Published on February 05, 2010

Women: Take Charge of Your Heart Health

National Wear Red Day promotes heart disease as No. 1 killer of women

After surviving colon and thyroid cancer and enduring two knee replacements, Mary Jo Holder didn't have much time to think about heart disease.

It was easy to ignore the occasional chest pains. It was easy to push aside her own family history; her mother had five heart attacks while in her 50s.

"I was having chest pains, but not awful ones," Holder, 59, of Davenport says. "I honestly thought it was muscle strain because I was trying to work out more."

An appointment with a cardiologist led to a stress test; an angiogram; and then an angioplasty at Genesis Medical Center, Davenport to clear two blocked arteries and prop them open with two stents.

"I wasn't expecting this at all," she says of her procedure last October. "Thankfully, I didn't have a heart attack before discovering the blockages. For years, I've played at losing weight, but this has been a real wake-up call for me. As women, we need to take better care of ourselves."

Rose Dahlstrom had just finished breakfast and was getting ready for an outing with her daughter when she suddenly began to feel terrible.

"I had back pain, chest pain and pain radiating from my left arm to my shoulder. I felt nauseous," said the 80-year-old resident of Carbon Cliff, Ill. "I wasn't sure, but I thought I was having symptoms of a heart attack."

She did the right thing. She called 911, and was rushed by ambulance to the Genesis Medical Center, Illini Campus. She was in the midst of a heart attack and ultimately received two stents to open her blocked arteries in the hospital's Cardiac Catheterization Lab. She realizes she had symptoms she shouldn't have ignored.

"I had a stroke the year before, which increased my risk of a heart attack," she says. "I was taking medication for my cholesterol and high blood pressure. Yet, I was still occasionally experiencing headaches and a rapid heartbeat but did nothing about it."

Wear Red Day for Women
Today, in celebration of National Wear Red Day, Holder and Dahlstrom want to remind women that heart disease is not just a man's problem. It remains the No. 1 killer of American women, says the American Heart Association.

"Heart Disease and Stroke Statistics 2010 Update," a new AHA report, says there are still disparities in how women are diagnosed and treated for heart disease - even though there is broader awareness. One woman dies every minute from cardiovascular disease - a total of more than 432,700 female deaths in 2006. That's more than the combined deaths from all cancers, chronic lower respiratory disease, Alzheimer's disease and accidents, the report says. More women than men die of heart disease each year. Yet, they are less likely than men to receive appropriate treatment after a heart attack. They also comprise only 27 percent of participants in heart research studies.

"Women have different symptoms than men and go to the doctor later than men do," says female cardiologist Rafat Padaria, M.D., who has an office at the Genesis Heart Institute in Davenport. "They are the nurturers in the family, and don't pay enough attention to their own health. When they finally come to the Emergency Room, they often are in the later stages of heart disease."

Fewer women with heart disease receive angioplasties and bypasses than men, she says. "The medical community is working to correct this, but it's up to female patients to come in for screenings and stress tests and take control of their health."

Several factors may explain the apparent disparity in treatment of men and women with heart disease.

• Atypical symptoms - Women often don't have the "classic" chest pain that grips the chest and spreads to the shoulders, neck or arms. Instead, they have a greater tendency to have atypical chest pain or to complain of abdominal pain, difficulty breathing, indigestion, nausea and unexplained fatigue, Dr. Padaria says.
• Later diagnosis - Since women tend to have heart attacks later in life than men do, they often have other diseases like arthritis or osteoporosis that can mask heart attack symptoms, she says. They often are diagnosed at a later age, which explains women's greater mortality after heart attacks.
• Diagnostic test accuracy - Some diagnostic tests may not be as accurate in women, so the disease process leading to heart attack or stroke isn't detected until later, with more serious consequences, Dr. Padaria says. The routine exercise stress test can be less accurate in women. Estrogen, depending on the phase of the ovulatory cycle, affects EKG changes, accounting for some of the false-positives in young women. In contrast, single-vessel heart disease, which is more common in women than in men, may not be picked up on a routine exercise stress test. Nuclear stress testing and stress echocardiography are more accurate tests for women.

"Educate yourselves. Learn the signs of a heart attack. Change the risk factors that you can. Stop smoking; lose extra weight; become active; manage diabetes; and, control your cholesterol and high blood pressure. Make yourself a priority, and make yourself aware. That's what will save your life," Dr. Padaria says.

Gender Differences
She points to other differences between men and women when it comes to heart disease:

• Women have smaller heart arteries, and their hearts are thicker when they present with heart disease. That can lead to higher complication rates. Women die earlier than men after heart attack.
• Females with diabetes are at much higher risk for heart disease than males.
• Women who smoke are 2-6 times more likely to suffer a heart attack. Use of birth control pills and smoking compounds the risk.
• Research shows that low levels of "good cholesterol" or HDL appear to be a stronger risk factor for women than men.

"I had the family history and was being treated for high blood pressure," explains Mary Jo Holder. "I had let myself become overweight. I later found out that my HDL, or good cholesterol, was too low, as well. Even though my total cholesterol had always been normal, it was a misleading picture of my heart health."

Since then, Holder has been active in Phase II Cardiac Rehabilitation at the Genesis Heart Institute. She has seen a dietitian and is more conscientious about her diet and sodium intake. Dahlstrom, who began her cardiac rehabilitation at the Illini Campus, now exercises at the Genesis PULSE Program at the Two Rivers YMCA in Moline.

Both women recommend participating in cardiac rehabilitation and having the reassurance of medically supervised exercise.

"It's very comforting to know that the program is medically supervised and that staff is monitoring you while you exercise," Dahlstrom says. "I probably wouldn't exercise at all if I wasn't going there."

Just last week, Mary Jo Holder went back to the Genesis Emergency Department after experiencing burning sensations in her chest. Although tests revealed she was not having a heart attack, the incident reminds her that heart disease is part of her life now. She also is encouraging her 29-year-old daughter to take seriously her family history.

"Cardiac Rehab at Genesis is so helpful, and the nurses and exercise specialists are so encouraging and always make you feel safe. I'm learning a lot in the classes," Holder says. "Women don't take care of themselves the way they should but once we find out what the problem is, I think we're more willing to get it taken care of."