Small Steps Lead to Healthier Hearts for Women

But many still don't know cardiovascular disease is their biggest enemy

By Dennis Thompson
HealthDay Reporter

SUNDAY, April 8 (HealthDay News) -- For years, doctors have been fighting the perception that heart disease is a mainly male affliction.

But, in fact, cardiovascular disease is the number one killer of both men and women in the United States, according to the National Institutes of Health. Two of every five women who die are taken by heart disease or stroke, more than from all forms of cancer combined.

Now, health officials are broadening their push to educate more women about their heart risks. The renewed campaign follows an American Heart Association study, initially done in 1997, that found that only 30 percent of women were aware that heart disease and stroke were their greatest health threats. A follow-up survey released last year found that number had climbed to 55 percent.

"The problem I see is that, yes, women are much more knowledgeable, but they aren't translating that knowledge into action," said Dr. Jennifer Mieres, director of nuclear cardiology and associate professor of clinical medicine at New York University School of Medicine, and a national spokeswoman for the American Heart Association. "That's where the disconnect is."

The heart association continues to push its "Go Red for Women" campaign, which includes an online self-survey to evaluate an individual woman's specific risk factors.

"That way, women can increase their thought process about their risk factors," said Dr. Nieca Goldberg, a cardiologist and associate professor of medicine at New York University, and medical director of the university's Women's Heart Program. "We still have to get women to take the plunge to personalize it. If you ask the average woman on the street, she will not say, 'It's going to affect me.' "

A big part of the problem is that women often don't experience a heart attack the same way men do.

"Women's symptoms can be more subtle," Goldberg said. "It can be shortness of breath without any chest pain. Some suddenly feel very exhausted with minimal activity. Pain often is felt lower in the chest and mistaken for a stomach problem."

Because the symptoms are less obvious, women often wait too long to get treatment.

"If you look at statistics of women who've died suddenly of heart attack, two-thirds died before they could reach the hospital," Goldberg said.

Heart disease also often takes place in women differently than it does in men, Goldberg added.

In men, plaque forms on the walls of blood vessels in specific places, eventually causing a "kink" in the vessel that stops blood flow. To treat it, doctors implant a stent -- an artery-opening mesh tube -- at the point of blockage, which reopens the blood vessel.

But as many as 30 percent of women suffer from micro-vascular coronary disease, Goldberg said. The plaque distributes more evenly throughout the blood vessels, slowing blood flow without creating a flow-stopping kink.

In those cases, arteries have difficulty dilating during exercise or exertion, causing extreme fatigue in women.

"When women go to have an angiogram, there have been situations where doctors don't see any blockages, even though the patient has symptoms and a bad stress test," she said.

Since there's no specific blockage, treating micro-vascular coronary disease is much harder.

"When doctors go in to look, there are no kinks, so they can't be stented," Goldberg said. "Women are given drugs to thin the blood and take care of symptoms, as well as reduce cholesterol levels."

Since heart disease is often harder to detect and harder to treat in women, prevention is the key to saving most women's lives. Women need to take a hard look at their risk factors, Mieres and Goldberg said.

"If they can't recite their cholesterol levels or blood pressure, they need to schedule a visit with their doctor because that shows those probably haven't been checked in a while," Goldberg said.

Women also should consider whether or not a relative has had heart disease. There is a genetic risk involved, and family members often share the same lifestyle risks, such as drinking, smoking or eating unhealthy foods.

Once that risk is known, women can take steps to improve their health, Mieres said.

Mieres recommends taking small steps that lead to big ones -- walking 10 minutes a day and increasing that to 30 minutes, or eating an apple for a snack instead of a candy bar.

"Everyone thinks it's so overwhelming in terms of making lifestyle changes," Mieres said. "Doctors want women to realize that simple steps can make a world of difference in terms of your heart health."

More information

For more information on the "Go Red for Women" campaign, visit the American Heart Association.

SOURCES: Nieca Goldberg, M.D., cardiologist and associate professor of medicine, New York University, medical director of the university's Women's Heart Program, and author of The Women's Healthy Heart Program; Jennifer Mieres, M.D., director of nuclear cardiology, and associate professor of clinical medicine, New York University School of Medicine, New York City, and a national spokeswoman, American Heart Association