Heart Disease in Women: What You Need to Know

Women often wait longer than men to go the emergency department, which is a mistake. It is important to pay attention to symptoms. A woman who thinks she is having a heart attack should chew a full-strength aspirin and go to an emergency department immediately.
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By Maryann McLaughlin, MD, MPH, FACC
Medical Director, Cardiac Health Program Mount Sinai Health System

Most people know that post-menopausal women and smokers are at risk for heart disease, and that having diabetes, and high cholesterol and blood pressure, can be contributing factors. Heart disease, however, remains the No. 1 killer of women, according to the Centers for Disease Control and Prevention, and that makes it a serious threat to all women.

Lesser-known risks:
  • Early menopause, before the age of 40;
  • Depression;
  • A parent or sibling with heart disease;
  • Polycystic Ovarian Syndrome, (PCOS), characterized by imbalance of estrogen and testosterone;
  • Inflammatory diseases, such as lupus and rheumatoid arthritis, where risk results from both the disease and medication treating it; and
  • A sedentary lifestyle.
  • Also, experiencing gestational diabetes or high blood pressure during pregnancy increases the risk for high blood pressure or diabetes later in life, which can increase the risk for heart disease.

New Guidelines Help Cardiologists Assess Risk:
The American Heart Association and the American College of Cardiology recently collaborated on guidelines to access the risk for heart disease and stroke. Cardiologists now use a calculator, factoring in age, gender, ethnicity, blood pressure, cholesterol level and whether or not you smoke or have diabetes, to project an individual's 10-year risk.

Those with a moderate risk for coronary heart disease, but who have not been diagnosed with any blocked arteries, may benefit from a coronary calcium score scan. This test is performed in minutes, using a CT scan with no injection and low radiation, to take a photo of the patient's heart and determine her risk. If her score is increased, her risk of having a heart attack is increased, and she should receive more aggressive treatment.

Treatment and New Research on Lifestyle Changes:
Treatment may include medicine, medical and surgical procedures, and lifestyle changes. A patient's doctor will weigh her risk for heart disease against the benefits of any treatment, even aspirin. If she is over 50, smokes and has diabetes, taking a low dose aspirin daily may help prevent a heart attack, but if she has no cardiac risk factors, but a history of ulcer disease or bleeding disorders, the risk of bleeding may outweigh the benefit.

Lifestyle changes alone may be enough to prevent or help heart disease in some women. Recent studies conducted at the University of Sydney and the University of Queensland in Australia, and reported in The Independent, show that lack of exercise is the leading cause of heart disease in women over the age of 30, so women should exercise 30 minutes a day, an hour if they are overweight.

Women should follow a diet high in fish, lean meat and poultry, low-fat dairy products, whole grains, and plenty of fruits and vegetables. To lower cholesterol, they might consider snacking on a handful of almonds or walnuts and adding ground flaxseeds to yogurt or salads. Studies conducted at the University of California Davis show that eating two medium apples a day lowers cholesterol, and consuming blueberries and strawberries three times a week reduces the risk for heart disease, as reported by the Harvard School of Public Health.

The most common symptoms of heart disease for both men and women:

  • Pressure in the chest. Both men and women will complain of pressure -- not a sharp pain -- like someone sitting on their chest. Women sometimes say they feel as if their bra is too tight.
  • Indigestion, or burning, in the chest;
  • A dull, heavy, aching pain radiating down either arm; and
  • Diminished exercise tolerance.
Symptoms more commonly reported in women:
  • Extreme fatigue;
  • Diminished exercise tolerance;
  • Nausea with sweating;
  • Pain between the shoulder blades, and
  • Broken Heart Syndrome (Takotsubo cardiomyopathy), a condition that commonly occurs after an emotionally charged event, such as the sudden death of a spouse or a loved one, but that can also occur after sudden good news. It is a sudden increase in adrenaline levels and it looks and feels like a heart attack. Evaluation in the cardiac catheterization lab, however, will show a weak heart muscle but no blockage in the arteries. Most patients survive the initial event with their heart returning to normal in a few months. The key is getting help quickly.

Getting Help:
Women often wait longer than men to go the emergency department, which is a mistake. It is important to pay attention to symptoms. A woman who thinks she is having a heart attack should chew a full-strength aspirin and go to an emergency department immediately. "Time is muscle," meaning the longer the patient delays treatment, the more damage she will do to her heart. Ideally, patients should receive treatment within two hours of an event, so it is critical to not delay.