Women Too Need to Pay Attention to Heart Disease

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NEW YORK—Heart disease is the No. 1 killer of both women and men in the United States. But for years, women haven’t received the same lifesaving care that men do, partly because they have different symptoms that are misdiagnosed or marginally treated.

Nieca Goldberg, M.D., medical director of the Women's Heart Program at NYU Langone Medical Center. (Courtesy of NYU Langone Medical Center)

Dr. Nieca Goldberg, medical director of the Women’s Heart Program at NYU Langone Medical Center in New York, said heart disease had been considered a man’s disease because one of the largest ongoing heart health studies concluded at one point that women didn’t get heart disease.

However, since 1984, more women than men have died from heart disease in the United States.

This data has sparked a push to re-evaluate the thinking on women and heart disease, and awareness in the medical community is on the rise.

As a result of increased awareness, prevention, and improved treatment, there has been a significant reduction in heart disease mortality in women since 2000. But despite improvements, the number of women living with and dying from heart disease still remains higher than men.

A woman’s best defense against heart disease is to take matters into her own hands and think twice about why she may not be feeling well.

Here are some signs to watch out for and ways to prevent heart disease and heart attacks.

Heart Disease Symptoms

Men and women have the same risk factors for heart disease, including high blood pressure or cholesterol, obesity, sedentary lifestyle, smoking, and diabetes.

However, women tend to have worse outcomes than men due to symptoms that are not correctly diagnosed.

“Women will have shortness of breath, jaw pain, back pain, nausea, vomiting and not be aware that it’s [their] heart,” said Dr. Suzanne Steinbaum, director of Women’s Heart Health at the Lenox Hill Heart and Vascular Institute in New York.

Suzanne Steinbaum, M.D., director of Women's Heart Health at the Lenox Hill Heart and Vascular Institute. (Courtesy of Lenox Hill Heart and Vascular Institute)

“By the time she gets diagnosed, a woman has already had problems for a while and she ends up being much sicker,” she said.

In addition, poor mental health, depression, metabolic syndrome, pregnancy complications, and low estrogen after menopause, can increase a women’s risk of heart disease.

Signs of Heart Attack

This year for the first time, the American Heart Association (AHA) published a scientific statement on heart attacks in women, outlining gender differences in causes and symptoms

While the most common symptom of a heart attack in both men and women is chest pain, women can have atypical symptoms like pain or discomfort in their arms, back, neck, jaw, or stomach; shortness of breath; lightheadedness, nausea; sweating; and fatigue.

These symptoms can occur without any chest discomfort. “It could be shortness of breath without any chest pressure,” Goldberg said.

“It could be incredible amounts of exhaustion to do simple levels of activity.”

It doesn’t help that women are under great amounts of stress trying to juggle full-time jobs and handle households, tend to take care of themselves last, and ignore the signs like fatigue, which can lead to a heart attack, Steinbaum said.

Women are also more likely to have heart spasms, where the muscles of the coronary artery contract, narrowing the artery and limiting blood flow to the heart. This restriction of blood flow can lead to a heart attack, she said.

Called a coronary artery spasm, Prinzmetal’s angina, or variant angina, these painful spasms usually occur when she is at rest during the night or early in the morning.

Because traditional coronary angiograms mainly look for blockages in the main artery leading to the heart, they can miss the narrowing of the artery and not diagnose a heart problem in women.

So how does a woman know whether or not she is having a heart attack?

She doesn’t.

Goldberg says a woman should see a doctor who can help her get perspective.

“You really judge it in the context of risk factors. … Are they at higher risk of heart disease to make it more likely?” she said.

Certain risk factors, like high blood pressure and diabetes, increase the risk of heart attacks in women more than in men, according to the AMA statement.

Testing

Family history of heart trouble is a risk factor for both men and women, and Dr. Steinbaum said that if heart disease runs in your family, start getting tested early.

Both doctors agree that having your primary care doctor regularly test your blood pressure, blood sugar, and cholesterol is important since these diseases are strong risk factors for heart failure.

Primary care physicians start the therapies for these conditions but may also suggest the patient see a cardiologist if she has signs of heart disease. A cardiologist can conduct more advanced testing, such as a stress test or coronary artery calcium score.

The calcium score test looks for calcification in the arteries, which can occur subsequent to plaque buildup.

Not everyone has to be tested this way, and lab tests are usually done first. Both doctors said this test is a bit controversial because it’s expensive, and it requires exposing a patient to radiation via a CAT scan. But Steinbaum said it is less controversial than when it first came out, and she uses it.

Prevention

Since women do worse when they get heart disease, their best medicine is prevention.

It all starts with the basics—diet and exercise. It’s not about trying to lose weight, although this can be a welcome byproduct; rather, these doctors recommend making healthy choices to sustain your life.

Dr. Steinbaum advises her patients to try the Mediterranean diet, which emphasizes eating mostly plant-based foods.

Dr. Goldberg tells her patients to avoid takeout. She also recommends the DASH diet, which is designed to lower blood pressure without medication.

When it comes to exercise, neither doctor expects her patients to run a marathon, but they should be active.

It’s also about managing stress. Managing your stress is integral to leading a heart-healthy life, Dr. Steinbaum said.

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She recommends transcendental meditation. Studies have shown a reduction in cardiovascular disease by as much as 40 percent in one trial. “And the reason for that was a reduction in blood pressure,” she said.

So empower yourself with knowing yourself and your risks.

 June Fakkert contributed to this report.