Heart disease is commonly associated with being a man’s disease. However, many women are surprised when they learn that heart disease is their number one killer. Almost the same number of women die each year from heart disease as compared to men.
According to the Centers for Disease Control and Prevention, in 2017 heart disease resulted in approximately one in every five female deaths in the United States alone. More recently, the American Heart Association claims that one in three female deaths are heart related.
In African American and white women in the United States, heart disease is the leading cause of death. In American Indian and Alaska Native women, heart disease and cancer related deaths equally occur annually. While cancer is the leading cause of death Hispanic, Asian and Pacific Islander women, heart disease is only second.
Dr. Sonia Henry is the Director of Echocardiography and cardiology at Northwell Health, which is New York’s largest healthcare provider. She specializes in advanced cardiac imaging inclusive of Adult Comprehensive Echocardiography and Interventional ECHO for The Structural Heart Program. She is also recognized as a “Top Cardiologist” by Consumers Research Council of America.
Photo Courtesy of Dr. Sonia Henry via Twitter
According to Dr. Henry, the term heart disease describes a range of conditions, including: “coronary heart disease or heart blockages, heart muscle disease (otherwise known as cardiomyopathy or congestive heart failure), electrical problems with the heart, which [are] arrhythmias, and heart valve problems.” She said congenital heart disease at birth is also a possibility.
47 percent of Americans have at least one of the three key risk factors of heart disease. They are: high blood pressure, high cholesterol and smoking.
“Smoking and hypertension really changes the biology of the lining of the blood vessels,” said Dr. Henry. 80 percent of risk factors are modifiable, with the unmodifiable factors coming from age and genetics.
There are several female-specific disorders and female-predominant disorders that can increase a woman’s chances of developing heart disease. They include lupus, rheumatological conditions, pregnancy complications (preeclampsia, gestational diabetes, etc.), depression, birth control pills (especially in combination with cigarette smoking) and breast cancer.
Especially in the 1950s and 1960s, heart disease was predominantly believed to be an issue solely for men, though that myth still lingers to this day. Dr. Henry claimed that the main reason for this was the difference between male and female heart symptoms during that time period.
“Men presented in a clear, concise form to the emergency room with this classic what we call ‘Hollywood heart attack,’ and they were being taken to the lab,” said Dr. Henry. On the other hand, women were sent home. This was because the symptoms they prevented were often less obvious than a man’s.
“There was a bias in terms of how a physician saw who was getting the heart attack at that time period,” said Dr. Henry. “Because it was all men presenting with your typical symptoms, that’s what was studied.”
Dr. Henry explained the typical symptoms seen in men that identify a heart attack.
“[Men] present with those classic symptoms such as substernal chest pain, pain in the center of your chest. They feel as if an elephant is sitting on the chest, they are weakened, they are sweaty all over [and] there are clear signs, what we call tombstones, on the EKGs” (an EKG is a test used to measure electrical activity of the heartbeat).
A woman’s heart attack is much more difficult to identify because they are more likely to have symptoms that aren’t necessarily heart attack specific.
“For women in general, we can present more with non-specific symptoms where you have nausea or extreme fatigue, or you can’t finish a task. Back pain, abdominal pain, very non-specific symptoms where it can really touch upon a lot of different pathologies,” said Dr. Henry.
In a ted talk called “The Single Biggest Threat Women Face” featuring Dr. C. Noel Bairey Merz, she said that heart disease is more deadly for women than breast cancer. She also touched on the prevalence of ischemic heart disease in women, claiming that “women erode, men explode.” Dr. Henry explained this analogy.
“Men typically deposit their cholesterol plaque in a coronary vessel in a focal distribution, meaning one area of the coronary vessel is obstructed,” said Dr. Henry. “Women deposit their plaque in a very diffused way across all of their blood vessels. If you think of a blood vessel like a straw, and you put for example a piece of gum at the end of the straw, there’s no flow through that straw. For women’s arteries it’s like the straw becoming narrower and narrower.”
According to the American Heart Association, cardiovascular diseases kill nearly 50 thousand women each year and 49 percent have some form of heart disease. However, only one in five African American women believe she is personally at risk, and only 52 percent know what signs and symptoms of a heart attack look like. Similarly, the average Hispanic woman is likely to develop heart disease up to 10 years earlier than non-Hispanics. Only one in three Hispanic women are aware that they could be at risk. Dr. Henry says education is paramount, especially for minority women.
“There is a difference in cardiovascular risk prevalence in this population,” said Dr. Henry. For example, African Americans have a higher risk of hypertension and obesity. According to Dr. Henry, “The reason is partly genetic, partly cultural, but in this population there is decreased awareness, decreased access to care and also in this population, unfortunately we have decreased use of guideline based treatment.”
It can take months for the heart to heal from damage after a heart attack or other heart complications. For women who have suffered from a heart disease or other coronary problems, there are many steps they can take to recover and lower the risk of complications moving forward.
“We need to make sure they’re aware of what caused the issue…and those things need to be treated,” said Dr. Henry. “It’s really a combination of wellness, nutrition, diet, aggressive risk factor modification, a follow up with your physician. That really decreases your future risk.”