Women's Heart Health

The National Campaign

The Centers for Disease Control (CDC) has been aggressively trying to educate women of all ages about heart disease.  The reality is that heart disease is the #1 killer of American women.  In fact, greater than 25% of women will die of heart disease.  Heart disease can also lead to a significantly decreased quality of life.  Unfortunately, many women are not aware of these facts.  Certainly significant progress has been made increasing awareness among women, though still almost half of women fail to make the connection between risk factors and their personal risk of developing heart disease.  While most women’s risk of heart disease starts to rise between the ages of 40 to 60, both older and younger women should not be ignored. Since heart disease develops gradually and can start at a young age, even in young adulthood, greater attention needs to be paid. It’s never too late to act to reduce the risk of heart disease and therefore, older women need to be reached as well. We also know that African American and Hispanic women are disproportionately affected. Lastly, those women who already have heart disease can gain additional years of life and improved quality of life with appropriate cardiac care.  

How does a heart attack present in women?

Most people often imagine someone gripping their chest and collapsing to the ground with a heart attack. While chest pain is the most common symptom of a heart attack, not everyone experiences chest pain during a heart attack.  In fact, there is a difference between how men and women experience a heart attack.  These different or “atypical” symptoms can be felt as fatigue, nausea, shortness of breath or back pain.  Others note vague symptoms in the chest, sweating, or pain in one or both arms.  A heart attack usually doesn’t strike without warning.  In fact, the majority of women recognize that they had some symptoms of “angina” prior to eventually suffering a heart attack. For this reason, women should look for various signs and symptoms of heart disease.   Earlier recognition by women can save countless lives of friends and family. 

How can I recognize a heart attack before it happens?

Pre-heart attack symptoms are symptoms that can occur from 1 week to 4-6 months and sometimes even longer prior to a first heart attack.  Common symptoms may include shortness of breath, unusual fatigue, chest discomfort, new sensation of anxiety, indigestion, sleep disturbances, and pain in the upper back or shoulder blade.  Shortness of breath is particularly important, as this symptom is associated with a much higher rate of death when compared to those that did not have shortness of breath.  If you have any of these symptoms or concerns about heart disease, medical attention should take place as soon as possible.

Why is it necessary to recognize heart attack symptoms as early as possible?

The earlier a patient receives lifesaving heart attack treatments, the better chance of survival.  When a vessel is blocked, the only therapy is to open the clogged vessel.  Of the two main types of therapy, such as balloon angioplasty or stenting and clot breaking drugs, successful therapy should be initiated within the first hour if possible after a heart attack begins. Unfortunately heart attack patients, especially women, wait 2 hours or more after their symptoms begin before they seek medical assistance. This extra delay can result in death or permanent cardiac damage.  Many experts believe this difference in seeking medical assistance is one of the reasons why women tend to experience worse outcomes after a heart attack than men. Learning to recognize the many symptoms that can be experienced before and during a heart attack can ultimately save your life in the future.

What is known about hormonal replacement and risk of heart disease?

Not that many years ago, it was believed that hormonal replacement decreased the risk of heart disease.  This notion was based on the observation that the risk of heart disease rises significantly after reaching menopause.  By “correcting” low levels of estrogen, the hope was to keep women at low risk for heart disease.  Originally retrospective, observational studies supported this concept.  The Women's Health Initiative, the first large, prospectively designed research, officially debunked this belief when the study was released in July 2002. This study revealed that the previously believed benefit of long-term use of hormone therapy could poses serious risks and may increase the risk of heart attack and stroke.  Currently it is not recommended to use hormonal replacement to decrease the risk of heart disease and hormonal replacement should be seriously reconsidered with your physician if planning use for other reasons.