For years I have heard complaints in the media that doctors haven’t done enough research on heart disease in women. There was a time when we ladies had a legitimate beef in this area, but today this is really an antiquated argument that only serves to make headlines and unnecessarily raise the collective anger of women against the “medical establishment.” Despite the popularity of this idea that men rule medicine and just don’t care about or understand women, it’s really not based in fact. Large studies in the last 20-30 years have searched aggressively for how to better detect and treat heart disease in women. Monumental undertakings such as the Nurses’ Health Study and Women’s Health Initiative, along with a multitude of other smaller studies, have compiled data on hundreds of thousands of women. So here’s what we now know about coronary artery disease (CAD), the leading killer of women:
The risk factors for CAD (atherosclerosis of the heart’s arteries-aka buildup of cholesterol plaque in the arteries that causes heart attacks) are very similar in women and men. People of both genders are more likely to develop coronary artery disease if they:
-are older than age 55
-have abnormal cholesterol
-have high blood pressure
-have a family history of premature CAD (a first degree male relative <55 or female relative <65 at diagnosis)
-are overweight, particularly when the weight is carried in the abdomen
-live a sedentary lifestyle
-have evidence of atherosclerosis in other arteries of the body (legs, neck, aorta, etc.)
So what’s different for women? The type of cholesterol abnormalities that convey the most risk for women are are not the same as for men. While elevated LDL (“bad”) cholesterol is definitely concerning for women, a low HDL (“good”) cholesterol is even more concerning, and is a better predictor of coronary artery disease for women. In fact, the ratio of total cholesterol to HDL is an important number for women. Elevated triglycerides (transporters of fat in the bloodstream) and elevated CRP (c-reactive protein-a marker of inflammation) also seem to represent a higher likelihood of atherosclerosis in a woman than a man.
Another major difference between men and women is the symptoms of heart disease. Men are more likely to experience the classic angina symptoms: crushing mid-chest pain that’s described as a “tightness,” “pressure,” or “heaviness.” When women are having a heart attack, they are more likely to describe pain or abnormal sensations in the neck or jaw. They often will describe nausea and/or a pain that is “sharp” or “burning.” Over half of women having heart-related pain will complain primarily of shortness of breath or fatigue. Physicians have learned that they need to consider heart disease in women with these “atypical” complaints.
Stress testing is also not as useful in women. There tends to be a higher rate of “false-positives” for women undergoing these tests, making them harder for doctors to interpret. Unfortunately, women are less likely to be treated aggressively when they do have heart disease and are more likely than men to die if they do have a heart attack. The reasons for this are not clear. Researchers have speculated that this may be a result of the fact that women with heart disease tend to have more other serious medical problems. We also think that women’s symptoms of heart disease may lead doctors to attribute the symptoms to another cause. Others think there is a gender bias that is contributing to this unfortunate difference. Hopefully, ongoing research will provide more answers and narrow this gap.
The most important thing women need to know is how to prevent coronary artery disease. The best ways to prevent heart disease are pretty basic and boring-for both men and women. These things are simple in concept, but can be difficult to implement. If you are worried about heart disease, do the following things that have consistently been shown to decrease your risk of heart disease:
4.Maintain a healthy weight.
5.Exercise at lease 4 days per week for at least 30 minutes, preferably more.
6.Eat lots of fruits, vegetables, whole grains, fiber, and fish.
7.Limit red meat and processed or fried foods that are high in fat and calories.
8.If you have high blood pressure, diabetes, and/or high cholesterol, see your doctor regularly and heed his/her advice about how to control these risk factors. This may mean doing all of the above activities, and medication. Some people may need to take several medicines. Work with your doctor to find a regimen that works for you and has little or no side effects. Medications are not a failure and they are not your enemy. The right medication may be the one that saves your life.
Shari S. Phillips, M.D.
Your Lake Norman Physician