Heart disease is the No. 1 killer of American women. Now there is evidence showing that traditional screening may underestimate heart disease risk for women.
If the heart of a woman is her greatest strength, it can also contain her greatest vulnerability. Almost every minute, another woman dies of cardiovascular disease, according to the American Heart Association. Disease of the heart muscle and blood vessel system is the number one killer of women, accounting for one in every 2.6 deaths.
"Many women mistakenly think breast cancer is the number one killer, and they get their mammograms," said Dr. Mary Ann Bauman, Medical Director for Women's Health and Community Relations for INTEGRIS Health Inc. and a spokesperson for the Go Red For Women campaign. "The truth is that 40,000 American women die of breast cancer each year but 400,000 die of heart disease and stroke. It's good that they get their mammograms, of course, but women still have a tendency to ignore or discount symptoms of heart disease."
The human heart is a muscle a little larger than the size of a fist, weighing between seven and 15 ounces. Each day, the average heart beats 100,000 times, pumping about 2,000 gallons of blood throughout the body. Through the heart's pumping action, blood and its payload of oxygen and nutrients flows through the arteries to the organs, tissues and cells of the body. Blood also removes the carbon dioxide and waste products made by the cells. It is returned to the heart by the veins.
Within the heart muscle itself are 20 major arteries as well as smaller vessels and capillaries. The heart has four chambers: the left and right atria (on top) and the lower chambers called the left and right ventricles. There are also four types of valves that regulate the blood flow through the heart and a sinoatrial node that acts as a "natural pacemaker," sending out an electrical impulse that sparks the heartbeat.
The heart of the matter
Though there are a number of diseases that can affect the heart and vascular system, the most common is coronary heart disease. Coronary heart disease, or CHD, is commonly known as "hardening of the arteries" or atherosclerosis. Plaque, made of fatty substances like cholesterol, builds up along the walls of the arteries, narrowing and hardening the pathway for blood and oxygen.
The most common symptom of CHD is angina or heart pain, according to the Centers for Disease Control. Pain or discomfort happens when there is not enough blood flow to the heart muscle. This can lead to heart attack, heart failure and irregular heart beats, or arrhythmias. Heart failure occurs when the weakened muscle is unable to pump enough blood to meet the body's needs. The chambers of the heart respond by stretching to hold more blood or by becoming more stiff and thickened. Congestive heart failure affects nearly 5 million Americans and is the leading cause of hospitalization in people older than 65, according to WebMD.com. Symptoms include congested lungs, fluid retention and fatigue.
Cardiomyopathy is a progressive disease of the heart muscle that can be inherited or can be caused by another condition such as severe coronary artery disease, alcoholism, thyroid disease and diabetes. The heart becomes abnormally enlarged, thickened or stiffened. lessening its ability to pump blood. Some people with the disease have few or only minor symptoms. Others may need to be medicated or undergo surgical intervention such as a pacemaker. Symptoms that may increase with time include chest pain, shortness of breath and fatigue, swelling of the legs and feet, weight gain, dizziness or fainting.
Arrhythmias are irregular heartbeats that occur when the electrical impulses that pace the heartbeat are disturbed. Mild, occasional "mis-beats" are different from recurrent arrhythmias which need a doctor's care. Longer term abnormal heartbeat rhythms, whether too fast (tachycardias) or too slow (bradycardias) can cause dizziness and fainting spells. Rapid heart beating in the ventricles can be life-threatening.
Heart attacks and women
A heart attack is one of the most frightening aspects of coronary heart disease due to its often unexpected and sometimes fatal nature. Each year, about 1.1 million Americans experience heart attack and 460,000 die as a result, according to the American Heart Association. Most heart attacks occur when the plaque on the inner walls of coronary arteries breaks open, causing a blood clot to form at the site. If the clot is large enough to cut off most or all blood flow to the heart, the heart muscle becomes damaged and can die if the blockage is not treated quickly enough. Heart attack can also occur due to blockage in the very small blood vessel of the heart. This condition is called microvascular disease and is believed to be more common in women than in men, according to the National Heart Lung and Blood Institute (NHLBI).
Though heart attacks were once thought to be primarily a male problem, more women than men die every year of cardiovascular disease in the U.S. Despite this fact, women are still less likely to believe they're having a heart attack and more likely put off going for emergency treatment, according to the NHLBI. Women seem more likely to attribute their symptoms to anxiety or fatigue and may be unwilling to face the embarrassment of an unnecessary trip to the hospital. In a 2004 study published in the AHA's Circulation journal, women are also more likely to be misdiagnosed and incorrectly discharged from emergency rooms.
"Women don't ignore their husband's symptoms, but they do tend to ignore their own," Bauman said. She recalls treating a woman who ultimately died of a heart attack suffered one Christmas Eve. The patient's daughter explained that her mother had been experiencing symptoms for about a month but had not sought treatment.
"She told me, 'My mother needed a wife,'" the physician said. "A wife would have gotten her to the doctor. A wife would have made sure she got checked out.'" Though chest pain or discomfort is the most common symptom of heart attacks in both sexes, there are some differences in how women experience heart attacks. Knowledge of heart attack signs and symptoms in women can be lifesaving information.
• Women heart attack victims tend to be, on average, about 10 years older than men who have heart attacks - 55 instead of 45.
• Women heart attack victims are more likely to have other health conditions such as diabetes, high blood pressure and congestive heart failure - making emergency care even more important.
• During a heart attack, women are somewhat more likely than men to experience some of the other symptoms besides chest pain - symptoms like shortness of breath, upset stomach and vomiting, and back or jaw pain. Women are also less likely to have pain radiating down the arm.
Dr. Pamela Ivey, a cardiologist with Cardiovascular Consultants of Nevada who has served on the board of the American Heart Association, says there is evidence to suggest that there are gender differences in the way plaque builds in the artery lining. Men and women may have a similar total volume of plaque , but women tend more often to have microvascular disease, in which plaque collects in smaller arteries rather than the larger arteries. These blockages are not easily detectable with angiography.
According to womenshealth.gov, a Federal Government source for women's health information, other symptoms women may experience during heart attack are unusual tiredness, trouble sleeping, and anxiety. A survey of more than 500 women found that 95 percent had new and different symptoms for up to a month prior to their heart attacks. The most common symptoms? Unexplained or unusual fatigue and sleeping problems.
"Fatigue is one of the red flags," Bauman said. "If you are feeling tired, you need to go to your doctor and have a good physical examination." Bauman, author of "Fight Fatigue - Six Simple Steps To Maximize Your Energy," said she is always concerned when a female patient complains of difficulty completing once common activities like walking around the mall.
So, she who hesitates may truly be lost - to the one death per minute statistic. Women who fear they may be having a heart attack should seek emergency care immediately. Heart attacks often come on slowly - but don't give yourself too much time to think. Minutes can matter especially with some of the new medications available to heart attack sufferers.
Who is at risk
One in three adult women has some kind of heart disease, according to the American Heart Association. Being 55 or older, having a prior history of heart disease or a family history of heart disease (father or brother diagnosed before age 55; mother or sister diagnosed before age 65) are leading risk factors. African-American women are 35 percent more likely to die from heart disease than non-Hispanic white women, according to womenshealth.gov. The Web site notes that studies have shown African-American women are less likely to get the same tests and treatments for heart disease that white women get.
“African American women commonly present with atypical chest pain,” Ivey said.
Risk factors that relate to lifestyle choices - and can therefore be changed to a greater or lesser extent - include smoking, high blood pressure, high cholesterol, overweight and obesity, sedentary lifestyle and diabetes. Women who smoke and use oral contraceptive greatly increase their risk for heart disease and stroke compared to nonsmoking women who use oral contraceptives.
Postmenopausal women have a higher risk of heart disease, possibly due to the loss of natural estrogen, according the the AHA. The organization does not advise women to take hormone replacement therapy, however, due to the results of recent studies that show the benefits do not outweigh the risks.
Treatment
Prevention is, of course, the best cure. Eating a heart-healthy diet, getting regular physical activity and quitting or not starting smoking are the best advice. Managing conditions such as diabetes, high blood pressure and high cholesterol are also a good line of defense. Your physician may prescribe a statin drug to help in managing cholesterol levels if lifestyle changes aren't enough.
Statin drugs work in the liver to prevent the formation of cholesterol and help lower the "bad" cholesterol or LDL. They have some positive effects on lower triglycerides (blood fats) and raising "good" cholesterol, or HDL. A newer type of medication works by preventing the absorption of cholesterol from the intestine. Drugs known as ACE inhibitors are prescribed to relax blood vessels and reduce high blood pressure. Niacin can affect the liver's production of blood fats, but the AHA notes that over-the-counter niacin should not be used as a substitute for prescription niacin due to potentially serious side effects.
Emergency intervention
The medical profession has made extensive strides in the research and treatment of heart disease in the last 20-25 years. As a result, new medications can greatly decrease the amount of damage done to the heart muscle during a heart attack - if a patient gets to an emergency room quickly.
One of the first tools that will be used is an electrocardiogram (ECG) that measures electrical activity in the heart. A defibrillator may be used to "shock" the heart back into a normal rhythm if the ECG shows the patient is in cardiac arrest. Medications called thrombolytics or "clot busters" can help dissolve blood clots. These are especially effective if they can be started within an hour of the heart attack onset. Beta-blockers slow the heart rate, reducing strain and oxygen requirements on the heart. Nitroglycerin dilates blood vessels to increase the blood flow to the heart. Other medications can be used to help prevent the formation of blood clots.
Aspirin has recently gotten a lot of press for helping the survival rate of heart attacks. it is important to note that while physicians prescribe low dosages of aspirin to heart attack survivors, it is not recommended to low-risk people who have not experienced a heart attack.
Coronary angiography will often be part of the diagnosis and treatment of heart disease. A cardiologist makes an incision in the femoral artery at the groin, or occasionally the brachial artery in the arm. A thin plastic sheath is inserted through the artery and a flexible catheter is passed through the aorta to the heart. A fluid that shows up on x-ray is inserted into the heart muscle which will show exactly where and to what extent the heart arteries are blocked. Angioplasty, or a mechanical widening of the blocked vessels, may be recommended as a result. A balloon may be inserted into the vessel and expanded at the point of blockage to flatten the plaque against the vessel walls. Stents, small, mesh-like metal devices, are often used with the balloon angioplasty. They act to keep the blood vessel open after the balloon is removed. Other procedures designed to reduce the blockage in arteries involve the use of lasers or high-speed drills placed at the end of the catheter.
Coronary bypass surgery acts to re-route the blood around the arteries that are blocked. It is generally reserved for patients whose heart disease cannot be solved by angioplasty. In conventional bypass surgery, the surgeon makes an incision down the center of the chest and spreads the ribs to expose the heart. The heart is stopped during surgery while a heart-lung machine takes over the heart's job of blood circulation. A healthy blood vessel, usually from the patient's leg, is grafted onto the heart to replace the diseased arteries. In some conditions, minimally invasive or "keyhole" surgery can be performed through smaller incisions on the chest.
A heartbeat away
vThe experience of heart disease is unfortunately so common as to be almost a rite of passage for middle-aged women. According to the American Heart Association, the average lifetime risk for cardiovascular disease in women is very high - approaching one in two. But it doesn't have to be that way. Decreasing the risk factors of smoking, obesity, a high fat diet, lack of physical exercise and controlling medical conditions like diabetes, high blood pressure and high cholesterol - can go a long way to changing those statistics.
"We tend to think of heart disease as a disease of adults and older people, but it's actually a disease of adolesence that manifests itself in older age," Bauman said.. "You find the beginning of atherosclerosis in young age groups. We're not immune to heart disease because of our sex, age or race."
Facts from the AHA 2007 guidelines:
1. Cardiovascular disease is the single greatest cause of death among women worldwide, accounting for one-third of all deaths.
2. In the United States and some other countries, more women than men die every year of cardiovascular disease.
3. In the United States, 38.2 million women, or 34 percent, are living with CVD.
4. The average lifetime risk for CVD in women is very high - approaching one in two.
5. Even the presence of a single risk factor at 50 years of age is associated with a substantially increased lifetime risk for CVD and shorter life span.
6. Within one year of quitting smoking, heart attack risk decreases by about 50 percent; and within 5 to 10 years of quitting, the risk is about the same as for anyone who is the same age and has never smoked.
7. Women who smoke and use oral contraceptives greatly increase their risk of coronary heart disease and stroke compared with nonsmoking women who use oral contraceptives.
Source: lvrj.com