Women and Heart Disease: Fact and Fiction

Most women consider breast cancer the greatest threat to their lives. Yet heart attack, stroke, and other heart conditions kill approximately half a million American women each year -- twice as many deaths as from all types of cancer combined.

The good news about heart disease is that it can be prevented. And the more women understand about their unique risks and warning signs for heart disease, the more they can do to protect themselves.

Browse through the article below to learn more about heart disease in women as well as the Duke Women’s Heart Care Clinic, which is dedicated to raising awareness about women and heart disease and delivering multidisciplinary care designed specifically to meet women’s heart health needs.

Carol M’s Story

Carol M. was doing everything right -- or so she thought. “I considered myself very healthy,” recalls the Chapel Hill, NC, resident, now 62. “I was slender, walked about five times a week, and ate lots of fruits and vegetables.” So when she became frighteningly weak and woozy while taking a walk three years ago, Carol wasn’t positive that she was having problems with her heart. She’s alive today, however, because she didn’t take the chance.

Heading immediately to her local hospital, Carol received clot-busting drug treatment in the emergency department, then was admitted for a full diagnostic workup the next day. That’s when she learned that she had suffered a major heart attack and that there were no fewer than four blockages in her coronary arteries, which would require bypass surgery. “It was a real shock,” she says. “I didn’t want to believe it -- but I had no choice.”

During the months of rehabilitation that followed her surgery, Carol -- who now manages her condition with the help of a Duke cardiologist -- sifted for clues to what might have caused her cardiac crisis. She realized that her driven, always on-the-move personality might have been a factor: “I was always pushing myself,” she says. “I never just relaxed and chilled out.” Her cholesterol and blood pressure, too, had been dangerously elevated.

Now, Carol says, “I spend much more time doing less demanding things, and I read all the labels in the grocery store to avoid foods that are high in saturated fats.”

Carol also does everything she can to help spread the word about heart disease. “If you experience something that doesn’t feel right, get it checked out immediately,” she says. “Because, if it is a heart attack, the sooner you get help, the sooner you’re going to save your heart -- and save yourself.”

Correcting Misconceptions

Stories like Carol’s have, in recent years, helped raise awareness of the danger that heart disease poses to women. But misconceptions stubbornly linger. Sixty-one percent of women age 45 to 64 say breast cancer is their most-feared health threat; only 9 percent name heart disease. Yet breast cancer kills only 4 percent of women, while heart disease kills more than one in three. In fact, heart disease ends the lives of more women each year than all types of cancer combined.

“Cardiovascular disease is the number-one killer of women in the U.S.,” says Duke cardiologist Pamela S. Douglas, MD. “But less than half of women are aware of the risk.”

As a result, too many women are dying of heart disease, she says. “The good news about heart disease is that it can be prevented. And the more women understand about their risks, the more they can do to protect themselves,” says Douglas. So give up those old wives’ tales and get acquainted with the following facts: Knowing them by heart could save your life.

Fact vs. Fiction: The Truth about Women and Heart Disease

Fiction: Men are more at risk than women for developing heart disease.
Fact: “Part of the confusion around women’s heart disease is that it tends to appear nearly a decade later than men’s,” says Duke cardiologist Kristin Newby, MD, who has studied the relationship between women’s midlife hormonal changes and cardiac disease for several years. Although some women do experience a heart event in their 30s or 40s, women usually develop heart disease less often than men before reaching menopause, Newby says. However, after menopause (average age 52), there is a marked increase in heart disease among women. And by age 75, the risk of women and men is equal.

Fiction: The symptoms of heart disease are the same for men and women.
Fact: The initial onset of heart disease symptoms is often different in women than in men. Men are more likely to suffer a heart attack or sudden death without any previous symptoms. Women, on the other hand, are more likely to experience symptoms first, such as chest pain (also known as angina). Being in touch with your body's signals, and resisting any tendency to ignore or deny symptoms, may result not only in a longer life, but a greater quality of life.

Fiction: All heart attacks are accompanied by severe chest pain.
Fact: Although the most typical warning sign of a heart attack is chest pain that travels to or begins in the neck, jaw, or arms, there are a number of less obvious symptoms that are especially common in women.

If you have one or more of these symptoms, discuss them with your health care provider. If your symptoms should occur and persist for more than 15 minutes, you should seek immediate medical attention.

• Indigestion/heartburn
• Nausea
• Shortness of breath
• Profuse sweating
• Dizziness or lightheadedness
• Extreme fatigue

Fiction: You can’t find out you have heart disease until it’s too late to do much about it.
Fact: There are many clues your physician can use to find out about your risk for heart disease, such as a detailed medical history, physical exam, a blood test, and an EKG (electrocardiogram). After this initial evaluation, you may need to undergo further diagnostic tests, such as a treadmill test or cardiac catheterization. New or so-called “emerging” tools are sometimes used to identify heart disease before it causes symptoms, such as certain blood markers and the cardiovascular CT scan, which measures calcium buildup in coronary arteries. For people who have already experienced heart events, the specialized cardiac MRI shows great promise as a tool to assess damage to the heart muscle and determine how much remains viable.

Fiction: The likelihood of death or serious complications from a heart attack is greater for men than for women.
Fact: Just the opposite is true, for a number of reasons. Women typically develop heart disease at an older age than men, and are more likely to deny their symptoms and delay medical treatment. Research suggests that, in addition, women’s narrower coronary vessels may be more vulnerable to blockages--and more susceptible to spasms that choke off the heart’s blood supply. Combined with their higher prevalence of medical conditions such as diabetes and hypertension, these factors put a woman who suffers a heart attack at greater risk than a man to die within a year of the event. Women who survive a heart attack also are more likely than their male counterparts to suffer congestive heart failure, life-threatening arrhythmias, stroke, and other complications.

Woman-Centered Heart Care

As bleak as these facts seem, there is hope. While heart disease treatment and research has historically focused on men, a new generation of cardiologists are turning their attention to improving understanding and management of heart disease in women.

In 2004 Duke established a clinic designed specifically to meet the needs of women with heart disease—and those who seek to avoid it. The Duke Center for Women’s Heart Care, part of the internationally respected Duke Heart Center, is staffed by highly experienced female cardiologists who are also leaders in various aspects of cardiology research, including unique gender issues. They and the entire center team are dedicated to raising awareness about women and heart disease and delivering multidisciplinary care to meet women’s particular heart health needs.

In fact, while there are numerous state-of-the-art strategies to help those who already suffer from cardiovascular problems, women can lower their risk of heart disease by as much as 82 percent just by leading a healthy lifestyle, Douglas points out. “The bottom line in preventing heart disease is about taking responsibility for ourselves. Things like regular exercise, a healthy diet, smoking cessation, and the proper management of conditions like diabetes and high cholesterol can literally mean the difference between life and death.”

And that’s good reason for women to take heart.

For more information, visit: Duke Women’s Heart Care Clinic