Heart Disease in Women on the Rise
By Dr. Mitchell Kahn

There has been a lot of news lately about the difference between cardiovascular disease in men and women. Unfortunately, many women and too many doctors don’t realize that cardiovascular disease is not just a man’s disease. Symptoms appear very differently in men and women. Most women think that breast cancer is the leading cause of death in women, but cardiovascular disease claims the lives of more women than all forms of cancer combined. Furthermore, while the death rate from cardiovascular diseases has decreased among men for the past 20 years, it continues to increase in women.

Pre-menopausal women have a substantially lower rate of heart disease than men of the same age but have a higher likelihood of having the diagnosis missed or of dying: 38 percent of women will die within one year of having a heart attack compared to 25 percent of men. Coronary heart disease rates in women after menopause are 2 to 3 times those of women the same age before menopause. And by age 60, the rate of cardiovascular disease is the same in men and women.

New findings on women and heart disease
A recent study of women and heart disease by the National Institutes of Health (NIH) made a substantial contribution to understanding some of the differences in heart disease in men and women and yielded important findings on a frequently undiagnosed coronary syndrome. The National Heart, Lung, and Blood Institute (NHLBI) began the Women’s Ischemia Syndrome Evaluation (WISE) study in 1996 to increase scientific knowledge about ischemic heart disease, cardiovascular disease, in women. WISE aimed to develop accurate diagnostic approaches for ischemic heart disease detection in women and to better understand the ways in which heart disease develops in women. They were also examining the significance of ischemia without obvious coronary blockages in women, and to evaluate the influence of hormones on ischemic heart disease development and diagnosis.

In as many as three million U.S. women with coronary heart disease, cholesterol plaque may not build up into major blockages the way it seems to in men, but instead spreads evenly throughout the artery wall. As a result, when the usual diagnostic coronary angiography is performed it reveals that these women have “clear” arteries — no blockages — incorrectly indicating low risk. Despite this, many of these women have a high risk for heart attack, according to this newly published research from the NIH.

In women with this condition, called coronary microvascular syndrome, plaque accumulates in very small arteries of the heart, causing narrowing, reduced oxygen flow to the heart, and pain that can be similar to that of people with blocked arteries, but the plaque does not show up when physicians use standard tests, such as an angiogram. As a result, many women go undiagnosed.

If a diagnosis of this condition is missed, women are not treated for their angina and high cholesterol and they remain at high risk for having a heart attack, Furthermore, WISE investigators found that the majority of women with “clear” angiography who are not diagnosed will continue to have symptoms, a declining quality of life, and repeated hospitalizations and tests.

Symptoms in women
They found that women might not describe their discomfort as “chest pain”. If they do, they might call it an achy, tight or “heavy” feeling instead of pain. The pain might even be in the back between the shoulder blades, instead of the chest.

They found that the most important symptom in women was feeling really tired — even if after enough sleep. Other different symptoms of heart disease in women were feeling scared or nervous and new or worse headaches. Of course, some women had the same signs as men: trouble breathing, nausea, aching, burning or heaviness in chest, pain in the back, between the shoulders, or pain or tightness in the chest that spreads to the jaw, neck, shoulders, ear, or the inside of the arms.

Here are some tips for men and women to help stay heart healthy:

• Don’t smoke. Stay away from other people who are smoking.
• Get your blood pressure checked and treat elevated blood pressure.
• Control your diabetes.
• Get your cholesterol checked often and use cholesterol lowering drugs if indicated.
• Stay active. Walking every day can lower your chances of a heart attack.
• Eat right and keep a healthy weight.
• Eat less salt.
• Hormones for menopause should not be used to prevent heart attacks.
• Being stressed, angry or depressed may add to your risk of a heart attack.

If you have had a heart attack, talk to your doctor about the medicines that help cut down the risk of having another heart attack. Too many women are not put on these medications.

There are two interventions which don’t seem to be useful in women. The first is low dose aspirin which does not appear to be beneficial for women who are not at high risk for heart disease. The risk of taking the aspirin outweighs the benefits in low risk women. The second is antioxidant vitamin supplements (Vitamin C and Vitamin E) which have been shown to have no benefit in either sex.

With increased awareness among doctors and patients of the prevalence of heart disease in women, hopefully the diagnosis of cardiovascular disease will not be missed and aggressive intervention can be instituted to lower the risk of heart attacks.

Mitchell Kahn, M.D., is Assistant Clinical Professor of Medicine at Columbia Medical School and is Director of the Miller Health Care Institute at New York’s St. Luke’s Roosevelt Hospital.