Wednesday
Nov072012

Women & Heart Disease

Question:  I am 55 years old and I’ve always been worried about dying of breast cancer.  However, I have been told recently, that a woman my age has a ten times greater chance of dying from heart disease instead.  Is this true?

Answer:  Many women fear that breast cancer poses their greatest risk of dying. Studies have shown that a woman has about a ten percent chance of dying of breast cancer but nearly a fifty percent chance of dying from heart disease.  This is a statistic many women are not aware of.  In fact, a recent survey of women (of various ages) revealed that only forty three percent of women were aware that they had to be concerned with heart disease. The unfortunate truth is that heart disease is the number one killer of women in the United States.

Historically the risk of heart attack has always been associated with men.  Despite the efforts and in fact has long been known to enlighten us, even many health care professionals still perceive the typical heart attack victim pose a great threat to be male. In recent years we have learned much more about different presentations of heart disease in men and women.  Heart disease tends to occur about ten years later in women than in men.  It seems that women are protected somewhat by estrogen production until they reach menopause.  After that, the risk of heart disease continues to rise until it equals that of men in their sixties and seventies.  In fact, slightly more women died of heart attacks last year than men in this country. It has been important for treatment and prevention to learn allMuch evaluation has been made of these facts and we can have learned a great deal about the risk factors of for coronary artery disease in women and the atypical symptoms they may experience a heart attack. 

We now know that women often present differently at the time of a heart attack which can create a delay in their treatment.  Men more commonly present with a “Hollywood heart attack”: severe gripping chest pain in the center of the chest, sweating, nausea, a feeling of weakness, difficulty breathing and a feeling of impending doom.  Women may have other symptoms like pain in the arm or neck, shortness of breath, fatigue, a feeling of anxiety and profuse sweating.  Indeed, many of these symptoms are not so dramatic in women thus they often delay seeking treatment.  Even though there has been a rise of heart attacks in women under the age of forty-five, when these women seek treatment, they are often evaluated for something other than heart disease. Many younger women fail to respond to their symptoms because they simply feel that “this cannot be happening to me.” 

A family history of heart disease is a definite risk factor in women, even more so if their mother developed heart disease in her early years.  The other common risk factors include obesity, diabetes, hypertension, high cholesterol, a sedentary lifestyle and smoking.  American women live considerably longer than men, with a life expectancy of 80.3 years compared to 77.6 years for men.  Women are generally better about preventive care and overall tend to be more attentive to their own bodies.

There are other reasons why heart disease seems to be on the rise in women.  Many women who are now in their seventies and eighties smoked heavily in their younger years.  It was quite chic during and after World War II for women to smoke, thus affecting the incidence of heart disease later in life.  Smoking seems to take a greater toll on women than men in several ways: they are generally smaller in stature, have smaller lung capacities, and usually have smaller coronary arteries that tend to clot.  The protective effects of naturally produced estrogen diminishes when a women stops menstruating.  It also seems that the hormone replacement, which was felt for many years to protect women from heart attacks, may indeed provide no protection and possibly even increase their risk for having vascular disorders.  Additionally, many older women were not brought up with an emphasis on exercise.  We now know that regular exercise can help prevent heart disease and slow the risk of heart attacks.

Women who have a history of heart disease in their family, particularly with the early onset of heart disease in their mothers, need to be especially aware.  Family history is certainly a risk factor for heart disease, and the presence of this problem in siblings increases the risk even further.  The other common risk factors include obesity, diabetes, hypertension, high cholesterol, a sedentary lifestyle and smoking.

The American Heart Association in recent years has stressed the risk of heart disease in women with a Herculean effort to educate the American people about these risks.  Here are some of the symptoms prior to and during a heart attack:

Symptoms Before Heart Attack                               Symptoms During Heart Attack

Fatigue (71%)                                                             Shortness of breath (58%)

Sleep disturbances (48%)                                            Weakness (55%)

Shortness of breath (42%)                                          Fatigue (43%)

Indigestion (39%)                                                       “Cold sweat” (39%)

Anxiety (35%)                                                                        Dizziness (39%)

Interestingly enough, in women, chest pain is often absent and a woman’s heart attack symptoms are more likely to be dismissed as anxiety or fatigue.  That is why a greater awareness about reducing risk factors and full knowledge of the atypical symptoms of a heart attack which may prevent such an event in women.  Furthermore, pharmaceutical advances such as statin drugs that reduce cholesterol, various diagnostic tests and interventional procedures using medicated stents give promise to a better outlook for all women that encounter heart disease.   

In closing, I encourage everyone, that communication between you and your doctor is very important.  If you think you’re experiencing any of the symptoms we’ve presented, see your health care provider and get your point across.  As long as you understand the risk factors involved and how to alter some of these risk factors, you can seriously decrease your chances of suffering from heart disease. 

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