Women and Heart Disease

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To help us observe National Wear Red Day (and who doesn’t look good in red?), here are some of the basics you should know about the risks, warning signs, evaluation, and treatment of heart disease in women. Although there are many types of heart disease, this post will focus on coronary artery disease, by far the most common and deadly type of heart disease.

Is heart disease really different in women and men?

No and yes. The underlying pathology is the same: Atherosclerotic plaque (comprised of, among other things, cholesterol) builds up in the coronary arteries, the small blood vessels that supply oxygen and nutrients to the heart muscle. As plaque builds up, the affected blood vessel narrows, impeding blood flow. If complete blockage occurs–as can happen when a plaque ruptures, causing a blood clot to form–regions of the heart that receive their blood supply from that vessel can die, resulting in a heart attack.

What differs about heart disease in women and men? Plenty, including the warning signs the patient experiences; the age at which symptoms typically develop; the way both patients and health care providers anticipate and evaluate suspected coronary artery disease; and even the accuracy of the tests used to diagnose heart disease.

Isn’t heart disease much more common in men?

It’s true that men comprise the majority (about 70 percent) of the approximately 13 million people in the US with coronary heart disease, but coronary artery disease remains the number one cause of death in American women.

By age 65, a third of women have symptoms of underlying heart disease. And although coronary artery disease is uncommon in younger women, it’s not unheard of. As many as 1 in 9 women between the ages of 45 and 65 have some degree of symptomatic atherosclerosis.

What are the symptoms of heart disease?

Most of us know the typical symptoms of coronary artery disease. Angina, the classic pain that occurs when the heart muscle is deprived of blood, is usually described as a pressure or tightness felt across the chest, often radiating into the neck, jaw, and left or right arms. Angina is almost always brought on by physical exertion. Other symptoms, such as nausea, shortness of breath, dizziness, and a cold sweat may accompany angina.

While some women may develop these symptoms, many women with heart disease don’t experience typical angina at all. Rather, they tend to describe their pain as sharp or stabbing, or they may have painful or odd sensations only in the neck, throat, jaw, or back. Additionally, these symptoms may occur as a result of physical exertion, but they often appear at rest, during sleep, or with psychological stress. As many as 43 percent of women experience no chest pain at all, even when they develop a full-blown heart attack. In these instances, nonspecific symptoms such as fatigue, weakness, and shortness of breath may be the only clues to underlying heart disease. Finally, some women may have no symptoms at all!

Does chest pain mean that I have coronary artery disease?

Absolutely not. There are many causes of chest pain, and your primary care provider can help you sort them out. Common causes include heartburn, musculoskeletal pain, esophageal spasm, lung infections, and even psychological stress. However, because coronary artery disease is common, if you’re not sure what’s causing your chest pain, contact your health care provider right away.

How do I know if I have heart disease if I don’t have symptoms?

The usual tests for coronary heart disease–an electrocardiogram (EKG) or stress test–aren’t very good at detecting underlying heart disease if you don’t have symptoms.

An EKG is an invaluable tool for diagnosing coronary heart disease during episodes of chest pain. But it can’t detect disease when you aren’t having symptoms. Therefore, the typical EKG done in-office isn’t a good screening tool. In fact, it can actually do more harm than good (through falsely positive results) for patients who don’t have any symptoms.

A stress test provides information about how well your heart works during physical activity. During a stress test, you exercise on a treadmill or stationary bike while your health care team monitors an EKG and, in some cases, real-time images of your heart muscle. An abnormal result may necessitate confirmation with an even more accurate test, such as an angiogram. Unfortunately, doctors are less likely to order follow-up tests for women with positive stress test results, perhaps because they tend to assume that such results are “false positives.”

A newer test uses a CT scan to look for atherosclerosis, and gives a fair estimate of the amount of plaque in the coronary arteries. Unfortunately, it’s not yet clear whether knowing this information can actually help you prevent a heart attack.

Like most of us, you probably don’t know if you have underlying coronary artery disease. Therefore, the best approach to lower your chances of developing heart disease is to control your risk factors for coronary artery disease.

What are the risk factors for heart disease? What I can I do to reduce my risk?

The risk factors are the same for men and women: smoking, high cholesterol, hypertension, diabetes, obesity, a family history of heart disease, and increasing age. You can control a lot of these by carefully managing your lifestyle. Don’t smoke, exercise, watch your weight, and eat a healthy, balanced diet (such as the Mediterranean diet, high in healthy grains, fruits, vegetables, nuts and fish, and low in high-fat dairy products and red meat).

Psychological distress such as depression or anxiety may also increase your risk of heart disease. Even if you don’t feel that you need medication to help you manage them, consider contacting your health care provider for guidance. Your primary care provider can also help you fine-tune your lifestyle and help measure and manage your cholesterol, blood pressure, blood sugar (for diabetes), and weight.

Hormone replacement therapy (HRT) for women who are in early menopause may have a protective effect, but investigation is ongoing. We don’t recommend HRT to prevent disease.

What do I do if I think I’m having chest pain from heart disease?

If you’re experiencing chest pain for whatever reason, call your health care provider for guidance. However, if you’re experiencing episodes of chest pain that are increasingly frequent or severe, seek medical care right away. Call 911, pop an aspirin (chewable ones may be best), and try to relax.

No one can be 100 percent certain if you have a real cardiac problem that needs urgent attention. But with the help of your health care provider, you can learn how to make an informed decision, and when in doubt, err on the side of caution and get help.

What will happen to me if I go to the emergency room?

The ER staff will try to determine whether your symptoms are related to your heart. If you’re truly having a heart attack, their goal will be to reopen the blocked coronary artery as quickly as possible, usually through some combination of clot-busting medications and a special type of minimally invasive surgery called cardiac catheterization.

The difference between heart disease in men and women can become most pronounced in the ER, and not in a good way. ER doctors are less likely to consider a diagnosis of coronary artery disease in female patients, and may not even order an EKG. This is probably because women often don’t experience typical symptoms of angina, and due the common misconception that heart disease is uncommon in women. However, now that you’re armed with all this information, you can be your own best advocate and insist that your symptoms be taken seriously and, not dismissed as just “an anxiety attack” until you’ve had a proper evaluation.

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The One Medical blog is published by One Medical, an innovative primary care practice with offices in Boston, Chicago, Los Angeles, New York, Phoenix, the San Francisco Bay Area, Seattle, and Washington, DC.