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Women and Heart Disease

Posted Apr 06 2010 11:52pm

Heart disease is the number one killer of Americans.   There are many areas of confusion still, despite all that we know.   Prevention is the main key.   Women are at great risk as their symptoms and type of heart disease may vary from that normally thought of as typical. Some basic tenets to keep in mind include:

* Cardiac stress tests, also called exercise or treadmill tests, are commonly used to find evidence of blockages in the arteries of the heart. However, they are not 100% reliable

* Men mostly suffer from coronary artery disease, but women predominantly suffer from problems with smaller arteries.

* Women often have atypical or no symptoms

* Nearly 67% of Americans are overweight and at risk for heart complications from a sedentary life

* Heart disease killed 26% of the women who died in 2006—more than one in every four

* In 2006, about 6.9% of white women, 8.8% of black women, and 6.6% of Mexican American women were living with coronary heart disease

* Almost two-thirds of the women who die suddenly of coronary heart disease have no previous symptoms

* Regardless of time of day or situation, heed the symptoms and call 911

Exercise stress tests are only about 60% effective.   In other words, they miss as much as 40% of the problems. In women, these tests are even less accurate.   This may be due to the fact that when women have heart disease, the smaller branches of the blood vessels are often affected. Breast tissue can trigger false negatives. Other factors, including sex or stress hormones or estrogen’s effect on the cells of the heart muscles, can also come into play.   Stress tests effectively show whether the heart’s arteries are 70% narrowed or more.   Yet, heart attacks can arise from arteries that are less than 50% blocked.

Given the shortcomings of the treadmill test, the US Preventative Task Force, which is reviewing the current guidelines, says prevention is a key strategy. That means reducing the risk factors, such as high blood pressure, obesity, diabetes and high cholesterol. It’s also critical to know the symptoms: chest pain, pressure, tightness or unusual shortness of breath that lasts more than five to ten minutes. If symptoms occur when you exercise and gradually disappear when you stop, it’s a sign something is wrong. For 50% of women with heart disease, however, chest pain never appears. Instead, they’re fatigued or have indigestion or upper abdominal or jaw pain.

Each woman will present with different symptoms of a heart attack. Some experience several symptoms while others show all symptoms. Many women show no symptoms before their heart attack. The sooner you recognize your symptoms and take appropriate action, the better. The symptoms to be aware of include any of these: discomfort, tightness, uncomfortable pressure, fullness, squeezing in the center of the chest lasting more than a few minutes, or comes and goes; crushing chest pain; pressure or pain that spreads to the shoulders, neck, upper back, jaw, or arms; dizziness or nausea; clammy sweats, heart flutters, or paleness; unexplained feelings of anxiety, fatigue or weakness – especially with exertion; stomach or abdominal pain; shortness of breath and difficulty breathing.

It appears a significant number of women suffer from another form of heart disease that affects not the coronary arteries but rather the smaller arteries, called microvessels, that deliver blood directly to the heart muscle tissue.Researchers are learning about this new form of heart disease and what they learn may explain why some patients experience different heart-related symptoms and why women, as a group, have higher mortality and poorer outcomes from the suite of disorders that make up cardiovascular disease.

Cardiovascular disease kills more Americans, both men and women, of all races and backgrounds, than any other cause. Since 1984 more women (432,709 in 2006) have died of cardiovascular disease (which includes not just heart disease and heart attacks but also stroke and heart failure) than men (398,563 in 2006). Men develop heart disease on average 10 years earlier than women. Women who have a heart attack tend to fare worse right after the event and also suffer a poorer quality of life.

Only about 50% of patients will have classic heart attack symptoms – severe chest pain, clutching at their chest, sweating, facial expressions of agony and a feeling of a crushing weight on their chest. The other half experience what are called atypical symptoms -fatigue, pain in their arms, shoulders, back or jaw, and shortness of breath, or they’ll have no symptoms at all. Women are much more likely to fall into this group, something physicians have long known.

Cardiologists who study microvessel disease think that these patients should be offered the same drug treatments used for coronary artery blockages until more specific treatments are developed for this problem. The drugs used to treat blockages include statins to lower so-called bad, or LDL, cholesterol and prevent more plaque buildup and medicines such as aspirin, ACE inhibitors, beta blockers and nitroglycerin to improve blood flow around the blockages. If blockages are severe, they may also be treated with interventions such as a balloon angioplasty to open up a blockage, a wire mesh stent to hold a blockage open or bypass surgery to create a new route for the blood to take.

Cancer, diabetes, accidents — heart disease beats them all, killing more people in the US than any other condition. The term “heart disease” is a broad one, encompassing an array of conditions, but it’s most often used as shorthand for coronary artery disease. The latter is caused by a buildup of plaque in the arteries that supply blood to the heart, which in turn can lead to chest pain, arrythmias, heart attacks and heart failure.

Risk factors for heart disease and cornary artery disease include: high blood cholesterol, high blood pressure, smoking, diabetes, insulin resistance or metabolic syndrome, being overweight, growing older, and family history of heart disease.

What you can do to be proactive and possibly prevent heart disease: get high blood pressure and high cholesterol under control – now, exercise more, stop smoking, control stress, which we all have, instead of letting it control you, lose weight if you need to (you know who you are). As for age and family history, you can’t control that, but you should consider those steady reminders to take your risk seriously.

In the end, prevention is key, and it starts early.   We know that young children and teens may already have substantial build up of disease within their arteries before even reaching young adulthood.   Prevention is something every family should adopt and focus on, offering support for all family members in achieving goals to maintain a healthy heart and prevent disease.

Demystifying the cardiac stress test –,0,4373756.stor

The gender line –,0,5672954.sto

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National Coalition for Women with Heart Disease –

Women and Heart Disease Fact Sheet –

Are you having a heart attack? –

I have symptoms – what do I do? –


Women and Cardiovascular Disease –


Go Red for Women –

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