It started with a mild pain in the upper back -- the kind you get after sitting at the computer too long, working out too hard at the gym, or doing too many household chores. It's the kind of discomfort many women know and often live with every day.
Even when combined with unexplained fatigue, there was nothing about her subtle symptoms to make Caren Duncanson think she was experiencing the beginning of a heart attack. Despite her father having had heart disease, she was an energetic 47-year-old mother and career woman --someone who exercised daily, ate a healthy diet and never smoked.
Heart attacks happen to older, overweight, out-of-shape men, right?
Wrong -- almost dead wrong.
Duncanson's symptoms escalated through the day -- sweating and aching in both arms -- until paramedics were called and doctors found that the main artery in the back of her heart was 99 percent blocked. If treatment had been delayed by only a couple more hours, her name could have been added to the dismal statistics.
Cardiovascular disease is the leading cause of death in American women, killing 1 in 2.5. Breast cancer, on the other hand, still the most feared disease by many women according to the American Heart Association, kills 1 in 30. In fact, cardiovascular disease claims more women's lives than the next seven causes of death combined -- about a half a million a year. And, while heart disease most often strikes post-menopausal women, it kills more than 10,000 younger than age 50 annually.
"I was shocked. Everyone who knows me was shocked," says Duncanson of Encinitas, Calif., who had a stent implanted in her artery to keep it open 3 1/2 years ago. "I lived too cleanly. I didn't think I was ever at risk for something like this. I didn't have any of the typical symptoms."
That's part of the problem, doctors say. Too many people don't recognize their risks for heart disease. And too many women expect to have the classic "elephant sitting on your chest" pain that men experience when having a heart attack. With more research finally being done on female heart disease, medical experts are finding that not only are women's risks and symptoms for cardiovascular disease sometimes different than men's, so are their treatments and prognoses.
"Although women can have the classic symptoms of chest pain and pressure with radiating pain down the arm, they're more likely to have other symptoms like back pain, fatigue, nausea or gastrointestinal problems," says Dr. Denise Barnard, cardiologist and director of the Women's Cardiovascular Health Program at University of California San Diego.
According to studies, only 29 percent of women report experiencing chest pain when having a heart attack. But 70 percent of them say they had extreme fatigue.
There are subtle but important differences in how women's cardiovascular systems respond to stress, hormones, excess saturated fat and toxins such as tobacco. Women aren't just small men.
"It shouldn't come as a shock that heart disease is different in men and women. Women learn differently, they're wired differently, there are differences based on psychological and genetic differences," Barnard says. "But the recognition of how vast the differences are in heart disease is surprising and very underappreciated."
Although the risk factors for cardiovascular disease for both men and women appear to be identical, the difference is in the significance of some factors for women.
While diabetes is a known risk factor for both men and women, for reasons doctors still don't understand, it's a three-to-eight times more potent heart disease risk for women than men.
It's a statistic 42-year-old Melissa Journey learned about the hard way.
Although a diabetic since age 9, she kept her cholesterol levels and weight down, exercised regularly and ate wisely. So when she had a heart attack 2 1/2 years ago (symptoms included back pain and aching in her right arm), she "was just blown away."
"Sure, I knew that diabetes was a risk factor, but it just wasn't a reality for me. I felt so good and so strong. I thought I was doing all the right things," says Journey, who after more symptoms, underwent heart bypass surgery at Sharp Hospital in San Diego.
Today, she continues to live the healthy lifestyle she did before heart surgery, but now follows her healthy regimen even more diligently.
Hypertension also appears to hold a greater risk for women than men in the development of heart disease and stroke. This has special implications for black and Hispanic women since they have higher rates than white women of diabetes and hypertension, as well as heart disease.
And, though it's widely known that high cholesterol puts everyone at greater risk for heart disease, women need to be especially careful about keeping their HDL (good cholesterol) high (above 50 mg/dL) and triglyceride level low (below 150 mg/dL). Women with low levels of HDL are more likely than men to develop heart disease.
"High triglyceride levels in women, especially older women, are a significant risk factor for cardiovascular disease. This does not appear to be the case for men," Barnard says.
The internal manifestations of women's heart disease can be different from a man's and sometimes a bit deceptive. Both men and women accumulate plaque, a buildup of fat on vessel walls, which can cause dangerous clogs in blood flow and lead to heart attack or stroke. But women often distribute these deposits in a more diffuse manner than men. Instead of gathering in clumps or bulges, as in men, the plaque in women is spread more evenly along the vessel lining.
Diagnostic tests designed to spot classic blockages and clogs sometimes miss women's gradually narrowing arteries.
A woman has a 50 percent chance of dying from her first heart attack, compared with a 30 percent chance for a man. Of those who survive their first heart attack, 39 percent of women will die within a year versus 25 percent of men.
One of the reasons heart disease affects women more severely may be because it usually strikes women about 10 years later than it does men.
"In general, women don't do as well as men (in treatment) and are more likely to have complications," Barnard says. "By the time women have heart disease, they often need bypass surgery, they're older and may have other conditions such as kidney disease or diabetes, which increases the complication rate."
In addition, with an older, more frail female patient, doctors may take a more conservative approach than they would with a younger man.
And some treatments simply don't work the same for both sexes. At the recent conclusion of a 10-year study, it was found that low-dose aspirin therapy does not protect women younger than 65 against first heart attacks in the same way it does men. On the other hand, aspirin can cut the risk of strokes for women; however, that's not the case for men.
Because the symptoms of cardiovascular disease in women can be vague or mimic common maladies, it's imperative that they be aware of their own risk for heart disease to better interpret what may be a heart attack.
"Knowing your risks informs your thinking," says Dr. David Ostrander, Sharp Hospital cardiologist. "If you're at high risk for cardiovascular disease and you're walking across the parking lot and you feel pain you've never felt before, you should be asking yourself, 'Could this be my heart?'"
Cardiologists admit that primary physicians sometimes fail to bring up the subject of heart disease or its risks to women, so the responsibility may fall to the patient.
"If doctors don't ask you about your risk factors, you ask them," says Dr. Dennis Goodman, chief of cardiology at Scripps Memorial Hospital. "Everyone, both men and women, needs to take the opportunity to go to the doctor at least once a year and discuss their risk factors for heart disease."
After family medical history has been traced, cholesterol and blood pressure numbers calculated, and other risk factors examined, "women should do what women do best," Barnard says.
"Talk to other women. Tell them about the risks for heart disease," she says. "It can save their lives."
Source: Copley News Service. Powered by Yellowbrix.
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