The grace period of a woman’s biology that delays onset for seven to ten years has given many women the impression that heart attacks are a man’s problem.
“Women tend to get to the hospital later when more damage has been done,” Anuradha Rao, MD, FACC of Cardiovascular Associates said. “Sometimes that is because symptoms in women can be different. But we also see women who would get their husband to the hospital at the first sign of chest pains, but delay themselves, waiting to see if it gets better. They think it must be something else because they are women.
“Women also seem to be more reluctant to take cholesterol medications. They don’t seem to have a clear understanding of their future risks of dying from heart disease or how it could impact their quality of life.”
Since 1984, more women have died each year of heart disease than men. One in four women die of heart disease—a risk higher than all cancers combined. Yet in the most recent Women’s Heart Disease Awareness Study, 44 percent of American women still didn’t know that heart disease is the number one cause of death in women. In black women, that awareness was only 36 percent, and just 24 percent in Hispanic women.
While overall death rates have fallen, they have fallen less in women than men. Women are also more likely to die of a first heart attack and many have factors that may affect outcomes during treatment.
“Women tend to be diagnosed with heart disease at a later age when their health may be more fragile and when comorbidities are more advanced,” Rao said. Smaller blood vessels can be a problem in procedures, and women tend to develop blockages deeper where they are usually less obvious than those in men. Women can have a clear angiogram but a positive stress test and be at risk.”
There are also differences in how physicians should approach diagnostic testing in women, particularly in women under age 50.
“One very important point is that stress echoes are usually preferable to nuclear stress tests in younger women. Ionizing radiation is cumulative, and we definitely shouldn’t be doing annual nuclear stress test when each year is adding to a woman’s risk of cancer. With few exceptions, an echo stress test should give us the data we need,” Rao said.
When testing suggests that a woman is beginning to develop heart disease, how should treatment be approached?
“An important recent change in cardiology for both women and men, is that instead of treating only by numbers, we need to be treating by risk factors,” Rao said. “Diabetics and African Americans may have cholesterol numbers that appear to be within an acceptable range, but considering other risk factors, it could be wise to start them on preventive medications earlier.
“Another change is that we are returning to more aggressive treatment of hypertension. A few years ago, we received new guidelines suggesting that 140/90 might be an adequate target. However, a recent study comparing it to earlier guidelines ended early when it became clear that there is a significant improvement in outcomes when aim for 120/80 or below.
“We also need to listen closely and ask the right questions when we are talking with women. If we ask if a woman is a smoker and she says no, she may mean she doesn’t smoke every day but she is a social smoker and may smoke when she is with friends. On a day when her heart is already under stress, that can make a difference.
“If we ask if she drinks and she says ‘a little wine,’ we need to make sure she doesn’t mean splitting a bottle of wine with her husband every night or using an extra large goblet rather than a standard size wine glass. Men can usually drink more alcohol than women without it having a toxic effect on their heart,” Rao said.
Stress is a given in almost everyone’s life in the modern world. Extreme stress, as in the loss of a spouse or child, can put women at greater risk of broken heart syndrome. This syndrome can have the effect of temporary heart failure, which may reverse itself with time. However, physicians should be watchful when a patient is experiencing extreme stress or grief.
How can being more aware of their risks for cardiovascular disease help women protect their health?
“It’s motivating when women understand why they need to eat healthy, be active, not smoke, limit alcohol and take their anticholesterol medications when they need them,” Rao said. “They also need to know that in addition to the classic symptoms a man may experience when having a heart attack, their symptoms may be different.
“It may just be breathlessness and palpitations, extreme fatigue, sweating or jaw pain. Getting to the hospital sooner rather than later could save your life.”
Rao also pointed out that women are usually in a position where they can have a positive effect on the heart health of their whole family.
“Everyone’s busy and when a mom is driving her kids from here to there, it’s tempting to settle for fast food through the drive through too often. We’re on course now for the next generation to develop heart disease even earlier. Doing things is good, but we need to look for balance. It’s important to take time to eat healthy and to help our kids develop healthy habits, too.”
