February 2, 2012Physician Focus: February 2012
By Loryn Feinberg, M.D.
As waistlines among Americans grow, so do concerns about overall
heart health. This is especially true for women who, according to a
recent report by the American Heart Association (AHA), have
increased their caloric intake by 22 percent in the last two
decades, compared to 10 percent for men. About two-thirds of women
in this country are now considered overweight. This can put a
strain on the heart and lead to cardiovascular disease, including
heart attacks, strokes and even sudden death.
Heart disease is now the number-one killer of American women,
claiming more than 500,000 lives a year, or almost one every
minute. Exacerbating the problem is misinformation among women and
healthcare providers: Women often don't correctly identify their
symptoms of heart disease, and physicians may misdiagnose symptoms
their patients present to them.
For too long, there's been a perception that heart disease is
primarily an older man's disease. But women, once they reach 65
years, have a higher incidence of cardiovascular disease than men,
and they are more likely to die from it than men. While the
mortality rate in men has steadily declined over two decades,
cardiovascular mortality for women has increased slightly.
Studies show that women frequently don't get the care they need
regarding their cardiovascular health, indicating a lack of
awareness about women's heart risks and gender differences. For
instance, an AHA survey found that only 21 percent of women were
aware that cardiovascular disease poses a significant risk to them.
Women with chest pain often delay going for treatment, and they
often don't recognize other symptoms - including abdominal pain,
difficulty breathing, nausea, and fatigue-which are different from
men's symptoms.
Also, 46 percent of women perceive that breast cancer is their
most serious health threat, while only 4 percent cite heart
disease. In fact, the total number of deaths from heart
disease this year among women is expected to be nearly double the
total deaths caused by all types of cancer combined.
Surprisingly, the lack of women's heart health awareness is also
prevalent among healthcare providers. Many doctors don't know that
women are at greater risk than men, and they often attribute chest
pains in women to non-cardiac issues, leading to misinterpretation
of their condition. Common misdiagnoses include indigestion, gall
bladder disease, and anxiety attacks.
Gender bias, therefore, may still affect physicians' decisions.
A national survey of physicians found that almost two-thirds of
respondents were unaware of gender differences in the symptoms,
warning signs, and tests used to diagnose heart disease.
Studies also show that a woman's risk of heart disease increases
dramatically at the time of menopause and associated hormonal
changes. As women enter menopause, usually around 50, they
experience a drop in estrogen, which is believed to protect the
heart.
Post menopause, cholesterol levels in women often change
unfavorably, while their metabolism slows down. Also, weight gain,
often associated with the risk factors of high blood pressure,
diabetes, and high cholesterol, can increase the chances of heart
disease or stroke after menopause.
We must recognize the fundamental differences between men and
women regarding cardiovascular health, including the fact that
women have smaller hearts and arteries than men, which can result
in more complications for women when they undergo
procedures.
A key to improved heart health is education. Women need to
become more informed and active partners in their cardiovascular
care. They can empower themselves by researching reputable sources
like the American Heart Association (AHA) or American College of
Cardiology (ACC) and asking cardiologists for a second opinion if
they have doubts about their diagnosis.
Of course, men and women who may be at risk should make
necessary lifestyle adjustments, including weight control, diet,
exercise, and smoking cessation. According to the AHA and the ACC,
while patients often don't do well on their own, they tend to see
marked improvement when they receive the proper diagnosis and
treatment. To learn more, visit www.heart.org or www.bidmc.org/cvi.
Loryn Feinberg, M.D., is medical director of the Women's
Cardiovascular Health Program at Beth Israel Deaconess Medical
Center in Boston. Physician Focus is a public service of the
Massachusetts Medical Society. Readers should use their own
judgment when seeking medical care and consult with their physician
for treatment. Send comments to PhysicianFocus@mms.org
