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Heart disease in women: Unheralded killer

By on September 24, 2018 in Columnist with 0 Comments

Jim BrownBy Jim Brown, M.D.

Surprise! Women are different than men.

I am not referring to the obvious but it might surprise you to know that heart disease is the leading cause of death for women in the United States. It causes one out of every four female deaths annually or about 290,000 per year, about the same number as males.

That may come as a surprise as most people, including myself, have thought of heart disease more as a “man’s disease.”

About half of all women surveyed did not recognize that heart disease is their number one killer. Women worry more about getting breast cancer even though heart disease kills six times as many women every year.

Some of the reasons that have been suggested are breast cancer affects the body image, sexuality and self esteem in ways heart disease does not.

Another reason is the average age of the first heart attack in women is 70. Most 50-year-old women rarely know females their age with heart disease but know many who have had breast cancer.

I remember years ago when I was a member of a North Pacific Internal Medicine society, one of the guest speakers was a female cardiologist from the University of Washington. She was talking to our nearly all-male physician audience. I think at that time most of the physicians in the audience didn’t realize how common coronary disease was in women. She pointed out that women’s symptoms of heart disease and of heart attack are not the same on women as what men experience.

Many women say their physicians rarely talk to them about coronary risk and sometimes don’t recognize the heart symptoms females might have. I remember one of the speaker’s examples of women’s coronary symptoms was a complaint they felt their brassiere was feeling too tight and uncomfortable at times of exertion.

Some of the most common heart attack symptoms in women one month before their heart attack are unusual fatigue (70 percent), sleep disturbance (72 percent), shortness of breath (42 percent), as well as frequent nausea, anxiety, heart racing, and arms feeling heavy or weak.

I suspect some male physicians would not put heart disease at the top of their list in a female patient with these symptoms.

During a heart attack, the symptoms are frequently different for females than the crushing chest pain often radiating down their left arm that males experience.

About half of females having a heart attack complain of shortness of breath, and roughly 40 percent complain of weakness or unusual fatigue as well as about 36 percent of the time feeling a cold sweat, dizziness, nausea and their arms feeling heavy. A woman’s symptoms are not only different than a man’s, but she is more likely than a man to die within a year of having a heart attack.

Current research is trying to uncover new advances in tailoring prevention and treatment to women.

In the past, most of our ideas about heart disease in women came from studies of heart disease in males.

Fortunately, that is changing, not only with new and better knowledge but also because now about one half of all medical students and recent graduates are female. When I graduated from medical school, the percentage of females was around 7 percent whereas now it exceeds 50 percent.

I think a majority of women now prefer to go to female physicians whom they think are more understanding of their gender-related illnesses and issues. (That is just an educated guess on my part).

A recent study indicated female physicians did spend more time listening to their female patients than male physicians did to their female patients.

I recently saw a map of the United States showing the incidence of female heart disease in each state. Fortunately, the Northwest including Washington, Oregon, Idaho and Montana have the lowest incidence of female coronary heart disease in the nation.

By far the highest incidence is in the Southeastern states. From my perspective the highest incident states are also the leading states for morbid obesity and diabetes that goes along with elevated lipids and blood pressure related to coronary heart disease.

I think, in general, people living in the Northwest are more physically active, generally smoke less and overall lead healthy lifestyles.

Most people know or have heard of things they might do to lower their risk of heart attack.

Knowing is one thing, but the motivation to do something about it is another.

There are several things everyone can do to reduce their risk of coronary heart disease.

Don’t smoke. Smoking from one to four cigarettes a day doubles the risk of heart attack. Even breathing passive smoke increases the risk.

Be more active. Get at least 30 minutes of moderate intensity exercise daily. Take the stairs rather than an elevator; park your car farther from your destination and walk to it.

Eat healthfully. The Harvard Medical School recommends a healthy diet including whole grain, fruits, vegetables and nuts. Use unsaturated oils. I prefer olive oil for everything.

Eat more fish and avoid trans fats. Read labels. My daughter got me to get a free app for my phone called “Fooducate.” With it, I can scan any bar code on food or snacks and see if it is rated from a D (bad) to A (excellent and healthy). I try to eat primarily the B and A rated foods or snacks.

Reduce stress and treat depression. You should discuss helpful measures with your healthcare provider.

Keep your waist under 35 inches and your blood pressure 120/80 or better.

Reducing your risk of heart attack is not only possible, but should be imperative.

Jim Brown, M.D., is a retired gastroenterologist who has practiced for 38 years in the Wenatchee area. He is a former CEO of the Wenatchee Valley Medical Center.

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