• E-mail
• Print
• Comment
• Font Size
• Digg
• del.icio.us
• Discuss article

The Risk is Real ; Patients -- and Many Doctors -- Still Don't Know How Often Women Get Heart Disease

Posted on: Tuesday, 15 February 2005, 18:00 CST

Nobody seriously considered Carol Howard might have heart disease until she suddenly passed out 12 years ago in her early 50s.

The Englewood woman hadn't felt right for nearly 10 years before that, but her symptoms were mostly indigestion and fatigue. She was overweight. (She has lost 130 pounds since then and wants to lose 50 more). "A lot of the problems, I just automatically blamed on my weight," she said.

Her father had died of a heart attack, but her mother was still healthy, and Howard always assumed women needn't concern themselves about heart disease. Her doctors seemed to agree.

Little has changed since then about popular misconceptions that heart disease is for men, the American Heart Association reported last week in its journal, Circulation.

Women are more aware than ever of their risk, but still only 57 percent properly identified heart disease as the leading cause of women's deaths in a survey last December, and breast cancer outpolled heart disease 28-20 as the top health threat. Doctors are coming around even more slowly, with only 8 percent of primary-care doctors and 17 percent of cardiologists realizing heart disease kills more women than men.

Prevention undercut

Their underestimation of women's risk leads to under-prescribing preventive care, said Dr. Lori Mosca of New York-Presbyterian Hospital. Her research team found doctors were less likely to provide anticholesterol drugs, blood-thinning aspirin therapy and cardiac rehab to women than to men with comparable conditions. Women also were less likely to receive important diagnostic tests or angioplasty to unclog cardiac arteries.

"If we educate physicians to more accurately assess risk in women, they will be more likely to receive appropriate preventive care," Mosca said.

As in Howard's case, doctors often miss heart disease in a women because they're the wrong gender with the wrong symptoms, said Dr. Michael Barrow of Samaritan North Family Physicians. "When you don't have a heightened awareness (of heart disease for women) and you're presented with symptoms that don't fit, it doesn't even click," he said.

Paradigm shift needed

"You'll never make a diagnosis that you don't think of. That sounds simplistic, but if you're not even thinking of heart disease, you won't make that diagnosis until it's too late. So you have to have that on your list of things it could be."

Adding heart disease to that list has "required a paradigm shift," Barrow said of his primary-care practice, where chronic conditions generally surface first. The first indication of a woman's heart disease might be fatigue or dizziness or pain in the shoulders or the back, and not the chest or abdominal pain that is more common for men.

So if a woman complains of pain between the shoulder blades, Barrow said, the doctor has to broaden his suspicions beyond bone or muscle ailments. "That doesn't mean that every woman with pain between the shoulder blades gets a stress test," but it means the doctor has to think about whether she smokes, has high cholesterol or lost a middle-aged relative to heart disease.

Improving diets, getting more activity and taking the right drugs can keep heart disease at bay in women just as well as in men, Mosca said. But even among women with dangerously high cholesterol levels, barely one-third are on medication to lower them.

"We don't do a good enough job of pointing out that they ought to quit smoking or lose weight," Barrow said, but patients are partly to blame. "When they come in for a cold, they don't want to hear about needing to lose weight."

Making matters worse, he said, is that the patients who are receptive to changing their habits often have insurance that won't cover the cost of preventive tests or medicines.

'Need to be more aware'

"A lot of women think of their husbands for heart disease, but they don't think of themselves," Barrow said. "I think they need to be more aware that they can suffer from it, too, and that their symptoms might not be the typical ones."

Howard is a believer, now exercising regularly as part of her treatment for high blood pressure and an enlarged heart. But for many years, she held on to the perception that heart disease wasn't much of a threat to women, even as doctors brought it up more often.

"I didn't want to believe it," she said. "Of course, now that I've had a number of episodes, I don't feel that way at all."

Contact Kevin Lamb at 225-2129 or e-mail klamb@DaytonDailyNews.com.

Source: Dayton Daily News

More News in this Category