“It doesn’t take a medical degree to know that men and women are different …” Paula A. Johnson Jan 5, 2014 The Boston Globe

Women’s Heart & Vascular* Health will be an ongoing topic at HeartHealth Doctors.  Why?  Ladies first applies for women and heart disease; but not in a polite, etiquette way- Since 1984 more women than men have died from heart disease.

I attended a recent meeting about improving women’s heart and circulation health, and have written this post about the meeting, as well as a response to Why consider Women’s Heart & Vascular health.

The American College of Cardiology held the 8th Annual Heart of Women’s Health meeting at Heart House in Washington DC January 24 & 25. The statistics presented this year and each year I have attended (2012, 2013) contrast any idea that heart disease is only a man’s disease.

Heart attack (also termed ischemic heart disease) is the leading killer of women; the numbers show it. When heart attack is combined with death due to stroke or “other” heart disease the total is ~400,000 lives lost every year.

The Heart of Women’s Health is a meeting for Cardiologists, Nurses, and health care professionals. Dr. Janine Austin Clayton, Director, Office of Research on Women’s Health, National Institutes of Health (NIH) Associate Director for Research on Women’s Health gave an excellent opening presentation. Her talk included sharing that countries similar to the U.S. have different heart health.  Compared with women in Europe, women in the US have 159% HIGHER heart attack risk (U.S. men have 34% higher heart attack risk).  Why?

Dr. Clayton expanded her talk with a slide showing the word HEALTH in the center.  Surrounding figures overlapped and show the complex network that makes up our HEALTH.  Genes, Race, Sex/Gender occupy the first orbit around HEALTH but Socioeconomic Status, Education, Access to Care, Biology, Urban vs Rural revolve just beyond and interact.  It’s complex and applies to both men and women, but for me highlights factors with women’s heart and circulation health; the interplay of chemistry, economics, biology, sociology.

Remember, sex begins in utero, determined by chromosomes (genes).  Paula A. Johnson’s recent article 1/5/14 in The Boston Globe, “Every cell has a sex” points out limitations in research that does not include both males and females.  This is important because how we treat our patients is based on research; what we recommend for lifestyle is based on research. Sex is part of but different from gender.  Gender refers to a person’s self – representation as male or female. Sex AND Gender BOTH affect behavior and perception.  All of these factors contribute to women’s heart health.

Many national organizations have made progress in increasing awareness that heart problems can affect women.  The National Heart, Lung, and Blood Institute Heart Truth campaign, initiated in 2001, the American Heart Association’s Go Red for Women  campaign launched in 2003, and more recently the Department of Health and Human Services Office of Women’s Health Make the Call, Don’t Miss a Beat campaign, established in 2011 have helped increase awareness for heart disease in women.

As a doctor I have been impressed with the different ways people experience heart problems – from a heart attack that seemed like an attack of indigestion or maybe back pain, to fainting or tiredness. It is hard to tell.

What’s more, women are often caregivers and don’t tend to draw attention to themselves.  Health care providers may dismiss a woman’s symptoms as not her heart.  When in training I took care of a woman whose adult son (he was a paramedic, conveniently enough) gave her CPR when she had a cardiac arrest in front of him at the kitchen table.  A cardiac arrest means the heart abruptly stops beating.  My patient had been receiving chiropractor – therapy from a provider for her intermittent left shoulder and back pain in the week or two leading up the the cardiac arrest.  Her shoulder and back pain were from her heart; her son saved his Mom’s life.

Dr. Lori Mosca et al’s survey of women highlights our behavior. The survey asked women about symptoms of heart attack, and also took the next step to ask, what would you do if you were having these symptoms, or if someone you were with were appearing to have them. Dr. Mosca et al. compared results from 15 years ago to 2012 in the study. The survey showed improvement in women’s knowledge of risk factors for and symptoms of a heart attack… BUT … only 65% of women reported they would call 9-1-1 if they were having symptoms of a heart attack (chest discomfort, chest pressure, shoulder/jaw/back aching, nausea/sweating, shortness of breath), however if someone near them (family, friend, coworker) were experiencing symptoms, 81% would call 9-1-1.

When I share these results with women, many identify with the survey findings; “wouldn’t want to be a bother” is a comment I hear.  You may have seen the American Heart Association video Just a Little Heart Attack.

The Heart of Women’s Health Meeting provided lectures on the recent Guidelines for Lipid management. There were great lectures on heart function and pregnancy, arrhythmia (a term for abnormal heartbeats) in women (did you know more men than women experience atrial fibrillation?), heart risks for women who have undergone treatment for breast cancer (radiation and chemotherapy can affect heart function), and a lively discussion about high blood pressure (hypertension) and how best to approach this for women.

The meeting was a great opportunity to meet attendees, and to learn from excellent faculty. Each of the past 3 years I have returned from the Heart of Women’s Health meeting energized and excited for Heart Month in February.

The bottom line: it confirms how important it is for women and providers to know about heart symptoms and prevention. While over 90% of women have one risk factor for heart disease, with lifestyle changes women can reduce their risk (or improve their Heart & Vascular health) by more than 82%!

Lifestyle? by not smoking, keeping a healthy weight, eating a heart healthy diet, and getting regular exercise. …Stay tuned to Heart Health Doctors …

*Vascular health is part of circulation, meaning the arteries and veins, the heart is the main active pump in our circulation.