Heart disease top killer of women
May 10, 1999
From Medical Correspondent Rhonda Rowland
(CNN) -- What is the leading cause of death in women? Most women will say it's breast cancer. So it comes as a surprise to many people that heart disease is the No. 1 cause of death in both women and men.
"One out of two women are going to have, live with, and/or die from heart disease and stroke," said Martha Hill, Ph.D., R.N., a professor at the Johns Hopkins University School of Nursing and immediate past president of the American Heart Association. "It is amazing women are still not getting that message, and one has to ask why."
Hill said women may not know a lot about heart disease because they often see gynecologists, who focus on reproductive health. Also, many doctors are not aware of the risk of heart disease in women because up until 10 years ago, women were largely excluded from heart disease studies.
When men and women suffer a major heart attack, the symptoms are similar.
"It's the sensation of an elephant sitting on the chest, crushing it, a cold sweat and pain running up the left side of the neck and down the left arm," said Hill.
But women tend to report more subjective symptoms such as not feeling good, nausea, dizziness and weakness. These symptoms are often overlooked by both women and their doctors or attributed to something else.
Studies show women also wait longer than men to seek help.
"They were less likely to call 911 and present with an ambulance on arrival; they were more likely to prolong before presenting to the hospital," said Dr. John Canto, University of Alabama at Birmingham.
Because doctors didn't have information and were not looking for heart disease in women, it was often not diagnosed or treated. But recent studies show this may be improving.
Women tend to develop heart disease a decade later than men.
"It's related to the aging process and menopause," said Hill. "The menopausal process takes five to 10 years, during which there's a progressive decline in estrogen, weight increases, blood pressure goes up, and cholesterol levels change."
Studies are looking at the role of estrogen, testosterone and other hormones in the development of heart disease in both sexes.
Other research shows differences in the size and elasticity of coronary arteries in men and women, which could explain differences in heart disease presentation. Studies are also under way to better understand blood vessel activity and differences in exercise, body fat distribution and physical activity.
One study found women with advanced congestive heart failure can live twice as long as men with the condition. Heart failure occurs when the heart muscle is damaged or overworked. It's the only heart failure that is dramatically increasing.
"What we think may be going on is there are biologically differences between men and women that affect the way they respond to the heart failure state," said Dr. Kirkwood Adams, University of North Carolina at Chapel Hill.
Understanding that difference could lead to better treatments.
Other studies show diabetes is associated with an increased risk for heart disease in women, compared to men.
Research studies now under way should yield new information in the next two, five and 10 years.
"Women need to wait, watch, ask about what's new and keep an ear to the ground," said Hill. "They also need to be encouraged to participate in clinical trials so we can get more answers."
A Centers for Disease Control and Prevention (CDC) survey showed doctors are missing opportunities to reduce the risk of heart disease. The study of almost 30,000 routine office visits showed women were counseled less often than men about exercise, nutrition and weight reduction.
Uncontrolled blood pressure is the No. 1 cause of stroke and long-term disability and the third leading cause of death.
"Women think of heart disease as an old person's disease and a good way to die," said Hill. "But heart failure is every bit as bad as cancer, and the death rate is higher."
Therefore, women need to take steps to prevent heart disease. That includes knowing your blood pressure and cholesterol levels, exercising and not smoking.
"Women should also talk to their doctors about hormone replacement therapy once they reach menopause," said Hill. "We should have more information in several years about different doses and hormone combinations, so a woman's regimen can be more tailor-made."
Preventing or lowering the chance of heart disease starts at an early age. It's an investment that can pay off in quality years later in life.
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Johns Hopkins University School of Nursing
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