Here’s what women need to know about their risk for heart disease

Tania Chao, M.D. breaks down common misunderstandings about heart disease in women, and offers heart-healthy tips.

By Tania Chao, M.D.

Tania Chao, M.D., is a board-certified cardiologist with Mid-Atlantic Permanente Medical Group. She sees patients at the Kaiser Permanente Tysons Corner Medical Center.

Heart disease is an equal-opportunity killer—the No. 1 cause of death for both women and men worldwide. As a cardiologist who treats many women in my practice, what concerns me most are women’s unique risks.

Perhaps the most critical is a lack of awareness among women that they are at risk for a heart attack. Despite decades of public health campaigns, many women—nearly half in a recent American Heart Association (AHA) survey—don’t realize a heart attack is by far their biggest serious health hazard. Among women of color, some two-thirds are unaware of their risk, according to the survey. But the reality is that more women die from heart disease each year than men, and heart disease is more deadly than all forms of cancer combined. Further, cardiovascular death rates for American women and men have actually increased in recent years after decades of declining, according to a recent study. Consider this startling statistic from the AHA: While one in 31 American women dies from breast cancer each year, heart disease is the cause of one out of every three deaths.

This lack of awareness can have serious consequences. It has been estimated that as much as 80% of heart attacks are preventable with lifestyle changes—healthy diet, regular exercise and managing weight, blood sugar, cholesterol, triglycerides and blood pressure. But if you don’t realize that you are risk, you may not take these steps in time, and you might ignore symptoms when you have them. Researchers have found that women wait longer than men to call 911 when they have their first heart attack, often because they see themselves as caregivers for other people and are more inclined to dismiss their own symptoms, especially when symptoms temporarily subside.

Even when women do show up with symptoms, heart trouble may not be the first thing on their primary care provider’s mind. This is especially true if the symptoms are atypical for heart problems: nausea, faintness and extreme fatigue, for instance. And in some cases, the patient is young and has few of the traditional risk factors. These risk factors apply to both men and women and include high blood pressure, high cholesterol and triglycerides, diabetes, smoking, high alcohol intake or drug use, being overweight or having a family history of heart disease.

Some risk factors for heart attacks that are more prevalent in women (depression, for example) aren’t even included in standard risk assessments. Women are also more likely to be sedentary than men and more likely to be obese. Many common risk factors increase women’s heart attack risks much more than men’s. For example, women smokers have a 25% greater risk than men of developing heart disease, and women with diabetes have a 44% greater risk.

It’s also a myth to assume that heart disease is only something to worry about when you are very old. I remind my patients that heart disease impacts women of all ages. In fact, for younger women, the combination of taking birth control pills and smoking can increase your risk by 20%. Along these lines, a study published last year in the AHA journal Circulation has been a cause of concern for me and my colleagues. It showed an increase in the number of hospitalizations for heart attack among young people, most dramatically among young women between the ages of 35 and 54.

Recognize the Symptoms

Heart attacks occur when the blood supply to the heart is severely reduced or cut off, most often because of a blocked artery. For most people, this results in uncomfortable pressure or fullness in the center of your chest. Some describe it as the feeling of an elephant sitting on your chest. It’s hard to ignore.

But for some women experiencing a heart attack, the symptoms can be less obvious, and thus easier to miss. Some of my women patients, for example, experience pain in one or both arms, feel short of breath and/or feel extremely exhausted. Some feel pain in areas of the body not typically associated with the heart, like the neck and jaw, the shoulders, upper back or abdomen. Sometimes these symptoms are accompanied by nausea or vomiting. If you or someone close to you experiences these symptoms, you may be having a heart attack and it is important to call 911 immediately. The longer the blood supply is cut off, the more likely your heart will be damaged.

Prevention is Key  

While it’s important to know your risk and to recognize the signs of a heart attack, remember that the overwhelming majority of heart attacks can be prevented. Here’s how:

  • Keep your blood pressure, blood sugar and cholesterol and triglyceride levels in check, and if they’re not in a healthy range, work with your doctor to better manage them.
  • Don’t smoke.
  • Limit alcohol to one drink a day.
  • Manage stress with meditation, yoga, massage, qi gong or a related therapy.
  • Get treatment for grief or depression.
  • Eat a healthy diet.
  • Maintain a healthy weight.
  • Get at least 30 minutes of moderate-intensity physical activity (e.g., walking) a day.

I’ve seen patients change their lives, especially after a heart attack, which is for many a wake-up call. My goal as their doctor is to help them realize how much power they have, not only over their heart health, but over their general wellbeing.

To read more about women and heart disease, visit the website of the Centers for Disease Control and Prevention or the website of the Office of Women’s Health at the U.S. Department of Health & Human Services.

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