Why do more women than men die after heart attacks?
The most common symptoms of a heart attack occur in both men and women: chest pain or pressure and arm pain that radiates to the back, neck or jaw. Emergency department doctors follow a specific protocol when a patient comes in with heart attack symptoms.
But after the patient is stabilized and discharged, women tend to fare far worse than men. A recent study funded by the British Heart Association and published in the Journal of the American Heart Association found that women were three times as likely as men to die within a year of having a heart attack.
Cardiovascular disease is the leading cause of death in women in the United States, taking the life of one woman every 80 seconds in the U.S. But with a condition that’s so common, why does care for women lag so far behind? The answers lie with both the patients and the providers.
What patients can do
First and foremost, many women have difficulty putting their health first. With career, family and social obligations, many of us feel that we “just don’t have time to be sick.” Unfortunately, when it comes to heart health, ignoring symptoms or putting off treatment can have devastating consequences. For women, heart attack symptoms may be mild and vague and can include:
- Abdominal pain
- Arm or shoulder pain without chest pain
- Fatigue that lasts a couple of days
- Nausea or vomiting
- Poor sleep
- Shortness of breath
Women, if you have these symptoms or you just don’t feel right, get to the emergency department right away. I’ve cared for patients who thought they just had severe gas but actually were suffering a heart attack. Had these women not followed their instincts and sought emergency help, they could have suffered severe heart damage or died as a result of their heart attacks.
It’s also vital that women see a doctor regularly to proactively manage their overall health and heart health. While it can feel like a chore to see the doctor when you aren’t sick, regular physical exams can help us pinpoint risk factors such as high cholesterol, blood pressure or blood sugar before tragedy strikes.
Just for women: Learn your personal risk for heart disease.
What providers can do
As primary care doctors, cardiologists and specialists, our No. 1 goal is to reduce illness and help patients achieve and maintain healthy lives. We must take it upon ourselves to become familiar with our patients’ risk factors and work together to protect their hearts.
We can divide a woman’s risk factors for heart disease into two categories: factors they cannot control and factors they can control. Fortunately, the list of nonmodifiable includes just two factors: family/genetic history and getting older. We can’t change our DNA, and heart disease risk increases for everyone as we age. However, we can offer preventive therapies, such as statin medications, stenting or lifestyle modification plans to reduce the risks associated with these factors as women age.
The list of controllable factors is substantially longer, and doctors can do a lot to help patients overcome these lifestyle-related risk factors:
- Behavioral conditions, such as depression and anxiety
- Excess alcohol use
- Excess weight around the waist, which is a factor of metabolic disease
- Lack of exercise
- Smoking cigarettes or using tobacco
- Stress at work and home
- Uncontrolled high blood pressure
- Uncontrolled diabetes
Many of these risk factors require special considerations for women. For example, starting at age 50, more women than men are likely to develop high blood pressure. Women with Type 2 diabetes are twice as likely as men to develop coronary heart disease.
Before heart attacks happen, we must encourage our female patients to make healthy lifestyle changes, such as quitting smoking, eating a diet rich in fruits and vegetables and getting help for behavioral health conditions. Exercise is huge as well. Some research suggests that women derive more benefit from exercise and healthier eating habits than men to reduce their heart disease risk, and we should help patients find exercise plans that fit their abilities and schedules.
Advances in women’s heart health
The heart team at MedStar Heart & Vascular Institute at MedStar Washington Hospital Center has made amazing strides in women’s heart testing and ongoing patient care. In the past, heart disease risk-calculation data was derived from an older, male population. Today, patients can benefit from new screening and diagnostic testing that provides more widely relevant data across all ages and genders. One such test is coronary calcium scoring, which can be done in as little as 15 to 20 minutes and can provide deeper insights into a patient’s personal risk.
Our heart team includes experts in imaging and interventional cardiology to effectively assess heart disease in women. In the past, stress tests could cause a lot of false positives in women, and the best way to get an accurate diagnosis was catheterization. Now, we offer noninvasive angiographies, so we often can avoid catheterization. When catheterization is necessary, we often can use a transradial approach and enter a blood vessel through the wrist rather than the groin. This technique is more comfortable and associated with less complications for women.
Women are also having better outcomes with bypass surgery here at MedStar Heart & Vascular Institute thanks to our excellent cardiac surgery team working in tandem with cardiac rehabilitation, as part of patient discharge planning. We provide a standard of care for all of our patients that includes preparation instructions for procedures, education about disease management and follow-up care and red flags that should signal them to come to the doctor.
If you have any concerns about your heart health—no matter how minor your condition may seem—visit your doctor. Be sure to accurately describe your symptoms and don’t downplay anything. Together, we can help avoid heart health emergencies and protect your health for years to come
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