Did you know that cardiovascular disease is the leading cause of death among women? Coronary heart disease impacts 6.6 million women in the U.S. each year and is the leading cause of chronic ill health and death among women.
In spite of gains in education and treatment of heart disease since 1984 (when the American Heart Association began to compile annual reports on mortality rates), women are still more likely to die from a heart attack than men.
Why is heart disease a woman's issue?
The American Heart Association names three main reasons why women outnumber men in death from heart attack:
- The symptoms women present are different than men.
- The rate at which women report symptoms lags behind men.
- The medical and drug interventions for treatment can adversely impact a woman’s health in the short term despite high rate of her survival if used.
Additional factors influencing a woman’s heart health include biology, psychosocial reality, and effects of menopause.
Most studies on heart health have been done on men who do not experience the changes to the body brought on by menopause. The complex influence of estrogen on heart health is not fully known; and it is difficult to differentiate from effects of aging on overall health.
A woman’s symptoms are different than a man’s
The traditional image of a man clutching his chest suddenly in pain is what many of us imagine. But this image of pending heart attack does not apply to a woman. A woman’s symptoms are not only slower to manifest, but may pass, recur, or build over time. In fact, shoulder and arm pain are twice as predictive of a heart attack diagnosis in women compared with men.
What does a heart attack look like for a woman?
- Acute upper arm, neck, and/or jaw pain
- Nausea, vomiting
- Sudden shortness of breath
These symptoms that are different for women can sometimes result in misdiagnosis and delay of appropriate triage when she seeks medical attention.
A woman may not respond to symptoms quickly
Women, especially young women, fail to assess their risk even with a family history of heart disease, and may not address preventive care specific to their heart health. There is growing evidence that depression and other psychological factors influence onset of adverse heart health outcomes as well. Women suffer from depression at twice the rate of men in the general population, and it impacts cardiac health.
Because a woman’s symptoms are not the characteristic “chest pain” that is better known for men, she may not think she is in danger. Social and psychological barriers can also delay a woman seeking medical attention for symptoms of a heart attack:
- Lack of awareness of risk
- Considering symptoms non-urgent
- Older age
- Living alone
- Fear and embarrassment
- Language barriers
- Caregiving for aging spouse or parents and neglectful of one’s own symptoms
Diagnosis and treatment can be overlooked and delayed
Despite more cardiac risk factors, secondary prevention efforts such as lipid-lowering medication use and counseling for smoking cessation is less commonly used for women. Cigarette smoking is the single most important preventable cause of heart attack in women. While the U.S. rate of smoking has declined over the years, the decline has been less prevalent among women than men.
In the event of a heart attack, many of the treatments available for acute symptoms themselves have risk for female patients, even though use of the treatments could also save their lives. Simply being female presents a higher probability of bleeding, for instance. The medication (also called thrombolytic therapy) used to break up a coronary blood clot and save the patient’s life may cause bleeding on the brain for the female patient. In addition, many female patients also have concurrent conditions such as hypertension, advanced age, and small body size which make physicians reluctant to use thrombolytic therapy.
What can a woman do to reduce her risk for heart disease?
There’s a lot you can do to reduce your risk of heart disease and improve your chances for a longer, healthier life. First, learn more about some of the risk factors for heart disease. Then, take steps to minimize those risks over which you have some control, such as a heart-healthy diet, exercise and seeing your doctor regularly.
- Family history of heart disease or heart attacks
- Abnormal cholesterol
- Elevated blood pressure
- A lack of regular exercise
Humera Ali, MD, is board certified in cardiovascular disease. Her practice covers all areas of heart disease with a particular interest in preventing and treating advanced forms of heart disease. Dr. Ali is available to see patients at The Polyclinic Madison Center and Issaquah. Call 206-860-2302 for scheduling.