Women and Heart Disease I: Debunking the Myths

When it comes to preventing heart disease, knowing the facts and making educated choices are the best tools we have. Several myths abound regarding heart disease in women. The following are the five most common misconceptions, along with the relevant facts.

Myth 1: Cancer kills more women than heart disease does.

In fact, heart disease and stroke cause twice as many deaths than all types of cancer combined. Heart disease leads to the deaths of half a million American women every year. According to American Heart Association (AHA), about one woman dies from cardiovascular disease every minute in the United States. Moreover, more women die of cardiovascular disease than the sum of the next five causes combined; these include cancer, respiratory failure, Alzheimer’s disease, diabetes, and accidents.

Myth 2: More men are killed by heart disease than women.

The opposite is true. In recent years — since 1984 — more women die from heart disease than men. The disparity in death rates is highest for young women (less than 65 years of age). Moreover, over 90% of primary care physicians were not aware that more women than men die of heart disease each year. This may contribute to the fact that women are less likely than men to receive the appropriate medical therapy after a heart attack (see Myth 5 below).

Myth 3: Heart disease in men and women are similar diseases.

The pattern of coronary artery disease in women is often very different from that in men. For males, most cases of coronary disease is focal: it is a discrete narrowing in a specified region of a coronary artery. In women, the narrowing may be more diffuse, and also more difficult to establish by conventional techniques of coronary angiography. This pattern may have implications for the types of diagnostic tests that women should undergo as well as the type of therapy.

Myth 4: Heart attack symptoms in women are the same as those in men.

Women’s heart attack symptoms are more often generalized and nonspecific. The classic symptom of pressing chest discomfort is less commonly seen in women. This may lead to a dangerous delay in seeking medical attention. Hence, angina and heart attack may be more subtle in women than men, and their symptoms are less likely to be “classic.” Symptoms in women are often characterized as trouble breathing, an “achy feeling," insomnia, feeling anxious, chest ache, belly pain, sweating, nausea and vomiting, and generalized malaise.

Compounding the problem is the fact that many physicians are not aware of the disparities in the presentation of men versus women. This may create further delay in the diagnosis. And with heart attacks, every minute counts. To borrow a phrase from finance: “Time is muscle!” In other words, with every passing minute of an untreated heart attack, more heart muscle dies. Therefore, the quicker one gets appropriate medical treatment, the greater the ability to salvage heart muscle.

Myth 5: Women are as likely to undergo recommended therapy as men are.

A recent study in Circulation, funded by the American Heart Association, found that many recommended therapies for heart disease are underutilized in women, as compared to men.

In the study, Dr. Hani Jneid and colleagues found that, compared to men, women were:

• 14% less likely to receive early aspirin;
• 10% less likely to receive beta blockers;
• 25% less likely to receive reperfusion therapy (to restore blood flow);
• 22% less likely to receive reperfusion therapy within 30 minutes of hospital arrival; and
• 13% less likely to receive angioplasty within 90 minutes of hospital arrival.

The reason for this difference may lie in physician failures to administer appropriate therapy versus legitimate reasons for this difference.

Summary: Armed with the facts and not the myths, women will be in a position to make rational choices regarding their heart health. Read more in the next blog, entitled "Women and Heart Disease II: C.H.O.I.C.E.S. To Make"