of cvd development increases as women age. during the fertility age of a woman, the high levels of estrogen provide cardioprotective effects. this, however, curbs significantly after menopause and increases the prevalence of cvd found in women. research has found that for women 75 years old and higher, the incidence of cvd is significantly higher than for men. autoimmune diseases certain autoimmune conditions such as rheumatoid arthritis (ra) and systemic lupus erythematosus (sle) are significantly more likely to occur in women. some populations of women are also more likely to be affected than others. for example, sle is two to four times more prevalent in black women when compared to white women. studies have also shown that women with sle are at least nine times more likely to experience a myocardial infarction when compared to the general population, with some estimates showing a 50-fold increase in risk. similarly, ra increases the risk of death from cvd by 50%. in autoimmune diseases, the immune system reacts to the individual's antigens itself, which can cause local or systemic issues. this is furthered by the microvasculature in women that puts women at increased risk to develop autoimmune diseases themselves. polycystic ovary syndrome polycystic ovarian syndrome (pcos) is an endocrine disorder prevalent in young women that is classically associated with irregular menstruation, androgen excess, and infertility. it is unclear whether pcos is associated with an increased risk of developing cvd. however, pcos is associated with multiple traditional risk factors of cvd such as diabetes, obesity, dyslipidemia, and hypertension, which may naturally put the individual at increased risk of developing cvd. depression due to biological and sociological causes, women are twice as likely to have depression when compared to men. studies have shown that women with depression are at greater risk of developing cvd when compared to peers without depression, although this relationship is still unclear. moreover, depression has also been associated with smoking, a traditional risk factor for cvd. breast cancer treatment because of the location of the heart in relation to the breasts, breast cancer treatments have shown to cause the increased risk, acute or chronic, of cvd. exposure to radiation and chemotherapy in cancer treatments have shown to cause complications in the heart and its blood vessels, causing scarring or stiffening of heart tissue, which is detrimental to the heart's function. hormones estrogen and other associated female sex hormones have been shown to have major cardioprotective effects on women. this may be why it is less common to see women with cvd prior to menopause, after which estrogen levels decline rapidly. this causal relationship is still yet to be established clearly, as unfortunately hormone replacement therapies have not been successful in controlling this effect and may reflect a larger feedback loop in play to protect females of reproductive age from cvd. diagnostic tests there are various tests that are used to diagnose cvds. these include scans, imaging, blood work, and other laboratory tests. here are the most frequently used diagnostic tests: electrocardiogram (ecg or ekg): an ecg or ekg monitors the wave representing the activity of the heart. any discrepancies or changes in the typical patterns indicate a cardiac condition, such as cvd, affecting the individual. echocardiogram an echo provides an outline of the heart's function to help assess how well it is operating. this is often combined with a doppler ultrasound to help track the blood flowing through the heart's chambers and valves. holter monitor: the holter monitor is a portable device worn for a few days to monitor the heart's rhythm and any changes seen throughout the day. this allows for a more in depth understanding of how well the heart is functioning and whether any irregular patterns are common or infrequent. cardiac magnetic resonance imaging (mri): a cardiac mri is an imaging machine that uses waves to develop a clear picture of your cardiovascular. it allows for a 3d image of the heart to be produced to allow for more thorough investigations of any issues. exercise stress test: this is a physical activity test for healthcare providers to be able to see how an individual's heart functions in times of physical stress. the results from this test can demonstrate how to guide treatments for different conditions and even the efficacy of the current treatment in affected individuals. nuclear stress test: a nuclear stress test involves trace amount of a radioactive substance put into your blood and is followed as it flows through the heart. the imaging machine uses this as a guide to create a picture of the heart and the flow. by following the flow of the substance, healthcare providers are able to better understand where the impairment is and in what form. cardiac catheterization and angiogram: in this procedure, a thin tube is inserted and threaded to the chambers of the heart. this catheter allows for varying instruments to be inserted through it to either measure blood pressure, collect blood samples, or to remove a sample of the heart's tissue for further testing. cardiac computerized tomography (ct) scan: this cardiac ct scan is an x ray imaging machine that shows the blood supply to the heart and its arteries. this form of testing offers a non-invasive method to assess for narrowed or blocked vessels. treatment and prevention as cvd is the primary result of long-term damage to the cardiovascular system, research has been unable to develop a way to cure it permanently. however, through the available therapies and prevention strategies, there are methods of bettering its effects and making it so the individual's quality of life remains. this can help manage and reduce further risk of developing life-threatening cvds. the strategies that have been established in routine care include pharmacological therapies, lifestyle changes (including nutrition and exercise), surgery, and smoking cessation. pharmacological therapy: various medications have shown to mediate the negative symptoms of cvd. these typically work to lower the individual's blood pressure or widen their angiotensin ii receptor blockers (arb) & angiotensin-converting enzyme inhibitors (acei): both types of drugs work to limit the effects of angiotensin ii, which raises blood pressure through a feedback loop in the kidneys. they have shown to greatly reduce the mortality associated with cvds, with aceis being more effective than arbs. aspirin: aspirin, or asa, promotes platelet function inhibition which reduces the risk of plaque buildup in vessels. this has been shown to alleviate the effects of vessel narrowing and blood flow impairment, and prevent numerous cvds. the women's health study in 2005 also found that aspirin reduced the risk of developing stroke, as well as myocardial infarction in some age groups, in the long term. beta-blockers: beta-blockers impede the effects of adrenaline, also known as epinephrine, and subsequently slow the heart rate. this type of medication is generally prescribed for hypertension, a major risk factor for many cvds. however, recent studies have shown that this medication may lead to a higher rate of heart failure than men, thus these medications should be taken with precaution. blood thinners: blood thinners prevent clot formation, which contribute to vessel blockage, and is an effective method of anticoagulation that naturally plays an important role in cardiovascular system conditions. low dose blood thinners have shown to significantly reduce the risk of developing stroke, heart attacks and even the mortality associated with cvd. calcium channel blockers: calcium channel blockers are vasodilators, i.e. widen our arteries by regulating the calcium entering the cells, which lowers blood pressure. this has shown to be effective across all patient groups regardless of age and severity. this has been shown to be even more effective in combination with other therapies and must be used in moderation to prevent chronic cell damage. diuretics: diuretics assist the kidneys in clearing extra fluid present in the body to help maintain a steady blood volume for the heart to pump around. this helps bring blood pressure down, relieving pressure on the vessels and, consequently, the heart, thus making it a successful treatment for hypertension. hormone replacement therapy (hrt): hrt is taken by women to replace the declining estrogen levels during times of menopause. this is to control the cardio-protection offered by estrogen as women hit menopause and their levels decline. nitroglycerin and other nitrogen oxides: nitroglycerin and other nitrogen oxide use have been a strong influence on vasodilation, cell permeability, inflammation, and various other cardiovascular processes. statin therapy: this form of therapy aims to reduce levels of fat in the blood, specifically triglycerides and cholesterols. the proposed mechanisms for them are that they stabilize the plaque and reduce blood clots, which prevents most cvds from developing. as a primary prevention, they are significantly effective on patients at reducing the mortality and other life-threatening aspects of cvd. nutrition and exercise: adjusting an individual's lifestyle through their diet choices and increased physical activity has shown to reduce the long-term negatives associated with most risk factors, including plaque buildup and weakening of the heart muscle. exercise has been shown to strengthen the heart muscle, allowing it to pump greater blood volume at a regular pace, thus preventing overexertion and tissue damage. additionally, a diet with low trans fat, saturated fat, refined carbohydrates, and sugar-sweetened beverages, and enriched with fruits, vegetables, whole grains, and unsaturated fats have reflected a significant reduction in the risk of developing. smoking cessation: the adverse effects associated with smoking have overwhelmingly shown it to contribute to numerous risk factors that cause cvds. these include contributing to atherosclerosis and contributing to blood clot formation. for patients that have a history of smoking, it is important to focus on quitting smoking to prevent additional damage and allow healing to begin. surgery: in severe cases of cvd, various forms of surgeries offer a more permanent treatment to replace or remake the affected vasculature to prevent this from reoccurring. coronary angioplasty: the insertion of a thin tube with a balloon on the end into the clogged artery which becomes inflated to widen the channel for blood to pass through. in some cases, a stent is left behind to maintain the opening and prevent further relapse of the artery. coronary artery bypass graft: using another blood vessel to replace and divert blood around an occluded vessel to maintain regular blood flow of nutrients and oxygen, and prevent tissue death. heart transplant: the replacement of an individual's heart that is affected by disease with one of a healthy donor. depending on the risks associated based on age, type of disease, prognosis, pregnancy or menopausal stages, the following primary preventions can be prescribed to women under the guidance and proper consultation with their healthcare provider. epidemiology cvd remains the most common cause of death for women, with approximately one-third of deaths worldwide attributed to cvd. in 2015, approximately 8.5 million women died from the disease. in the united states, approximately 47.8 million women over the age of 20 were diagnosed with cvd between 2011 and 2014, and data from 2015 shows over 400,000 deaths due to cvd in women. while overall deaths from cvd are falling, the decline is slower in women, particular black women. the death rate for women with cvd surpasses that of men from cvd. in europe, over half of the deaths in women are attributed to cvd. the death rate in some eastern european countries is high, with over 500 deaths per 100,000 population attributed to cvd. studies predict that in certain developing countries in asia and africa, women will account for a greater percentage of deaths related to cvd by 2040. cardiovascular disease is more prevalent in older populations. on average, women develop cvd approximately 10 years after their male counterparts. in the united states, approximately 6% of women over 20 have coronary heart disease. the highest prevalence of cvd is present in adults over the age of 80, and women and men have similar rates of disease after the age of 60. history in the last few decades, the greatest changes have been made to acknowledge and focus on sex as an influential factor, thus establishing a great need to incorporate women into research. the events of significance are as follows: in 1994, the united nations stated that in order to establish a policy, there must be more sex-specific research done regarding treatment efficacy, thus encouraging researchers to pursue this line of inquiry.