clinical update publication

Women and Heart Disease

Nearly twice as many women in the United States die of heart disease and stroke each year than from all forms of cancer, including breast cancer. This year, heart disease is expected to kill 50,000 more women than men.

Yet women remain convinced that heart disease is a man’s disease. According to the American Heart Association and American College of Cardiology’s Guide to Preventive Cardiology for Women, women’s risk factors are typically not managed as aggressively as men’s.

How, in 2002, when women are bombarded with health information on the Internet and in the media, could this still happen? Unbelievably, a lack of awareness among women is part of the reason. While many women are diligent in their regular mammograms and pap smears, they make little effort to adhere to lifestyle habits that could drastically lower their risk factors for heart disease.

“Here we are, in an age when women are scouring the Internet for health information, and they still don’t understand how high their risks are for heart disease,” said Fatima Hakkak, DO, Attending Cardiologist at Deborah. “Many are not aware that heart disease is the number one killer of women in this country. This lack of awareness results in a multitude of other problems: women don’t manage risk factors; they don’t recognize their symptoms; they ignore symptoms; and they seek treatment much later in their disease progression.

It’s no secret that by managing weight, quitting smoking, and having regular bloodwork to monitor cholesterol and triglyceride levels, a woman can significantly lower her chances of developing heart disease. It’s also well known, among physicians, that women’s symptoms of heart disease can be atypical or vague. The challenge is helping women understand this so that they begin prevention and risk factor management, and seek immediate treatment when potential symptoms present.

It’s vital for physicians - general practitioners, gynecologists and cardiologists alike - to communicate to female patients that their risk of coronary artery disease is just as great as men’s. Women, as early as in their 20s, should be screened for family history and begin having bloodwork. The earlier a woman begins prevention efforts, the less likely it is that she’ll develop heart disease in the future.

Deborah cardiologists have emphasized that prevention is especially important for women since, once heart disease develops, its progression and different physiological consequences can cause women to respond poorly to commonly available treatments that are effective in men.

Women present with coronary artery disease much later in life than men do, typically in their 60s and 70s - men present in their 40s and 50s - not surprisingly, more comorbidities exist at that age. Additionally, their arteries are smaller and they tend to present with more diffuse disease, making angioplasty, stenting and bypass grafting much more difficult.

Challenges also exist in helping women recognize symptoms when they occur. Though men typically present with symptoms commonly associated with heart disease, such as chest pain or pressure, women, more often, do not. More likely, they’ll present with vague symptoms: shortness of breath, fatigue, shoulder or back pain, or others. Not only are these symptoms more challenging to diagnose, they’re easier to ignore than crushing chest pain.

woman being examined

“If a woman begins experiencing shortness of breath or fatigue, her first instincts will not say, ‘heart disease.’ Rather, she’ll attribute it to being out of shape, not getting enough sleep, or just getting older,” explained Dr. Hakkak. “Sometimes these symptoms persist for months before she seeks treatment, and by then, her disease has further progressed. Women must be aware that something as simple - and as easily ignored - as fatigue may be a sign of a much more serious problem.”

Of course, there’s no guarantee that women will implement lifestyle changes once they leave their doctors’ offices or even seek treatment when symptoms occur. The most physicians can do is provide them with the information they need to make informed health decisions. However, if women are encouraged to begin prevention efforts from a young age, and are made aware of the unique issues they face as they age, it’s more likely that, over time, the message will be heard.

“If women quit smoking, manage their weight, exercise and watch their diet in earlier years, we will see far fewer of them in our offices and on operating tables in 40 years,” stated Dr. Dennis. “We must help them understand that heart disease is an equal opportunity killer, and give them the equal opportunity to begin fighting it.”

Fatima Hakkak, DO.

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