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Doc Talk Doc Talk: Heart disease differs between genders; prevention the same

  • Published Monday, Feb. 4, 2013, at 11:51 p.m.

One in three people in the U.S. will die of cardiovascular disease, a ratio more deadly than all cancers combined. Heart disease includes stroke, high blood pressure, angina (chest pain), rheumatic heart disease and disorders of the heart blood vessels that may lead to heart attack.

In the past, there was a widespread misconception that heart disease was a man’s disease, but recent studies have proven that it claims women and men in nearly equal numbers, totaling about 500,000 lives annually. While both genders are at risk, there are some inherent differences in the way heart disease presents and is diagnosed between men and women.

Women have smaller hearts and smaller arteries than men. Researchers from Columbia University and New York Presbyterian Hospital believe that women also have a different intrinsic rhythmicity to the pacemaker of their hearts, which causes them to beat faster. They believe it may take a woman’s heart longer to relax after each beat. Some surgeons hypothesize that the reason women have a 50 percent greater chance of dying during heart surgery could be related to the fundamental differences in the way women’s hearts work compared to men’s. These differences continue to be studied and may also account for the fact that women are more likely than men to die after their first heart attack.

Women rarely have coronary disease before menopause, likely because of the protective effects of estrogen. Women develop coronary disease in their 60s, about a decade later than men. They are also about 10 years older when they have a heart attack – age 76 on average for women and 66 for men.

Men typically experience obvious, often crushing chest pain during a heart attack, while women may have pain just under the breastbone, or complain of abdominal pain, indigestion, difficulty breathing, nausea and unexplained fatigue. Women are often misdiagnosed with indigestion, gall bladder disease, or an anxiety attack. The likelihood of misdiagnosing a heart attack is also increased by the fact that women tend to have heart attacks later in life when they often have other diseases, such as arthritis or diabetes, which can mask heart attack symptoms.

Diagnostic procedures are often less accurate in women than in men. For example, when performed on a young woman with a low likelihood of coronary heart disease, an exercise stress test may give a false positive result. In contrast, single-vessel heart disease, which is more common in women than in men, may not be discovered during a routine treadmill test. One way to improve the accuracy of the exercise stress test is to use it in combination with a stress echocardiogram. This involves taking an ultrasound image of the heart while the patient is exercising. This provides information both about the mechanics of the heart in terms of muscle and valve function, and also about the health of the arteries supplying the heart.

Although some things are different between the genders when it comes to heart disease, preventative measures are the same:

• Don’t smoke. Risk declines significantly within months of cessation.

• Lower your cholesterol. Aim for total cholesterol below 200, LDL cholesterol below 130 mg/dL, and HDL above 35 mg/dL.

• Maintain a healthy weight. Obesity is a major contributor to increased risk of cardiovascular disease.

• Exercise regularly. Even moderately intense activity, such as brisk walking, 30 minutes most days of the week, substantially reduces risk.

• Eat less saturated fat, more produce and more fiber. Diets low in saturated fat and high in fruits, vegetables, whole grains and fiber are associated with a reduced risk of cardiovascular disease.

• Avoid trans fats. Trans fatty acids have been linked to adverse lipid profiles and an increased risk of heart disease.

• Consume alcohol only in moderation.

• Manage stress. This helps relax the myocardium and improve circulation.

• Control blood pressure. Aim for a blood pressure of 120/80 or lower either with diet and exercise or with medications if prescribed.

• Control diabetes. People with diabetes are five times more likely to have a heart attack. Aim for a blood A1C test of less than 7 percent.

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