Heart Of A Woman
With cardiovascular disease, women face unique challenges
Heart disease is the number one killer of women.
This is a difficult but crucial fact for women to understand when considering their primary health risks.
“To put this in perspective, about 1 in 29 women annually will die from breast cancer,” says cardiologist Karen Hanna, MD. “Whereas with heart disease, the number is 1 in about 2.4.”
Compounding the problem of this formidable disease is how differently it can present itself in women as compared to men (heart disease is also men’s number one killer) and the challenges brought about by these differences in diagnosis and treatment.
Even the risk factors for heart disease, which are the same for everyone, hold unique characteristics for women:
- Diabetes - A much more powerful predictor of heart disease development in women than in men, with cardiovascular mortality rates about 3 times higher for women than men with diabetes.
- Hypertension – In the elderly population, this is a stronger predictor of heart disease for women than for men.
- Tobacco use – Older but pre-menopausal women who are smokers, particularly those that take oral contraceptive agents, have a twentyfold increased risk of heart attack. “This is a combination of factors that leads to a high risk of heart attacks and strokes,” Dr. Hanna says.
- Cholesterol – Women typically have higher HDL’s (good portion of cholesterol) longer than men. However, Dr. Hanna warns that women need to understand that if their LDL (bad cholesterol) is high, they may still be at increased cardiovascular risk.
- Obesity – In the United States, adult women have a higher incidence of obesity than males.
Symptoms of cardiovascular disease typically manifest for women about ten years later, on the average, than their male counterparts. Women have a higher frequency of atypical presenting symptoms, such as fatigue, shortness of breath, and jaw pain.
“Women may also experience more atypical-type chest pain,” Hanna says.
Sorting through these symptoms, which can be indicative of so many other conditions, is something that challenges physicians every day.
“Unfortunately, these non-typical presentations can lead to a delay in diagnosis and appropriate treatment,” Hanna says. “The disease therefore tends to be more advanced when identified, and the mortality rate is higher for women in the first year of diagnosis.”
Smaller-caliber coronary arteries in females (along with more advanced disease at diagnosis) partially explain why the mortality rate is higher for women during interventions that are meant to revascularize—or restore adequate blood flow to—the heart, such as stents, balloons, and bypass grafting.
“The mortality rates for women and men who have had revascularization become similar about a year following procedures,” Hanna says.
Some women may downplay their own symptoms because their first focus is their family’s wellbeing. Dr. Hanna hopes that women who see themselves as the caretakers will remember to take care of themselves.
“Women really need to understand the importance of communicating any new symptoms they may have to their cardiologist or primary care physician,” Hanna says. “We are concerned with both new patterns and progressive patterns of symptoms.”
Understanding their complete cholesterol profile through regular check-ups and keeping track of their blood pressure, even if they’re not on hypertension medication, can help women—and their doctors—stay aware of their cardiovascular health and any potential risks.
“It’s helpful if you can track the trends of your blood pressure in a calm, resting state, which can’t always be achieved in the doctor’s office,” Hanna says.
Dr. Hanna is excited about the new support group that has developed at St. Joseph’s/Candler through WomenHeart: The National Coalition for Women with Heart Disease. The WomenHeart support network will provide the women in the region not just extensive information but also solidarity and encouragement.
“I think that no matter what problem you are facing, it’s very helpful to be able to talk to someone who shares that same problem,” Hanna says. “A good local support system is tremendously beneficial and helps bring awareness to this important topic.”
Champions for your heart
There are many types of cardiovascular disease that affect people in different ways. Murem Sharpe had hypertrophic obstructive cardiomyopathy, an inherited condition causing thickening of the wall of the heart’s left ventricle.
“Like a lot of women, I didn’t know about how the symptoms could be quite different for us,” Sharpe says. “I had what I thought was indigestion, but my heart was not sufficiently pumping blood.”
After being successfully treated with surgery, Sharpe learned about WomenHeart: The National Coalition for Women with Heart Disease. This organization has grown into a national network of support groups and educational communities. Through a grant from the National Hospital Alliance, St. Joseph’s/Candler has developed a WomenHeart program in this region.
Sharpe took an opportunity to train with the organization at its Science and Leadership Symposium at the Mayo Clinic in Rochester, MN. Now she is a WomenHeart Champion who will be helping women learn about the same symptoms that she was unaware of before her diagnosis, as well as all the other aspects of heart disease. Sharpe will use her own experience, as well as her training with WomenHeart, to welcome women into acircle of supporters, each assuring the other that they are not alone.
“There may be women who feel uninformed or discouraged, even after they’ve received treatment,” Sharpe says. “They may be struggling with whether or not to go to cardiac rehab, or whether they even have the time and resources to make it there. We want to give encouragement to these women, to put our arms around them.”
UPDATE: Long-time Savannah health advocate Lizann Roberts has been named a WomenHeart Champion and will work with Sharpe to share their stories of survival to support other women in our community.
If you are interested in learning more about the support group being developed at St. Joseph’s/Candler, visit www.sjchs.org/womenheart. Learn the story behind the WomenHeart organization by visiting www.womenheart.org.