Diabetes. The Framingham Study, an important study of cardiovascular disease risk that has been ongoing in Massachusetts since 1949, found that women with diabetes are twice as likely to have a heart attack as nondiabetic women. Diabetic women are also at higher risk of developing serious visual problems and kidney complications, as well as hypertension and higher cholesterol levels.

Lifestyle Factors
Cigarette Smoking. Because smoking narrows the diameter of the blood vessels, impairing circulation, smokers have an increased risk of heart attacks and strokes. Smokers are also more likely to have higher levels of the bad LDL and lower levels of the good HDL. Unfortunately, 27 percent of all women smoke and this percentage is not declining rapidly, despite the great amount of public information on the health perils of smoking. Women smokers also enter menopause two to three years earlier than nonsmokers.

Physical Inactivity. Women with sedentary lifestyles have three times the risk of developing heart disease than women who are physically active. The heart is a muscle that needs to be exercised. Women who engage in aerobic exercise, such as walking at least three times a week for a half hour, have lower resting heart rate, greater lung capacity, and an improved ability to handle stress.

Stress. Several studies suggest that severe stress is a risk factor in developing coronary artery disease, though this link has been researched much less in women than in men. Many studies have been done on the Type A, hard driving, aggressive male personality. However, women with multiple home and work responsibilities are often as hard driving and stressed as men. This can predispose certain women over time to an increased risk of heart attack.

Female-Related Risk Factors
Menopausal Status. The risk of coronary artery disease increases twofold to threefold once a woman enters natural menopause. Research studies, including the Framingham Study, have confirmed that premenopausal women with intact ovarian function enjoy significant protection against the development of heart attacks.

Surgical or Natural Menopause Before Age 45. Recent studies have shown that women who, during their premenopausal years, undergo a hysterectomy involving removal of their ovaries have three times the risk of coronary artery disease compared to women who cease menstruating at a later age. Similarly, a study of 122,000 nurses found that women who went through surgical menopause before the age of 35 have two to seven times the risk of heart attack. The risk is also higher in women who go through natural menopause at an early age. Estrogen appears to confer significant protection against heart attacks during the active reproductive years. The longer a woman menstruates, the more years her vascular system has estrogenic protection.

Hormonal Therapy for Heart Disease Prevention. Both estrogen alone and combined estrogen-progestin therapy have been studied for the effects on the cardiovascular system. Estrogen appears to be beneficial; it lowers the levels of LDL cholesterol, which is linked to heart attacks, and raises the level of HDL cholesterol, which appears to confer protection. The one negative factor noted on studies of estrogen users was a moderate rise in triglycerides. On the other hand, however, physicians believe the use of estrogen will confer protection against heart attacks. The addition of progesterone to an estrogen treatment program does not appear to negate estrogen's positive effects on the heart.