In the U.S., 1 in 10 women between 45 and 64 years of age has some form of heart disease. In fact, heart disease is the number one killer of women in America.

Heart disease and stroke are cardiovascular diseases. This means that they affect your heart and blood vessels. Other cardiovascular diseases include:

• High blood pressure (hypertension)
• Angina (chest pain)
• Rheumatic heart disease (damage to the heart caused by rheumatic fever)
• Atherosclerosis (thickening and hardening of the arteries)

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 you can feel it in the arms, left shoulder, neck, throat, jaw, or back as well. Some people dismiss angina and chest pain as indigestion. Other symptoms of heart disease include:

• Shortness of breath
• Heart palpitations (irregular beats)
• Increased heart rate
• Weakness
• Dizziness
• Nausea
• Sweating

A recent study showed that women at risk for heart attacks tend to report extreme fatigue, shortness of breath, and difficulty sleeping more often then men, and chest pain less often than men. If you have any symptoms, it is important to contact your doctor right away.

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 of the same.

Recent 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. You should discuss your family history and risk factors with your doctor to decide what is right for you.

Other risk factors include:

• High blood pressure
• High cholesterol
• Smoking
• Lack of exercise
• Stress
• Poor diet
• Being overweight or obese
• Diabetes

There have been some studies on the connection between HIV and heart disease. Unfortunately many of the results are conflicting and more studies are required to make a definite link.

However, HIV drugs and possibly HIV itself can cause lipodystrophy. Lipodystrophy is a group of fat-related body changes. Some of these changes are risk factors for heart disease, including:

• High cholesterol
• Diabetes

There is also evidence of an increased risk of heart disease in HIV+ older women (over 45) with lipodystrophy.

If you are taking HIV drugs like protease inhibitors, you should have your cholesterol and your blood sugar checked regularly.

There are many things you can do to reduce your risk for serious heart problems. Some studies have shown that switching from protease inhibitors can help to reduce the risk. This may not be an option for everyone and you should not stop or switch HIV drugs without talking to your doctor.

Some of the other things you can do to reduce your risk for heart disease include:

• Quit smoking - smoking is the biggest risk factor for heart attacks
• Watch your blood pressure - high blood pressure increases the workload of the heart. If you have high blood pressure, speak to your doctor about treatment options
• Monitor your cholesterol - The higher your “bad” cholesterol the higher your risk for heart disease (ask your doctor for a breakdown of your cholesterol). If HIV drugs cause your cholesterol to rise, you may need to switch drugs or use cholesterol-lowering drugs called statins. 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

Heart disease poses a serious threat to the health of many women. HIV+ women may have special concerns related to the use of HIV drugs. Further research is required to fully understand the connections between HIV and heart disease.

In the meantime, there are many things that you can do to reduce your risk of 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.

1		Aberg, J. (2003). HAART to Heart: Cardiovascular risk in HIV. Conference Reports for NATAP from10th Conference on Retroviruses and Opportunistic Infections. Retrieved December 2004 from  http://www.natap.org/2003/Retro/day19.htm
2		Levin, J. (2001). Risk for Increased Heart Disease in 45-Year Old Women with HIV and Lipodystrophy. Retrieved December 2004 from http://www.natap.org/2001/nov/110101_3.htm
3		Levin, J. and Kaufman, G. (2001). What Is Risk For Increased Heart Disease From HAART? Conference Reports for NATAP from the 8th Conference on Retroviruses and Opportunistic Infections. Retrieved December 2004 from http://www.natap.org/2001/8thcroi/what_is_risk022201.htm