Heart Disease

Heart Disease in Women

Heart disease and stroke are the No. 1 and No. 3 killers of women and are two of the many cardiovascular diseases that kill nearly 500,000 women each year. Cardiovascular disease (CVD) accounts for more deaths than the next seven causes of death in women combined, including all forms of cancer. Since 1984, men have experienced a decline in deaths due to CVD; women have not. Each year CVD kills 50,000 more women than men. This article contains the following information:

Statistics
Risk, Diagnosis and Treatment
Understanding Risks
Understanding Signs and Symptoms
Contraception
Menopause
Women and their Doctors
Risk and Gender

Important statistics about women and cardiovascular diseases

Cardiovascular disease (CVD) ranks first among all disease categories in hospital discharges for women.
41.3 percent of all female deaths in America occur from CVD, particularly coronary heart disease (CHD) and stroke.
CVD is a particularly important problem among minority women. The death rate due to CVD is substantially higher in black women than in white women.
In 2000, CVD claimed the lives of 505,661 females; cancer (all forms combined) 267,009.
In 2000, coronary heart disease claimed the lives of 254,630 females compared with 41,872 lives from breast cancer and 65,052 from lung cancer.
38 percent of women compared with 25 percent of men will die within one year after a heart attack.
Stroke is a leading cause of serious, long-term disability; an estimated 15 to 30 percent of stroke survivors are permanently disabled.
Misperceptions still exist that CVD is not a real problem for women.

Important facts about women's risk, diagnosis and treatment

Risk of heart disease and stroke increases with age, and in the year 2000, over 42 million American women will be 50 and older.
Women heart attack victims under the age of 50 have higher rates of death during hospitalization compared to men of the same age. The younger the patient, the greater the risk of death after heart attack among women relative to men.
Smoking lowers the age of first heart attack and raises the relative risk of heart attack more for women than for men.
Pre-menopausal women with risk factors such as smoking and diabetes are more likely to have a heart attack during or just after their monthly periods, when their estrogen levels are lowest.
More women than men die of stroke.
Women are more likely than men to have a stroke within six years of a heart attack
Approximately 40,000 more women than men die from strokes each year in the US
African American and Mexican American women are at much higher risk of CVD than Caucasians, even when socioeconomic status is taken into account.
Low blood levels of HDL appear to be a stronger predictor of heart disease death in women than in men in the over 65 age group; high blood levels of triglycerides may be a particularly important risk factor in women and the elderly.
Regular physical activity and a healthy weight reduce the risk of non-insulin-dependent diabetes, which appears to be an even stronger contributing risk factor for heart disease in women than in men.
Diagnosis of heart disease presents a greater challenge in women than in men.

Women lack understanding of their risks

A June 1997 survey of over 1,000 women conducted by Yankelovich Partners, Inc. revealed the lack of understanding women have of the dangers of heart disease and stroke. According to the results, a mere 8 percent of women in America believe that heart disease and stroke are the greatest health threat to women. When asked what they fear most in a recent survey on health concerns, the number one response for women was breast cancer, even though heart attack, stroke and other cardiovascular diseases kill more than 10 times as many women every year. This reveals the lack of knowledge and understanding a majority of women have for their most serious health threat.

Women lack understanding signs and signals

Women also lack awareness of heart attack warning signals. While most women surveyed knew some of the "classic" signals of heart attack such as chest pain, shortness of breath, pain in the arm and tightness in the chest, 90 percent did not mention the less common signals that women may have like nausea, fatigue and dizziness. Women are more likely to have subtle symptoms of heart attack such as indigestion, abdominal or mid-back pain, nausea, and vomiting.

The lack of awareness of stroke warning signs is equally alarming. Barely a third of the participants could name sudden weakness or numbness of the face or limb on one side as a signal. Even fewer could name other signs.

Women and contraception

Studies of oral contraceptives done on pills that had higher levels of estrogen and progestin than the ones commonly used today show that women who used the high-dosage pills had an increased risk of heart disease, especially if they were heavy smokers. Oral contraceptives were also linked with an increase in risk of stroke in women who had high blood pressure and smoked.

Women and menopause

Only half of those surveyed knew that women after menopause are more likely to have heart attacks than men. Women typically develop CVD up to 10 years later than men.

Women and their doctors

The causes of this dangerous lack of understanding among women are numerous and varied. However, the survey did reveal two enlightening statistics: Only 30 percent of the women polled said that their doctors mention heart disease when discussing general health. And only 18 percent said they saw, heard or read anything about heart disease in their healthcare professional's office in the past 12 months. One out of three primary-care physicians surveyed in 1995 did not know that CVD is the leading cause of death among American women.

Because of the lack of research data on women, as recently as 1996 the American College of Physicians suggested women not be screened or treated for high cholesterol as a primary means of CVD prevention. However, it is now known that women benefit as much as men from cholesterol-lowering drug regimens.

Primary care physicians are less likely to refer a woman with chest pain than a man with the same symptom to cardiac catheterization and are least likely to refer African American women to this procedure. Women are less likely to receive standard diagnostic and treatment procedures for unstable angina and heart attack.

Is women's CVD health risk due to gender difference or gender bias?

Several factors may explain the apparent disparity in treatment of men and women:

In the past, many of the major cardiovascular research studies were conducted on men. Results of clinical studies under way may help clarify the gender differences that affect diagnosis and treatment of women with heart disease.
Clinicians and patients often attribute chest pains in women to noncardiac causes, leading to misinterpretation of their condition.
Both women and men may present "classic" chest pain that grips the chest and spreads to the shoulders, neck or arms. Women may have a greater tendency to have atypical chest pain or to complain of abdominal pain, difficulty breathing (dyspnea), nausea and unexplained fatigue.
Women may avoid or delay seeking medical care, perhaps out of denial or not being aware of both typical and atypical heart attack symptoms.
Since women tend to have heart attacks later in life than men do, they often have other diseases (such as arthritis or osteoporosis) that can mask heart attack symptoms. Increased age and the more advanced stage of coronary heart disease in women can affect treatment options available to physicians. Increased age can also help explain women's greater mortality after heart attacks.
Some diagnostic tests and procedures may not be as accurate in women, so physicians may avoid using them. That means the disease process resulting in a heart attack or stroke may not be detected in women until later, with more serious consequences.
The exercise stress test, or stress ECG, may be less accurate in women. More precise noninvasive imaging tests tend to cost more.

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Last Reviewed: Jan 25, 2006

Karen Kutoloski, DO
Director, Cardiac Rehabilitation and Assistant Professor
Heart and Vascular Center
MetroHealth Medical Center
School of Medicine
Case Western Reserve University