Mention the term "heart attack" and most people imagine a pudgy, middle-aged man drenched in sweat and clutching his chest. Ask a woman what she fears most and chances are good she'll reply "breast cancer."
Few patients seem to consider cardiovascular disease (CVD) as a "woman's disease."
But in fact, heart disease kills more women each year than the next 14 causes of death combined. Approximately 250,000 American women will die from a heart attack this year. Yet only a handful of women believe that heart attack and stroke are their greatest health threat.
The misleading notion that heart disease is not a real problem for women can be blamed in part on medical research. For a very long time, heart disease studies have focused primarily on men. Changes are under way, but some doctors still fail to recognize the warning signs displayed by female patients.
EARLY HEART SIGNS
A study funded by the National Institute of Nursing Research found that women experience undiagnosed warning signs weeks, months, and even years before having a heart attack.
"We're finding that, on average, most women experience warning signs 4 to 6 months prior to their heart attack," says study investigator Jean McSweeney, a professor at the University of Arkansas for Medical Sciences.
To obtain her results, McSweeney's team interviewed more than 600 female heart attack survivors at medical centers and hospitals in Arkansas, Ohio, and North Carolina.
Significant differences exist in the symptoms displayed by women and men. Men typically experience the "classic" heart attack signs: tightness in the chest, arm pain, and shortness of breath. Women's symptoms -- nausea, an overwhelming fatigue, and dizziness -- are strikingly different and are often chalked up to stress.
"Women started telling me how they had a hard time getting physicians to listen to them about these early warning symptoms," says McSweeney.
Unusual fatigue, trouble sleeping, shortness of breath, indigestion, and anxiety were the top 5 symptoms reported by both black and white women in the study. However, black women had more intense episodes and reported them more often.
"That surprised us, and we plan to look into it," says McSweeney. "We do know that black women have more co-existing conditions, such as obesity and diabetes, that could increase their likelihood of having heart disease."
ACT IN TIME
Recognizing and treating a heart attack right away dramatically improves a patient's chance for survival. The typical American, however, waits 2 hours before calling for help.
"Time is heart muscle," says Nieca Goldberg, MD, chief of the Women's Heart Program at Lenox Hill Hospital in New York and author of Women are Not Small Men: Life-Saving Strategies for Preventing and Healing Heart Disease in Women. "If you get to the hospital during a heart attack, we can administer aggressive clot-busting treatments."
Studies have shown that drugs that dissolve coronary blood clots during a heart attack can reduce the death rate in both men and women, although women have a higher risk of stroke from the therapy. Unfortunately, statistics show that a woman in the midst of having a heart attack receives clot-busting therapy much later than a man would.
"Women coming into the hospital for a heart attack have a higher death rate and higher risk of complications. A premenopausal woman having a heart attack has twice the death rate of a similarly aged man," says Goldberg.
Know the warning signs and always call 911 within 5 minutes of the onset of symptoms, advises James Atkins, MD, program director of emergency medicine education at UT Southwestern Allied Health Sciences School. By acting quickly, a heart attack victim is less likely to experience cardiac arrest (where the heart stops beating).
PREVENTION TIED TO BELIEF
There is no denying that an ounce of prevention is worth a pound of cure. But preventing a disease means believing you are actually at risk -- and many women fail to see that.
"Women absolutely need to become more aware of their risk for heart disease," Goldberg says. "Whenever a woman comes to see me after a heart attack, I always ask when they last felt well. Often it was several months, even a year, before the attack."
Women are advised to take charge of their health by working with their doctor to address risk factors, and keep tabs on cholesterol levels, blood pressure, and lifestyle.
According to the American Heart Association, low blood levels of "good" cholesterol (high density lipoprotein, or HDL) are a stronger predictor of heart disease death in women than in men. Also, a major study showed that post-menopausal women taking hormone replacement therapy have an increased risk of heart attack and death by coronary artery disease.
"Heart disease is the leading women's health care issue," says Goldberg. "If your symptoms aren't taken seriously, seek a second opinion."
WOMEN AND HEART DISEASE
Source: American Heart Association
- Cardiovascular disease (CVD) ranks first among all disease categories in hospital discharges for women
- More than 43% of all female deaths in the US and most developed countries are due to CVD.
- In 1997, CVD killed about twice as many women as all forms of cancer combined.
- More women than men will die within the first year after a heart attack
- Only 8% of women in America believe CVD is their greatest health threat.