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Women and Heart Disease

Cardiologist/Researcher Dr. Cara East Provides Commentary

Do you think about heart disease as a man's problem? Then think about this:

  • Cardiovascular disease is the single most common cause of death and disability for men and women.
  • For women, we tend to worry about cancer, but heart disease still kills more women than all forms of cancer combined.
  • Death rates from heart disease have gone down for everyone in recent years, but we've made greater strides among men.
  • And as cancer death rates have gone down in women, it's more important than ever to realize that heart disease remains a big deal for women.

Several key factors contributed to the misconception that heart disease was a predominantly male affliction. Many women with heart disease don't exhibit the classic symptoms that men do, such as chest pains, shortness of breath and feeling ill after overexertion.

Women are more likely to suffer what is called a silent heart attack, a temporary blockage that can damage the heart, sometimes while they're resting or asleep. They may have discomfort in their shoulder blades or even their abdomen, but then they feel OK and nobody worries about it. What you think could be an ulcer could actually be a heart attack.

They're almost twice as likely to have a heart attack induced by mental stress, a syndrome where you can damage the heart without having blocked arteries. So overall, women are more likely to have atypical symptoms and it's easier to miss them.

On average, when women do have heart disease they're 10 years older than men, so doctors tend to be less aggressive in treating it. If a 70-year-old has a heart attack, he or she is less likely to be referred for more invasive procedures than a 60-year-old would be.

And we still have a lot to learn about heart disease in women. For decades, research studies consistently included vastly more men than women, an unacceptable scientific bias. Part of that came out of the 1950s thalidomide tragedy, when a new drug tested on women caused horrific birth defects. There was such a backlash that we just excluded women from these studies.

So we weren't getting enough data. We just assumed what worked for men also worked for women, without doing the proper studies.

Things have gotten much better. The American Heart Association's Go Red for Women campaign, which began in 2004, has done a great job in highlighting these issues and promoting awareness about women's heart health. The whole education process for physicians and for patients has made everyone more cognizant of the problem.

In the last five or 10 years the U.S. Food and Drug Administration and the National Institutes of Health have strongly urged inclusion of women and minorities in new studies. They ask you straight out, what plan are you going to use to not exclude them? It's going to take time to build up the data and make up for a dismal past, but we're moving in the right direction.

Add to that more women than ever specializing in cardiology, as well as other medical specialties that refer people to cardiologists. This can only improve the situation going forward.

Even if the symptoms of heart disease can differ among men and women, the risk factors are the same for both genders — diabetes, tobacco exposure, high blood pressure, high cholesterol, excess weight, and inactivity. But as caregivers, many women tend to backburner their concerns. They're used to providing care for everybody else in their lives, but not for themselves.

We all have to keep working to change that. Because heart disease is an equal-opportunity killer.

Cara East, M.D., is a cardiologist on the medical staff and principal investigator and medical director at Baylor University Medical Center's Soltero Cardiovascular Research Center in Dallas, Texas.