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Getting to the Heart of the Matter: Understanding Women's Risks and Symptoms of Heart Disease

“National Wear Red Day” Is February 5

Despite the common misconception that heart disease is a “man’s disease,” it also is the leading cause of death for women in the United States. According to the Centers for Disease Control and Prevention’s National Center for Health Statistics, heart disease is responsible for one out of every four female deaths, which is more than for all types of cancer combined.

“Heart disease in women who are pre-menopausal is less common than it is among men of the same age, but that gap narrows quickly after age 55,” says Rohit Sehgal, MD, FACC, a cardiologist with Washington Township Medical Foundation.

The American Heart Association (AHA) notes that in the past, many of the major cardiovascular research studies were conducted on men, which adversely affected the diagnosis and treatment of women with heart disease. Thanks to educational efforts such as the AHA’s annual National Wear Red Day – observed this year on Friday, February 5 – women and their physicians are becoming more aware of heart disease among women. Also, in the 10 years since the first Wear Red Day, increased gender-based research on heart disease has revealed important differences in women’s risks, symptoms and responses to treatments.

“Overall, women’s risk factors for heart disease are similar to those for men – including age, high blood pressure, high cholesterol, lack of exercise, obesity, diabetes, smoking and a family history of heart disease,” Dr. Sehgal explains. “There are some differences, however. Type 2 diabetes may be a stronger contributing risk factor for heart disease among women. Low blood levels of HDL – the ‘good’ cholesterol – are more associated with cardiac disease in women than in men. In addition, high blood levels of triglycerides and lipoprotein(a) may be stronger predictors of heart disease in women than in men.”

Dr. Sehgal observes that risk factors such as age, menopause and family history are beyond a woman’s control. Risk factors related to lifestyle, such as lack of exercise, poor eating habits and smoking are another matter.

“You really can control many risk factors associated with lifestyle choices,” he emphasizes. “For example, smoking is an important risk factor for heart disease, and yet the number of teens and young women who take up smoking has increased substantially in recent years. Also, using birth control pills might increase the risk of blood clots, and smoking can increase that risk dramatically.” Women’s symptoms of heart disease, including heart attacks, often differ from men’s, too.

“Men and women often feel chest pain during a heart attack, but women who have heart attacks may describe their pain as more diffuse, rather than as a crushing pain in the chest,” Dr. Sehgal says. “Women having a heart attack may experience pain in the neck, throat, shoulder and upper back in addition to sharp or burning pain in the chest.”

Women suffering a heart attack also may experience a range of other symptoms, including:

  • Nausea and dizziness
  • Acute shortness of breath
  • Atypical pain in the stomach or abdomen
  • Unexplained weakness or overwhelming tiredness
  • Cold, sweaty skin and paleness
  • Swelling of the ankles or lower legs

“There also are certain types of heart disease that are more common in women than in men,” Dr. Sehgal adds. “For example, women are five to six times more likely to suffer a condition in which the heart suddenly and temporarily takes on the appearance of a Japanese octopus fishing pot called a ‘takotsubo.’ Takotsubo cardiomyopathy features the symptoms and signs of an acute heart attack, but there are no blockages in the arteries in the heart.”

Because takotsubo cardiomyopathy occurs predominantly in postmenopausal women soon after exposure to sudden, unexpected emotional or physical stress, it is sometimes called the “broken heart syndrome.”

“The exact cause of takotsubo cardiomyopathy is not known,” Dr. Sehgal says. “Some researchers propose that it may be a result of excess adrenaline – a hormone that is released in the body of a person who is feeling a strong emotion such as fear or anger and that causes the heart to beat faster. The adrenaline may cause spasms in the arteries or smaller blood vessels that mimic the symptoms of a heart attack.”

Dr. Sehgal reports that, fortunately, takotsubo cardiomyopathy can be treated effectively with medications such as beta-blockers and nitrates, and most patients recover completely. Another heart condition that primarily affects women – endothelial dysfunction – is more difficult to treat.

“Endothelial dysfunction is a condition in which the lining of the arteries does not secrete the appropriate levels of the chemicals that keep the blood vessels dilated,” he says. “As a result, a person with this condition may experience spasms in the coronary arteries, causing chronic, ongoing angina – chest pain or pressure that is felt when the heart does not get enough oxygen."

“Because there are no blockages in the arteries, endothelial dysfunction is often misdiagnosed as being psychosomatic – or ‘all in your head’ – but the symptoms are real, and these patients must be taken seriously,” he adds. “Inserting stents or performing bypass surgery won’t help, since there are no blockages in the arteries. Instead, we focus on treating these patients with medications such as nitrates, calcium blockers, statins and ranolazine, which is used to treat ongoing angina, and we are achieving reasonable success with medical treatment.”

Another form of heart disease that can affect both men and women is heart failure. Men are more likely to develop heart failure due to “systolic dysfunction,” while women are more prone to heart failure resulting from “diastolic dysfunction.”

“Heart failure doesn’t mean your heart has stopped beating,” Dr. Sehgal explains. “Heart failure results from a weakening of the heart muscle or when the heart is stiff and inflexible. When that happens, the heart fails to squeeze hard enough to pump blood through the body. Heart failure also is often called congestive heart failure. ‘Congestive’ means that fluid builds up in the lungs and body since the heart isn’t pumping properly.”

Systolic heart failure occurs when the muscle of the heart’s lower left chamber, called the left ventricle, loses some of its ability to pump the amount of oxygenated and nutrient-filled blood the body needs. Diastolic heart failure occurs when the left ventricle is not able to fill properly with blood during the filling phase, so the amount of blood pumped out to the body is less than normal.

“Most people are aware that systolic refers to the upper number of a blood-pressure reading, which indicates the blood pressure when the heart is pumping,” notes Dr. Sehgal. “Diastolic refers to the lower number of a blood-pressure reading, which indicates when the heart is at rest. Elderly women are most likely to have diastolic dysfunction and a stiff heart, especially if they have a history of high blood pressure. The primary means of treating diastolic heart failure is to treat the underlying high blood pressure with beta-blockers, calcium blockers and statins, as well as with diuretics to eliminate excess fluids.”

Dr. Sehgal acknowledges that there is no explanation, so far, for why women have different symptoms and types of heart disease than men do, but he emphasizes that early treatment for heart disease is important.

“Don’t make the mistake of assuming your symptoms could not possibly be signs of heart disease,” he says. “Insist on being tested. It’s your heart – and your life.”

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