Ask Dr. Pat · Health

Heart Disease in Women Is Still Under-Diagnosed

Patricia Yarberry Allen, M.D. is a Gynecologist, Director of the New York Menopause Center, Clinical Assistant Professor of Obstetrics and Gynecology at Weill Cornell Medical College, and Assistant Attending Obstetrician and Gynecologist at New York-Presbyterian Hospital. She is a board certified fellow of the American College of Obstetrics and Gynecology. Dr. Allen is also a member of the Faculty Advisory Board and the Women’s Health Director of The Weill Cornell Community Clinic (WCCC). Dr. Allen was the recipient of the 2014 American Medical Women’s Association Presidential Award.

My sister died last year at fifty years old from a heart attack. We were very close and neither of us knew that she was at risk for having a heart attack.  She had a stressful job, two teenage kids and was divorced.  She took care of everyone but herself.  She knew she had high cholesterol and that she needed to lose a little weight, exercise and stop smoking. However, food and a few cigarettes were her stress relievers.  She had called to tell me that she had a sudden attack of bad indigestion and felt short of breath, believing that “it was probably something that was going around.” I told her I would be right over, but I never thought she was having a heart attack or I would have told her to call 911.   It took me fifteen minutes to get to her house.  She was still alive but having lots of trouble breathing and was having really bad chest pain when I arrived. I called 911 and we got her to the hospital quickly, but she died shortly after arriving at the emergency room. The autopsy showed blockage of a main artery to the heart and heart muscle death. Why didn’t her nurse practitioner order any tests since she had untreated high cholesterol and other risk factors for heart disease?  I feel certain that a fifty-year-old man would have been referred to a heart specialist. Yet, my sister was only told, “Stop smoking, lose weight.”  Why don’t we know more about women and their risks for heart attack?

Heidi

 

Dear Heidi,

I am sorry to hear about your sister’s death from a heart attack at only fifty years old.  She did indeed have risk factors for heart disease: overweight, smoking, no exercise, stress, and high cholesterol.  And, as so often is the case, referral to a cardiologist who would have known what tests to do and what interventions might have been helpful.

We have asked Dr. Kirsten Healy to discuss your important questions. Dr. Healy is the Associate Medical Director of The Foundation for Gender-Specific Medicine, a cardiologist at New York Cardiology Associates, an attending cardiologist at New York-Presbyterian Hospital, Weill Cornell Medical Center and a member of our Medical Advisory Board.

Dr. Pat

 

Dr. Healy Responds:

Heart disease is the number one cause of death for both men and women in the United States and more men and women die from heart disease than all other cancers combined. For the past fifty years, more women than men have died in this country from heart disease. Once a woman gets diagnosed with heart disease she will do worse and be more likely to die from it than a man. Why is this? What is the reason for this large discrepancy?

One main problem has been the lack of awareness of heart disease in women and not enough focus on gender differences in risk factors, presentation and treatment. Most of what we know about heart disease has come from studies on men designed by men. For various reasons women were not included in these studies. It has only been in the last decade that the National Heart Lung and Blood Institute (NHLBI) and the American Heart Association (AHA) campaigns were successful by raising community awareness on gender differences in cardiovascular disease but there is still a lot to do. Continuing to increase awareness about women and heart disease right now will save lives. Women know they are at risk for breast cancer—but they are much less aware of their risk of heart disease. A woman is 5.5 times more likely to die of heart disease than breast cancer and more women die of heart disease at every age than breast cancer (National Center for Health Statistics, 2003.) Research has also shown that women are less likely to act on signs or symptoms suggestive of heart disease. A 2012 AHA survey found that 64% of women in the US who believe they are having a heart attack would call 911. That means that 36% would not call 911. The reason for this discrepancy was unclear but the main reasons given were “I don’t have time to have a heart attack right now” or “I am too busy.” Another study found that when patients called EMS for a heart problem, EMS arrived at the homes of callers equally, but women were 55% more likely to experience a delay in getting to the hospital.

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  • Kirsten Healy July 9, 2018 at 11:17 pm

    Walker,
    To clarify, Men and women often have different symptoms. However I want to point out that men and woman most often present with “typical symptoms” and their presentations are similar. I use the term “atypical” to describe the constellation of symptoms that a woman more frequently presents with in comparison to men.

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  • Walker Thornton July 9, 2018 at 8:49 am

    Note that Dr. Healy refers to a woman’s heart attack symptoms as “atypical” which just reinforces the idea that the male symptomatology is considered the norm. Another example of gender differences or bias, even as she writes about the differences and the need for awareness. This kind of thinking reinforces the idea that women are ‘other’ and continues to lead to a lag in diagnosis and treatment time.

    Reply