Harvard Women's Health Watch

Ask the doctor: How should I be screened for cardiovascular disease?

Q. I have a family history of cardiovascular disease. Although I don't have high blood pressure, high cholesterol, diabetes, or any other risk factor, I'm concerned about how my cardiologist is screening me, because women can have small-vessel disease and not necessarily arterial disease. How should I be screened?

A. In general, the decision to screen a woman for cardiovascular disease depends on her risk for the disease and whether she has symptoms. The risks include some things that are out of our control, such as a strong family history (that is, heart attack or stroke in a father or brother before age 55 or in a mother or sister before age 65). But we can prevent or lessen many other risks through lifestyle changes, or, if necessary, medications. Major risk factors include obesity, smoking, physical inactivity, high blood pressure, high cholesterol, and diabetes. All of these affect both genders, but several have a greater impact on women. For example, diabetes raises the risk of heart disease in women more than in men.

Metabolic syndrome is another risk factor. A woman is diagnosed with metabolic syndrome if she has three or more of the following: a waistline (measured at the navel) of 35 inches or more, higher-than-normal triglycerides, lower-than-normal HDL (good) cholesterol, higher-than-normal blood pressure, and higher-than-normal fasting blood sugar. There's some evidence that, for women, metabolic syndrome is the most important risk factor for having an early heart attack.

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