 |
|
|
|
|
| [an error occurred while processing this directive]
|
If you believe that women do not develop heart disease as often as men, think again. Heart disease is the number one killer of women in the United States. Unfortunately, many women do not recognize the early signs of a heart attack. While a man may feel chest discomfort during stress or exertion, a woman may have chest discomfort that comes and goes, or shortness of breath with stress or exertion. To learn more about the differences between men and women with regard to coronary heart disease, Medical Update interviewed Emory University cardiologist, author, and well-known advocate for women's health, Dr. Nanette Wenger.
Q: Are there significant differences between male and female in regard to coronary heart disease?
A: Based on information from the Framington Heart Study and other studies, we know that the initial manifestation of coronary disease is likely to occur a decade later in women than men. Myocardial infarction may even occur 20 years later. We see the disease presenting typically at an older age in women. Coronary disease is not, however, solely a disease of older women. In the United States each year, about 20,000 women younger than 65 die from heart attacks; one-third are younger than 55. This is important because most women don't perceive coronary disease to be a health problem for them. They believe coronary disease happens very late in life. While the predominance of coronary heart disease occurs in older women, many younger women have died of myocardial infarction.
Q: Do women confuse or ignore symptoms?
A: That is probably the major challenge. If a woman doesn't think she is vulnerable, first she won't heed preventive messages across her lifespan. Secondly, she will not respond promptly to symptoms of chest pain. I see a man coming into the office clutching his chest and saying, "I have angina," or "I am having a heart attack." A woman with the same symptoms will say, "I have indigestion."
If a woman has chest pain--particularly exertional chest pain, it warrants evaluation for coronary disease. The questions that should be asked when there is coronary disease are what medications need to be taken and for how long, and what are the preventive strategies that can be used to prevent another event or even the first event. A woman is really vulnerable to heart disease.
Q: Do the symptoms differ between the sexes?
A: The predominant presentation both for women and for men is chest discomfort. But often women misinterpret chest pain. But having said this, the nonpain presentation, including shortness of breath and extreme fatigue, is more common in older and diabetic patients, and more of those patients tend to be women. In addition to having chest pain, women are more apt to have some atypical pain in the chest, neck, back, shoulder, and even the abdomen.
Q: Are the diagnostics that we are presently using equally effective in men and women?
A: There are two kinds of tests. First we do noninvasive tests, which are basically exercise-based tests. Many women may not be able to exercise to adequate intensity, either because of associated illnesses, such as arthritis or stroke, or because they are very sedentary. In order to get a good exercise-based test, the patient has to be able to exercise. If you do the simplest of the tests, the exercise ECG without any special imaging study, you have to have a normal resting cardiogram. Very often women will not have a normal resting electrocardiogram, so we have to do some special imaging studies, such as echocardiography or nuclear imaging. Those imaging tests are usually quite good for men and women. For someone who can't exercise, we can use a medication that essentially tricks the heart into thinking it is exercising, so you can get a good imaging study.
Q: Do women with coronary heart disease have poorer prognoses?
A: Yes, much worse. Again, many of the studies suggest that it may not be solely a gender issue but rather the characteristics of the woman. The woman who has a myocardial infarction, or heart attack, is more likely to be older and have hypertension, diabetes, and many other medical problems. Often when you correct those medical problems, the difference disappears. That doesn't mean that women don't do worse.
The question is if we were better at earlier recognition and control of diabetes, high cholesterol, and hypertension in women, might we delay the infarct and might they do better when they have a heart attack? That is the challenge. Gender plays a role, but most of it relates to the fact that when we see women with the illness, they have a group of characteristics that are associated with a less favorable outcome. The same is the case when they come to bypass surgery. In many of the large registries or databases, women have almost twice the mortality from bypass surgery than men do.
Q: Are women more likely to die soon after a heart attack?
A: Yes. Not only during the hospitalization, but also during the first two years. When you compare mortality rates overall, women are more likely to die than men, and obviously the mortality associated with older age increases. The biggest gender difference is in young women. When you compare young women with young men, there is a far greater likelihood of the young woman dying with a heart attack and after heart bypass surgery, which is counterintuitive. The biggest difference between genders is in the young woman, which has not been completely explained and is an area of very active investigation.
|
