A recent study showed that women are beginning to recognize that heart
disease is a major threat to them on the whole (54 percent knew it was
the No. 1 killer of women in the U.S.). But only 13 percent said they
were personally worried about their risk.
“I think a lot of women are shocked when they find out they are at
risk,” said King’s Daughters cardiologist Jennifer Listerman, M.D.
“Women definitely have heart disease,” she said. In fact 90
percent of women in the U.S. have at least one risk factor for the disease
and many have multiples, according to the U.S. Centers for Disease Control
and Prevention. These include:
- High blood pressure
- High LDL cholesterol
- Family history
- Preeclampsia during pregnancy
- Age (55 or older)
Diabetes, poor diet, being overweight or obese, physical inactivity and
excessive alcohol use also increase risk of heart disease.
Getting women to recognize their personal risk and take action can be a
challenge for many reasons, Dr. Listerman said. One issue is women tend
to develop heart disease several years later than men. This may lull some
into believing that heart disease doesn’t affect women. Why women
develop symptoms and have heart attacks later in life isn’t entirely
clear, Dr. Listerman said, but researchers suspect it’s due to hormonal
levels before and after menopause.
Women also tend to experience heart attacks differently than men. They
may have the classic “as-seen-on-TV” heart attack, complete
with crushing chest pain. But many don’t. Often their heart attacks
are more subtle, with vague symptoms such as fatigue, shortness of breath
or just not feeling well. Nausea, stomach discomfort, and sweating may
“The challenge is that symptoms can be very variable,” Dr.
Listerman said. In the early stages, chest pain or discomfort (angina)
tends to come on with activity and get better with rest. Typically, the
angina lasts more along the line of minutes or seconds. At this stage,
the heart muscle hasn’t suffered any damage.
With a heart attack, symptoms are not as closely tied to activity. Symptoms
last longer and won’t go away, at least without intervention. “Eventually,
the heart muscle that isn’t getting good blood flow will die and
so the symptoms do eventually stop,” she said. “At that point,
there’s been substantial damage done to the heart that cannot be
undone.” This is an important point – heart muscle does not
regenerate or regrow. Once it has died, it is gone, permanently impairing
the heart’s ability to do its work.
The American College of Cardiology recently reported that women, on average,
delay seeking medical care for heart attack by 37 minutes, much longer
than men. “Usually it seems like, 37 minutes – how big a deal
is that? But time is muscle,” Dr. Listerman said. The goal is to
get blocked arteries open as quickly as possible, preferably within 60
to 90 minutes. “So 37 minutes is a pretty big chunk of time.”
The consequences of delaying care can be huge. Women don’t do as
well after a heart attack as men do. Because they are generally older
when they have that first heart attack, their physical health may not
be as good. They typically have to stay in the hospital longer, and are
more likely to die before leaving. It’s unclear exactly why this
is so, but researchers theorize it’s because risk factors, such
as diabetes and high blood pressure, have gone undiagnosed and untreated
And women’s smaller anatomical features – smaller hearts, smaller
chambers, thinner chamber walls, smaller blood vessels – along with
differences in way their hearts function can create more treatment challenges.
All of these issues make it even more imperative for women to seek care
at the very first sign of trouble, not later.
It’s not exactly clear why women delay seeking care as long as they
do. Of course, there are problems in recognizing personal risk, figuring
out your symptoms, and realizing how serious things are. There is also
the tendency among women to worry about others more than themselves.
“They worry about who will take care of the kids and grandkids, how
their being sick will affect co-workers, spouses and others. I understand
completely where they are coming from. So many folks don’t have
time to be sick. They have other folks depending on them. But the problem
is, you can’t help other people if you’re not around. And
it’s hard to help other people if you are so limited in your activity
because of permanent damage done to your heart,” she said.
“It’s really like they say on the airplane, you have to secure
your own oxygen mask first before you can help other people.”
It’s something women need to take to heart: “The people who
depend on you, need you there. They care about you, they want you there,
and they want you to seek care if you need it.”
And as for inconveniencing cardiologists, nurses or others, that should
never be a concern. “The best case scenario is if we have folks
in the ER and I can come in and say I have good news, you’re not
having a heart attack.
“That’s so much better than folks trying to tough it out at
home, or caring for the kids, or at work, and there’s damaging being
done to the heart that can’t be undone,” she said.