Today, nearly 44 million American women are living with some form of heart disease and, quite surprisingly, less than a third of women actually know the symptoms of a heart attack. February is designated as Go Red For Women month – its purpose is to raise awareness about heart disease in women and promote engagement in hopes that thousands of unnecessary cardiac deaths can be prevented.
While overall death rates from heart disease have declined over the last 20 years, heart attack death rates in women still outpace those in men. Earlier this year, the American Heart Association released a new scientific statement on women and heart disease. In the statement, the AHA recognized that, many times, heart attacks in women have different causes and symptoms compared to those in men. In addition, the AHA cites evidence that suggests women who have heart attacks have higher complication rates as well as higher death rates during the first year after a cardiac event.
Why Do More Women Than Men Die From Heart Disease?
1. Societal norms and pressures play a role. Traditionally, heart disease has been thought to be a disease of men. However, more women than men die from heart disease in the U.S. every single year. Women tend to be the caregivers of the family and often put the needs of spouses, children and others ahead of their own. In addition to demands at home and in the workplace, women often have inadequate opportunities for stress relief, and constant stressors increase circulating levels of certain hormones that can contribute to inflammation and the development of heart disease.
2. Women are treated differently for heart disease than men. Women are not screened for heart disease as aggressively as men. While women can develop classic symptoms like chest pain, more often than not, women have more vague and atypical symptoms. While breast cancer screening garners much attention, little emphasis is placed on screening women for heart disease outside of the month of February and the Go Red for Women awareness campaign. Moreover, physicians are less likely to treat women in the throes of a heart attack aggressively – including with angioplasty or coronary stenting, which can be a life-saving procedure and actually stop a heart attack from progressing if performed quickly – for fear of higher complication rates. That’s due to the fact that, on average, women have smaller blood vessels and smaller hearts and tend to have higher rates of bleeding and other potentially life-threatening complications during cardiac catheterization and while undergoing other emergency treatment for a heart attack.
Following a heart attack, women are less likely to be prescribed well-studied medications, such as ACE inhibitors, beta blockers and statins, that have been shown to prevent future cardiac events. These drugs are essential to helping the heart remodel after a heart attack and have also been shown to decrease the risk of death in patients with heart disease. In addition, women who survive a heart attack are less likely to be referred for cardiac rehabilitation, as compared to men – even though numerous clinical trials have shown women derive more benefit from cardiac rehab participation.
3. Often patients lack awareness of their risks. Most women believe that their greatest health risk comes from breast or uterine cancer. However, more women die from heart disease than from breast and lung cancer combined. Breast cancer affects 1 in 8 women – heart disease affects 1 in 3. Women are often not aware of their risks for heart disease and, as a result, do nothing to modify these risks. Many women do not attend to their own health needs and, due to the multiple roles that they play, often take no time for themselves. Certainly genetics play a role in the development of heart disease and every woman should be aware of her family history. That’s in addition to paying attention to lifestyle factors, including staying active and eating a heart healthy diet.
What Can Every Woman Can Do
1. Learn about the risks. It’s critical that every woman educates herself and her friends and family about the risk for heart disease. Every woman must know the risk factors for heart disease: diabetes, high blood pressure, high cholesterol, smoking, family history of heart disease and obesity. Work to spread the word about women and heart disease.
2. Engage in care. A key component to reducing risk for heart disease is engagement with a health care provider. Every woman must become an active participant in her own care – she must openly discuss risk with her physician, and demand that she receive appropriate screening. Most importantly, every woman must understand how she can reduce her risk through lifestyle changes as well as drug therapy, if indicated. A commitment to better diet and regular exercise will go a long way toward reducing risk through the prevention of Type 2 diabetes, improvement in cholesterol, reduction in blood pressure and, most importantly, the elimination of obesity.
3. Become an advocate. Reduction of heart disease-related deaths in women requires a team approach. We must all work together to advocate for others. It’s essential to engage with local leaders in health care as well as politicians and other advocacy organizations like the AHA. It’s important that those of us who understand heart disease in women make sure that those who don’t have the ability to advocate for themselves have a voice. We must all make sure that we are able to support our spouses, mothers, daughters and friends, and we must continue to work for more equitable care for all women. Women deserve the same treatments as men and should be actively screened and treated based on the best available evidence and current AHA guidelines.
4. Promote research. In order to continue to reduce death rates from heart disease, more research is needed. In particular, we must work to design clinical trials that specifically examine the best treatments for women. Historically, most of the evidence for the treatment of heart attacks has been gleaned from predominantly male populations in large clinical trials. However, until we have more evidence from research that studies female populations, we must continue to apply the same guidelines in women as we do in men. We must continue to fund research and allow researchers from all over the world to collaborate in order to determine the best ways to prevent and treat heart disease.
The Time to Effect Change Is Now
The Go Red for Women campaign in February is just one example of how we can all make a difference in the lives of women with heart disease. The first step in effecting change is to help women realize that their greatest health risk is from heart disease. While there are many factors that have contributed to increased death rates for women with heart disease as compared to men, none is greater than the lack of awareness regarding the cardiovascular dangers women face.
As we move beyond February, we must all commit to change. Health care providers must redouble their efforts to better identify and treat women with heart disease. Women of all ages must advocate for one another and engage in their own heart health – and spouses, family members and grown children should also step up to provide support as well. Together, we can make a difference in the lives of millions of women throughout the U.S. It only takes 80 seconds for a life to be lost from cardiovascular disease. How long will it us take to prevent more deaths in the future?