By Lt. Col. (Dr.) Julie Remo
Landstuhl Regional Medical Center staff cardiologist
During February’s Heart Health Month observance, it’s important to recognize that cardiovascular disease remains the No. 1 killer of Americans despite advances in detection and treatment.
Previously thought to be a “man’s disease,” heart disease also plagues women. In fact, according to an American Heart Association 2011 update on heart disease and stroke statistics, CVD causes more deaths in women than cancer, lung disease, Alzheimer disease and accidents combined. Heart disease is the No. 1 killer of both women and men.
There are some distinct gender differences in the way heart disease affects women compared to men.
Heart attacks, known as myocardial infarctions, are a result of blockage of a blood vessel that feeds the heart muscle. The most common symptom of a heart attack is pain in the chest. In women, this is not necessarily the case. Women may experience:
- Neck, shoulder, back or abdominal discomfort
- Shortness of breath
- Nausea or vomiting
- Unusual fatigue
Because these symptoms are not “classic,” they may not be recognized as symptoms of a heart attack, which may cause delay in getting to the hospital for evaluation. A recent AHA national survey showed that only 53 percent of women said they would immediately call 911 if they thought they were having a heart attack. Health care providers seeing these women may also under-appreciate the symptoms. This can lead to delays and withholding of appropriate diagnostic tests or therapeutic procedures. This can lead to increased damage to the heart. The longer an artery is blocked, the more heart muscle that dies.
Women presenting to the emergency department with chest pain are less likely than men to:
- Receive an electrocardiogram, cardiac monitoring or cardiac enzyme measurements
- Receive a cardiology consult
- Be admitted to a coronary care unit
- Since CVD is the No. 1 killer of women, and the CVD death rate in women aged 35 to 54 years is growing, it is important to understand what causes CVD and how to prevent it. The increasing CVD death rate in women aged 35 to 54 years is thought to be secondary to the increasing burden of CVD risk factors in this group. These factors may lead to a worse prognosis for women than men.
- Examples of CVD risk factors for women include:
- Age older than 55
- Abnormal cholesterol (low HDL, high LDL, high triglycerides) – In women low HDL may be more predictive of risk than high LDL. The opposite is true for men.
- Family history of premature CVD – more commonly found in women with CVD than in men.
- Diabetes mellitus – a stronger risk factor for women than men.
- Smoking – associated with half of CVD events in women. Rapid decrease in risk with smoking cessation. Within three years of quitting, risk returns to that of a non-smoker.
- Hypertension (high blood pressure)
- Personal history of peripheral arterial disease (carotid arteries, leg arteries, aortic disease)
- Obesity – four times increase risk in CVD related death. Obesity prevalence in women is rising with 2 out of 3 women older than 20 years old being overweight or obese. Obesity can lead to hypertension and diabetes mellitus.
- Metabolic syndrome –
- Waist circumference larger than 35 inches
- Elevated triglycerides
- Low HDL cholesterol
- Blood pressure over 130/85
- Fasting blood sugar over 110 mg/dL
- Diet high in saturated fat and/or trans fat
- Sedentary lifestyle
- Chronic kidney disease
- Autoimmune collagen-vascular disease (lupus or rheumatoid arthritis)
The more risk factors a woman has, the greater her risk of developing CVD. The best way to treat CVD is to prevent it. Prevention involves eliminating or treating the risk factors listed previously. The American College of Cardiology recommends:
- Quit smoking
- Eat a healthy diet rich in fruits and vegetables, whole-grain, high fiber foods, and oily fish two times a week. Limit saturated fat, cholesterol intake, alcohol, sodium and sugar and avoid trans-fats.
- Do 30 minutes of aerobic (cardio) exercise daily most days of the week.
- Maintain a healthy weight. Goal BMI 20 to 25 kg/m2; goal waist circumference should be under 35 inches.
- Treat high blood pressure: BP goal under 120/80
- Treat high cholesterol: LDL goal under 100, HDL goal great than 50, Triglyceride goal under 150
- Good blood sugar control in diabetics: HbA1c goal under 7 percent.
- Consider aspirin: only for high risk women or women over 65 years old with good BP control.