A middle-aged man clutching his chest is the classic image associated with heart attacks. Although this scenario is all too common, it may not be an accurate depiction of what a heart attack is like for a woman. In addition to chest pain, women often experience symptoms such as back, jaw and neck pain; shortness of breath; nausea or fatigue.
This scenario is one of many common misconceptions that may be contributing to a gender gap in the health and treatment of women with cardiovascular disease (CVD). Now that research is uncovering new information about heart disease’s impact on women, raising awareness has become a priority for cardiologists and organizations like the American Heart Association.
Nandita Scott, MD, co-director of the Corrigan Women’s Heart Health Program at the Massachusetts General Hospital Corrigan Minehan Heart Center, emphasizes the importance of educating all women about heart disease and highlights some common myths that may keep women from improving their cardiovascular health.
Myth #1: Young women do not get heart disease
Heart disease is the leading cause of death of women over age 20. In fact, more women die of heart disease each year than the next five leading causes of death combined.
Unfortunately, there is a gender gap in the mortality rates between men and women. Although the death rate for men has declined in recent decades, the death rate for women has lagged behind. A recent study found that women were more than twice as likely to die within the first 24 hours after being hospitalized for a heart attack, according to the report in Circulation: Journal of the American Heart Association.
This trend has been attributed to a lack of data pertaining to women and CVD. In addition, women generally seek medical attention an hour later than men after the onset of a heart attack.
Raising awareness is critical so that women address their risk factors and seek treatment promptly. However, more research is needed to identify the most effective treatments for heart disease in women.
"Part of the burden of CVD in women is due to lack of gender-specific data and so far, we have realized that differences exist between men and women," says Scott.
Myth #2: You can die from a broken heart
Stress-induced cardiomyopathy has recently been described by researchers as a condition most often affecting postmenopausal women. The phenomenon is usually provoked by sudden stress or shock, such as from the death of a loved one, and causes symptoms similar to a heart attack, such as shortness of breath and chest pain.
"This stress-induced cardiomyopathy appears to be a form of stunning of the heart associated with a surge of adrenaline," says Scott. "In these cases, the heart’s ability to pump is impaired, and the arteries are not clogged."
After the event, most patients return to normal with no signs of damage to heart tissue. The prognosis is excellent once the patient has recovered, but a recurrence is possible.
Myth #3: Hormones should not be used for the management of menopausal symptoms due to their adverse effects on heart health
Estrogen is the most effective treatment for the relief of menopausal symptoms. Previously, hormonal replacement therapy was also widely prescribed to postmenopausal women for prevention of heart disease until data showed it increases the risk of blood clots and stroke. Now many women are questioning the safety of the treatment in managing the symptoms of menopause.
Dr. Scott says that should be a decision discussed by the woman and her doctors. "The absolute cardiovascular risk of taking hormones is low, but the decision to start should be made after careful consideration of these risks versus the benefits," she says. "More research is also underway investigating other formulations of hormone replacement therapy to try to further reduce the risk."
Myth #4: My father had a heart attack when he was 43, so I am going to have heart disease also
"Heart disease is absolutely preventable," says Scott. "The key to prevention is addressing your risk factors. The best thing you can do is improve your risk factors through good nutrition, exercise and by not smoking."
It is also important for women to know their blood pressure, cholesterol, body weight and blood sugar to create a clear picture of their individual risk of heart disease. However, many of the common risk assessment tools may underestimate the true risk of heart disease in women.
"Know your numbers and talk to your doctor about what options are best for you based on an individual assessment," she says.
Despite being preventable, heart disease is a serious part of the lives of too many American women. The key is awareness and a lifestyle that incorporates exercise, a healthy diet, not smoking, maintenance of ideal body weight and stable blood pressure and cholesterol. For more information about heart disease, visit the Corrigan Minehan Heart Center.