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Myths Persist about Women and Heart Disease

Surveys have shown that women fear breast cancer more than heart disease. The reality is that heart disease kills many more women - by far - than breast cancer. Heart disease is the number one killer of women and accounts for more deaths than the next seven causes combined. Looking at the statistics another way: breast cancer kills one in 29 women while heart disease kills almost one in two.

There is a lingering myth among women - and even among some health-care professionals - that heart disease is more a man's disease. Heart disease may be associated more with men in part because they tend to get it at a younger age than women, and they are more likely to have the classic symptoms of heart disease.

Men tend to be diagnosed with heart disease when they are in their 50s and 60s. Women tend to be diagnosed in their 60s and 70s. Heart disease manifests about a decade later in women because, up until menopause, their hearts benefit from the protective effects of estrogen.

Men usually are warned of a problem when they experience the classic symptom of heart disease: a crushing pressure on the chest that comes with physical exertion. Women, too, can feel this classic symptom, but they are much more likely than men to feel atypical symptoms. Perhaps about a third of women with heart disease do not feel chest pressure at all. Instead, they may feel nausea, back pain or shortness of breath with exertion. Further, women tend to get heart disease around retirement age, when they may be less physically active, so they may be less likely to feel pronounced symptoms.

Along with persistent misconceptions about the incidence of heart disease in women, there is also new evidence that women who have been diagnosed with heart disease are treated less aggressively than men. A recent report in the Annals of Internal Medicine showed that both men and women were undertreated for heart disease, but more so for women. This may be due partly to an age bias as much as a gender bias, since women get heart disease at an older age. Older people often have more complex interacting health conditions and more sensitivities to medications, so they may be treated less aggressively for these reasons as well.

Nonetheless, medications to prevent heart attacks or other heart problems - aspirin, cholesterol lowering drugs, beta-blockers and ace inhibitors - are needed to prolong the life of a woman with heart disease. Each one of these medications has certain restrictions. (For example, people with severe lung disease cannot take beta-blockers.) So women who have been diagnosed with heart disease should talk to their physicians about getting the right combination and right dosages of drugs for their particular condition.

A note about hormone replacement therapy: At one time, physicians believed that, since estrogen protects the heart, hormone replacement therapy would offer the same protective benefit. Two large, randomized trials now have shown that taking hormone replacement therapy for several years does not lower - and may even increase - a woman's chance of having a heart attack. Women may still take hormone replacement therapy on a short-term basis to relieve menopause symptoms or for other health reasons, such as severe osteoporosis, but hormone replacement therapy is no longer prescribed simply to decrease the likelihood of heart disease.  ‚

Leslie Cho, M.D.
Cardiologist at Loyola University Health System
Assistant Professor of Medicine at the Loyola University Chicago Stritch School of Medicine

Risks, Tests and Symptoms

• A strong family history of heart disease (a close male relative who had a heart attack before age 45 or a close female relative who had a heart attack before age 55)
• Diabetes
• High blood pressure
• High cholesterol
• A history of smoking

Women should have these screening tests to monitor for heart disease risks:

• Annual blood pressure screening
• Annual cholesterol check after age 45
• Routine blood tests for diabetes
• Baseline stress test around age 50 for women with a family history of heart disease

Heart attacks often start slowly with mild pain or discomfort. Women especially may wait too long before getting help. Contact your doctor or call 911 right away if you feel any of these symptoms:

• Chest discomfort (pressure, squeezing, fullness or pain) that lasts more than a few minutes or goes away and comes back
• Pain or discomfort in one or both arms, the back, neck, jaw or stomach
• Shortness of breath with or without chest discomfort
• Cold sweat, nausea or lightheadedness

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