Women Now Equal with Men in Heart Attack Risk
Heart disease is by far the leading cause of death for American women
News Tribune — There was no reason for Angela Stephan to think she was having a heart attack. Her blood pressure had always been low, her cholesterol level fine. And at 53, she didn’t feel old enough.
Surely it must be heartburn, she thought on that November day in 2001. After all, she’d been feeling this way for at least a month.
When the burning sensation failed to subside, she consulted her doctor, who – knowing she is a former smoker – performed some tests.
“I passed with flying colors,” Stephan said. “I kept insisting it was heartburn.”
She got a prescription for that, but the burning just got worse. At work – Stephan is an executive assistant at Tacoma General Hospital – a doctor spotted her coming out of the restroom with her eyes closed. The doctor asked her all the “right” questions, fishing for heart attack symptoms:
Did she have pain radiating down her arm? Shortness of breath? Was the pain worse with exertion?
The answer to each was no.
“So I just went home from work early,” she said.
Within hours Stephan was back at the hospital – as a patient.
Her daughter had become concerned and driven her to the emergency room. While answering questions at the admissions desk, she collapsed. She woke up five days later in the hospital. Doctors inserted a stent to open a blocked artery that had caused her heart attack – the health problem that had never entered her mind.
Women at risk
That day Stephan joined the ranks of 435,000 American women – including 83,000 under age 65 – surprised each year by heart attacks.
The statistics, compiled by the National Coalition for Women with Heart Disease, contradict a widely held assumption that nearly all heart attack victims are middle-aged men. Until recently, even doctors were less likely to consider women as potential victims.
But what most women, and some of their doctors, don’t know could be deadly.
The facts are grim. Heart disease is by far the leading cause of death for American women, far ahead of cancer and many times more deadly than any of the remaining causes of death. Each year, heart attacks kill six times as many American women as does breast cancer, according to the coalition.
Overall, death rates from cardiovascular disease have gone down, but the decline has been less for women than for men, according to the American Heart Association. Until recently, far more cardiovascular disease research was done on men. The balance still is tilted toward males, but new studies have shed more light on women’s risk.
One complicating factor is that among women many heart attacks occur later in life. That’s largely due to the protective effect of the hormone estrogen, which can guard against heart attacks in younger women. During menopause, estrogen levels drop. And after menopause, women are at greater risk of dying from a first heart attack than men are.
According to statistics provided by the Heart Association and National Coalition:
* Thirty-eight percent of women, but only 25 percent of men, die within a year of a first heart attack.
* Thirty-five percent of women, but only 18 percent of men, will have another attack within six years.
* Women are almost twice as likely as men to die after bypass surgery.
* Women are less likely than men to receive certain kinds of medications, tests and other treatments for heart disease. But some tests have proven less accurate in women, and some drugs that help men have side effects in women.
“Most women think they are immune to heart disease,” said Dr. Uma Krishnan, a Puyallup cardiologist who recently attended an American Heart Association luncheon and spoke to Pierce County women about heart attack risks. “Even if they have symptoms, they downplay them. They show up in the emergency room late. And with heart disease, time is muscle.”
Lifesaving treatments like the one Stephan received can make a difference – but only if doctors begin treating a patient quickly. The first hour is the most risky during a heart attack; that’s when the heart is more likely to suddenly stop.
Krishnan urges women who think they may be having a heart attack to call 911 first. “Nobody is going to say you should not have called,” she said.
Women may also describe heart attack symptoms that are somewhat different from those of men. Both genders may have “classic” chest pain that grips the chest and spreads to the shoulders, neck or arms. But more women report stomach upset or pain, nausea and vomiting, difficulty breathing, dizziness, a sense of impending doom or unexplained fatigue. Doctors aren’t certain why.
One risk factor for heart disease that is unique to women is menopause. After menopause – whether induced by nature or by surgery – a woman’s heart attack risk rises. The exact reasons why changing hormone levels make heart attacks more likely aren’t yet clear.
But in light of new clinical trials on the effects of hormone replacement therapy in postmenopausal women, the American Heart Association does not advise women to take the therapy solely to reduce heart disease risk. (However, many doctors say there may well be other reasons, related to the temporary symptoms of menopause, to start or continue the therapy.)
Two other heart attack risk factors that no one can modify are age and family history. Risk is elevated for men over age 55, for women over age 65. If your father or brother had a heart attack before age 55, or your mother or sister before age 65, you’re at increased risk.
In most cases, the risk factors you can do something about are equal opportunity predators, endangering the lives of both men and women. Even so, there are gender differences:
Smoking: Among women who have heart attacks, smokers typically have their attacks 19 years younger than nonsmokers, according to Krishnan. That’s a more striking difference than among men smokers, who succumb seven years earlier than their nonsmoking peers.
The good news is this: If you stop smoking, your risk drops to that of the general population in three to five years.
“Stopping smoking is my No. 1 message,” Krishnan said. “Most of the time after a heart attack patients are vulnerable, and this is the best time to hit them with it.”
High blood pressure: Through age 55, a higher percentage of men than women have high blood pressure. From the ages of 55 through 74, the percentage of women is somewhat higher, according to the American Heart Association. After that age, a higher percentage of women have the condition.
Elevated blood cholesterol levels: The only way to know your cholesterol number is to have your blood tested.
Risk is generally considered high if your total cholesterol measures 240 or above, but levels between 200 and 230 are counted as “borderline high.” The desired level is below than 200.
Risk is also elevated if HDL (high-density lipoprotein, the so- called “good” cholesterol) is too low. National guidelines state HDL should be at least 35. But some doctors say that for women, it should be at least 45.
Diabetes: While this blood vessel-damaging disease increases the risk of heart attack for everyone, it appears to be far more dangerous for women. Krishnan calls it the most gender-specific risk factor. Diabetes is associated with a three- to sevenfold increase in risk among women, she said. That compares to a two- to threefold increase in risk for men.
Obesity: Height and weight charts are now pass. Instead, doctors like to calculate your body mass index, or BMI. You can do that by multiplying your weight by 703. Divide that number by your height in inches squared. (Or find an Internet BMI calculator; www.nhlbisupport.com/bmi/bminojs.htm is one example.)
A BMI of 25 to 29.9 is considered overweight and one 30 or above is considered obese. Being either overweight or obese can heighten heart attack risk, as well as raise your chances of high blood pressure or diabetes.
Body shape as well as height affects heart health. People whose lower torso is shaped like an apple, with extra fat at the waistline, may have a higher risk than those shaped more like a pear, with heavy hips and thighs.
Women heart patients recently were asked what they would tell other women. Their suggestions to the poll-takers: “Educate yourself and ask questions. Listen to your body and don’t ignore symptoms. Find doctors who are attentive, understanding and knowledgeable about heart disease in women – and follow their advice.”
That’s something Angela Stephan, has taken to heart. She quit smoking and joined a gym. She takes her heart medication faithfully. Today, she feels great.
Her advice to other women: “If you have the slightest inclination that something is wrong, get it checked out.”
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Symptoms
Women may have slightly different heart attack symptoms than men. “Classic” heart attack symptoms in both women and men may include:
* chest pain that grips the center of the chest
* pain in the shoulders, neck, jaw or arms
* shortness of breath, nausea, breaking out in a cold sweat
Women may tend to have more:
* stomach upset or abdominal pain
* nausea and vomiting
* dizziness
* a sense of impending doom or unexplained fatigue
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On the Net:
www.nhlbi.nih.gov/health/hearttruth
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