Quick question: What disease kills the most women every year? Strokes? Lung disease? Alzheimer’s? Breast cancer? Lung cancer? Nope, it’s heart disease—in fact, heart disease is more lethal to women than ALL cancers combined. And it kills three times more women each year than either lung disease, stroke or Alzheimer’s.
So why do people think of heart disease as a “man’s illness?” There are several answers to that question. But the most likely is that coronary heart disease tends to strike women about 10 years later than it does men (which is why—as I indicated in last week’s blog—we have different cutoffs for determining what ages are considered “premature heart disease” in women and men). But because women live longer than men, the numbers of women having heart attacks gradually catches up with men in older age groups.
To the extent that men are more likely to have coronary heart disease than women during middle age, though, it doesn’t mean that a woman’s risk is low. Over 20% of women will die of heart disease. This includes not only coronary heart disease, but also heart failure (an entity that we will discuss in a later blog). And, while we are making inroads against coronary heart disease prevalence (the frequency of a disease in a population), the prevalence of heart failure is exploding.
What can you do to prevent coronary heart disease? First, read the blogs from January and February—about the risk factors for coronary heart disease. Keep your blood pressure and cholesterol under control. Eat a healthy diet that minimizes your risk of diabetes. Don’t smoke! Exercise! In fact, exercise is not only beneficial in lowering a woman’s risk of a heart attack, but also has separate benefits in lowering her risk of heart failure.
One common question that I am asked is whether to start/stay on HRT (hormone replacement therapy). Based on the observation that women don’t tend to have heart attacks until after menopause, it was believed that estrogen was the protective factor and that it should be given to post-menopausal women to prevent heart disease from developing. However, large studies failed to demonstrate a benefit and actually suggested some cardiac risk in the first few years of use. My advice is that it is generally OK to continue HRT if a woman has been on it for years without any problems. And if a woman has severe post-menopausal symptoms and HRT is felt to be the best way to treat them, then it is reasonable to start HRT. Women at higher risk of having heart problems, though, should be carefully monitored. But it has definitively been proven that a woman should not start HRT for the main purpose of preventing heart problems.
Another piece of advice, women: Listen to your heart. Don’t ignore symptoms, even if they don’t seem severe. Symptoms of heart problems can be different in women, particularly older women, where the classic chest pressure may not be present. Ischemia (poor blood flow to the heart) can be suggested by a vague discomfort in the chest or only occur in the jaw, shoulder or arms. Sudden shortness of breath or profuse sweating may be all that a woman notices when she is experiencing a heart attack.
And women are often busy caring for their family—their husbands, children, parents—and don’t pay enough attention to their own health. So, again, take care of yourselves. Pay attention to what your body is telling you. And don’t assume that being female protects you from having heart disease. Heart problems are a threat to women, too, not just men.
Greg Koshkarian, MD, FACC