Understanding Women’s Risks for Cardiovascular Disease

Most women think cardiovascular disease is a “man’s disease.” Wrong.

Coronary heart disease caused one in six female deaths in 2004 compared to one in 30 from breast cancer, says the American Heart Association. Its 2007 update shows that more than 460,000 women die each year from heart attacks or strokes, about 50,000 more than the number of men.

Few women or doctors understand that. Only 13 percent of women in a recent survey knew that more women than men died from heart attacks and strokes. Just as troubling, this fact was known by only 8 percent of primary care physicians, 13 percent of ob-gyns and 17 percent of cardiologists.

“There is a huge amount of room to create change,” says Paula A. Johnson, director of the Connors Center for Women’s Health and Gender Biology and chief of the Division of Women’s Health at Brigham and Women’s Hospital. In a March 28 Capitol Hill seminar on “Women and Cardiovascular Disease: Closing the Gender Gap,” she emphasized that ignorance of symptoms compounds the problem. Fifty percent of women showing up in emergency rooms with heart attacks had no symptoms that they linked to heart disease, let alone the stereotypical chest pain that radiates toward the left arm. Some suffer nausea or vomiting and 26 percent in a recent study felt “an overwhelming fatigue,” said Johnson.

“We should stop using language of ‘typical symptoms’ and start talking about the full array of symptoms,” she said. “Every minute counts so recognizing these as you show up in the ER is very important.”

Even if ER doctors take women seriously, they may be confused by the tests. Blockages of veins may show up in women as “just a thinning, not a blockage,” said Johnson, and a plaque rupture, which can lead to acute heart attacks, may show up in women “as just an erosion of this plaque, not a rupture.”

With both the medics and the women poorly understanding the symptoms, far too often doctors don’t refer women for more aggressive treatment, says Johnson. Only 38 percent of female CDV patients got angioplasties or stent placements, which the AHA calls “disproportionately low.”

A bipartisan congressional coalition is backing legislation to change this picture.

This February, Sens. Debbie Stabenow, D-MI, and Lisa Murkowski, R-AK, and Reps. Lois Capps, D-CA, and Barbara Cubin, R-WY, introduced the Heart Disease Education, Research and Analysis and Treatment (HEART) for Women Act. Its goal is to improve prevention, diagnosis and treatment of heart disease and strokes among women. By early April, 76 members had signed onto the bill. House hearings could be held later this spring.

Many congressional sponsors know the CDV risks well. Capps is a registered nurse who also co-chairs both the Congressional Caucus for Women’s Issues and the Congressional Heart and Stroke Coalition. Cubin survived a heart attack in 2005. Rep. Mary Fallin, R-OK, watched both her parents die of heart disease.

Young people also can be at risk, Michaela Gagne told the Capitol Hill seminar. She was a standout three-season athlete when, at 17, doctors told her she had a life-threatening heart condition and implanted an internal cardiac defibulator. “I was very isolated. I was the only woman under 60 sitting in that waiting room.”

As she returned to health, she worked to alert other young women. She won the title of Miss Massachusetts in the Miss America pageant on a platform of “heart health” and speaks nationally on behalf of the AHA’s “Go Red for Women” campaign. She wants to dispel the notion that heart attacks claim mostly older men. “Nothing could be further from the truth.”