Matters of the Heart

Most people think heart disease is a man's problem, but when it comes to affairs of the heart, women don’t escape unscathed. In fact, one in four men as well as one in four women has some form of cardiovascular disease (CVD). The statistics are depressing. Coronary heart disease takes the lives of more than 500,000 women each year and is the No. 1 killer of women over the age of 25. Yet in spite of these facts, most women don't consider heart disease to be their greatest health risk.

Why the disconnect?

Many women think cancer, especially breast cancer, is their top health worry. But the facts don’t bear this out. One in 2.5 women die from the effects of heart disease or stroke, compared to one in 30 from breast cancer. Unfortunately, many women don't get that message. Women’s hearts, as men’s, need to be sheltered from the effects of high blood pressure, high cholesterol, obesity, diabetes and inactivity. Women also need to take precautions if they have a family history of early heart disease.

The medical community is perhaps also to blame for this lack of healthy heart urgency on the part of many women. In the past, many medical studies were only done on males, and the model for diagnosing and treating heart disease was based upon this information. Thankfully, that’s changed. Now, we have up-to-date information regarding how heart disease manifests in women.

But, even so, when it comes down to diagnosing and treating CVD, a gender gap remains. Sadly, women who suffer heart attacks are more likely to die than men ... and that's not just older women. Women of all ages are more likely to die. It’s estimated that the cardiac death risk for women is 1.7 times that of men. But again there’s good news on the horizon. Women and their health care providers are beginning to team up to be more proactive in the prevention, recognition and treatment of heart disease. As this approach becomes the norm, a woman's heart will be better protected.

Where to begin

As a woman, you need to know your risk factors for heart disease, change behaviors that contribute to the problem, and finally listen to your heart.

Risk factors you cannot control:

• Family history
• Age (55 and over)

Risk factors you can control:

• Smoking
• High blood pressure
• Physical inactivity
• Diabetes
• Elevated blood cholesterol levels
• Overweight
• Metabolic syndrome (a group of health problems including abdominal obesity, elevated blood glucose levels, and high amounts of cholesterol and triglycerides)
• Waist measurement of 35 inches or more
• Hormone replacement therapy
• Overwhelming stress
• Excess alcohol

After reviewing your cardiac risks, your physician will encourage you to begin lifestyle modifications (exercise, dietary changes, etc.) in an effort to reverse the risk factors you can control. Next, further medical information may need to be gathered via blood tests, EKG, an exercise stress test or even a CT scan using next-generation electron beam technology to look into your heart and its blood supply. Depending upon the results of these tests, a heart healthy plan will be put into place.

Listen to your heart

When we think of a heart attack, the most common thought is a sudden "crushing chest pain" that goes into the neck, jaw, left shoulder and arm. But this isn't always the case, especially in women. In fact, about a third of women don't even have chest pain. What they may experience is an unusual and unexplained fatigue, in addition to one or more of the following symptoms, which may appear in a gradual, rather than sudden, manner:

• Pressure, fullness, discomfort or squeezing in the center of the chest
• Shortness of breath or difficulty breathing
• Pounding or a feeling of extra heartbeats
• Upper abdominal pain
• Nausea, vomiting or severe indigestion
• Sweating for no apparent reason
• Dizziness with weakness
• Panic with feeling of impending doom

Please know the above symptoms can be caused by many other conditions. However, if you exhibit them, it is best to play it safe and consult your nearest health care professional or emergency room.

Every beat counts

If you suspect you’re having a heart attack, here is a checklist of things to do:

• Call 9-1-1 right away. An ambulance will take you to an emergency room with 24-hour cardiac care capability.
• As long as you are not allergic or have any other reason why you cannot take aspirin, chew an aspirin immediately, as this can reduce damage to the heart muscle.
• Even if you are not sure you are experiencing a heart attack, it is best to go to your local emergency room to find out.
• Every minute counts. The quicker you get diagnosed and treated, the better the chance for your heart muscle to survive.

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Robert Danoff, D.O., M.S., is a family physician and program director of The Family Practice Residency, as well as the combined Family Practice/Emergency Medicine Residency programs at Frankford Hospitals, Jefferson Health System, Philadelphia, Pa. He is the medical correspondent for CN8, The Comcast Network, a regular contributor to Discovery Health Online and a contributing writer to The New York Times Special Features. (Read his full bio.)