Not all hearts are created equal. And that means the diseases that affect the heart arenβt, either.
For women, thatβs a problem. Heart disease is the No. 1 killer of American women, more lethal than all forms of cancer combined, including breast cancer. But the nature of cardiovascular diseases in women, along with the treatments for those diseases, have been woefully understudied.
βThe concept of women and heart disease is a really new concept; research has only included women to even a mildly significant degree since about 2000,β says Dr. Deirdre Mattina, director of the Henry Ford Womenβs Heart Center. βWe have very little data, really, to show which medications are equally effective in women and men. Even today, most trials only have about 20-25 percent women in the trial.β
A fair bit of press has been given to the fact that women experiencing a heart attack may have different symptoms than those commonly associated with men. Typically, women are less likely than men to go from feeling fine one minute to clutching their chest and collapsing the next.
But Mattina notes that people report a broad array of symptoms that can be linked to heart disease, from tingling in their shoulder to an all-over feeling of being unwell.
Instead, she says, the real gender difference is in cardiovascular anatomy and physiology.
Women are much less likely than men to have macrovascular disease β problems with the large blood vessels in the body, including those that supply the heart. Artery blockages can be ameliorated through bypass surgery or the insertion of a stent, which creates space in the artery for improved blood flow. Women, on the other hand, are much more likely to have microvascular issues: blockages in the tiny vessels.
βThis becomes a problem, because they have the same symptoms, and outcomes are very similar for men and women who have big-vessel disease and small-vessel disease,β Mattina says. βHowever, there is a therapy for big-vessel disease, which is stents. But small vessels are very hard to even see with heart catheterization, and you canβt bypass them. So weβre really struggling with how to treat it in women.β
In addition, says Dr. Pamela Marcovitz, director of Beaumont Health Systemβs Ministrelli Womenβs Heart Center, βwomen are more likely to have an unusual heart attack.β The most common mechanism for heart attack is rupture of an existing plaque. Women are more likely to have plaque erosion, which is a more gradual process β and which could be why women sometimes have different symptoms.
The Experience of Emotions
Another manifestation of heart trouble that primarily affects women is stress-induced cardiomyopathy β more commonly known as Broken Heart Syndrome. Occurring most often in postmenopausal women, the syndrome typically occurs after acute emotional distress, which can set off a physiological reaction that causes the heartβs pumping action to slow severely. The syndromeβs symptoms mimic a heart attack, so its sufferers are often sent for an angiogram, only to discover they have little or no heart disease.
βOne of the things we know now is that the experience of emotions β itβs not just βin your head,β β says Ethan Kross, a professor of psychology at the University of Michigan who has studied the similarities between peopleβs experience of emotional and physical pain. βYou can see how these emotions play out in your brain and how they play out physically as well. We shouldnβt ignore feelings of emotional distress just because people canβt point to a black-and-blue mark.
βWe know that stress doesnβt just feel bad,β he adds. βWe know what it does to your blood pressure, for example, quite directly. It can have implications for stress-hormone release, cellular aging β literally how your body is functioning.β
Fortunately, nearly all people with Broken Heart Syndrome recover completely, and rarely suffer it twice. For those with the syndrome, stress reduction is critically important, Marcovitz says.
Always the Caretakers
Elvira OβBryan, 74, says she noticed nothing in particular before she developed serious cardiac issues.
βIβm not one that really pays much attention,β she says. βWomen are like that; weβre busy being caretakers.β
The Troy resident had a strong family history of coronary heart disease β her mother had died at age 45 from heart failure β but regular stress tests had turned up nothing for years, so she eventually stopped getting them.
Then, one evening last May, OβBryanβs chest started to hurt. She took several baby aspirin, felt better, and went to bed. The next day, she called the Ministrelli Womenβs Heart Center, where she had been a regular patient for years. After performing an EKG, her doctor told her to high-tail it to the hospital. But OβBryan needed to make arrangements for her puppy β she raised canines for Leader Dogs for the Blind β so she went the next day instead. She ended up needing a quadruple bypass.
Today, she says, βI feel great β I even moved the fridge and cleaned behind it.β Looking back, she says she doesnβt see any particular warning signs: βI didnβt realize I wasnβt feeling well. My tiredness, my lack of energy β I thought it was just aging. Seventy-four is no spring chicken. But now Iβm going like Iβm in my 40s.β
OβBryanβs disregard for her fatigue isnβt unusual in women.
βWomen are, in the majority of households, the primary caregivers,β Mattina says. βTheyβre busy taking care of everyone else and really donβt prioritize their own health in the equation.β
As a result, women can miss subtle symptoms of serious disease.
At Henry Ford Health System, an online quiz and screening are designed to help women (and men) tune into those symptoms and get the care they need.
The Heart Disease HealthRisk Assessment was rolled out on the health systemβs website and social media about a year ago, says Ruth Fisher, the health systemβs vice president of heart and vascular services.
The assessment takes 10-15 minutes and stratifies a respondentβs risk; those who are high-risk are contacted to see if theyβd like to make an appointment or obtain a list of their local health care providers. Patients can submit comments and questions through the assessment and receive a response from staff.
Henry Ford also offers a $99 screening program that comprises seven tests with same-day results and a consultation with a physician. (Insurance companies often wonβt pay for screening.)
βBefore you leave, you know your risk and now youβre well informed,β Fisher says. βYou can do more advanced testing or see your own physician.
βOften times you donβt know you have heart disease because you donβt feel it,β Fisher says. βSo how do you know you have risk?β
Staving Off Heart Disease
The bad news is the medical establishment doesnβt know a lot about how to treat heart disease in women. The good news is that we know a lot about how to prevent it.
βHeart disease is on the decline for women, but not as much for men,β says Dr. Pamela Marcovitz, director of Beaumont Health Systemβs Ministrelli Womenβs Heart Center. βThe striking thing to me is that, in the case of coronary heart disease, weβre talking about a disease that is 80 percent preventable.
βNo matter when you start changing, itβs never too late to improve your prognosis.β
How to keep your ticker tip-top
β’ If you smoke, stop. There is no single bigger behavioral risk factor for heart disease.
β’ Get moving. Aim for 150 minutes of aerobic exercise a week. Tackle that in whatever sized chunks you want, and donβt worry about getting to the gym β you can go for a brisk walk or explore short interval workouts at home.
β’ If you have a sedentary job, no matter how fit you are, get up and walk around for a few minutes every hour. βSitting is the new smoking,β Marcovitz says. βThe stats on it are alarming β the average adult sits for nine hours a day.β
β’ Eat whole grains, lean protein, legumes, and plant-based foods; this nutrition switch should be viewed as a long-term lifestyle change, not a short-term fix.
β’ Find ways to alleviate chronic stress. You may not have the time or money for regular yoga, but meditative breathing is free and helps in just a few minutes (find books and videos at your local library). In any case, deal with what ails your mind as well as your body.
β’ If youβre on medication designed to keep your cardiovascular system healthy, like a statin, keep taking it. That itβs working is not a sign that you no longer need it.
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