Heart Disease: Symptoms and Prevention

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Silent Symptoms

What happened to Bullers and Lachowyn is, unfortunately, not that unusual. Many doctors still consider coronary artery disease (CAD, essentially a narrowing of heart arteries due to buildup of fatty deposits called plaques) mostly a concern for men. Yet it's the No. 1 cause of death for Americans of both sexes, eventually afflicting one-third of women and nearly half of men, and killing in similar numbers (255,000 American women lose their lives to CAD each year, compared with 261,000 men). In many cases, heart attack is the first symptom of heart disease that's been developing for decades.

Yet symptoms in women are still poorly understood and often go unrecognized and untreated. "Women's symptoms are definitely more likely to be missed or misinterpreted than those of men," says Marianne Legato, MD, professor of clinical medicine at Columbia University College of Physicians & Surgeons and the founder and director of the Partnership for Gender-Specific Medicine at Columbia University, in New York City.

"Significant numbers of physicians still believe women are more likely to die of breast cancer than cardiovascular illness and consider heart disease a man's province."

The typical woman is no more enlightened. Only 9 percent of women ages 45 to 64 name heart disease as the condition they most fear -- while 61 percent consider breast cancer the most dangerous threat to their health, according to a September 2002 report from the National Institutes of Health. In reality, heart attacks kill six times as many women as breast cancer does. And a woman's chances of dying of cardiovascular disease (CVD) -- disorders of the heart (including CAD), or blood vessels, including heart attack and stroke -- are even greater. CVD kills 1 in 2.4 women, compared with 1 in 29 for breast cancer. Indeed, CVD claims more women's lives each year than all forms of cancer combined.

Why don't women get better cardiac care? First of all, the warning signs may be missed because heart disease symptoms are subtler in women than in men. A 2002 study at the University of California, San Francisco, found that of 721 men and women treated in the ER for heart attack, 58 percent of the men had chest, arm, shoulder, neck, or jaw pain, while only 41 percent of women had any pain at all. Other research shows that during a heart attack, women have a higher rate of so-called atypical symptoms, such as nausea, unusual fatigue or weakness, dizziness, heart palpitations, a cold sweat, or indigestion or gas-like pain.

Women's symptoms may also be missed because so many doctors still perceive heart disease as a man's illness, says Nieca Goldberg, MD, chief of women's cardiac care at Lenox Hill Hospital, in New York City, and author of Women Are Not Small Men: Life-Saving Strategies for Preventing and Healing Heart Disease in Women (Ballantine, 2003). "Even though I know better, when I think of a heart attack, I see the picture they showed us in medical school: a middle-aged businessman sweating and clutching his chest," says Dr. Goldberg. "Until several years ago, that's what young doctors were always taught, so even if they see a woman with obvious symptoms and risk factors, they may not think they're looking at heart disease. I recently treated a 42-year-old mom who was overweight and a heavy smoker, and who had consulted two doctors about her chest pain. Neither of them did any heart tests: One said she was stressed out and needed a vacation, and the other prescribed Valium. Actually, she had a 99 percent blockage of a coronary artery and was at high risk for a heart attack."

Continued on page 3:  How Women Get Shortchanged


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