Women are not small men when it comes to hearts

At the Feb. 27 Healthy Woman Ladies Night Out event, cardiologist Dr. Michael Vargas gave an informative talk on “Women are not Small Men, Myths and Truths about Women and Heart Disease.” The evening was hosted by Affordable & Quality Home Care at Fallbrook Library.

Vargas explained that women’s hearts are proportionately smaller than men’s and their physiology is also different. Furthermore, women develop heart disease 10 years later, usually, than men because men’s plaque distributes in clumps whereas women’s plaque distributes more evenly throughout artery walls. This results in women’s angiographic studies being misinterpreted as “normal” he said.

Vargas then reviewed eight common myths that most people believe about heart disease. The first is that heart disease is a man’s problem. The truth, however, is that more women than men have died of heart disease each year since 1984 and women have a 28 percent increased risk of dying within the first year after a heart attack when compared to men.

According to Vargas, of the 500,000 deaths each year from cardiovascular disease, 267,000 women die from heart attacks each year. Four million women suffer from angina.

He said 435,000 American women have heart attacks annually; 83,000 are under age 65; 35,000 are under 55. The average age is 70.4.

The second myth is that most women in America die from cancer.

On the contrary, heart disease is the leading cause of death of women in the U.S. Almost every minute, a woman in the U.S. dies from heart disease and nearly five times as many women (200,000) will die from heart attacks alone this year than will die from breast cancer. In total, heart disease kills more women annually than the top seven cancers combined.

The third myth is that it is not possible to die of a broken heart or to be scared to death. It is possible as a real-life broken heart can actually lead to cardiac consequences because there are established ties between depression, mental health and heart disease. Broken heart syndrome, called stress-induced cardiomyopathy or takotsubo cardiomyopathy, strikes those who are healthy.

Vargas said that following a loved one’s death, women are more than twice as likely to die than normal, and men more than six times as likely. This is why spouses married for many years often die within days or weeks of each other. The symptoms present like a heart attack but it is not, often there is no blockage in the arteries.

In broken heart syndrome, a part of the heart temporarily enlarges and doesn’t pump well, while the rest of the heart functions normally or with even more forceful contractions. The body unleashes a flood of chemicals, including adrenaline. This sudden flood can stun the heart muscle, leaving it unable to pump properly.

The treatment of takotsubo cardiomyopathy is generally supportive in nature, medications and certain devices can be prescribed to provide a higher blood pressure. Aspirin and other heart drugs also appear to help in the treatment of this disease, even in extreme cases. Long-term prognosis is excellent except in the very frail.

The fourth myth is that most doctors know about women’s risk of heart disease but the truth is that a 2005 American Heart Association study showed that only eight percent of primary care physicians and 17 percent of cardiologists knew that heart disease kills more women than men.

Another myth is that women’s and men’s heart disease should be treated the same. The truth is women have smaller arteries, hormonal differences and false positives from some diagnostic tests

Women are more likely than men to have coronary microvascular disease (MVD) possibly because of the drop in estrogen levels during menopause combines with other heart disease risk factors. Coronary MVD. may be the reason death rates from heart disease have dropped in the last 30 years, but not as much for women as men.

Standard tests for coronary heart disease are not designed to detect coronary MVD.

The sixth myth is that women and men with heart disease get the same care. He said, “Sadly they don’t.” Women are not accurately diagnosed and do not receive prompt care. They are less likely than men to receive medications such asbeta blockers, statins and ACE inhibitors. Women are also less likely to receive aspirin, following a diagnosis of heart disease.

Two hundred years has made a difference but the majority of the true breakthroughs have been in last 30 years. He said it was long considered improper for a male doctor to put his ear to the chest of a woman patient so, until the stethoscope was invented in 1819, women probably never received accurate heart exams.

Therefore, prevention, diagnosis, and treatment of heart disease in women lagged behind that of men for years. The vast majority of cardiovascular research has been performed on men and/or data have not been separated out based on gender.

Vargas said, heart disease is multifactoral and reviewed age-specific risk factors for cardiac disease in women. Those factors are: family history, smoking, oral contraceptive use, polycystic ovary syndrome, elevated LDL or “bad” cholesterol, low HDL or “good” cholesterol, high triglycerides, diabetes, perimenopause, obesity, hypertension, sedentary lifestyle, age, surgical menopause and menopause

Contrary to the myth that a person cannot do anything to stop heart disease, everyone can significantly reduce the risk of heart disease if they are given the information needed, know the questions to ask the health provider and have the support to make heart-smart changes in their life. He added that women who smoke risk having a heart attack 19 years earlier than non-smoking women.

Genes, hormones and lifestyle all play a role when a woman does have a heart attack. More than half of all cases of heart disease result from lifestyle factors: lack of exercise, overweight, high blood pressure and smoking while 25 percent may be related to family history and reduced estrogen at menopause.

Vargas said that the most tried and true way of prevention is for women to take control and change their health habits permanently, including smoking cessation, stress reduction, diet, and exercise. He said, “The key to preventing a heart attack is to acknowledge that these changes will put you back in control, and control self efficacy is essential for wellness.”

Some people say, “I’m too young to worry about heart disease.”

In truth, plaque can start accumulating in the arteries as early as childhood and adolescence. One in three Americans has cardiovascular disease, but not all of them are senior citizens. Even young and middle-aged people can develop heart problems – especially now that obesity and Type 2 Diabetes are becoming more common at a younger age.

Heart disease is not just an older woman’s disease; the rate of sudden cardiac death in women in their 30s and 40s is increasing much faster than in men the same age, rising 30 percent in the last decade.

Under age 50, women’s heart attacks are twice as likely as men’s to be fatal.

The last myth is that chest pain will accompany a heart attack, but that is not necessarily true. Vargas said chest pain or discomfort is not the primary symptom in women. Sixty percent of women who die suddenly from coronary heart disease have no previous symptoms.

From studies done mostly with men, classic symptoms of a heart attack are pain or discomfort in the center of the chest; discomfort in the arms, back, neck, jaw or stomach; shortness of breath; cold sweat and nausea or lightheadedness.

From newer studies done on women, heart attack signs in women are shortness of breath, weakness, unusual fatigue, cold sweat, nausea or dizziness. Whereas men typically have symptoms right before or during a heart attack, women can have symptoms for weeks before the attack.

Most common symptoms that women notice for a month or more before a heart attack include unusual fatigue, sleep disturbances, shortness of breath, indigestion, and anxiety.

He said, “Trust your gut. A women’s intuition is a very strong thing; don’t ever discount it.” Women patients, who just had a heart attack, often say that they knew it was their heart all along. That they just “had a feeling.” He added, “Not feeling ‘normal’ is a symptom, don’t ignore it.”

Since women are the care givers, they tend to ignore their symptoms and put others first. He showed a diagram for a woman’s inverse pyramid of priorities – top to bottom: children, career, parents, pets, husband, self.

Vargas told the women, “You count! For once in your life focus on yourself, believe in yourself and your health goals. Take time for yourself and take charge of your heart health!” He urged them to take the time to change their lifestyles and do it for themselves. He also recommended that men take care of the women they love, pay attention if they do complain, and help them to act.

The next Ladies Night Out event is scheduled for Thursday, March 27, when Dr. Alexander Delgadillo, internal medicine physician with Fallbrook Healthcare Partners, will discuss “Fibromyalgia: Facts and Myths.”

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