February is American Heart Month, and the Go Red For Women campaign reminds us to bring awareness to cardiovascular disease in women all month long.  Today in the U.S., nearly 44 million women are living with heart disease.  Even though heart disease is quite prevalent in women, only 1 in 5 women are aware that they are at risk for developing a cardiovascular problem in their lifetime.

Cardiovascular disease is the #1 killer of American women. More women than men die of heart disease every single year — in fact, one woman dies from heart disease every 80 seconds. Most women believe that their greatest health risk comes from breast cancer. However, one in eight women will develop breast cancer in their lifetime, and one in three women will develop cardiovascular disease. Nearly 90 percent of all women have at least one risk factor for heart disease.

Heart disease affects men and women differently.   Biologic and hormonal differences in men and women contribute to the ways in which heart disease develops and progresses.   Studies have shown that after menopause, women have an even higher risk for heart disease.  Estrogens seem to promote better cholesterol profiles as well as have other cardioprotective metabolic effects.

Women tend to present to a health care provider far later in the course of the disease process and have more diffuse and widespread cardiovascular disease as compared to men. While we are making progress in reducing deaths from heart disease in the U.S., rates continue to be disproportionately high in women.   In fact, women who suffer from a heart attack have a much higher mortality in the first year following the event. In the first six years following a first heart attack, women have a much higher rate of a second heart attack as compared to men.

What can women do to prevent heart disease?

As we recognize February and the American Heart Association’s Go Red For Women campaign, here are four questions every woman must consider.

1. How big a problem is cardiovascular disease in women? Women are undertreated and underserved when it comes to heart disease. Heart disease has long been associated with men — the truth is, it affects both sexes equally. However, men tend to be treated more aggressively and earlier in their disease. Women present later and often have more extensive disease. More women than men die from heart disease in the U.S. today.

2. What are the symptoms of heart attacks in women? Are they different from men? In women, heart disease symptoms can be quite vague and nonspecific. Traditional symptoms are chest pain or pressure, sweating, nausea and pain in the arm or neck. Shortness of breath may also occur. Women may experience these traditional symptoms but sometimes they do not.

In women, symptoms are more difficult to tease out. Sometimes they may have a feeling of dread, flu-like symptoms, fatigue, anxiety or pain in the back.   . The key to preventing unnecessary cardiac deaths in women is for both patient and doctor to know their risks and interpret symptoms within the context of the risk.

3. Are women and men with cardiovascular disease treated the same? There is a larger gender disparity in the way in which men and women are treated. Men are more likely to receive more timely and more aggressive therapies. Much of this disparity may be because women are not diagnosed as quickly, may not recognize their own symptoms and may be billed as anxious or depressed when presenting with a heart attack — because they may have atypical symptoms.

While there are lots of advanced treatments available for heart disease, men tend to be treated more quickly are more likely to receive advanced therapies — women do tend to have higher complication rates with cardiac catheterizations and bypass surgery, and this increased risk may also explain some disparities in care.

Unfortunately, women who suffer a heart attack are less likely to be prescribed well-studied medications — such as ACE inhibitors, aspirin, statins and beta blockers — that have been proven to reduce mortality in patients with documented coronary artery disease. In addition, female patients are less likely to be referred to cardiac rehabilitation following a cardiac event even though studies show that women reap a bigger benefit than men from these activities.

4. What can every woman do to reduce her risk for heart disease? The most important thing all women can do is to recognize their risk for heart disease and engage with a healthcare provider. By understanding risk factors women are able to work to modify their risk through diet, exercise and, if necessary, treatment of other conditions such as hypertension, diabetes, and hyperlipidemia. Women must work to take control of their own cardiac health –every woman must take stock in her own heart health — understand her risk and work with her health care provider to modify those risk factors

While we have made great strides in reducing cardiovascular death rates in women over the last 20 years, we still must continue to educate and advocate for women of all ages — this advocacy begins with dispelling the common myths surrounding heart disease in general. It is my hope that through efforts such as the Go Red For Women campaign every February, we can promote better heart health for millions of American women.

Ultimately, we must engage women and their families in order to most effectively eliminate needless cardiac-related deaths in the next decade. Women must understand their individual risk and actively work to take control of their own heart health.  Physicians must engage with their female patients and advocate for them in order to ensure that all women get the very best cardiovascular care.

Kevin R. Campbell is a cardiac electrophysiologist who blogs at his self-titled site, Dr. Kevin R. Campbell, MD. He is the author of Women and Cardiovascular Disease.

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