Advances & Insights: Women’s Health
What the news means for you
Susan S. Smyth, MD, PhD
Women must act to prevent heart disease
Heart disease affects women differently for many reasons. Unfortunately, because many older studies predominately enrolled men, we understand much less about heart disease in women. In fact, most of our understanding about cardiovascular risk factors comes from studies in men. This information may or may not be applied equally to men and women.
“Women tend to have delays in receiving treatment, in part because their symptoms are often atypical.”
National efforts led by organizations such as the American Heart Association and the National Institutes of Health are resulting in more emphasis placed on women’s cardiovascular issues. Studies focused on women have presented the opportunity to expand our understanding of features that are unique to women’s heart disease.
It’s different for women
Women tend to have delays in receiving treatment, in part because their symptoms are often atypical. They are also less likely to be treated by a cardiologist when they do present with symptoms. Women presenting with heart attacks usually have more associated risk factors (high blood pressure, diabetes, high cholesterol and others) than do men. Symptoms (common and uncommon) from coronary artery disease develop in women six to seven years later than in men.
Women as a whole have smaller blood vessels, higher rates of vascular abnormalities and their vessels are thought to be less expandable than those of men. Additionally, the type of blood clots that form in women may be different. This may make the decision about performing a percutaneous coronary intervention (PCI or PTCA) more difficult.
Diabetic women are a group needing special attention. Women age 40-59 with diabetes are up to eight times more likely to develop cardiovascular disease than nondiabetic women of the same age. Since the 1980s, diabetic women are the only subgroup with cardiovascular disease who have not shown an improvement in survival rates. In fact, diabetic women had a 23 percent increase in mortality.
“Treat high blood pressure, high cholesterol and diabetes vigilantly.”
Women are more likely to die from cardiovascular disease than from all forms of cancer combined. Despite seemingly overwhelming bad news, there is reason to be optimistic. Women can turn the tide by seeking heart health information and taking an active role in their own cardiovascular health.
Knowledge is power
Educational efforts are helping improve awareness and recognition of women’s heart disease. With the initiation of national educational campaigns to highlight cardiovascular disease in women, the awareness of heart disease in women is higher than ever before. While educational studies show awareness of women’s cardiovascular disease is higher than in years past, awareness for black and Hispanic women still needs to be improved.
The message here is for women to seek education about their cardiovascular health. Knowledge is power. Women must talk to their doctors; learn the common and uncommon symptoms of a heart attack and treat high blood pressure, high cholesterol and diabetes vigilantly. Smoking must stop and exercise and healthy eating must increase.
Heart attack symptoms in women
A woman should seek medical attention immediately if she notices one or more of the following symptoms:
- Chest pain, pressure or discomfort
- Discomfort that radiates to the neck, back or arm
- Shortness of breath
- Nausea or vomiting
- Feelings of numbness, tingling, weakness in arms or legs
- Sudden changes in vision or speech
- Unusually severe headache
Dr. Smyth is a cardiologist with the UK Gill Heart Institute and an associate professor of medicine at the UK College of Medicine.
Women and heart attacks
According to the Centers for Disease Control and Prevention, 400,000 to 460,000 patients die of acute myocardial infarction (AMI) or heart attack each year before or just after reaching an emergency room. The majority of these patients are women. This surprises many as cardiovascular disease has long been considered a man’s disease. The truth is more women than men have died of heart attacks since 1984. Cardiovascular disease, especially coronary artery disease, is the leading cause of death for American women.
“Cardiovascular disease, especially coronary artery disease, is the leading cause of death for American women.”
If a woman survives her first heart attack, the outlook for her cardiovascular health is still grim. According to an article in the December 2006 issue of Critical Pathways in Cardiology, 38 percent of women die within one year of their first heart attack compared to 25 percent of men. The article also reports 35 percent of women will have a second heart attack within six years and 46 percent will develop heart failure.
Failure to recognize symptoms
A critical factor in the cardiovascular mortality rate for women is failure to recognize symptoms of a heart attack. This failure is common for the patient, those around the patient and in some cases health care providers. While chest pain is the most common symptom for men and women, women often suffer atypical (less common) symptoms at the onset of a heart attack. Atypical symptoms such as shortness of breath, nausea, vomiting and pain in the jaw, neck or back are often attributed to other conditions, which leads to misdiagnosis.
Delay in care
Another factor in the higher mortality rate for women is delayed care after the onset of a heart attack. Three phases of delay have been identified. The time required for the patient or bystander to recognize heart attack symptoms, the time between recognition and arrival at an emergency department (the action phase), and the time between arrival and the initiation of advanced care. The recognition and action phase account for the majority of the delay.
Ideally, care for a heart attack should begin within one hour of onset. Unfortunately, 25 to 50 percent of all patients delay seeking care for over four hours. Seeking medical care within one hour is critical. Mortality can be reduced by 47 percent with rapid initiation of treatment by percutaneous coronary intervention (previously called angioplasty) or thrombolytic agents. Both therapies restore blood flow to the heart.
Percutaneous coronary intervention is the insertion of a small tube with a balloon tip at the groin. The tube is threading through lower arteries until it reaches the coronary arteries of the heart. The balloon is then inflated to open the arteries. Once the coronary arteries are open and blood flow is restored, a wire mesh tube (stent) is placed in the arteries to keep them open.
Thrombolytic agents are drugs used to break down a blood clot (thrombus) and restore blood flow. Thrombolytic agents are also effective for stroke victims if initiated quickly.
Research has shown that education and awareness among women of heart attack symptoms and need for action is just as important as the availability and types of health care provided.
For more information, see:
- The healthy heart handbook for women, National Heart, Lung, and Blood Institute, National Institutes of Health (PDF)
- Understanding prehospital delay behavior in acute myocardial infarction in women, Critical Pathways in Cardiology, v. 5, no. 4, December 2006
- National study of women’s awareness, preventive action and barriers to cardiovascular health, Circulation, v. 113, 2006, pp. 525-534
- Cardiovascular disease prevention, Health Information, UK HealthCare
- Heart attack (women’s health), Health Information, UK HealthCare
- Gill Heart Institute, UK HealthCare
- Cardiac procedures, Health Information, UK HealthCare
- Percutaneous coronary intervention (Percutaneous transluminal coronary angioplasty/Stent placement, PTCA or PCI), Health Information, UK HealthCare
- Diabetes and heart disease, Health Information, UK HealthCare
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