues.

In addition, these guidelines may

help in deciding on HRT:

■ Postmenopausal women who have

not had a hysterectomy (removal

of the uterus) should consider 

taking a therapy that combines

estrogen with progestin or natural

progesterone. A woman with a

uterus who decides to take estrogen-only should have a yearly

endometrial biopsy (an examination of the uterine lining).

■ Postmenopausal women who have

had a hysterectomy would get no

additional cardiovascular or bonemass benefit from adding a progestin. They are not at risk for

overgrowth of the uterine lining.

Finally, if you decide to use HRT,

you should periodically review your

status with your health professional.

And be alert for signs of trouble,

especially abnormal bleeding, 

dizziness, or severe headaches, and

immediately report these to the 

doctor. They may or may not be

due to the HRT.

Aspirin

The research on aspirin is promising: This well-known “wonder

drug” may help to both prevent

and treat heart attacks. A study of

more than 87,000 women found

that those who took a low dose 

of aspirin regularly were less likely

to suffer a first heart attack than

women who took no aspirin.

Women over age 50 appeared to

benefit most. 

Other recent research suggests

that only a tiny daily dose of

aspirin may be needed to protect

against heart attacks. One study

found that, for both women and

men, taking only 30 mg of aspirin

daily—one-tenth the strength of 

a regular aspirin—helped prevent

heart attacks as effectively as the

usual 300 mg dose. The smaller

dose also caused less stomach 

irritation.

Aspirin also reduces the chances

that women who have already had

a heart attack or stroke will have,

or die from, another one. If taken

quickly, aspirin may also increase

the chances of survival after a 

heart attack.

Keep in mind, however, that

aspirin is a powerful drug with

many side effects. It can increase

your chances of getting ulcers, 

kidney disease, liver disease, and a

stroke from a hemorrhage. Because

of these serious risks, you should

not take aspirin to either prevent

or treat a heart attack without first

discussing it with your doctor.