Women’s
Heart Disease
Written
by Dr. Jesse Hsieh, MD
Q:
What is the leading cause of death in women?
A:
Coronary Artery Disease
- Every
year, in the US, more women than men die from this.
- The
prognosis after a heart attack is worse in women than
men with a mortality rate about twice as high.
- Even
after surviving a heart attack, the outcomes are worse.
- Women
have smaller coronary arteries than men.
- The
disease process inside women’s arteries may be different
than in men.
- Hormonal
changes account for some differences.
- The
symptoms of heart disease are different in women.
- Cardiovascular
mortality is three times higher in diabetic women than
men.
According
to the CDC (Center for Disease Control), 38% of deaths in
women are due to heart disease, compared with only 22% to
cancer. Recent studies are showing that heart disease appears
to be substantially different in women than men, physiologically
and clinically.
Coronary
artery disease is different in women and hard to evaluate
Women
with heart disease often don’t have the same symptoms that
men have, such as crushing chest pain called angina. Women’s
symptoms are often vague, and nonspecific, including fatigue,
trouble breathing or sleeping. A recent study by the National
Heart, Lung Institute reported that 65% of women with coronary
artery disease did not have typical angina. A reported 50%
of women who suffered a heart attack did not report any prior
chest pain.
Worse
yet, traditional evaluations such as treadmill stress tests
do not appear to be as accurate in women. In fact, the American
Heart Association has recommended that a stress test include
cardiac imaging in women with diabetes, abnormal EKG or functional
impairment (too out of shape to go the maximum duration of
the stress test).
Once
a heart catherization is done in a woman with chest pain or
an abnormal stress test, studies show that over half did not
have a traditional blockage of the arteries, but rather,endothelial
dysfunction. That means the arteries were unable to dilate
when more blood flow was needed such as in exercise. Their
plaques were also twice as likely to erode and create a clot
than in men.
Women
are treated differently
Unfortunately,
many women who go for an annual physical never even address
the heart issue, settling for just a breast and gynecological
exam. Smoking, high blood pressure, and high cholesterol with
elevated LDL are risk factors that need to be checked with
everyone. But in women, high triglycerides and low HDL (good
cholesterol) levels are more potent risk factors than in men,
and should be examined carefully.
There
was also a study in circulation showing gender bias when women
with chest pain did seek treatment. They had far fewer heart
catheterizations, aspirin and anti-cholesterol drugs. Many
believe that this bias may account for the worse prognosis.
Other
risk factors that we need to start emphasizing include:
- Abdominal
Obesity. Apples are at higher risk than pears.
- Estrogen
Loss. But replacing it doesn’t seem to help.
- Elevated
C-Reactive Protein - increases atherosclerosis.
- High
Triglycerides and Low HDL. Both are on a typical cholesterol
panel.
What
to do
- Be
aware. Statistically, this is the number one risk of death
for women. With the onset of menopause, the risks increase
dramatically.
- Get
a lipid panel done yearly. Keep HDL >50 and Triglycerides
<140.
- Quit
smoking. There are some great medications available today
to help.
- Get
the blood pressure checked regularly and keep it under
control. Maximum is 135/85 and goal is 110-120/70-80 or
less.
- Reduce
saturated fat intake, to less than 7% of your calories
a day.
- Walk
more. 20-30 minutes daily helps.
- Listen
to your body, and don’t ignore symptoms, especially if
you have risk factors.
I
often get asked about supplements, like vitamins, and commercial
products like Juice Plus. If the fundamentals above are not
followed, I doubt any supplement is going to help. Fish oil
and aspirin can be helpful.
It
amazes me how many women have never had their cholesterol,
triglycerides and HDL checked. And when they did get tested,
how many failed to follow up on abnormal numbers.
As
more and more of the baby boomer population of women continue
get older, concerns about heart disease will become more relevant.
Sounds pretty gloomy. But it doesn’t have to be that way.
Don’t wait. On the annual exam, remember to check the heart
too.
