Associated Cardiovascular Consultants, P.A.

What women should know about heart disease

Interview with Dr. Denise M. Nachodsky, MD, FACC

The busy schedules women keep provide them every reason to sink into a chair at the end of the day and say "I'm exhausted." That's normal, but, if weariness after a long day changes into fatigue so deep that it's difficult to get through the day, beware - your heart may be telling you something. Don't ignore the message because of the misconception that cardiovascular disease (CVD) is a "man's disease." CVD is the leading cause of death among American women. Consider that:

  • Every year since 1984, more women than men have died from cardiovascular disease (CVD).
  • CVD claims the lives of about a quarter-million women annually in the United States, more than breast cancer, accidents and diabetes combined.
  • About a half-million women a year have heart attacks. Nine thousand of these are younger than 45.
  • By age 65, the number of deaths from CVD in women surpasses deaths in men by 11 percent.

Despite these facts, surveys show that most women still regard breast cancer as their greatest health risk. Advances in cardiac care improve and save lives, but women benefit from these advances only if they know the symptoms and risk factors of CVD.

Symptoms

Despite many similarities, the symptoms of CVD and the presentation of the disease differ in women and men. In general, women present with symptoms and cardiac events 10 years later than men. The delayed onset is generally attributed to the protective effect of estrogen, lost after menopause. Both men and women exhibit the typical symptoms of CVD: substernal pressure or tightness in the chest, pain radiating to the neck, jaw arms or back, shortness of breath, sweating, dizziness or nausea. These symptoms often occur during exercise and are relieved by rest.

Women, however, may also present with atypical symptoms: unusual fatigue, confusion, abdominal pain or isolated jaw, neck or back pain without chest pain. These symptoms occur initially during normal daily activities, at rest, while under mental stress or wake women from sleep.

Many older women don't associate these symptoms with CVD. They attribute them to a benign cause and delay seeking treatment. This lack of awareness together with atypical symptoms with delayed presentation may explain why women tend to have more advanced CVD at the time of diagnosis and a less favorable outcome.

Risk factors

Women and men share the major risk factors for cardiovascular disease, but the relative importance may differ. The risk factors are:

  • Advancing age
  • Family history of heart disease
  • Use of tobacco
  • Diabetes
  • Hypertension
  • Dyslipidemia
  • Obesity
  • Sedentary lifestyle

In both men and women, elevated levels of total cholesterol, low density lipoproteins ("bad cholesterol" or LDL) and triglycerides and decreased levels of high density lipoproteins ("good cholesterol or HDL) are risk factors. In women, however, decreased HDL levels and increased levels of triglycerides are stronger predictors of risk for CVD while elevated LDL is the stronger predictor in men.

Diabetes has a particularly significant impact on CVD risk in women. Diabetic women have a 3-to-7-fold increase in risk for CVD compared to a 2-to-4-fold risk in diabetic men.

In addition to the factors above, women must be aware of certain novel risk factors that may call for further assessment for CVD, including anemia, narrowing of the retinal artery, coronary calcification and elevated protein levels in the blood that may indicate systemic inflammation. Women should know also that multiple studies have concluded that hormone replacement therapy (HRT) provides no reduction in CVD risk. Current guidelines do not recommend HRT for the express purpose of prevention or treatment of CVD.

Diagnostic, treatment options

Advances in cardiac care provide an array of non-invasive diagnostic and treatment options including medical therapy, standard stress test, stress test with echocardiography or nuclear imaging, cardiac MRI or CT angiography. If a woman presents with urgent symptoms or a high risk profile, invasive testing may be warranted, including heart catheterization, angioplasty/stent or surgical intervention.

Lifestyle modification

Of equal importance to both women and men is early and comprehensive risk modification. In some patients, drug therapy may be necessary to control hypertension and elevated cholesterol. To make these positive lifestyle changes:

  • Stop smoking
  • Lower high blood pressure
  • Reduce high cholesterol
  • Maintain a healthy weight
  • Exercise regularly
  • Control diabetes

Armed with the knowledge that their symptoms may differ from those of men and with the control of risk factors in mind, women should also know that:

  • Cardiovascular disease can affect women at any age, but disease rates rise sharply after menopause.
  • Women's heart attacks are likely to be more damaging, more likely to give rise to medical complications and more likely to be fatal in the short-term than heart attacks in men.
  • A family history of heart disease is as great a risk factor for women as it is for men.
  • Heart disease is twice as likely in women who do not get regular exercise of at least 30 minutes three times a week.
  • Women who drink heavily have higher rates of heart disease than light drinkers and non-drinkers.
  • Women who smoke and take hormonal contraceptives significantly increase their risk of heart attack, stroke or cardiovascular disease.
  • Quitting smoking reduces the risk of coronary heart disease by 60 percent in three years. The risk to former smokers equals that of nonsmokers in 5 to 15 years.
  • 38 percent of all women die of cardiovascular disease; 4 percent of all women die of breast cancer.
  • All treatments for heart attack that benefit men also benefit women.

Cardiovascular disease is not gender-specific. Women must recognize the symptoms and know the risk factors. When symptoms are present, they must seek medical attention promptly. Armed with this knowledge and in partnership with their doctors, women can begin to make inroads against the most formidable challenge to their health.

About Dr. Nachodsky

Dr. Nachodsky of Associated Cardiovascular Consultants, P.A. received her M.D. from the Medical College of Wisconsin, completed a fellowship in cardiology at Dartmouth-Hitchcock Medical Center in New Hampshire, and served as instructor of clinical medicine at Dartmouth Medical School. She served as an attending cardiologist in the Department of Cardiovascular Diseases and as instructor of clinical medicine in the D.O. Fellowship Program at Deborah Hospital in Browns Mills. Earlier, she was associated with Gundersen Lutheran Medical Center, Wisconsin. Certified by the National Board of Medical Examiners, the American Board of Internal Medicine, the American Board of Internal Medicine, Cardiovascular Diseases and licensed in nuclear cardiology, she is a Fellow of the American College of Cardiology and a member of the American College of Cardiology Women's Chapter, American College of Physicians, American Heart Association, American Medical Association, American Society of Echocardiography and the Society of Nuclear Medicine. Dr. Nachodsky resides in Medford.

© 2006 - 2007 Associated Cardiovascular Consultants, PA. All Rights Reserved.

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