As waistlines expand, so does risk of heart disease for men and women

Feb. 22, 2012

By Loryn Feinberg, M.D.

PhysicianFocus@mms.org

As waistlines among Americans grow, so do concerns about overall heart health. This is especially true for women who, according to a recent report by the American Heart Association (AHA), have increased their caloric intake by 22 percent in the last two decades, compared to 10 percent for men. About two-thirds of women in this country are now considered overweight. This can put a strain on the heart and lead to cardiovascular disease, including heart attacks, strokes and even sudden death.

Heart disease is now the number-one killer of American women, claiming more than 500,000 lives a year, or almost one every minute. Exacerbating the problem is misinformation among women and healthcare providers: Women often don't correctly identify their symptoms of heart disease, and physicians may misdiagnose symptoms their patients present to them.

For too long, there's been a perception that heart disease is primarily an older man's disease. But women, once they reach 65 years, have a higher incidence of cardiovascular disease than men, and they are more likely to die from it than men. While the mortality rate in men has steadily declined over two decades, cardiovascular mortality for women has increased slightly.

Studies show that women frequently don't get the care they need regarding their cardiovascular health, indicating a lack of awareness about women's heart risks and gender differences. For instance, an AHA survey found that only 21 percent of women were aware that cardiovascular disease poses a significant risk to them. Women with chest pain often delay going for treatment, and they often don't recognize other symptoms — including abdominal pain, difficulty breathing, nausea, and fatigue — which are different from men's symptoms.

Also, 46 percent of women perceive that breast cancer is their most serious health threat, while only 4 percent cite heart disease. In fact, the total number of deaths from heart disease this year among women is expected to be nearly double the total deaths caused by all types of cancer combined.

Surprisingly, the lack of women's heart health awareness is also prevalent among healthcare providers. Many doctors don't know that women are at greater risk than men, and they often attribute chest pains in women to non-cardiac issues, leading to misinterpretation of their condition. Common misdiagnoses include indigestion, gall bladder disease, and anxiety attacks.

Gender bias, therefore, may still affect physicians' decisions. A national survey of physicians found that almost two-thirds of respondents were unaware of gender differences in the symptoms, warning signs, and tests used to diagnose heart disease.

Studies also show that a woman's risk of heart disease increases dramatically at the time of menopause and associated hormonal changes. As women enter menopause, usually around 50, they experience a drop in estrogen, which is believed to protect the heart.

Post menopause, cholesterol levels in women often change unfavorably, while their metabolism slows down. Also, weight gain, often associated with the risk factors of high blood pressure, diabetes, and high cholesterol, can increase the chances of heart disease or stroke after menopause.

We must recognize the fundamental differences between men and women regarding cardiovascular health, including the fact that women have smaller hearts and arteries than men, which can result in more complications for women when they undergo procedures.

A key to improved heart health is education. Women need to become more informed and active partners in their cardiovascular care. They can empower themselves by researching reputable sources like the AHA or American College of Cardiology (ACC) and asking cardiologists for a second opinion if they have doubts about their diagnosis.

Of course, men and women who may be at risk should make necessary lifestyle adjustments, including weight control, diet, exercise, and smoking cessation. According to the AHA and the ACC, while patients often don't do well on their own, they tend to see marked improvement when they receive the proper diagnosis and treatment. To learn more, visit www.heart.org or www.bidmc.org/cvi .

Loryn Feinberg, M.D., is medical director of the Women's Cardiovascular Health Program at Beth Israel Deaconess Medical Center in Boston. Physician Focus is a public service of the Massachusetts Medical Society. Readers should use their own judgment when seeking medical care and consult with their physician for treatment.

Send comments to PhysicianFocus@mms.org.

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