Mention the term "heart attack" and most people imagine a pudgy, middle-aged man drenched in sweat and clutching his chest. Few people seem to consider cardiovascular disease (CVD) as a woman's disease.
But according to the American Heart Association, cardiovascular disease is the leading killer of women over age 25. It kills nearly twice as many women in the United States than all types of cancer, including breast cancer. Only 13 percent of women think heart disease is a threat to their health.
The misleading notion that heart disease is not a real problem for women can be blamed in part on medical research. For a very long time, heart disease studies have focused primarily on men. Changes are under way, but some doctors still fail to recognize the warning signs displayed by female patients.
EARLY HEART SIGNS
Studies have shown that women may have undiagnosed warning signs weeks, months, and even years before having a heart attack.
Significant differences may exist in the symptoms displayed by women and men. Men typically experience the "classic" heart attack signs: tightness in the chest, arm pain, and shortness of breath. Women's symptoms may resemble those of men, but on occasion nausea, an overwhelming fatigue, and dizziness are the main symptoms and are ignored or chalked up to stress. Women have reported that they have had a hard time getting their doctors to listen to them about these early warning symptoms.
Unusual fatigue, trouble sleeping, shortness of breath, indigestion, and anxiety were the top 5 symptoms reported by both black and white women in the study. However, black women had more intense episodes and reported them more often.
ACT IN TIME
Recognizing and treating a heart attack right away dramatically improves a patient's chance for survival. The typical American -- male or female -- however, waits 2 hours before calling for help.
Studies have shown that drugs that dissolve coronary blood clots during a heart attack can reduce the death rate in both men and women, although women have a higher risk of stroke from the therapy. Unfortunately, statistics show that a woman in the midst of having a heart attack often receives clot-busting therapy much later than a man would.
Women coming into the hospital for a heart attack have a higher death rate and higher risk of complications. A premenopausal woman having a heart attack has twice the death rate of a similarly aged man, according to experts.
Know the warning signs and always call 911 within 5 minutes of the onset of symptoms. By acting quickly, a heart attack victim is less likely to experience cardiac arrest (where the heart stops beating).
PREVENTION RECOMMENDATIONS FOR WOMEN
There is no denying that an ounce of prevention is worth a pound of cure. But preventing a disease means believing you are actually at risk -- and many women fail to see that.
Women are advised to take charge of their health by working with their doctor to address risk factors, and keep tabs on cholesterol levels, blood pressure, and lifestyle.
According to the American Heart Association, low blood levels of "good" cholesterol (high density lipoprotein, or HDL) are a stronger predictor of heart disease death in women than in men.
Estrogen may increase the risk of heart disease in older women. However, it may still be somewhat protective in preventing heart disease when given under certain circumstances. Estrogen is probably the safest for women under 60 years of age.
Current guidelines support the use of HRT for the treatment of hot flashes. Specific recommendations:
Women taking HRT should have a low risk for stroke, heart disease, blood clots, or breast cancer.
The American Heart Association has published guidelines regarding prevention of cardiovascular disease in women. The guidelines recommend the following lifestyle changes:
Keep blood pressure under 120/80 mmHg. Blood pressure drugs should be used when blood pressure is higher than 140/90 mmHg. (Persons with diabetes may need medication at lower levels.)
New guidelines do not recommend antioxidant supplements or folic acid to prevent heart disease in women.
Aspirin therapy (dose 75 mg to 325 mg a day) or a drug called clopidogrel may be prescribed for women at high risk for heart disease. Aspirin therapy is recommended for women over age 65 to prevent heart attack and stroke as long as blood pressure is controlled and the benefit is likely to outweigh the risk of gastrointestinal side effects. Regular use of aspirin is not recommended for healthy women under age 65 to prevent heart attacks.
For more information about the treatment of heart disease, see:
Women and heart disease