Subtle symptoms make females more vulnerable in heart attack
Experts say heart disease in women is often missed.
(Cristina Byvik illustration)
By Beth Wood
If you, your wife, mother, BFF or any woman close to you had a heart attack, would you be surprised? Many of us would be, due to the persistent belief that heart disease isn't a threat to women.
The American Heart Association's Go Red for Women — an educational campaign now celebrating its 15th anniversary — reports that a little more than half of women know that heart disease is the most common cause of death for both genders.
It's true that chest pain may be a symptom both men and women experience during a heart attack. "But with women, more frequently it's fatigue or pain in the jaw, more nonspecific symptoms," said Poulina Uddin, an integrative cardiologist at the Scripps Women's Heart Center in San Diego. "It can be weeks or months before it's diagnosed. A lot of time, shoulder or jaw pain is ignored. Sometimes women think it's just anxiety or stress.
"Women are often underdiagnosed and undertreated. Heart disease in women is often missed."
Other heart-attack symptoms women may experience include unusual sweating, nausea or vomiting — all easy to brush off since they're associated with common illnesses like the flu.
The Scripps Women's Heart Center opened in early 2017 to provide more female-oriented diagnosis and treatment. Uddin, who was active in the center's planning stages, stated that another goal was educating both the community and professionals about women and heart disease — as well as how to keep the heart healthy.
Achieving heart health
No rolling of the eyes if you heard this drill before! After all, it's American Heart Month, so reminders are in order.
You may know how to avoid heart disease or cardiovascular disease (CVD), but do you make the effort? According to Go Red for Women, about 45 percent of U.S. deaths caused by heart disease, stroke and Type 2 diabetes are due to eating poorly. That means many of us are consuming too much sodium and too many sugary drinks. And we're not eating enough fruits and vegetables.
If you smoke, you probably know you shouldn't. Most experts say smoking is a major cause of heart disease.
A report from the American College of Obstetricians and Gynecologists put it this way: "Your risk of heart disease increases the more you smoke and the longer you smoke. Female smokers have a higher risk of heart disease than male smokers."
Maintaining a healthy weight, managing stress and controlling high blood pressure (hypertension) also help prevent CVD. High blood pressure is second only to smoking in causing preventable heart disease and stroke deaths.
Another key to heart health is physical activity.
"I always ask my patients: 'What are you doing for exercise?'" said Uddin, a certified yoga instructor who teaches a weekly class at the Scripps Women's Health Center. "If it's nothing, I recommend an exercise plan that they can stick to and continue to increase.
"Think of exercise as a shower for your body — getting rid of the junk inside. You wouldn't think of going three days without brushing your teeth or showering."
Let's get specific
Why are the results of CVD diagnosis and treatment for men better than for women? One basic reason is that, historically, the subjects of heart-related research studies have been men.
Medical decisions based on that research obviously aren't specific to women. Women tend to have smaller hearts and smaller veins than men. Estrogen helps protect women from CVD, so those who may be at risk are seldom tested until menopause, when they are more vulnerable.
Many doctors may not connect the fact that their patients who have autoimmune conditions or migraine headaches could be at higher risk for heart disease.
After being diagnosed with having a heart attack or heart disease, women often fare worse during treatment than men, Uddin said, because such traditional treatments as stents and bypass surgery were developed for men with CVD.
Uddin has seen a recent push for gender-balanced research, noting several new studies that at least include some women. But data from those efforts will take time to come out.
A focus of Go Red for Women has been female participation in STEM fields, which could eventually increase the number of women, and therefore awareness, in scientific research labs.
At the Scripps Women Heart Health Center, the emphasis is on an integrative approach. Uddin and the other staff physicians — Christina Adams, Elizabeth Kaback and Namee Kim — are experts in heart conditions specifically associated with women. They pay attention to the patient's mind, body and spirit.
"We consider ourselves very thorough," Uddin remarked. "We ask that patients fill out an eight-page questionnaire before they come in. We can empower women to take their symptoms seriously and not assume it's just anxiety or stress.
"We do a lot of preventive health and ask our patients to take information to their daughters and other family members. We encourage them all to work on lowering their cholesterol and improving diet. Everyone should be exercising regularly and seeing a doctor once a year."
Speaking from experience
Cindy Marten didn't hesitate when asked to become the 2019 executive chairwoman for the American Heart Association's Go Red for Women campaign. As the superintendent of San Diego Unified School District, it's not that Marten had nothing else to do. But she cites compelling reasons for taking on this task.
Cindy Marten, superintendent of San Diego Unified School District, also is the 2019 executive chairwoman for the American Heart Association's Go Red for Women campaign.
(Hayne Palmour IV / U-T)
"Having experienced some of my family members going through heart attacks, it matters to me — professionally and personally," the educator explained. "My husband, Sergio, suffered a massive heart attack that almost took his life. He survived, but seven years later, he had a serious stroke."
Sergio Marten died in August 2016 at the age of 57. He and Cindy had been a couple for more than 30 years. Then in January 2018, Marten's 80-year-old mother, Fern Siegel, had a heart attack. She survived after the surgical insertion of five stents. Siegel is now a member of AHA's survivor support network.
"People don't think of heart attacks as a women's issue," said Marten, who has helped establish heart-healthy programs in the San Diego school district. "Most think that men are more vulnerable. That's not true. There's so much we can do if we can see signs and intervene early.
"Let's interrupt heart disease so women don't have a fatal attack."
Disheartening statistics
• Heart disease is the leading cause of death among both men and women in the United States, taking the lives of 610,000 Americans every year.
• Heart disease is the No. 1 killer of women, taking more lives than all forms of cancer combined.
• More than one in three women is living with some form of cardiovascular disease (CVD).
• Women age 45 and younger are more likely than men to die within a year of their first heart attack.
• Median survival of people over 45 years old after their first myocardial infarction (coronary event) is 8.4 years for white males, 5.6 years for white females, 7.0 years for black males, and 5.5 years for black females.
Sources: American Heart Association / Go Red for Women; Scripps Health; American College of Cardiology
An event with heart
What: 2019 San Diego Go Red for Women 15th anniversary fundraising luncheon
When: 10 a.m., Thursday, Feb. 28
Where: Fairmont Grand Del Mar, 5300 Grand Del Mar Court, Del Mar
Tickets: $500
Online: heart.org/en/affiliates/california/san-diego
Wood is a San Diego freelance writer.
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