5 Myths for Ms. and Mrs.:
Correcting Misunderstandings about Heart Disease in Women
Ventura County Star
by Siegfried Storz, M.D.
Although her heart looks like a man’s heart and works just as hard, a woman should know that there are real gender differences which may affect her in unexpected ways. By learning when conventional wisdom is a myth, a woman is more likely to avoid misunderstandings which can increase her risk of a heart attack and to be an informed patient if she needs to seek help from her doctor.
- “The biggest risk to a woman’s life is breast cancer.”
Breast cancer is one of the most feared diagnoses a woman can face. Coronary heart disease, however, kills over 8 times as many women as breast cancer. In fact heart disease is more deadly than all cancers combined.
- “Men are more likely to die of heart disease than women.”
We know that women are more protected from heart attacks before menopause. Although less likely to strike younger women than men of the same age, heart attacks are more likely to be fatal. After menopause women’s heart disease mortality rates catch up with - and eventually exceed - men’s lifetime heart disease mortality.
- “Diagnosis of heart problems is similar for men and women.”
Unlike a heart attack in the movies, women are more likely to experience subtle, atypical symptoms such as fatigue, shortness of breath, nausea or discomfort in an unusual location. Non-cardiac causes of chest pain such as fibromyalgia and costochondritis occur more often in women. In addition, cyclic hormonal symptoms such as flushing, palpitations or sweating may feel just like symptoms caused by heart disease.
If their doctors are misled by women’s atypical symptoms, they may be less likely to schedule cardiac screening tests. No test is perfect, and some are more difficult to interpret in women. The treadmill stress test demonstrates abnormalities in up to 30% of normal women and may require additional cardiac imaging with ultrasound or radioactive tracers to definitely establish or rule out heart disease.
Even the gold standard for diagnosis of heart disease, the coronary angiogram, can be a challenge. Instead of localized blockages usually found in patients with disabling chest pain or heart attacks, the coronary arteries can be diffusely involved and appear surprisingly normal. As you might have guessed, this happens more often in women.
- “Treatment for heart problems is the same for men and women.”
Problems establishing a correct diagnosis may lead to gender differences in treatment as well. Important cardiovascular medications such as betablockers, ACE inhibitors and statins are prescribed less frequently for women. Women also receive approximately half as many angioplasties, stents and bypass surgeries as men. Although mortality rates for these cardiac procedures are low in both sexes, women are older and often frailer when they are treated, and experience higher mortality rates.
- “Having heart disease means losing control of my life.”
Receiving a diagnosis of heart disease is never good news; neither is being reminded that it may have been preventable. However, it’s really never too late to begin doing the right thing for our heart. It’s not always easy, but almost every woman can improve her long term outlook if she can exercise regularly, quit smoking, eat a heart healthy diet and lose a few pounds.
A doctor can help with early detection and treatment of other correctable risk factors such as high blood pressure, high cholesterol and diabetes. Many prescription medications have been proven effective in preventing heart attacks, avoiding hospitalizations and improving longevity.
Since diet and lifestyle play a major role in causing heart disease, a woman has a unique opportunity to protect her family as well. As a lean and active role model for her children, she can help them avoid the epidemic of teenage obesity and type II diabetes. She may even help her husband prevent a heart attack.
To learn more about what a woman can do for herself and her family, consult with your doctor or visit one or more of these Internet resources.
Siegfried Storz, M.D., is a local cardiologist, and a former Chief of Staff at Community Memorial Hospital in Ventura.