Many people think of heart disease as a problem for men, yet heart disease is the leading cause of death for women in the US. In fact, five times as many American women die from heart attacks each year as die from breast cancer.

Heart disease is a type of cardiovascular disease (CVD). This means that it affects your heart and blood vessels. There are several types of heart disease. The most common type in the US is coronary artery disease (CAD), also known as coronary heart disease (CHD). Over seven million women in the US were living with CHD in 2011.

CAD occurs when hard patches, or plaque builds up in the vessels 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 (blood vessels leading to the heart) to get narrower and become less flexible. This process is called atherosclerosis.

A heart attack occurs when a plaque breaks free from the blood vessel’s wall and forms a clot that blocks an artery supplying blood to your heart. This blockage means that the oxygen-rich blood necessary for the heart to pump cannot reach the heart and part of the heart muscle may become injured or die. CAD can also lead to heart failure or an irregular heartbeat (arrhythmia).

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

• Pain, pressure, or discomfort in the chest: this may feel like heaviness, aching, burning, fullness, squeezing, or stabbing
• Shortness of breath
• Heart palpitations (irregular beats)
• Increased heart rate (‘racing’ heart)
• Weakness
• Dizziness
• Nausea or vomiting
• Indigestion or heartburn
• 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. However, women are somewhat more likely than men to have some of the other common symptoms, particularly shortness of breath, nausea or vomiting, and back or jaw pain. Many women who have suffered a heart attack report that they simply felt like they had indigestion. If you feel heart attack symptoms, do not delay – seek medical attention immediately.

64% of women who die suddenly of CHD do not have any prior symptoms, so it is important to know your risk factors for heart disease and to maintain good heart health. 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 at age 45 and continues to grow each year. For women, the risk generally does not 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 is right for you.

Other risk factors for heart disease include:

• High blood pressure
• High cholesterol and/or high triglycerides ( hyperlipidemia)
• Smoking
• Lack of exercise/physical inactivity
• Stress
• Poor diet and nutrition
• Being overweight or obese
• Diabetes
• Alcohol use
• Depression
• HIV

People living with HIV (HIV+) 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.

It is important for HIV+ people to 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 raising your lipid (cholesterol and triglyceride) levels. Some newer classes of drugs may not affect your lipids as much. Switching drugs may not be an option for everyone and you should not make any changes to your HIV drugs without first 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.
• Check 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. Proper diet and nutrition can also help you maintain healthy lipid levels.
• Get regular exercise - being physically active can help 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
• Check 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; therefore, it is important that you check 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 sugar, and by finding out about your family's history of heart disease. If you are at high risk or already have symptoms, some tests can be performed to diagnose heart disease. These include an ECG or EKG (electrocardiogram), echocardiogram (“echo”), 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 naturally 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 staying physically active can all help you care for your heart. When lifestyle changes are not enough, a number of medications and other medical approaches are available.