Menstuff® has compiled the following information on Heart
Disease in Women.
Silent Risk: Women and Heart
Her Guide to a Heart Attack: Recognizing Female Heart Attack Symptoms
Women's Heart Guidelines
Related Issue: Heart Disease in Men
Silent Risk: Women and Heart Disease
Heart disease in women - the numbers are staggering. Cardiovascular disease, which includes heart disease, hypertension and stroke, is the number one killer of women, according to the American Heart Association. It kills half a million American women each year. That figure exceeds the next seven causes of death combined. Moreover, women are 15% more likely than men to die of a heart attack. And they are twice as likely to have a second heart attack in the six years following the first.
Yet in a 2000 national heart association survey, only 34% of women correctly identified heart disease as a leading cause of death.
And "only 8% of women saw it as their biggest health threat," says cardiologist Sharonne Hayes, MD, director of the Mayo Clinic Women's Heart Clinic in Rochester, Minn. "There's a disconnect. They know it's a major disease, but they think they're going to die of breast cancer."
Major issues surrounding women's heart health and medical care were brought to light in a survey of 204 women with heart disease reported in the January/February 2003 issue of Women's Health Issues. Hayes, who is Director of Mayo Clinic Women's Heart Clinic in Rochester, Minn., co-authored the report, funded by WomenHeart: The National Coalition for Women With Heart Disease. Among the issues women raised were:
Dissatisfaction with medical care, including major hurdles in getting support for recovery
Hayes says that awareness about women's heart health is gradually growing among women and healthcare professionals, but there's much room for improvement.
Mental Health and the Heart
One survey result has already changed how Hayes conducts her practice. She was surprised by the high percentage of women -- 57% -- who said they suffered depression, anxiety or both as a result of heart disease. "Following the survey, our women's heart clinic got a psychologist much more integrated in terms of evaluating patients and giving us cardiologists some insight into mental illness that we're not trained for."
That insight may help explain why only 14% of women made lifestyle changes following a heart attack. "If you're depressed, you're unlikely to be able to make the lifestyle changes that you need to prevent another heart attack," says Hayes. But the knowledge should now help healthcare professionals see and treat mental health problems brought on by heart disease.
Kathy Kastan was diagnosed with post-traumatic stress disorder following heart bypass surgery. (This condition is a form of anxiety brought on by a traumatic or life-threatening event.)
In spite of begin a psychotherapist herself, the 44-year-old wife and mother didn't recognize the signs of the condition until the second year after her surgery. "The first year I was in shock," she says. "When you go through trauma like that, you stay numb." She relates the trauma to the surgery itself, pain and humiliation caused by a nurse, and continued poor health after the surgery. "I worked through it, but these experiences change your life."
Missing the Diagnosis
Many women with heart disease say they were misdiagnosed in the early stages. In the survey, only 35% of the women and 68% of their doctors associated their symptoms with heart problems. Yet most of the women surveyed had typical cardiac symptoms, such as chest pain and arm pain or pressure, or shortness of breath. Others reported dizziness, nausea, fatigue, and back pain, which are less common symptoms.
Kastan was a 41-year-old non-smoker and a trim athlete when she began experiencing shortness of breath. She attributed it to asthma, which can be brought on by exercise. But it kept getting worse. On one bike ride, the symptoms became severe. Kastan's husband, a physician, said he doubted she had heart disease, nevertheless suggested she see a cardiologist. The cardiologist proclaimed her healthy. The very next week she collapsed in the mountains. "This time I had classic Hollywood heart attack symptoms with chest pain radiating up into my jaw and down my arm, shortness of breath, pasty pale skin and nausea," she says.
She immediately went to a second cardiologist. "He said to go home and exercise and we'll see what happens. The minute I started running I collapsed again." She finally had the cardiologist put her on the treadmill and raise the level of exertion. "Then he was the one who turned pasty pale. He said I had a blockage" in the arteries. The doctor quickly confirmed his suspicion by inserting a catheter to look into her arteries.
Kastan, who is now president of WomenHeart and on the board of the American Heart Association, says a walking treadmill test hadn't raise her heart rate sufficiently to pick up the blockage. "Dr. Hayes and the heart association are pushing for physicians to supplement a treadmill [stress] test with an EKG or thallium stress test [in women with suspected heart disease]," she says. "Those are more effective than treadmill tests, but none are 100%. The only way to see [a heart blockage] is with cardiac catheterization."
Hayes says health care providers need to become aware that heart disease is the number one killer of women, and to recognize gender differences that occur with heart disease, heart failure and arrhythmias. "When they have a woman in the office who is complaining of symptoms . . . they need to rethink their approach," she tells WebMD. Women need to be evaluated differently than men.
Physicians' Attitudes: Part of the Problem?
Doctors' lack of understanding may contribute to difficulty diagnosing heart disease in women. In the survey, 58% of women blamed problems in their medical care on physician attitudes and communication styles. "My husband thinks a lot of this has to do with the way I communicated, but I believe there's a lack of respect for what women say to their physicians," says Kastan. "I was seeing my second cardiologist three times a month. He'd put me on the treadmill and nothing would show up. The entire time I was talking to him, I didn't feel I was heard or believed. I felt I was annoying him."
She says he couldn't believe what he was seeing and perhaps had preconceived notions about young women and heart disease. "I don't know how much it was a feminist issue or his frustration at not being able to get me well," she says.
Kastan remained ill following double bypass surgery. "Friends started wondering if some of this was in my head," she says. She contacted WomenHeart for support and was urged to go to a women's heart clinic. She went to Hayes. "She listened. She may challenge me, but she always supports me. She'd never question me as an intelligent human being or question my feelings."
Obstacles to Recovery
Here's something else you may not know: women who have heart attacks may not recover as quickly or as fully as men. In the survey, 52% of the women were unhappy with their medical care, and faced major hurdles getting the help and support they needed for recovery.
Following her bypass surgery, Kastan couldn't walk without having chest pains. But she says her recovery began within a week after she went to the women's heart clinic.
One study has shown that 35% of women compared to 18% of men have a second heart attack within six years of the first. "We don't completely understand that, but we have theories," Hayes tells WebMD. "We know women are not treated as aggressively as men after a heart attack. They're less likely to be on statins or ACE inhibitors or beta blockers, all of which reduce the risk of a second heart attack. Women receive fewer angioplasties and bypass operations and even less aspirin."
Is the disparity due to a true sex difference or because women are undertreated? The only way to find out, says Hayes, is for doctors to "start treating women the same as men."
The Take-Home Message
Kastan, who speaks around the country about women and heart disease, has seen doctors' attitudes improve in the past couple of years. "They're more aware of women and heart disease and aren't dismissing women as readily," she says.
She urges women to pay attention to their bodies and become more active consumers of health care. "I was uncomfortable going to the Mayo Clinic [for a second opinion] because I didn't want to hurt my cardiologist's feelings," she says. "That shouldn't have been my concern. Be your own best advocate."
Hayes says momentum for change is rising due to recent health campaigns and research results. "We've got a snowball going," she says. "More people are aware. Whether they're taking action is another issue."
She wants women to know they're more likely to die of heart disease than anything else. It's important to know the risk factors and symptoms, and take preventive steps.
"Lifestyle changes, like diet, really help," she tells WebMD. "Women use the excuse that they don't have time because they're too busy with jobs and caring for families. I say, anything they do for themselves, such as changing their diet or taking walks, helps their families. You think it's selfish to take care of yourself, but you're doing this for everyone in your family."
To learn more about women's heart health, check out the Heart
Truth campaign of the National Heart, Lung and Blood Institute, and
the Go Red campaign of the American Heart Association.
Her Guide to a Heart Attack: Recognizing
Female Heart Attack Symptoms
But she never had chest paina typical male heart attack sign. When she got to the emergency room, doctors couldnt find any sign of heart attack and Rose says, They would have sent me home.
As Roses experience shows, many doctorsand women themselves--still dont realize that female heart attack symptoms can look very different than those of men. In fact, according to a 2004 study of womens early heart attack signs published in Circulation, women have more unrecognized heart attacks than men and are more likely to be, mistakenly diagnosed and discharged from emergency departments.
In the emergency room, physicians had assumed she had gastrointestinal illness. But at the time, no one told Rose that she had suffered a heart attack.
Fortunately for Rose, a cardiologist recommended by her regular doctor checked her arteries. The test found major blockage. It then that she learned that she had experienced female heart attack symptoms.
Thats the first I ever heard, Rose says. This doctor told me, They didnt connect the dots.
Female Heart Attack Symptoms: What are They?
These chest-related heart attack signs often appear in men, and many women get them, too:
But many women dont have chest pain. In the Circulation study on early female heart attack symptoms, researchers found that during a heart attack, 43% of the 515 women studied had no acute chest pain a hallmark symptom in men, according to study authors.
Nevertheless, the study cited evidence that many emergency room doctors still look mainly for chest pain. Only a minority check for the other types of symptoms that women tend to develop. As a result, doctors may miss heart attacks in women.
Although women can have chest tightness as a symptom of a heart attack, its also important for women to recognize that might not be their symptom, says Nieca Goldberg, MD, a cardiologist and chief of Womens Cardiac Care at Lenox Hill Hospital in New York City and author of The Womens Healthy Heart Program.
Women commonly have symptoms of shortness of breath, unexplained fatigue, or pressure in the lower chest, so they easily mistake it as a stomach ailment.
In the Circulation study, common female heart attack symptoms include:
Women also had these symptoms:
Female Heart Attack Symptoms: Warning Signs That a Heart Attack May Be Coming
In the weeks preceding an actual heart attack, some of these symptoms may even appear as prodromal, or early, warning signs, according to the Circulation study.
Goldberg, who is familiar with the study, says, About six weeks before the actual heart attack, women were more likely to experience shortness of breath, unexplained fatigue or stomach pain as an early warning sign that they might have a blocked artery.
Rose was a prime candidate for a heart attack: a family history of cardiovascular disease, high blood pressure, high cholesterol and type 2 diabetes. Long before her heart attack, she had struggled with extreme fatigue.
I felt like I was being rolled over by a steam enginecouldnt make plans, she says. Doctors put her on antidepressants. She also developed shortness of breath. I was constantly gasping for breath. But because of the depression diagnosis, I thought this was an anxiety issue.
I did have symptoms of heart disease, Rose says. They just didnt connect it and I didnt connect it.
If you get prodromal warning signs, call your doctor and talk about the possibility of heart disease.
Thats the time to come in for an evaluation, says Goldberg.
On the day of a heart attack, these symptoms can strike without any provocation; for example, shortness of breath may come without physical activity. Symptoms can appear during rest or even awaken a woman from sleep, and theyre much worse, Goldberg says.
They just come on and theyre severe. I had one patient describing that she was so short of breath that she could barely talk to the 911 operator.
Female Heart Attack Symptoms: Calling 911
If you believe youre having heart attack symptoms, dial 911 right away for an ambulance to take you to the emergency room. Wait no more than 5 minutes.
As a doctor, I know from experience that when chest pains or other symptoms occur, most women are reluctant to call 911, Goldberg says. Thats precious time that we could be saving your heart muscle.
Women often worry about being embarrassed if theyre not having a heart attack after all, she says. But embarrassment will pass without causing long-term damage; a heart attack may not.
Others dont appreciate the seriousness of the situation. One of Goldbergs patients had heart attack symptoms at age 57 and insisted on straightening up her house before she let her husband call 911. This delay could have been fatal, Goldberg says.
Calling for an ambulance is better than taking a taxi or having someone else drive you, Goldberg says. And unless you have absolutely no other option, you shouldnt drive yourself. You dont want to pass out driving your car, she says.
A big advantage to calling 911: emergency medical personnel can start treatment, such as oxygen, heart medication, and pain relievers, as soon as they arrive, says Mohamud Daya, MD, MS, an associate professor of emergency services at Oregon Health and Science University.
One more compelling reason to go by ambulance: When you come into the emergency room with the [cardiac] monitor hooked up, youre really taken seriously, Goldberg says. You look the part.
Female Heart Attack Symptoms In the Emergency Room
When you reach the emergency room, describe your symptoms, but dont offer your own conclusions, Goldberg says. I wouldnt go through this whole dissertation about how, Oh, I thought it was a stomachache, I thought it was this. You should just tell the doctor how you feel. Dont interpret it for them.
If it doesnt occur to the emergency room doctor to check for heart attack, be bold. Goldberg tells women to say outright: I think Im having a heart attack. Because many doctors still dont recognize that womens symptoms differ, they may mistake them for arthritis, pulled muscles, indigestion, gastrointestinal problems, or even anxiety and hypochondria.
In short, female heart attack symptoms may be missedand dismissed. When one of Goldbergs patients entered the emergency room with such symptoms, doctors gave her antacids. She said, Listen, Im diabetic and womens heart disease symptoms can be different, and unless you give me an EKG, Im not leaving this place. And the next day, she had a bypass.
Of course, stomach pain could prove to be nothing more than a bad case of gastrointestinal illness. But what I tell all my patients is, Its best to check out your heart first because a potential heart attack is life-threatening, Goldberg says.
And if your fear of cardiac problems turns out to be unfounded,
dont sweat it, she adds. Doctors would much rather diagnose you
with indigestion than a heart attack.
Women's Heart Guidelines
Heart disease kills 1 in 3 American women, but it doesn't have to be that way.
Women can prevent heart disease and stroke, show the latest guidelines from the American Heart Association.
Armed with new data -- and encouraged by the fact that 60% of U.S. women now know that heart disease is their No. 1 health threat -- the AHA has launched an ambitious prevention program.
The program is the work of an expert panel led by Lori Mosca, MD, MPH, director of preventive cardiology at New York-Presbyterian Hospital and of the Columbia University Center for Heart Disease Prevention.
"Women are still confused about cardiovascular disease prevention," Mosca said at a news conference. "We hope to clear up some of this confusion. These new guidelines will help our patients ... develop strategies to combat this leading killer."
Cardiovascular disease refers to any disease that affects the heart and blood vessels, including stroke.
The AHA women's heart disease prevention strategy has three main elements: living a healthy lifestyle, addressing major heart risk factors, and using appropriate medications.
Here's the plan:
All women age 20 and older should see a doctor to find out their heart disease risk.
About one in 10 women will learn she is at "optimal risk," meaning she's currently at no real risk of heart disease. These women should continue their heart-healthy lifestyles.
Most women will be "at risk" -- meaning they must start thinking about preventing heart disease and stroke. These women must stop smoking, adopt a heart-healthy diet, get at least 30 minutes a day of exercise, and watch their weight. With a doctor's advice -- and only with a doctor's advice -- some of these women may need blood pressure medications, cholesterol-lowering therapy, or regular aspirin.
Many women will be "high risk," meaning they already have some condition that makes it particularly likely they will suffer heart disease or stroke. In addition to taking the measures advised for their "at risk" sisters, "high risk" women may need more aggressive medical treatments or rehab.
Depression is common in women with heart disease. All women with heart disease should be evaluated for depression.
The new guidelines appear in the March 13 issue of the AHA journal Circulation.
Heart Disease in Women
These guidelines replace the AHA's 2004 guidelines with even more aggressive exercise and diet rules.
"All women should exercise a minimum of 30 minutes a day," Mosca said. For women who want to lose weight, Mosca and colleagues recommend 60 to 90 minutes of exercise "most, or preferably all, days of the week."
As for diet:
High blood pressure is a risk factor for heart disease. Women whose blood pressure gets to 120/80 or above should get more exercise and eat a better diet.
But when a woman's blood pressure reaches 140/90, Mosca says, it's time for her to talk with her doctor about blood pressure-lowering drugs.
Cholesterol is perhaps the best-known measure of heart disease risk.
Women should keep their bad LDL cholesterol below 100 mg/dL. If they are at very high risk of heart disease, Mosca says, they should talk with their doctor about using cholesterol-lowering drugs to drop their LDL cholesterol to less than 70 mg/dL.
Daily Aspirin for Women?
"There is a perception that aspirin protects a woman's heart the same as a man. But that is not the case," Mosca says. "Women under 65 should not be using aspirin routinely to benefit their heart -- unless they are at high risk of heart disease."
For women under age 65, regular low-dose aspirin does reduce the risk of one kind of stroke. But aspirin also greatly increases a woman's risk of serious bleeding. For many women, the benefit does not outweigh the risk.
"Women should consider aspirin for prevention of a certain type of stroke -- ischemic stroke -- but that choice needs to be very informed and based on an individual woman's risk factors for stroke and risk of side effects," Mosca says. "The additional benefit in women over 65 for heart attack prevention should be weighed into that decision."
That said, women who already have heart disease benefit greatly from regular low-dose aspirin, says Alice Jacobs, MD, director of interventional cardiology at Boston Medical Center.
"For women with established heart disease, aspirin is mandatory on a daily basis," Jacobs says.
The bottom line: Women should not take regular aspirin to prevent stroke or heart disease without discussing the issue with their doctors.
Sources: Mosca, L. Circulation, March 13, 2007; vol 115, manuscript received ahead of print. News conference with Lori Mosca, MD MPH, director of preventive cardiology, New York-Presbyterian Hospital; director, Columbia University Center for Heart Disease Prevention, New York. Alice Jacobs, MD, director of interventional cardiology, Boston Medical Center. www.webmd.com/heart-disease/news/20070220/heart-assn-toughens-womens-rules