Women and Coronary Heart Disease

Doctors and patients must be aware of the unique challenges associated with the diagnosis and treatment of coronary heart disease in women, according to Nanette K. Wenger, Chief of Cardiology at Emory University School of Medicine and keynote speaker at the American College of Sports Medicine summit last week.

Heart disease is the leading cause of death among women in the United States. 250,000 women die every year from cardiovascular disease, and one of every two women in the US will develop cardiovascular disease in her lifetime, according to Wenger.

“Women have different clinical profiles, different presentation, and different outcomes,” Wenger said. “There is a gender gap.”

Female patients with heart disease are often misdiagnosed, or not treated aggressively enough by their health care providers.

Part of the problem with the gap between the sexes is that much of the clinical research related to heart disease has focused almost exclusively on men. But more women than men die each year from cardiovascular disease.

Women will present different symptoms than men suffering from the same illness due to biological differences. Men generally complain of an immediate onset of chest pain or shortness of breath, while women often experience jaw or neck pain, indigestion or fatigue, which may lead some women to delay seeking emergency care.

But even when women do seek emergency care, they may describe their symptoms differently, Wenger said. Whereas men tend to emphasize their pain, women may focus more on the events surrounding the onset of symptoms, which may lead doctors to an incorrect diagnosis.

One symptom common among women that is not seen as frequently in men is angina pectoris––chest pain or discomfort resulting from a lack of oxygen to the heart muscle.

“Women have more angina, and this angina tells you that there is disease,” Wenger said. “Pain predicts Myocardial events.”

Women are more likely to have complications related to heart attack or treatments used to address the heart attack. Women have double the mortality men do after bypass surgery, and women under 75 with a myocardial infarction have double the risk of dying in the hospital as men.

Mortality trends associated with heart disease have gone down for men, but stayed relatively the same for women until recent years, but Wenger warned that mortality trends are not always the most accurate way of gauging the state of the disease. Mortality rates have been offset by the introduction of new medical technology and treatment options that can prolong life for people with heart disease. So while many people’s lives are prolonged by new medical treatments, the number of women diagnosed with heart disease may also have increased in recent years.

Women should be aware of the symptoms associated with heart disease while actively taking steps to reduce their risks, according to Wenger.

“The message that I want to give…is prevention, prevention, prevention,” Wenger said.

Specifically, women with a family history of heart disease, women who are smokers, or women who have hypertension, or high cholesterol should take steps through proper diet and exercise to reduce their risk of developing heart disease.

This coupled with proper medical care and an awareness of the unique symptoms associated with heart disease among women may lead to a reduction in heart disease.