Congratulations, ladies: breast and lung cancer are no longer the major threat to your lives. You’ve come a long way, baby, and now not only equal men, but outpace them, in yet another way. That’s not good news, however. The odds are, by a large margin compared to men and to all other causes of women’s mortality, that you will die from a heart attack, probably earlier than necessary. Many of you die from the same degree of heart attack men survive. Worse, most women and many doctors don’t know what women’s heart attack symptoms are, and many hospitals don’t treat women’s heart problems correctly.
Thought you were relatively immune to heart disease, did you, ladies? Sorry, but:
- Heart disease kills more women than any other cause -- six times as many as breast cancer -- yet only
- 1 in 12 of you knew until now that it’s your greatest health risk.
- About one third of you will die from it, including some youthful, fit, vibrant, apparently healthy women.
- After menopause, you drop at the same rate as men from heart disease.
- 50% more women than men die within a year after their heart attacks.
- Twice as many female as male heart attack survivors have another one within six years.
- If survived, half of women’s second attacks are permanently disabling.
- Black women’s risk is double that of white women.
- 95% of female heart attack victims had warning signs weeks in advance, but
- 2/3 of female heart attack victims, and many of their doctors, failed to recognize the warnings.
- Smoking can bring it on 19 years earlier.
- Diabetes, very often preventable, doubles to triples heart attack odds, more so in women than in men.
- Even though more women than men die of heart disease, women receive only about a third of the heart disease surgeries … partly because they’re more effective on men’s larger arteries.
To top it off, most heart attacks are still preventable, maybe as preventable as lung cancer. The single most important risk factor for early heart attacks in women is metabolic syndrome (aka Syndrome X, discussed in the August 2000 column), which is easily identified and can usually be reversed by losing some weight.
Everyone with an aging, supersized, or sedentary male in their lives should know the classic (i.e., men’s) heart attack symptoms. Any man or woman experiencing some of these, especially pain, should immediately call an ambulance. Whether the ambulance crew declares it a non-emergency and treats it on the spot or gets the victim to the hospital in time to save his/her life, these symptoms warrant the call:
- Mild to intense pain (or pressure, tightness, burning, or heavy weight) in chest, shoulders, neck, jaw or arms.
- Lightheadedness, fainting, sweating, nausea or shortness of breath.
- Anxiety, nervousness and/or cold, sweaty skin.
- Paleness or pallor.
- Increased or irregular heart rate.
- Feeling of impending doom.
But what should women do for simpler but unexplained sudden shortness of breath, weakness/fatigue, body aches, overall feeling of illness, mild heartburn, and/or an odd feeling or mild discomfort in the chest or back? Take a nap? Prepare for a week of flu? Take Tums or Maalox? Schedule a checkup if any chest pains appear? Take some Midol? Just suck it up as women tend to do?
If you’re female, call 911! Those are classic symptoms of a full-blown, potentially fatal heart attack in women. Pain, schmain; that’s for guys. Less than a third of women studied report discomfort, let alone chest pain, before their heart attacks, and nearly half reported no chest pain even during their heart attacks. Lucky you, ladies: you get to die in comfort relative to your men. Unlucky you: you may die because neither you, witnesses, nor some doctors know the distinct differences between men’s and women’s cardiovascular systems and heart failure modes. Lucky you: if you’re paying attention, you may notice symptoms a month before your heart attack, get treatment, avert the heart attack, and live extra decades … if you see an informed physician. Nearly all women heart patients feel advance symptoms, but many doctors don’t take those warning signs seriously because most of them rely on chest pain as the definitive symptom. That’s part of the reason fewer symptomatic women than men receive heart-protective medication.
Many women get their warning symptoms a month or two in advance. In decreasing order of occurrence, they are unusual fatigue (reported by 71%), sleep disturbance, shortness of breath, indigestion, anxiety, heart racing, arms weak/heavy (25%). During full-blown heart attacks, women’s reported symptoms in decreasing order were shortness of breath (58%), weakness, unusual fatigue, cold sweat, dizziness, nausea, arms weak/heavy (35%).
Notice the glaring lack of what many doctors consider the primary heart attack symptom: pain. Its lack leads many of them to rule out a heart attack. Even a man’s heart attack may not be unbearably painful at first, permitting its victim to delay seeking treatment for a few hours, while the heart suffers permanent damage often avoidable by prompt treatment. People have even driven themselves to ERs with ultimately fatal heart attacks an ambulance call could have averted.
Angina -- heart pain -- is the heart muscle’s response to oxygen deprivation due to diminished blood supply. Extreme oxygen deprivation, in which whole regions of heart muscle cells die for lack of oxygen, is a heart attack. Clearing the arterial blockage within a few hours of first symptoms can minimize permanent damage. That's why it is so vital to seek medical attention quickly if you feel the sort of pressing pain or heaviness described above; it’s angina 90% of the time. It will get worse and do more harm, and may be a man’s only advance warning of a potentially lethal condition.
Women aren’t even lucky enough to get pain before their heart attacks; their primary warning symptom is fatigue. Fatigue! It may as well be the rising sun for all the good that does … unless she and her doctor recognize unexplained fatigue for what it so often is: impaired blood delivery.
In fact, women’s whole list of warning or full attack symptoms don’t sound like a big deal, do they? Well, think about that, ladies; maybe that’s why so many of you die unnecessarily! Your man and your doctor need to know those are “just female things”, all right -- potentially fatal ones. If your doctor thinks the primary symptom of a heart attack is pain, change doctors; yours is coasting. I’d find a physician who’s not surprised by this article, because it comes straight from Harvard, the NIH (see http://www.nih.gov/news/pr/nov2003/ninr-03.htm), and the AHA.
The gender differences in heart disease and attacks are not just statistical; they are medical, and they are just now coming to light. Men deposit their arterial plaque in clumps which may slough off and block arteries, and tests are designed to look for those blockages. Women’s plaque spreads out more evenly through their blood vessels, however, so a third of them who subsequently have heart attacks don’t present blockages and thus don’t raise test flags.
Do we have your attention? Good; that was our objective this month. You’ll have to wait another month for root factors, risk assessment, and preventative measures. In the meantime, add the enlightening, easy-to-read research result capsules in this link to your heart health file: http://www.womenheart.org/home_resources/resources_3.asp . Examples: men are better than women at adopting healthy habits, such as exercising and quitting smoking, and caring for their grandchildren nine hours each week increases a grandmother’s heart disease risk by 55%.
Bet we’ll see you ladies next month. In the meantime, have your doctor ease you off that estrogen-only therapy unless you really need it just to get through ”The Change”. HRT is dangerous long term.