A recent survey offers clear grounds for concern: Only 1 woman in 3 has had her cholesterol levels checked, and of those tested, less than two-thirds remember the results. Another survey, sponsored by the American Heart Association, suggests that many women remain unaware of the major risk factors for heart disease. Though 84% of the women in the survey indicated that they had one or more cardiovascular risk factors (namely, high blood pressure, high total cholesterol levels, obesity or diabetes), only a third regarded themselves as being personally at risk for heart disease.
There are many misconceptions about this important disease. The truth is -- contrary to its reputation as mainly a problem for men -- heart disease is the most common cause of death in the United States for men and women. One in every four women will ultimately die from it. In fact, heart disease kills more women each year than all forms of cancer combined. (Women are six times more likely to die from heart disease than from breast cancer).
So what explains its comparative "stealth" quality as an issue for women? Heart disease tends to strike women later. For men, it's a significant concern once they hit their 40s. For women, the problems really start after menopause, in their early 50s. As women's estrogen levels drop sharply, their cholesterol levels begin to rise. By age 65, one in four women has some form of heart disease.
Over the past several decades, women have been greatly under-represented in many important studies of heart disease and heart attack. Researchers, though, are catching up. As a result, they have begun to investigate the distinctive ways that heart disease affects women.
One recent study, the Women's Ischemia Syndrome Evaluation (WISE), was the first to look at heart disease solely in women. One of the most important findings is that heart disease may produce distinctive and different signs in women.
Men tend to develop coronary artery disease as a product of atherosclerosis, a build-up of cholesterol-laden, artery-clogging plaque. (Picture how a traffic accident in one lane of an interstate can slow and ultimately stop traffic altogether, and you'll have a rough idea of the process of atherosclerosis.)
But the WISE study found that women can experience a very different condition, one that researchers have designated coronary microvascular disease. Unlike atherosclerosis in men, where plaque tends to build up and lead to blockage in the heart's largest arteries, coronary microvascular disease occurs in the heart's smallest arteries, spreading out evenly along artery walls. The result is a more subtle -- though no less serious -- threat.
Another important finding from WISE involved the angiogram, the standard test used to identify blockage in the major coronary arteries. When a woman has an angiogram, the results can be misleading. In many cases, angiograms suggest that her arteries are healthy and unblocked. (As many as half of all women who are tested get back "normal" results, compared to just 17% of men.) Yet postmenopausal women suffer high rates of heart attack and stroke. Coronary microvascular disease, which doesn't show up on standard angiograms, may explain the discrepancy.
Women's heart attack symptoms can also differ from those of men, according to the study. Women are less likely to experience a sudden, crushing chest pain -- that iconic symptom of heart attack in men. Women are more likely to have persistent low-level discomfort in the shoulders, neck or abdomen. They may also experience unexplained general fatigue and shortness of breath.
Research in to the particulars of heart disease in women is ongoing, but much remains unknown. So what can you do to protect yourself now?
Experts suggest following general recommendations for cardiovascular health:
- Monitor and control the key risk factors for heart disease.
- Maintain a heart-healthy diet.
- Get regular exercise.
- Minimize your exposure to tobacco smoke, including secondhand smoke.
In addition, if you experience persistent fatigue, chest pain (mild or severe) or shortness of breath, especially during normal daily activities, don't hesitate to consult your doctor, and remember, an angiogram may appear to give you a clean bill of health, so if you continue to have symptoms, seek testing for coronary microvascular disease.
Sources:
"High Blood Cholesterol: What You Need to Know." National Heart Lung and Blood Institute. Jun. 2005. US National Institutes of Health. 18 Sep. 2008 <http://www.nhlbi.nih.gov/health/public/heart/chol/hbc_what.htm>.
Sandmaier, Marian. The Healthy Heart Handbook for Women. 2007. US National Institutes of Health. 18 Sep. 2008 <http://emall.nhlbihin.net/product2.asp?sku=03-2720>.
Shaw, L.J., et al. "Insights From the NHLBI-Sponsored Women's Ischemia Syndrome Evaluation (WISE) Study: Part I: Gender Differences in Traditional and Novel Risk Factors, Symptom Evaluation, and Gender-Optimized Diagnostic Strategies." Journal of the American College of Cardiology. 47:3 Suppl(2006): S4-S20. 18 Sep. 2008 <http://linkinghub.elsevier.com/retrieve/pii/S0735-1097(05)02506-4> (subscription).
"What Is Coronary Microvascular Disease?" National Heart, Lung and Blood Institute. 2008. US Department of Health and Human Services. 18 Sep. 2008 <http://www.nhlbi.nih.gov/health/dci/Diseases/cmd/cmd_all.html>.
