Women and Heart Disease
By Alison Palkhivala
July 30, 2001 -- "I can't have heart trouble, I'm a woman!"
If you repeat that mantra to yourself when you feel signs of what might be a heart attack, you're certainly not alone. But you're still wrong.
Ask Harriet Rosenberg.
Rosenberg, 55, an anthropologist at York University in Toronto, has asthma, so when she started experiencing symptoms of fatigue, chest tightness, and shortness of breath, she figured that was the cause, despite her strong family history of heart disease.
"I had some numbness in my left arm," she says, "but I told myself I had slept funny or my shoulder was sore. I had a lot of ways of explaining it away."
"Women are totally, for lack of a better word, clueless with respect to their risk for ... heart disease," says Deborah Crabbe, MD, assistant professor of medicine at Temple University in Philadelphia, who specializes in heart disease in women.
It's a cluelessness that kills. One in six American women will die of breast cancer, according to Stephen Sinatra, MD -- but one in two will die of heart disease.
Sinatra, assistant clinical professor of medicine at the University of Connecticut School of Medicine, is a cardiologist in private practice in Manchester, Conn. He's the author of several books, including Heart Sense for Women: Your Plan for Natural Prevention and Treatment.
Most people, including many doctors, think of the classic heart attack symptom as being a crushing, squeezing pain in the chest, under the ribs. But that's a symptom generally experienced by men. Women are more likely to suffer from "'atypical" symptoms, including indigestion, nausea, weakness, and pain in other parts of her body, like the neck, shoulder, even the jaw.
Furthermore, medical professionals just don't think about heart attack as often when it comes to women.
"The index of suspicion in women tends to be lower," says Laura F. Wexler, MD, professor of medicine in the division of cardiology at the University of Cincinnati College of Medicine. "So if a woman comes to an emergency room with indigestion, she's more likely to be thought of as having indigestion. If a man comes in with indigestion, everybody knows that's a way in which heart attacks can present."
The good news, for women at least, is that, on average, a heart attack is likely to strike her about 10 years later than a man. Many men have their first heart attack between the ages of 45 and 55, but women usually don't have trouble until after they reach menopause, which in the U.S. is around age 51.
On the other hand, if women do suffer a heart attack between ages 45 and 55, they are more likely than men to die of it.
Identifying Heart Trouble
So how is a woman to know she's having heart trouble, or even a heart attack? It's not always easy, but here's some advice from the experts:
- If you're having some of the symptoms described above for the first time and have never experienced anything like them before, think of a heart attack, says Crabbe -- especially if you have passed menopause or have other risk factors for the disease.
- Trust your intuition, says Sinatra. "Women can track their bodies much better than men," he says. "So if a woman tells me, 'Doctor, there's something wrong with me,' I listen. ... A lot of younger women betray their intuition. If you have a doctor saying, 'Oh, women don't get heart disease,' and the woman is saying, 'This can't be heart disease,' you get two colluding people, one a professional and one not, so some of these women are sent home."
Harriet was lucky. She was feeling so bad a few days before a scheduled trip to Africa that she went to see her doctor. Unlike many physicians faced with a 54-year-old woman with rather vague complaints, he immediately thought of heart disease and sent her for testing, which came back positive.
Preventing Heart Disease
With conventional wisdom telling us heart disease is pretty much a male problem, it's no surprise that most prevention efforts have been pushed toward men. But that, too, is wrong-headed thinking. It turns out that many risk factors for heart disease are more important in women than they are in men, including high blood pressure and diabetes.
Women, especially those who've reached menopause, must be checked for the following risk factors:
Diabetes: The presence of diabetes can be checked with a blood test. It's an especially important risk factor for women.
Weight: The more overweight you are, the higher your risk for a whole host of diseases, including heart disease. Even a small increase in weight can significantly increase your risk.
Blood pressure: According to Sinatra, even slightly elevated blood pressure is a significant risk factor for heart disease in women. A class of drugs called thiazide diuretics show promise with respect to lowering blood pressure and reducing the risk of heart disease.
Cholesterol: You're aiming for high levels of the "good" cholesterol, called HDL, and low levels of the "bad" cholesterol, called LDL. Statin drugs are often prescribed to improve one's cholesterol levels.
Other blood factors: Sinatra says factors in the blood, like homocysteine and C-reactive protein, are important indicators of the risk for heart disease.
Smoking: Smoking significantly increases your risk of heart disease. Tobacco use is a growing problem in women because so much of the advertising targets women by suggesting that elegance, liberation, thinness, and smoking all go together, says Wexler.
Controlling these risk factors (possibly with medication), eating well, and getting plenty of exercise are probably the best ways for women to prevent heart disease. Some experts, such as Sinatra, also recommend taking certain supplements, such as vitamin B-12, coenzyme Q10, calcium, and magnesium.
Treating Heart Disease
Once you're diagnosed with heart disease, treatment is similar to that of men. You might be given medication or have to undergo surgery. These treatments have been studied primarily in men, but according to Crabbe, "there's no reason to believe ... they don't work in women."
In addition to the drugs mentioned above, you may be prescribed beta-blockers to regulate your heart rate or a small dose of aspirin every day, which helps prevent heart attacks by stopping blood clots from forming.
A controversial issue regarding the prevention and treatment of heart disease in women is the role of hormone replacement therapy. Experts' opinions vary widely. Some believe almost every woman should take hormone replacement therapy, or HRT, at the time of menopause to help protect their hearts while others believe this can make heart disease worse.
Just this month, however, the American Heart Association helped resolve this debate. The group has released recommendations to doctors saying that female patients who have a heart attack while on HRT should be taken off it, and that HRT should not be started in women just for heart attack prevention. Women should discuss this new recommendation with their doctors.
Harriet was treated with medication and surgery. She is also attending a six-month cardiac rehabilitation program at Women's College Hospital in Toronto. She finds the program very helpful because she is being taught not only how to exercise safely and effectively but also how to tell the difference between the signs of asthma and heart disease that her body gives her.
"I learned the important role of exercise, which you understand at one level but don't take in at another level," she says. "I also learned enough not to say, 'I slept funny, and it's going to go away.'"
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