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Cigarette smoking has been described as the most important health risk in the United States. It is the single most preventable cause of death. Women who smoke are 2 to 6 times more likely than nonsmoking women to suffer a heart attack, and the risk rises with the number of cigarettes smoked each day. Women who smoke also have a greater risk of suffering a stroke. Smoking among women in the United States is responsible for almost as many deaths from heart disease as from lung cancer. In addition, women who smoke and use birth control pills have a higher risk of heart attack and stroke than do nonsmokers who use birth control pills. Diabetes is a major risk factor for cardiovascular diseases in both men and women. 65% of individuals diagnosed with diabetes die of heart disease or stroke. This is 2 to 4 times higher than the rates of death for adults without diabetes. The risks of heart disease and heart-related death are higher for women with diabetes than for men with diabetes. Compared to women of the same age without diabetes, women with diabetes have 3 to 7 times greater risk of heart disease and heart attack and are at much greater risk of having a stroke. Women with diabetes are also more likely to have other risk factors for heart disease – such as high blood pressure and high cholesterol levels – than are women without diabetes. Although diabetes causes a number of medical complications, cardiovascular diseases are the most common. Approximately 2 of every 3 individuals (men and women) with diabetes die of some form of cardiovascular disease. Obesity is a common problem in the United States. Obesity is determined by a person’s body mass index (BMI). BMI is calculated by determining weight in kilograms divided by height in meters squared. A BMI of 29 or higher is considered obese for women. Being obese contributes to cardiovascular diseases by increasing the likelihood of developing other risk factors, such as hypertension, hypercholesterolemia, and diabetes.
The age adjusted prevalence of high cholesterol in overweight US women is:
But obesity, by itself, increases the risk of heart-related problems in women. Nearly 40% of heart disease may be attributable to obesity. Even a gain of as little as 11 to 17 pounds after the age of 18 may increase a woman’s risk of heart disease. Individuals with “apple” shapes, or fat concentrated around the waistline, are at 3 times higher risk for cardiovascular diseases than those with “pear” shapes, or fat concentrated around the hips and thighs. This effect is larger for those under age 65 than for those over age 65. Hypertension (high blood pressure) – Blood pressure is the amount of force that the blood exerts on the walls of the arteries. This pressure is necessary so that the blood can get to the body’s organs and muscles. But when blood pressure remains too high (140/90 mm Hg or above), it can damage the heart and kidneys. High blood pressure is a major risk factor for heart disease and the single most important factor for stroke. Among American women over the age of 55, more than half have hypertension. Hypertension is even more common, and more severe, in African American women than in Caucasian women. According to data collected between 1988 and 1994, the percentages of women 20 years of age and older with hypertension are 20.5% for non-Hispanic white women, 36.6% for non-Hispanic Black women, and 22.4% for Hispanic women. High blood pressure is also 2-3 times more common in women taking oral contraceptives, especially in obese and older women. Cholesterol is a waxy substance that the body produces and needs for normal functioning. The body produces all the cholesterol it needs. Over a period of years, extra cholesterol and fat circulating in the blood are deposited in the walls of the arteries that supply blood to the heart. These deposits make the arteries narrower. As a result, less blood gets to the heart. Studies show that beginning at age 50, women are more likely than men to have total blood cholesterol levels of 200 mg/dl or higher. The higher a woman’s blood cholesterol level, the higher her risk of heart disease. About 1 American woman in every 4 has a blood cholesterol level high enough to put her at risk for cardiovascular diseases. (For women without heart disease, a total cholesterol level of 200 to 239 mg/dl places an individual at borderline high risk for heart disease, while a total cholesterol level of 240 mg/dl or above places an individual at high risk for heart disease.) While total cholesterol levels and low-density lipoproteins (LDL) are important for women in determining cardiovascular disease risk, a low level of high-density lipoprotein (HDL) cholesterol, or “good cholesterol”, is an especially strong predictor of cardiovascular diseases in women compared to men.
Physical inactivity is a cardiovascular disease risk factor that is becoming increasingly prevalent among all Americans, but especially among women. 60% of American men and women do not achieve recommended amounts of physical activity. About 1 in 4 report undertaking leisure-time physical activity. Those whose main language is Spanish have the highest prevalence of physical inactivity (38% of men and 58% of women). Less-active, less-fit individuals have a 30% to 50% greater risk of developing high blood pressure and a greater risk of developing high cholesterol levels. An estimated 12% of all deaths in the United States each year are attributed to physical inactivity.
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