The Gift of a Generation: Women's Heart Disease Risk Dropping

Feb. 4, 2010— -- Today would have been Olivia Passanando's birthday. She died from congestive heart failure in 1988 at the age of 69.

Her daughter, Patty Norris, is 61 years old. Norris lives each day with the reality that she, too, has the disease that takes the lives of 450,000 American women each year -- nearly one woman every minute.

"It was very difficult for me to accept that I had heart disease, knowing the fact that my mother died from a heart problem," she said. "It's been extremely hard. It's still extremely hard."

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Indeed, as they age, some women worry that they'll inherit their mother's weak eyes or their father's bad back, but for women with cardiovascular disease in the family, the most fearsome thing can be having "your mother's heart."

For 56-year-old Janice Miles, this meant that even though she did "all the right things" -- healthy eating, regular exercise, keeping blood pressure low -- she was still at high risk for heart disease, as she found out this fall.

She noticed she was having breathing problems, chest discomfort and some pain going down her arm when she was exercising.

Though both her parents had early heart attacks in their 50s, Miles still thought her symptoms were most likely due to her asthma. But after a month, she went to a cardiologist anyway.

As it turned out, she had a 100 percent blockage in "the most important artery of the heart" and needed surgery to put in a stent, said Dr. John Schindler, Miles' cardiologist and an assistant professor of medicine at the University of Pittsburgh School of Medicine.

"I've always been so health-conscious -- I'm a little stymied that I still have [heart disease]. Now I see that there is no getting away from it when it's in your genetics," Miles says.

Fortunately, patients and doctors are more aware today of the risks cardiovascular disease can pose for women than in the days when her mother had a heart attack.

"Twenty years ago, a lot of women were told that they were under stress or had other reasons to have the types of symptoms they were complaining about when indeed, [heart disease] was just being overlooked," Schindler says.

"Education has been critically important over the years," he adds. "The more we get this information out there, the better."

In honor of February's national heart awareness month, the American Heart Association is sponsoring a "Go Red for Women" campaign Friday to celebrate the progress that's been made, and increase efforts to prevent heart disease in women.

Heart Disease in Women -- Then and Now

"Even up to the 1990s, if you asked women what they thought they'd die from, they'd say breast cancer," says Dr. Paula Miller, director of women's heart program and director of cardiac rehabilitation at the University of North Carolina School of Medicine.

But cardiovascular disease was becoming the number one killer for women, killing nearly 100,000 more women than men each year, says Miller.

"Out of all deaths in women, one in 30 is from breast cancer, whereas one in six is from cardiovascular disease," Schindler says.

It has been an uphill battle to raise awareness of heart disease in women, cardiologists say.

"Textbooks in the 60s and 70s didn't even mention heart disease in women -- weren't really educating women that the risks were there."

But since the American Heart Association and the National Heart, Lung and Blood Institute began campaigns early in the 2000s, introducing the Red Dress as a national symbol for women and heart disease awareness, that has been changing.

"We have definitely started to see a switch, though it's been very slow in coming," says Dr. Jennifer Tremmel, clinical director of Women's Heart Health at Stanford University Medical Center.

Schindler agrees. "We've made great strides in cardiovascular disease. From 1995 to 2005, the death rate from coronary heart disease has declined by 44 percent," he says. "The technology has advanced exponentially."

Education has been the largest triumph over the past decade, says Dr. Malissa Wood, co-director of the Corrigan Women's Heart Health Program at Massachusetts General Hospital.

"I have many patients in my practice who might never have gone to the emergency room 10 years ago because at that time they believed heart disease was only a man's disease. [Today], recognition has increased but there is still room for improvement."

Tremmel says the Go Red campaign "has been incredibly effective" in promoting the message of women's heart health.

Know the Signs

One of the stumbling blocks for women with heart disease is that their symptoms may be quite different from the classical signs we associate with heart attacks, cardiologists say.

"In general, men describe pressure in their chest radiating to left arm prior to a heart attack," Schindler says, but with women, there may not be any chest pain at all.

"Women will often get discomfort in their back, shoulder blade, neck, or even jaw. I think a lot of women [go] to other physicians -- I've even had patients go to the dentist -- looking for answers for their symptoms when it is...in fact, a cardiovascular [issue]."

To make matters worse, Miller says, women often "isolate themselves," writing off shortness of breath, cold sweat, or overwhelming fatigue as nothing more than signs they're "getting older." Women become even less likely, then, to seek the treatment they need for cardiovascular health.

"If you are a woman and you have chest pain, you show up to the emergency room on average an hour later than a man -- I think because people are rationalizing that 'this isn't my heart,'" Miller says.

Miles' case also points out the importance of knowing your risks.

While Miles was exercising, eating carefully, and not smoking, she wasn't paying enough attention to her genetic risk.

"In women, family history is probably one of the most important risk factors," says Miller.

"It's critically important to pay attention to the genetics," Schindler aggrees, but Miles says she just "thought [she] could beat it," and had she not been exercising, her heart disease might have progressed considerably before she recognized her risk.

"I don't think I ever would have picked up on this, because with just the normal everyday stuff I did, I had no symptoms," she says.

Lower Risk – What You Can Do Today

So what can women do to protect themselves from heart disease?

The best thing is to know their own risk, says Wood.

It's important for a woman to "know her numbers," such as cholesterol levels (both good and bad), fasting blood sugar, body mass index, and blood pressure. Smoking, diabetes and family history of heart disease are other major factors.

Ideal numbers for women are posted on www.goredforwomen.org, and Wood says that if one's levels are not ideal, one should take steps to control them.

The most obvious and immediate step is to stop smoking if you're a smoker, Miller says. "A woman who smokes has her first heart attack something like 19 years before one who doesn't."

"Alter your diet to include more fresh fruits and veggies, less fat, and try to include oily fish twice a week," she adds.

"And if you are not active, try to at least get in 10,000 steps a day, a little over two and a half miles. Get a pedometer and track your steps daily," she says. The exercise doesn't have to be all in one go at the gym, but can be broken up throughout the day into little spurts of activity or short walks.

And even if the numbers are low, and you're not a smoker, Miles' case is an argument for the importance of genetic risk.

"If it had not been for my brother's [condition]," Miles says, "I might not have thought I was at risk, I might have put it off longer."

But because she caught it early, Schindler says, "Jan has no heart damage and her heart function is normal. She was back exercising within 72 hours of her surgery."