The Quiet Killer: Heart Disease in Women

N E W   Y O R K, April 30, 2003 -- Heart disease is the No. 1 killer of U.S. women, yet few women consider the disease a major health concern. Not only are women unaware of their risk, they also have limited knowledge of the symptoms of heart disease.

Almost half of women with heart disease feel their diagnosis "came out of the blue," according to a survey conducted by WomenHeart: The National Coalition for Women with Heart Disease.

This lack of awareness stems in part from many patients' and doctors' view of heart disease as a condition that primarily affects men. Yet women are less likely to be treated aggressively and more likely die of heart disease than men. That's why it's crucial that women educate themselves about their risk factors for heart disease, as well its prevention and treatment.

Below, Dr. Sharonne Hayes, director of the Mayo Clinic Women's Heart Clinic and chair of the WomenHeart Scientific Advisory Board, discusses heart disease and its symptoms, and encourages women to play a larger role in their own heart health.

What are the most common types of heart disease?Cardiovascular disease, or heart disease, includes many conditions, but the most common type is coronary artery disease, which is also the most preventable. Coronary artery disease involves blockages in the arteries caused by plaque buildup. If this plaque progresses or ruptures, heart attack or sudden death can result.

Hypertension, which is under the umbrella of cardiovascular diseases, can have many serious effects on the heart, the blood vessels and the kidneys and, if untreated, is a major cause of stroke. It occurs when the blood pressure is greater than 140/90. Other types of heart disease include diseases of the heart rhythm, which can cause either a very slow heart rate or a fast heart rate. One could also be born with abnormal heart, a condition called congenital heart disease. And heart failure occurs when the heart can't pump properly because it has been damaged or weakened, or because of high blood pressure or hypertension.

How many women die of cardiovascular diseases each year?More than half a million women die of cardiovascular diseases each year, and more women die of cardiovascular disease than the next 10 causes combined. To put it in perspective, there are about 60,000 deaths from breast cancer annually, compared to 500,000 deaths from cardiovascular disease. Still, for many women, cardiovascular disease is basically an underrecognized and silent disease.

Every year more women than men die of heart attacks and cardiovascular disease, which is a very surprising statistic to many people. Women are also more likely than men to die from a heart attack, and to die after a procedure in which the artery is opened, such as a stent or a balloon angioplasty. And women are more likely than men to have another heart attack within five years.

Despite these statistics, a WomenHeart survey conducted in 2000 revealed that only 8 percent of women indicated that they perceived heart disease as their number one health risk; most indicated that it was breast cancer. Many women perceive heart disease as a man's disease or as a disease of older women. While public education has been very good for breast cancer and cervical cancer prevention, outreach about heart disease in women can be improved.

What are some of the risk factors for heart disease?The number one preventable risk factor for coronary artery disease among women, particularly young women, is smoking. Family history is important, though obviously that isn't something we can control. Controllable risk factors include high blood pressure, high LDL (bad) cholesterol, high triglycerides and low HDL cholesterol, which is the good cholesterol. Women over the age of 20 should know their cholesterol numbers.

Other factors are sedentary lifestyle, obesity and adult onset diabetes, a condition in which sugar is not metabolized properly. Women at risk for diabetes should have a fasting blood sugar test. In addition, the metabolic syndrome, which is defined by, among other characteristics, increased waist size compared to hip circumference, high blood pressure and glucose intolerance, or high blood sugar, dramatically raises risk of heart disease. Women need to be proactive and know what their numbers are in terms of the risk factors, and if their doctor hasn't checked it yet, then ask for that test.

What are some of the typical symptoms a woman experiences when she's having a heart attack?Heart attack symptoms can be varied, and women and men need to know that most individuals do not have the Hollywood heart attack, where they clutch their chest and fall over and die. Symptoms are usually not that dramatic, and it's very important that people don't wait until they have such serious symptoms to seek care, otherwise it may be too late.

The primary symptom that men and women experience is chest discomfort. This discomfort doesn't have to be severe pain; it can be pressure that radiates up to the neck and may radiate into the back or shoulders or down the arm. Shortness of breath, nausea, fatigue, light-headedness and palpitations — the heart seems to be racing — are other symptoms. Nausea and shortness of breath can be particularly prominent symptoms in women. That may be part of the reason why it's been tough to diagnosis women early. Women may have a little chest pressure, but they're focusing on the nausea and the physician starts going down that path.

The important thing for women to know is that there is a broad range of symptoms, and if they are not feeling well and have never felt this way before, particularly if they're experiencing chest or shortness of breath symptoms, they need to seek help.

What explains this lack of awareness of symptoms of a heart attack?They are focusing instead on their risks for other diseases. If women are aware of heart disease symptoms, they're often more concerned about looking for them in their husbands than in themselves. So when they get the symptoms — even the same ones they've read about — they don't think heart disease.

What kinds of heart disease screening tests are available to women?We're still looking for the test or set of tests that will help us provide an early diagnosis. In general, cardiologists do not conduct routine screening electrocardiograms (EKGs or ECGs) or treadmill exercise tests in people without symptoms. They don't usually provide much information when used as a screening tool, particularly in young women without symptoms.

Do men and women benefit equally from therapy?Men and women do appear to benefit equally from therapy, though some of the tests and treatments have not been adequately tested in large numbers of women. Yet recent clinical trials in which women were treated very aggressively showed that these women tended to do as well, and even better, than the men. Right now women are not experiencing the same benefits as men outside of clinical trials because they aren't being treated as aggressively.

What did the WomenHeart Patient Survey reveal about women with heart disease? We asked more than 200 women with heart disease about their diagnosis and health care, as well as how a diagnosis of heart disease changed their life. Several of the results surprised us. For example, when asked about their satisfaction with their overall health care experience, 52 percent of the women indicated that they were dissatisfied with some aspect of it. For most of those women, their dissatisfaction was related to their physician's attitude and communication skills, as well as the limited amount of information that the physician offered.

How does a diagnosis of heart disease affect women's lives?One of the things that we found from the survey that is borne out by my experience with patients is that many women become depressed after a heart disease diagnosis. If undetected, depression can have a significant effect on women's ability to get better. Women who are depressed are not going to want to exercise and eat right. Health care professionals need to better screen and treat women with heart disease for depression in order to improve both their mental and physical health.

What advice would you give women about staying healthy or about communicating some of their symptoms to their doctor?There are some very simple things women can do to try to stay healthy: know their risk factors; not smoke; exercise more; and look at their diet. Beyond that, I think it's important for individuals to know the signs and symptoms of heart disease. If they have those symptoms, they should go to their doctor. If their doctor is not taking them seriously, they should consider seeking a second opinion or switching doctors. Women have to be their own biggest advocates in order to get a proper diagnosis and proper treatment for heart disease.