Noel Peterson, MD, FACC
Eastern Cardiology, Greenville, NC
February is Go Red month, dedicated to raising awareness of heart disease in women. Please take advantage of the educational programs occurring throughout Eastern North Carolina this month.
One in four women die from cardiovascular heart disease, making it the #1 killer of women, regardless of race or ethnicity. One in three adult females has some form of cardiovascular disease. While more women today understand that heart disease is the leading killer of men and women, most women fail to make the connection between risk factors and their personal risk of developing CHD. Two-thirds of women who suffer a heart attack never fully recover. Women who are obese, physically inactive, older than 65 years, of certain ethnicities, have high blood pressure or cholesterol levels, diabetes or pre-diabetes, smoke or have had a history of pre-eclampsia, pregnancy induced hypertension or gestational diabetes have greater risk of developing CHD.
One-half on women with symptoms of heart disease have no apparent obstruction of coronary arteries – if it’s not a blockage – then what is the problem? Microvascular coronary artery disease or problems with the cells that line the inner surface of all blood vessels – otherwise known as endothelial dysfunction plays a key role in development of heart disease. Inflammation can be a major factor contributing to endothelial dysfunction. Microvascular coronary artery disease and endothelial dysfunction can be caused by any condition that creates inflammation such as diabetes, smoking, autoimmune diseases, hormonal imbalances, catecholamine fluctuations (from stress), and the food that we eat (processed foods, sugars, chemicals in foods, gluten, etc…). Because microvascular disease and endothelial dysfunction are not detectable by our current diagnostic cardiac tests many women risk being told their problem is in their head, not their heart.
Statistical Differences between Men & Women
- Women have a slightly higher cardiovascular mortality rate than men.
- 64% of women (compared with 50% of men) who die suddenly from heart disease do not have classic warning symptoms of an imminent heart attack.
- 42% of women who have heart attacks die within 1 year, compared to 24% of men.
- Women who have a heart attack are twice as likely to die within first 2 weeks.
- Women tend to present with atypical symptoms, therefore their symptoms are not being recognized as heart attack.
- Men were much more likely to be referred for invasive testing and treatment compared to women – when both showed the same abnormal diagnostic test results.
- Women were four times as likely as men to be given a psychiatric diagnosis to explain their CHD symptoms.
Women were not included in many of the clinical research trials which determined treatments for cardiovascular disease. Even when properly recognized, women are not being treated as aggressively as men. Therapy given to women is often inferior to that offered to men. Various recommended treatments are delayed and underused in women. Women are less likely to receive early aspirin, beta blockers, reperfusion therapy to restore blood flow, or urgent angioplasty to open an obstructed blood vessel in the heart.
Men were also five times more likely than women to recognize their symptoms as being related to their heart.
So, what are the warning signs of a heart attack?
- A crushing, squeezing, or burning pain, pressure, or fullness in the center of the chest. The pain may radiate to the neck, one or both arms, the shoulders, or the jaw. The chest discomfort lasts more than a few minutes or can go away and return. May be confused with indigestion.
- Shortness of breath, dizziness, nausea, chills, sweating, or weak pulse.
- Cold and clammy skin, gray pallor, or a severe appearance of illness.
Women often have more subtle symptoms than their male counterparts.
Heart attack symptoms in women may manifest as:
- A feeling of shortness of breath may not be accompanied by any chest pain.
- Symptoms that are flu-like- feelings of nausea, cold sweats, and clamminess
- Weakness, unexplained fatigue, dizziness
- Pain in the neck, the jaw, the chest, shoulders, and upper back
- General discomfort, loss of appetite, and feelings of anxiety
Given the gender specific differences in the presentation, manifestation, and diagnosis of heart disease, it’s important that women learn about these differences so that they can recognize when a heart attack is occurring and get proper, life-saving care as quickly as possible. Being proactive and taking steps to ensure your optimum health are key to preventing heart disease. Make this your year to take care of yourself by increasing physical activity (10,000 steps/day), commit to exercising on a regular basis (150 min/week), receive adequate sleep (7-8 hours a night), and making healthier food choices.