Women and heart disease
Published: January 27, 2012
Font size: [A] [A] [A]
Sharon Hinchey of Kingston, a career teacher, couldn’t believe it was happening to her. Yet, after her life was turned upside down by multiple heart attacks, she became acutely aware of the fact that heart disease is the No. 1 killer of American women.
Hinchey’s story confirms the documented differences that occur in the way men versus women suffer from heart disease. Many cardiologists now agree that American women are not being diagnosed or treated as efficiently as their male counterparts.
At the “heart” of the situation are heart disease symptoms. As a group, men have a strong tendency to experience classic signs such as squeezing sensations in their chest, crushing pain, and vomiting.
With women the signs are different, and they may present with symptoms not readily apparent as heart disease, even to a physician. Females often experience nausea, jaw pain that could drive them to a dentist, or simple fatigue with weak legs and a sense of wobbliness.
Behind this scenario are many ideas, but few concrete answers. Women may actually have a higher pain tolerance than men, but science acknowledges that estrogen is a protective factor for the female cardiovascular system, although menopause eventually becomes an equalizer between the sexes.
The American obesity epidemic, along with its sister disease of diabetes, is another huge factor in female heart disease. Cardiologists urge all women to be monitored for classic risk factors, such as high cholesterol, elevated blood pressure, and a family history with cardiovascular disease onset before age 65. A combination of obesity, smoking, and diabetes can be deadly.
Misguided fears
Eileen Rattigan, M.D., cardiologist with the Geisinger Health System, endorses her organization’s Women’s Heart and Vascular Health program that seeks to recognize and treat women’s heart disease. She explains that it is human nature to minimize symptoms, and that most American women mistakenly still fear cancer more than heart disease.
“Cancer activism has been so strong,” says Dr. Rattigan. “For example, if mammogram guidelines change there is outrage, but if many women gave up their blood pressure and cholesterol tests, they’d say it was no big deal!”
The resulting lack of diagnosis of heart disease in women, according to Dr. Rattigan, has varied causes. She notes that most women are very duty-driven and, when feeling poorly, tend to keep going despite their symptoms, thereby creating diagnostic delays.
Other factors that keep women away from doctors while simultaneously raising their risk factors include depression, a lack of exercise, reliance on fast food, and social restaurant visitation. Additionally, northeastern Pennsylvania’s notorious love of cigarette smoking is shared by many female residents.
It also is common for women to expand to a certain physical size and then declare it would be uncomfortable for them to begin an exercise program with its predictable aching and fatigue. The development of a heavy body mass index can make risk factor reduction very difficult, and subsequently discourage treatment after diagnosis, or even life-saving CPR.
“We ask our female patients to first try to achieve small weight losses,” says Dr Rattigan. “This will eventually create big changes for the patient.”
Ignoring risks
Michael Rupp, M.D., chief of cardiology at Wilkes-Barre General Hospital, zeroes in on avoiding a diagnosis as a tragic factor in the battle against heart disease in females. Many women first present with symptoms of a full-blown heart attack after ignoring their risk factors.
“Despite our best efforts, a lack of diagnoses in females is still an issue,” says Dr. Rupp. “Many women are also surprised when eventually diagnosed. Things may happen suddenly, and they just can’t believe it.”
Dr. Rupp isolates many factors as reasons behind female aversion to the cardiologist’s office. Multiple caretaker duties that many be intergenerational, obesity, busy work schedules, and love of ethnic diets make the list. Hypertension and diabetes can make also exercise difficult, creating a vicious circle.
“Young girls are also smoking frequently, because smoking clearly is a status symbol,” says Dr. Rupp. “Getting women to stop is 10 times harder than for men.”
He adds that, in many cases, a seemingly sudden onset of female heart disease is common. A woman may unknowingly up her intake of salt, and at the same time gain weight, raising her blood sugar and setting off a perfect health storm.
“In cases such as these, there’s no one cause for the heart disease,” says Dr. Rupp. “It’s just that the dominos fell the wrong way.”
Overblown claims
Linda Barrasse, M.D., a Lackawanna County cardiologist, emphasizes that after diagnosis, heart disease displays few differences between the sexes. Physical examinations, testing and treatment are usually the same, despite the sex of the patient.
“The claims of gender bias are overblown, and factors such as societal influences and personal responsibility affect both sexes” says Dr. Barrasse. “Once they’re in the office, women have the same experiences as the men. What varies is the journey taken to the office.”
Dr. Barrasse says that increases in the female cardiovascular disease can be traced, in part, to marketing that took advantage of the women’s equality movement. Images presented to women during the 1960s and 1970s, such as the infamous Virginia Slims advertising campaign, had disastrous effects as female smoking increased. “The people behind this marketing program had to know what the outcomes would be,” says Dr. Barrasse.
A modern issue that concerns Dr. Barrasse is the fact that many women fail to seek health care. She believes negative peer pressure can flow to women from overweight family and friends, influencing that woman not to take care of herself or consult with a physician.
“Physicians are not mind readers. Patients must talk to us,” says Dr. Barrasse. “We hear so many stories of how a woman climbed the steps with laundry, had chest pain, but then choose to go back downstairs for more clothes.”
Dr. Barrasse also says that America’s unhealthy eating habits will probably not cease anytime soon. Consequently, no one should expect the obesity crisis to ebb. She urges her patients to partake of a wide variety of foods, including the region’s famously fatty ethnic specialties, as long as they exercise personal responsibility and limit portion size.
“Unfortunately, America has become a super-size society,” says Dr. Barrasse.
Sometimes women should put self first
Sharon Hinchey’s difficult story has a positive postscript. She is involved with WomenHeart, a national coalition that champions early detection, accurate diagnosis and proper treatment of women’s heart disease. She was chosen to be a WomenHeart Champion in 2010, and has spoken out against traditional female care-taking and selfless behaviors that can postpone diagnosis and treatment.
“So many women make time for everyone else, and ignore their own health,” says Hinchey. “We must listen to our bodies, note deviations and abnormalities, be our own advocate, and visit the doctor. Our loved ones also must speak up and help us to change our behaviors with small goals.”
