Heart Disease and Women
Heart disease is the number one killer of women. Only 54% of women know this; only 13% believe it is their own greatest health risk. Most telling is that many women polled state they would call an ambulance for a family member with chest pain, but would not do so for themselves. The death rate from heart disease in women between ages 35 and 54 is increasing. There are more women dying from heart disease than men since 1984. Why is this?
The majority of medical research done in the past has excluded women, largely because it was not known how to factor in the effects of women’s complicated and fluctuating hormones. There are no requirements in Canada to include women in medical studies. The well-known Framingham study, which started in 1948 and is still adding data, led to the identification of risk factors for heart disease. The model based on data from Framingham is still widely used to calculate an individual’s risk of heart disease, although it has been found to be less helpful for women, especially those who are younger. The initial Framingham data suggested that only men developed heart disease. Women were only included in the 1964 American Heart Association conference in the talk “Hearts and Husbands: How to Care for Your Man”. Nothing was included about self care for the women themselves.
It is a common misconception that women have symptoms of acute heart attack that are different than those of men. While a few studies show that women may have a slightly lower incidence of chest pain specifically than men, most of the presenting symptoms of a heart attack are the same between the two genders. Roughly one-third of all heart attack patients, women and men, present without chest pain. Many other symptoms experienced before or during heart attacks have been described in studies, including profound unusual fatigue, anxiety, palpitations, difficulty breathing, indigestion, nausea, vomiting, sweating, dizziness and headache.
It is important that women know that the diagnostic procedures used for cardiac disease are not as helpful in women as they are in men. This is believed to be for a number of reasons. It has been shown in studies that women with heart disease often have involvement of smaller vessels than most men. Women have been shown to do more poorly during hospitalization for heart attacks; more women die compared to men. Women tend to bleed more, and are harder to graft. Women are less often admitted to specialized cardiac care units and are less frequently under the care of specialist cardiologists. Even with the increased knowledge gained in more women-centered research over the last decade or so, more women are discharged without being prescribed what has become regarded as “standard care” because their angiograms did not show significant occlusion of the coronary arteries.
Knowledge is power. In heart disease, as with many diseases and health problems, prevention is best. Learning what the risks for heart disease are and how to reduce them with lifestyle changes is something we all can do. Menopause is a time in a women’s life that leads many of us to change; make yours for the better.