According to the American Heart Association, heart disease is the single leading cause of death for American women. Although many women may believe that cancer is more of a threat, nearly twice as many women in the United States die of heart disease, stroke and other cardiovascular diseases as from all forms of cancer, including breast cancer.
Below Stacy Fisher, M.D., assistant professor of medicine at the University of Maryland School of Medicine and complex heart disease expert at the University of Maryland Medical Center, answers questions about women and heart disease, as well as heart disease and pregnancy. She also offers advice for women seeking to lower their risk for cardiovascular disease.
How prevalent is heart disease in women?
The prevalence of heart disease is probably equal among men and women. However, women are more likely to die following a heart attack than men. One in two women dies as a result of heart disease each year, often because women are typically older than men when they are first diagnosed with heart disease, presenting with symptoms an average of nine years later in life than men, and they often have other significant health problems at the time a heart attack occurs.
How do women's heart attack symptoms differ from men's symptoms?
Often the signs and symptoms of a heart attack for women are not as clear as they might be for men. Women may not show the classic symptoms associated with a heart attack at all. As a result, women typically seek medical attention an average of two hours later than men because they simply do not recognize that they are having a heart attack.
Women do not seek medical attention as early as men might and often come in at an older age with more co-morbid conditions such as diabetes, obesity, untreated high blood pressure and high cholesterol. Women see themselves as caregivers and are often reluctant to receive care. Late presentations are part of the reason that women often do not do as well with heart disease.
Why are women's symptoms different?
Why there happens to be a difference between heart attack symptoms for men and women is not clear. Women do have smaller blood vessels than men, which is, in part, why their outcomes are not as good. The technologies we use are often dependent on the vessel size. The earlier someone presents and the better controlled the underlying risk factors such as cholesterol, blood sugar, and blood pressure, the better the outcome will be.
What heart attack symptoms are women likely to experience?
Women often experience profound weakness -- maybe pressure or heaviness in the chest, but not necessarily an intense pain. Often, they experience breathlessness and a general feeling that they are not well, as well as palpitations, dizziness and nausea. A lot of times multiple symptoms go together, and whatever the main symptom is, it is often accompanied by profound fatigue that should prompt that individual to think about her heart health and consider getting an early evaluation.
Are there any specific symptoms women should be aware of that would prompt an immediate office visit?
Some of the symptoms that women should be aware of include:
What can women do to reduce their risk or prevent heart disease?
One of the biggest things that women can do to reduce their risk for heart disease, especially today, is to make the time to lead an active lifestyle. Women need to look at their level of activity. Exercise takes thought and planning and needs to be part of the schedule. It needs be a priority, but most women are missing that in their daily schedule. Women should get a minimum of 30 minutes of regular aerobic exercise a day, four days a week, or 45 minutes a day, three days a week. Women can exercise in the morning, evening or at lunch, but it has to be scheduled, just like a doctor appointment is scheduled.
Another important aspect to consider when trying to reduce the risk for heart disease is a low fat diet. Women need to look at what they are eating and try to reduce or decrease saturated fats, and increase lower-fat healthy foods, such as fruits and vegetables (no fried foods).
Lastly, it is very important for women to not smoke, maintain a normal weight and know their numbers -- blood pressure, cholesterol and triglycerides.
How common are heart problems during pregnancy?
Adult congenital heart patients are a growing population in this country because heart surgery is so prevalent and advanced. In past years, children with very complicated heart problems did not survive to adulthood, but now for the first time, we have a whole population of people that are living with some degree of cardiac impairment. These individuals want to have their own families, so this has become a growing issue that many women and labor and delivery centers are now facing.
Many of these patients know that they have a pre-existing condition, but there are also times when a patient is first diagnosed during her pregnancy, requiring rapid assessment and intervention. One specific pregnancy-related heart problem is called Peripartum Cardiomyopathy, a condition that develops during pregnancy, usually two months before to six months after delivery, where the heart muscle becomes weak as a result of the pregnancy.
Most of the patients diagnosed with heart problems can safely maintain their pregnancies and delivery in their local hospitals, but occasionally there is someone that is at high risk and needs special care and monitoring. As part of our Congenital Heart Program, the University of Maryland Medical Center offers this type of care to anticipate potential issues and try to prevent problems in our pregnant patients who have underlying heart disease.
What type of care do you provide to pregnant women, and what are some of the challenges?
One of the big issues doctors must confront when treating pregnant women who have heart problems, especially as they relate to blood pressure and cholesterol, is that we cannot use a lot of the medications we would normally prescribe during pregnancy. These medications can have adverse side effects to the baby, so we often need to substitute or hold off on prescribing those medications during the pregnancy. Because of this, we like to review the heart medications, underlying heart problems and the patient's own underlying exercise tolerance to determine how to help both the mother and baby safely through the pregnancy. We also screen for genetic profiles of certain underlying heart conditions that may affect the baby and have strong cardiogenetics services at the University of Maryland.
Describe the new Women's Heart Health Program now offered at UMMC.
Through the Women's Heart Health Program at UMMC, we offer a thoughtful approach to preventive cardiac strategies, listening very carefully to what each woman is saying about her symptoms, her stamina and lifestyle to try to promote a heart-healthier lifestyle and make sure that she is safe. For those women who need prompt medical attention, the program provides access to cardiac services that will improve the blood flow to their hearts to get them to a place where they can lead healthy, active lifestyles. We offer educational forums and screening programs both to the community and to the service providers.