Many women do not believe they are as at risk for heart attacks as men, but they are. Women make up nearly half of all heart attack deaths. Heart disease is the number one killer of both women and men in the US.

Heart disease is a cardiovascular disease (CVD). This means that it affects your heart and blood vessels. There are several types of heart disease. The most common in the US is coronary artery disease (CAD).

CAD occurs when plaque builds up in the coronary arteries that supply blood to the heart. Plaque is made up of cholesterol, a fat-like substance found in the blood. Plaque buildup causes the arteries to get narrower (atherosclerosis). A heart attack occurs when a plaque bursts and forms a clot that totally blocks a coronary artery. CAD can also lead to heart failure or an irregular heartbeat (arrhythmia).

Other cardiovascular problems include:

• High blood pressure (hypertension)
• Angina (chest pain)
• Rheumatic heart disease (damage to the heart caused by rheumatic fever)
• Stroke (interrupted blood flow to the brain, usually caused by a blood clot or burst blood vessel)

The most common symptom of heart disease is angina or chest pain. If you have angina you will feel discomfort. It may be a heaviness, pressure, aching, burning, fullness, squeezing, or painful feeling in the chest. Sometimes angina and chest pain can be mistaken for indigestion.

For some people, the first sign of heart disease is a heart attack. Symptoms of a heart attack include:

• Shortness of breath
• Heart palpitations (irregular beats)
• Increased heart rate
• Weakness
• Dizziness
• Nausea/vomiting
• Sweating
• Pain in the arms, left shoulder, neck, throat, jaw, or back
  

As with men, women's most common heart attack symptom is chest pain or discomfort. But women are somewhat more likely than men to have some of the other common symptoms, particularly shortness of breath, nausea/vomiting, and back or jaw pain. If you feel heart attack symptoms, do not delay - minutes matter! Immediately call 9-1-1.

Many factors can increase your risk for heart disease. One of the most important is family history. If someone in your family has had heart disease, you have a higher risk.

Age and gender also have an effect on heart health. Generally, men have a greater risk than women and at an earlier age. For men, risk begins to go up by age 45 and continues to grow each year. For women, the risk generally doesn't start to go up until after menopause. By age 65, the heart disease risk in women goes up substantially.

Some studies have shown that taking hormone replacement therapy (HRT) may increase a woman's risk for heart disease, stroke, pulmonary embolism (blood clot in the lung), and breast cancer. For some women, the benefits of HRT outweigh the risk of heart disease. Talk to your health care provider if you are thinking about HRT to decide what’s right for you.

Other risk factors for heart disease include:

• High blood pressure
• High cholesterol
• Smoking
• Lack of exercise/physical inactivity
  
• Stress
• Poor diet
• Being overweight or obese
• Diabetes
• Alcohol use

HIV+ people have higher rates of heart disease than the general population. There are a number of reasons for this:

• Some HIV drugs and possibly HIV itself can cause lipodystrophy. Lipodystrophy means abnormal fat changes. It is used to describe a number of unwanted changes in body fat that are experienced by many HIV+ people. Lipodystrophy can also include changes in fat and sugar levels in the blood. Some of these changes are risk factors for heart disease, including high blood fats or lipids (cholesterol and triglycerides) and diabetes.
• HIV infection causes inflammation that can lead to damage to the heart and blood vessels, potentially increasing the risk of heart disease.
  

While some HIV drugs can cause side effects that may increase the risk of heart disease, studies have shown that HIV drug therapy may actually protect against heart disease, as well as keeping HIV and other HIV-related conditions under control.

HIV+ people should evaluate their risk factors for heart disease and take steps to reduce them. Ask your health care provider about the HIV drugs you take to see if any may be increasing your lipid (cholesterol and triglyceride) levels. Some newer classes of drugs may have less impact on lipids. Switching drugs may not be an option for everyone and you should not make any changes to your HIV drugs without talking to your health care provider.

While there are some risk factors that you will not be able to change, there are many things that you can do to reduce your risk for heart problems:

• Quit smoking - smoking is the biggest risk factor for heart disease
• Watch your blood pressure - high blood pressure increases the workload of the heart. If you have high blood pressure, speak to your health care provider about treatment options
• Monitor your lipid levels - If HIV drugs cause your cholesterol or triglyceride levels to rise, you may need to switch drugs or use lipid-lowering drugs. Diet can also help to maintain healthy levels
• Get regular exercise - regular exercise can help to reduce your risk for heart disease. It may also help to reduce your cholesterol and blood pressure
• Watch your weight - if you are overweight, you are more likely to develop heart disease
• Monitor your blood sugar - If you have diabetes or high blood sugar, you are at an increased risk of developing heart disease. Keeping sugar levels in check can reduce your risk. If you are taking HIV drugs, you may be at a greater risk for diabetes and should monitor your blood sugar levels regularly
• Begin HIV drugs before your CD4 cell count drops to 500, if recommended by your health care provider, and do not take a break from treatment unless absolutely necessary

Your health care provider can determine your risk for heart disease by checking your blood pressure, cholesterol, and blood glucose, and by finding out about your family's history of heart disease. If you're at high risk or already have symptoms, some tests can be preformed to diagnose heart disease. These include an ECG or EKG (electrocardiogram), echocardiogram, exercise stress test, chest X-ray, cardiac catheterization, or coronary angiogram.

Medications may also be necessary. Medicines can treat heart disease risk factors such as high lipid levels, high blood pressure, diabetes, an irregular heartbeat, and low blood flow.

Heart disease is a growing concern for both HIV+ men and women. One reason for this is that HIV+ people are living longer due to the widespread use of HIV drugs and the risk of heart disease increases as you age.

The good news is that there are many things that you can do to help prevent and manage heart disease. Healthy lifestyle choices such as quitting smoking, improving your diet, getting regular medical check ups, and exercising can all help you to care for your heart. When lifestyle changes aren't enough, a number of medications and other medical approaches are available.