When Life is As Serious As a Heart Attack; Women Are Learning That Heart Disease Isn’t Exclusively a Man’s Problem. Cardiovascuar Disease Threatens Women. It’s Time to Take Note, and Take Action.

It wasn’t until she was en route to the hospital in the back of an ambulance that 68-year-old Evelyn Roberts realized she was having a heart attack.

Despite six years of intermittent and ignored symptoms, heart disease was the last thing on her mind, she said, “I had the feeling I was not going to make it,” she said, “but I thought that something else was happening.”

The heart attack that landed Mrs. Roberts in an ambulance that afternoon was actually the second she’d had that day. She’d shrugged off the warnings, rationalizing that she’d felt this way before; the sensations always went away.

Besides, she wasn’t having symptoms that are typically associated with heart problems, she thought. But, Mrs. Roberts, like many women, thought wrongly.

That’s because symptoms in women are slightly different, the female pain threshold is typically higher, and women tend to concern themselves with the ailments of friends and family members before their own. They ignore heart attack risks and warnings, sometimes with deadly results.

Cardiovascular disease (CVD) is the number-one killer of females, claiming a half-million each year. That’s more than double the number of all cancer deaths combined, and more than the total of the next seven causes of death in females.

Many women, however, don’t take CVD, or resulting heart attacks, seriously.

In the last couple of years, the number of annual female deaths from CVD exceeded the number of male deaths by 50,000 to 60,000, said Dr. Gordon Hutt, a cardiologist with Cardiac Consultants for 18 years. Despite the statistics, he said, studies note that women are more fearful of the risk of breast cancer.

“Breast cancer,” he said, “is more public. The pink ribbons, you know. There’s more marketing. “That’s wonderful,” he continued, “but there has to be more increased awareness of coronary artery disease.”

In August 2000, when Mrs. Roberts took her unexpected ambulance ride, she had already endured five years of symptoms, she said.

Even so, the Lititz woman never mentioned it to her doctor, discounting it as fatigue or indigestion. Besides that, she said, she was too busy being a wife, mother, grandmother and friend to concern herself with her own health issues.

“I didn’t think about it; I didn’t even mention it to the family doctor,” said Mrs. Roberts, who is now 72. “We are not as attuned to our bodies as we should be.”

Women are more guilty of this than men, she said. “We have a tendency of letting things go.”

This, alone, is a chief contributor to heart attacks in women. “It’s very important not to ignore the symptoms,” said Hutt. “There is a saying we like to use: Time is muscle …” The longer a patient with severe blockage waits, the more the heart muscle is damaged.

However, even the medical community diverted emphasis from women in the not-so-distant past.

As example, Hutt, who became Roberts’ doctor after her heart attack, described a 1960s-era American Heart Association brochure written specifically for women. Nowhere did it address CVD in females, he said. Instead, the pamphlet was titled, “How to Cope With Your Husband’s Heart Disease.”

And, Hutt said, at one time, men were the only patients included in clinical studies of CVD.

CVD is actually an umbrella term for both coronary-artery disease and stroke.

Coronary-artery disease is when the arteries that supply the heart muscle with oxygen are partially blocked or completely blocked causing no symptoms, angina or, at the worst, a myocardial infarction (heart attack).

Stroke, sometimes referred to as a brain attack, is when an artery in the brain is blocked causing part of the organ to die.

Coronary-artery disease was Mrs. Roberts’ nemesis. Her first heart attack happened around 9 in the morning, she said. “My arms were weak. I felt strange through my chest I didn’t have what I’d call pain.”

Her family was gathering for a big meal, so she ignored the symptoms and continued preparing food. The sensations, she said, disappeared after 20 minutes.

The second heart attack hit around 4:30 in the afternoon, and there was no ignoring the symptoms this time. “It was major,” Mrs. Roberts said, glancing at her husband Frances, 76, who has had two open heart surgeries of his own. She started sweating, then crushing chest pressure began. “You were hurtin’ pretty bad,” Roberts said to his wife of 55 years. “Her temperature dropped to 90.”

In the 20 minutes that it took for the ambulance to arrive, Mrs. Roberts began to get disoriented. “My mind was feeling very addled,” she said. “I couldn’t talk.”

Mrs. Roberts always told her husband that if she had a “major condition” she didn’t want heroics. This was on his mind as the emergency medical team instructed him to drive to the hospital in advance of the ambulance.

“I got to Stauffers, there on Lititz Pike,” he said quietly. “The ambulance came up behind me and I pulled over to let it pass.

“That’s the worst feeling,” he continued, as tears filled his eyes. “Someone you love is in that ambulance.”

Heart disease risk factors obesity, elevated total cholesterol, physical inactivity, high LDL cholesterol, low HDL cholesterol, smoking, family history, diabetes are similar for men and women, yet the mortality rate for women is higher.

During the first year following a heart attack, 25 percent of men die, compared to 31 percent of women, said Hutt. And, he said, two- thirds of women who have heart attacks never fully recover.

Females tend to have heart attacks a decade older than males, said Hutt. This advanced a ge contributes to the higher death rate. Being older, their bodies have a harder time of overcoming the damage.

“Women also tend to have other medical problems,” said Hutt. Diabetes and metabolic syndrome, which is a combination of obesity, high LDL cholesterol and high triglycerides, blood pressure and blood sugar . “Elevated triglycerides are more important in women,” Hutt said.

There is a theory that younger women are protected by estrogen and, therefore, when post-menopausal are more apt to have heart attacks, the doctor said.

But that theory has not been supported by testing. “The Women’s Health Initiative … and the HERS (Heart and Estrogen/Progestin Replacement) study … confirmed this,” he said. “Estrogen is not a treatment to prevent heart attacks.”

When someone comes in with a heart attack, Hutt said, the first order of business is to restore blood flow to the blocked artery. Doctors use a percutaneous transluminal coronary angioplasty (PTCA), also known as balloon angioplasty or balloon catheterization.

Typically, after the artery is open, a stent is inserted to keep the artery clear. The renarrowing rate with just a PTCA is 40 to 50 percent in the first six months. With a stent it is 20 to 30 percent. New technology has lowered those numbers.

“In the last couple of years we’ve used a drug-coated stent,” said Hutt. Taxol, which inhibits smooth muscle cell growth, is released from the stent at low levels and helps to keep the artery clear.

Those who have had heart attacks are also prescribed other medications. Aspirin is taken to reduce the body’s production of prostaglandins. Hormone-like prostaglandins can cause platelets in the blood to stick together, thus leading to blocked blood vessels. Beta-blockers are taken to help slow the nerve impulses that travel through the heart. And, ACE inhibitors, are prescribed to help keep blood pressure low.

When Mrs. Roberts arrived at the hospital that summer’s day in 2000, a blood clot was found in her right artery. She was catheterized and stents were inserted to keep the arteries open. “I have at least two,” she said. Afterward, Mrs. Roberts went through cardiac rehabilitation and learned about diet, lifestyle and exercise that could help reduce her heart disease risk and, ultimately, extend her life.

She joined a community exercise program and became diligent about watching her diet and taking medications. Although she and her husband ate fairly healthfully all along, she said, they are even more careful today. A smoker for 37 years though not heavily Mrs. Roberts quit eight years before her heart attack. She gives some credit to this decision for her survival.

Mrs. Roberts acknowledged that she should have paid attention to risks and symptoms. “I have a history of family with heart attacks,” she said shaking her head slowly. “Women and men on my paternal side died of heart attacks. “I learned a very big lesson; it’s not just an old person’s disease; it’s not just a man’s disease.”