Memorial Regional Health: Women and heart disease — Know your risks
Editor’s note: The following article is sponsored by Memorial Regional Health.
American physicians are trying to change the fact that women are often undertreated and underdiagnosed for heart disease, the No. 1 killer of women in the United States every year.
In fact, heart disease kills about 50,000 more women than men every year.
While more than 90 percent of women have at least one risk factor for cardiovascular disease, only about 45 percent of women know that their No. 1 health danger is heart disease, according to the American Heart Association.
Women typically see a gynecologist as their primary point of care, which is why the American Heart Association and the American College of Obstetricians and Gynecologists issued a joint advisory in the journal “Circulation” last year to promote a more coordinated effort to educate patients. A woman’s visit to her gynecologist is a logical place to talk about heart disease risk factors such as weight, nutrition, stress, and physical activity, according to the advisory.
Women have a higher prevalence of these avoidable heart disease risk factors, according to Dr. Gerald Myers, cardiologist at Memorial Regional Health. He said diabetes, in particular, is a powerful risk factor for heart disease in women.
In addition to the risk factors mentioned above, major heart disease risk factors also include hypertension, cigarette smoking, sleep apnea, and family history.
Women with high risk factors should take steps to control their blood pressure and elevated lipids with a low-fat, low-salt diet, medications, and regular exercise. Smoking is never healthy, and especially for the heart, so quitting is strongly advised. And sleep apnea, if present, should be treated, Myers said.
Heart disease isn’t something all women need to fear if they have low risk factors, he added.
“Those with a low risk factor profile and are asymptomatic are unlikely to harbor significant underlying coronary artery disease,” Myers said. “They, however, should also follow a healthy lifestyle, which includes a healthy diet, regular exercise, smoking cessation — if they smoke — and weight control.”
To know whether you’re maintaining a healthy weight, the body mass index, or BMI, is the best tool. It’s calculated by multiplying your weight in pounds by 703, then dividing that number by your height in inches times your height in inches. So, 703 x weight (lbs) / height (in)²
A woman’s risk does increase with age. Myers said estrogen creates a protective environment and delays the onset of coronary heart disease by a decade.
“It gives women an approximate 10-year advantage over men. If you had two fraternal twins — a male and a female — who were prone to heart disease, the man would likely develop it 10 years before the woman,” Myers said. “Menopause sets the clock ticking.”
With regular exercise — amounting to at least 150 minutes per week — someone with heart disease or a high risk of heart disease can hasten his or her recovery and improve heart function. Cardiovascular exercise can strengthen the heart, improve circulation to help the body use oxygen more efficiently, improve heart failure symptoms, lower blood pressure, and improve cholesterol. Myers said weight training “is also a valuable component of an exercise program.”
Symptoms and treatment
Women often experience different symptoms from men when they have a heart attack. While some women experience the classic chest pressure or tightening that’s typical in men, many women experience symptoms that are less obvious, such as fatigue, jaw pain, shoulder pain, and shortness of breath. This contributes to why heart disease in women is one of the most difficult diagnoses to make in the emergency department, Myers said.
Treating heart disease is complicated depending on the type and severity. Physicians typically always start by asking patients to change their lifestyle habits to reduce their risks of a first or repeat heart attack. Other treatments might include medication; antiplatelet drugs, such as aspirin, to keep blood clots from forming; and in advanced cases, surgical intervention, such as angioplasty, stenting, and/or coronary bypass grafting may be necessary, Myers said.
“Rhythm disturbances and conduction system disease are treated with medications and devices such as pacemakers, and implantable defibrillators may be necessary,” he said. “Valve disease responds to medications but, ultimately, may require repair or replacement.”