Andre Olivier, MD: Cardiologist
SAINT THOMAS HEART
TOPIC: Women and Heart Disease
Monday, October 18, 2010
news notes via www.webmd.com
Women and Heart Disease: Key Facts You Need to Know
Experts share information about symptoms and risks that even the most health-savvy people may not know.
Which one of the following statements is true?
The answer: All of them. And experts say they represent only the tip of the iceberg when it comes to the facts that many women, and even some doctors, don't realize about women and heart disease.
Women tend to think that breast cancer is their biggest health threat. And while it's important, heart disease remains the No. 1 killer of women, even young women. But that message just hasn't been fully recognized.
If you look at how many women get heart attacks and how many women die of heart attacks, you would be stunned; still, many women just don't seem to realize how great a threat heart disease really is.
The American Heart Association (AHA) reports that 42.1 million women had cardiovascular disease in 2004, resulting in some 461,000 deaths.
Moreover, too often the symptoms and risk factors of heart disease go unnoticed, sometimes even by doctors.
Even in the emergency room, many times doctors will attribute a woman's symptoms to something other than heart disease. There is simply not enough awareness on either side of the stethoscope.
To help get up to speed, take WebMD's Women's Heart Health Quiz. Find out what you need to know about the symptoms and risk factors of heart disease in women, and what steps you and your doctor can take to protect you.
The WebMD Women's Heart Health Quiz
1. True or False: As long as my cholesterol and blood pressure are normal, I don't have to worry about having a heart attack.
Answer: False. While both cholesterol and blood pressure are contributing factors to heart disease, there's clearly not enough emphasis on the other factors that can also play a role.
Family history is of major importance. So is weight and blood sugar. Often we don't see enough women who are overweight or who have diabetes getting their hearts checked, when these are leading risk factors for heart disease.
2. True or False: Estrogen and other hormones protect women from heart disease, so young women don't have to worry.
Answer: False. One of the biggest misconceptions out there right now is that young women don't get heart disease or heart attacks, or that they don't have to worry about the risk factors linked to heart disease. But nothing could be farther from the truth. Young women do get heart attacks and, they are often fatal.
According to the AHA, women under age 55 account for up to 16,000 heart-related deaths and 40,000 cardiac-related hospitalizations each year.
3. True or False: Health events that occurred during pregnancy -- such as preeclampsia or gestational diabetes -- can be risk factors for heart disease later in life.
Answer: True. Preeclampsia, gestational diabetes, high blood pressure during pregnancy -- it was always taught that these conditions go away after birth. Now we know that the impact and the effects linger, increasing the risk for heart disease.
Preeclampsia causes a woman to have twofold increased risk of heart disease at midlife; gestational diabetes often paves the way for glucose intolerance and other prediabetic conditions that contribute to obesity and other risk factors for heart disease later in life.
Because it could be 10, 15, 20 years or more since these things occurred, a woman who's 45 or 50 may not think to mention that part of her health history to her current doctor or cardiologist, but she should -- it's vital.
This is particularly true, she says, if you find yourself in an emergency room with heart attack symptoms. Knowing your full health history could help ensure you get the correct diagnosis and treatment -- and it may even save your life.
4. True or False: A stomachache, nausea, vomiting, or unexplained sweating and fatigue can all be signs of a heart attack in women.
Answer: True. While the "classic" signs of a heart attack -- like crushing chest pain and pain down the left arm -- can still occur in women having a heart attack, Women are more likely to present with "atypical" symptoms -- including gastrointestinal upset, pain in the jaw, shoulder, or upper back, or sometimes just extreme fatigue.
Women don't necessarily have the 'classic' symptoms of heart attack -- one reason it sometimes gets overlooked, even by doctors.
In terms of symptoms of heart disease, look for signs such as unusual shortness of breath or sudden changes in your level of activity. If you're a regular exerciser and run 5 miles a day and suddenly you can only run 1 mile a day, that's something to pay attention to. If you find yourself getting nausea and having an upset stomach and vomiting every time you exert yourself, that's something you need to talk to your doctor about.
5. True or False: Heart palpitations, flutters, or rapid heartbeat can sometimes be a sign of heart disease -- but not always.
Answer: True. While any heartbeat-related problems could be an indication of heart disease, experts say this is not a hard-and-fast rule. Sometimes they can also be clues to other ailments or problems not related to heart health.
What I find is that symptoms from the heart can also give you clues to other conditions, particularly when it comes to palpitations, or skipped or fluttering heartbeats. The problem could be linked to an overactive thyroid, to hormonal changes in menopause, to signs that you are experiencing increased stress, or that you're overcaffeinated. It may not be heart disease, but looking into the health of your heart may help you find and solve other problems that are causing your heart symptoms.
6. True or False: A hot flash is always a sign of menopause and never the sign of a heart problem.
Answer: False. While hot flashes are most often associated with -- and caused by -- the hormone changes of perimenopause and menopause, they can also be a symptom of certain cardiac conditions.
It depends on how and when they occur. If you get hot flashes when you're just sitting around watching television or talking on the phone, then it's probably hormonal. If you only get them when you exert yourself, then it could be a symptom of angina. Angina is a heart-muscle-related problem that is a form of heart disease.
When should you see a doctor? Anytime a symptom is really bothering you. But more important is how your symptom fits within the picture of your overall health screenings and risk factors for heart disease, including high blood pressure, high cholesterol, and a family history of heart disease.
7. True or False: To prevent heart disease all women should take one baby aspirin a day.
Answer: False. Not all women need -- or will benefit from -- daily aspirin use.
While studies show that aspirin's anti-inflammatory effects can help prevent heart attacks in those with a history of heart disease, regular use of nonsteroidal anti-inflammatory drugs -- including aspirin -- has also been shown to dramatically increase the risk of both gastrointestinal and brain bleeding. For women who have no risk factors for heart disease, the risks of a daily aspirin far outweigh the heart-health benefits.
If you have no personal risks factors for heart disease, if you have no strong family history of heart disease, then you should not be taking aspirin every day.
8. True or False: Smoking increases your risk of a heart attack.
Answer: True. According to the AHA, on average, women who smoke have heart attacks 19 years earlier than nonsmokers. Smoking is a major cause of heart disease and stopping, at any age, will help reduce those risks.
Women and Coronary Artery Disease - Topic Overview
Why is it important for women to learn about coronary artery disease?
Coronary artery disease is the number one cause of death of women in the United States. As many women die from coronary artery disease as from the next five leading causes of death combined (cancer, chronic obstructive pulmonary disease, Alzheimer's, diabetes, and accidents).
But many women underestimate the threat coronary artery disease (CAD) poses to their health. And many women do not know what they can do to help prevent heart disease.
What is coronary artery disease?
Coronary artery disease is caused by the gradual buildup of plaque (made of fat, cholesterol and other substances) on the inside walls of the coronary arteries. These arteries supply oxygen-rich blood to the heart. Over time, the plaque deposits grow large enough to narrow the arteries' inside channels, decreasing blood flow to heart muscle. If the plaque becomes unstable and ruptures, a blood clot can form at the rupture site and block blood flow, resulting in a heart attack.
What factors lead to coronary artery disease and death in women?
The rate of coronary artery disease increases 2 to 3 times after menopause, the time of life when a woman's menstrual periods stop.1 This increase is not completely understood. But cholesterol, high blood pressure, and fat around the abdomen-all risk factors for coronary artery disease-also increase around this time.
Other risk factors for coronary artery disease include smoking, diabetes, obesity, lack of exercise, and family history. Using birth control pills might increase your risk if you smoke and are older than 35 or if you have a family history of atherosclerosis or blood-clotting disorders.
How will my doctor determine my risk for coronary artery disease?
Your doctor will calculate your risk for coronary artery disease by assessing the number of risk factors you have. Risk factors include:
What can women do to prevent coronary artery disease?
Women can use healthy lifestyle changes and medicines to help prevent coronary artery disease. Women can also balance the risks and benefits of hormone replacement therapy when they decide whether or not to use it.
The American Heart Association published specific guidelines for preventing and treating coronary artery disease in women.2 These guidelines address lifestyle changes, medicines and supplements, and hormone therapy in menopausal women. Ask your doctor which recommendations are appropriate for you.
What are symptoms of coronary artery disease and heart attack?
Knowing symptoms of a heart attack can help save lives. So even if you're not sure that your symptoms are from a heart attack, do not delay seeking care. Do not wait more than 5 minutes to call 911 if you think you or someone else is having a heart attack.
Coronary artery disease symptoms might happen when the heart is working harder and needs more oxygen, such as during exercise. These symptoms typically go away with rest. The most common symptoms are:
Some people may feel tingling or numbness in their arm, hand, or jaw when they have angina. Chest pain that begins suddenly or lasts only a few seconds is less likely to be angina.
Heart attack symptoms do not go away with rest. Symptoms include:
The most common symptom for both women and men is chest pain or discomfort. But women are somewhat more likely than men to have other symptoms like shortness of breath, nausea, and back or jaw pain.
Women are also more likely than men to delay seeking help for a possible heart attack. Women delay for many reasons, like not being sure it is a heart attack, or not wanting to bother others. But it is better to be safe than sorry. If you have symptoms of a possible heart attack that last for 5 minutes, call 911 right away.
When you get to the hospital, do not be afraid to speak up for what you need. Be sure your doctors know that you think you might be having a heart attack so that you can get the tests and care you need.