In the United States alone, more than a half million women each year die of heart disease–the number one killer of women, according to the American Heart Association. It affects 1 in 10 women ages 45-64 and 1 in 4 women over 65. Annually, more women die of heart disease than of all cancers combined, and heart disease and stroke kill more women than the next seven causes of death combined–including breast cancer, fatal in only one-tenth so many cases as cardiovascular disease.

Falling levels of estrogen in women 50 and over greatly increase a woman’s risk for developing high blood pressure, which can affect the cardiovascular system.

Estrogen offers protection during a woman’s reproductive years because it keeps the blood vessels flexible and blood pressure levels in check. But after menopause, women are at a higher risk than men for developing high blood pressure, and in general have more cardiovascular problems than men. Shockingly, women are also more likely to die from this than men mostly due to lack of appropriate care.

Thus, it’s vital that women understand the warning signs and potential risk factors for cardiovascular disease, as well as any lifestyle changes that can help reduce the chance of a heart attack.

Women living with heart disease

Marla Kalish was an active, healthy woman who had never smoked and didn’t have the outward, typical signs of someone with heart disease. However, she was 53 years old when she noticed some strange symptoms.

“I’d play tennis in the mornings and occasionally have some chest pain while playing,” she said. “I’d slow down or stop the game, get some water, and figured it was acid-reflux from drinking orange juice or coffee before playing. I knew there was heart disease in my family—my dad, grandfather, and uncles had heart issues, but I was female, healthy, and in shape, and I thought I’d be okay.”

Kalish casually mentioned the pain to her friend, a cardiologist, who suggested she get a stress test. She actually passed the test, but continued to have the chest pain while exercising. So her doctor suggested she have a CT angiogram, which showed some blockages. Kalish had an angioplasty, in which the cardiologist placed three stents in her heart.

Kalish went from taking no medications to five medications at once, and the levels had to be adjusted several times before the side effects weren’t too overpowering—initially the drugs made her feel extremely fatigued and made it hard to function. But a few weeks after the angioplasty, she was back to her daily life and playing tennis again.

Four years later, in August 2009, Kalish was helping her daughter move when she had a crushing chest pain. She rushed to the emergency room, where doctors found that there was a blockage in one of her stents. A procedure was performed to fix the blockage within 90 minutes of the first symptoms, so she was lucky to have no heart muscle damage from the trauma.

Kalish has received training on heart disease from the Rochester, MN-based Mayo Clinic through WomenHeart, also known as the National Coalition for Women with Heart Disease. Kalish has taken that knowledge to her community, co-running three support groups in the Chicago area.

“It’s important to be aware and recognize the signs so you can get treatment and be taken seriously,” she said. “I volunteer with WomenHeart because I want other women to know and be alert—our mission is to raise awareness through advocacy, education, and patient support. We want to help women take charge of their heart health.”

Carol Allred is another member of the WomenHeart program and is president of the organization’s board of directors. She suffered a severe heart attack in 2003 when she was 60 years old and shares her story as often as possible.

“At first I didn’t realize what was happening because I didn’t have chest pain, which is a typical misconception for women,” Allred said.

Allred experienced extreme pain in her upper back and shoulders, as well as difficulty breathing and shortness of breath, but she attributed the symptoms to her allergies or asthma acting up because she had spent the previous day outside. Eventually she went to the emergency room, where she learned she was having a major heart attack.

“I had never had any previous symptoms—this came as a total surprise,” she said.

Allred was able to be treated with a stent, but she did suffer damage to the heart because

of the location of the attack, and because she had delayed going in to the hospital for treatment.

“The sooner you realize what’s going on and get to an emergency room for treatment, the less likely you’re going to have damage,” she concluded.

Heart attack warning signs

As Allred noted, it’s important to recognize the symptoms of a heart attack and act quickly to receive treatment as soon as possible. Below are some of the common warning signs of a heart attack:

• Chest pain or discomfort;
• Chest pressure, tightness or heaviness (like someone standing or sitting on the chest);
• Pain or discomfort in the upper body, including the arms, back, neck, stomach, or jaw; and/or
• Shortness of breath, nausea, vomiting, light-headedness, and breaking out in a cold sweat.

Women are more likely than men to experience more than just chest pain, and some women have symptoms excluding the chest pain, which makes women more likely to delay seeking treatment. Nearly half of all heart attack deaths are women.

What to do if you experience these warning signs

Doctors and organizations such as the American Heart Association and WomenHeart offer tips on what to do if you think you’re experiencing a heart attack.

●   Call 911 for an ambulance, or have a family member call, and say that you are having heart attack symptoms; ask to be taken to a hospital with advanced cardiac care facilities, if possible.

●   While waiting for the ambulance, crush or chew a regular aspirin tablet (unless allergic.) and swallow with a glass of water; lie down with head slightly elevated.

●   At the hospital, insist on immediate treatment and an electrocardiogram.

Risk factors for heart disease in women

Factors out of your control:

• Being age 55 or older;
• Being post-menopausal or having your ovaries removed; and/or
• Having a family history of heart disease or stroke.

Risk factors you CAN control:

• Smoking;
• High-fat diet;
• Obesity;
• Sedentary lifestyle/lack of exercise;
• Hypertension;
• Diabetes;
• Metabolic syndrome; and/or
• High cholesterol.

Prevention through exercise and diet

The risk of heart disease can decrease with lifestyle changes such as exercise and diet.

“The extraordinarily good news is that most cardiovascular disease is preventable,” say Chris Crowley and Henry S. Lodge, M.D., in their book Younger Next Year. Noting that up to 80% of heart attacks and stroke are caused by lifestyle, they cite research that the most sedentary women were five times more likely to die than the fittest women, and that “each rung up the fitness ladder put women a corresponding rung up the survival ladder.”

According to researchers at the Mayo Clinic exercise helps prevent heart attack by helping to maintain a healthy weight and by controlling cholesterol and blood pressure levels. They noted that difficult exercise is not required. So, look for fun ways to exercise a minimum of 30 minutes each day, whether it’s through walking your dog, dancing, or swimming.

The Mayo researchers note that too much saturated fat and cholesterol can narrow arteries, and too much sodium can raise blood pressure. A heart-healthy diet includes a variety of fruits, vegetables, whole grains, fish, legumes, and proteins low in saturated fat. The Mayor researchers also recommend no more than one alcoholic drink a day for women.

The mind/body connection with the heart

Studies have shown that people who are socially isolated carry a higher risk for heart disease.

“People who are isolated may be depressed and not follow a healthy lifestyle,” said Nieca Goldberg, M.D., cardiologist and director of the New York University’s Women’s Heart Center  in its Langone Medical Center. “Studies show that platelets (blood clotting cells) in depressed people are more likely to clump together to form blood clots. Blood clots in the coronary arteries cause heart attacks.”

Stress and tension have a real effect on a heart’s health because they raise a person’s blood pressure and heart rate. Women in stressful work or home environments have higher blood pressure and a higher rate of heart attacks, according to Dr. Goldberg. Yoga and meditation are two ways that enable women to cope with stress, but talking to a therapist can also be effective for learning techniques for better stress management.

Hospitals focusing more on cardiovascular health in women

There are many programs around the country that educate, diagnose, treat, and support women with heart disease. Many hospitals have created programs and departments specifically geared toward women’s cardiovascular health.

The Bluhm Cardiovascular Institute of Northwestern Memorial Hospital’s Center for Women’s Cardiovascular Health in Chicago works to identify cardiovascular disease in women of all ages and focuses on care designed specifically for women. Their information line is 312-MYHEART.

The NorthShore University Health System provides state-of-the-art care for women with heart disease in its Women’s Heart Health center in Glenview, IL, just outside Chicago. Women can participate in counseling for nutrition and smoking cessation, stress reduction programs, support groups, and a variety of hospital-based services.

The center uses risk assessment tools to determine how likely a woman is to have a heart attack, and takes into account such factors as age, blood pressure, cholesterol, body mass index, abdominal girth, whether the person smokes. It offers monthly screenings open to the general public for a small fee to make it convenient for women to come in for a risk assessment.

“We recommend that women know their cholesterol value and whether or not they have a family history of heart disease.” said Jean Skelskey, R.N., a cardiology nurse and coordinator for the program.

Skelskey said the women’s heart program is participating in the Virgo Study, run by the Yale University School of Medicine, which focuses on women and heart disease, specifically in women between the ages of 18 and 55 who have suffered heart attacks.

“We’re looking to see if there are any common denominators when women have heart attacks,” Skelskey concluded.

- Sarah Severson

Resources:

• American Heart Association: http://www.americanheart.org
• Center for Disease Control and Prevention, Heart Disease Risk Calculator:- http://www.cdc.gov/women/heart/
• Dr. Nieca Goldberg: http://niecagoldbergmd.com/about-dr-goldberg
• Heart Healthy Women: http://www.hearthealthywomen.org
• Mayo Clinic: http://www.mayoclinic.com/health/heart-attack/DS00094/DSECTION=prevention
• Women’s Heart Program of NorthShore University Health System’s Cardiovascular Care Center: http://www.northshore.org/clinicalservices/cardiology/treatment/whp/
• National Heart Lung and Blood Institute: http://www.nhlbi.nih.gov
• Women and the Risk Factors of Heart Disease: http://heartdisease.about.com   
• WomenHeart: The National Coalition for Women with Heart Disease: http://www.womenheart.org
• Yale Virgo Study: http://www.virgostudy.com/
• Chris Crowley and Henry S. Lodge, M.D. Younger Next Year: Live Strong, Fit, and Sexy Until You’re 80 and Beyond. New York: Workman Publishing Co., 2007