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March 01, 2021

Heart disease — the leading cause of death in women

Women's Health Heart Disease

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Though we’ve leaped from American Heart Month into March, it’s a yearlong message that we share: heart disease is the most common cause of death and disability in adults in the United States.

Sadly, many women are not aware of the magnitude of this risk. To raise awareness, Dr. Lisa Freed, a cardiologist at the Yale New Haven Hospital’s Women’s Heart and Vascular Program, recently joined me for a discussion on Your Radio Doctor, a medical talk show that airs every Sunday morning at 10 a.m. on Talk Radio 1210 WPHT. She reminded listeners that cardiovascular disease poses a significant risk in women, including heart attack and stroke.

An article published in the journal Circulation last May revealed startling statistics regarding how women think about heart disease. Online surveys of women over age 25 were performed in 2009 and again in 2019. During that 10-year period, awareness that heart disease is the #1 cause of death in women decreased from 65% to 44%. Many women were more likely to identify breast cancer as the leading cause of death in women, especially those under age 34. In fact, heart disease claims seven times as many lives as breast cancer in women. Women also tend to think it’s a man’s disease.

As reported in the Journal of the American College of Cardiology, 1/3 of women die from cardiovascular disease and 45 percent of women over age 20 have some form of the disease. These statistics stir us to renew our efforts to promote prevention. Since 2004, the American Heart Association has organized the campaign called “Go Red for Women” with educational events across the country.

Women are less likely to associate symptoms with heart disease and more likely to wait before seeking medical attention. This often results in heart disease being under-diagnosed.

Typical symptoms of a heart attack include:

  1. Chest pain/pressure in the mid or left chest
  2. Radiation of pain into the neck or left arm
  3. Shortness of breath
  4. Nausea/vomiting
  5. Sweating
  6. Palpitations

Atypical symptoms include:

  1. Nausea/vomiting without chest pain
  2. Shortness of breath without chest pain
  3. Extreme fatigue
  4. Neck/shoulder/back pain
  5. In women, chest pain occurs more often at rest or with mental stress (even while sleeping) instead of physical exertion

The takeaway message: though atypical symptoms are more common in women, chest pain is still the most common symptom for both men and women.

What do you do when you have symptoms? Call 911 and chew four baby aspirin (81 mg each) while you wait.

When asking for help, studies show that the shortest delay to the hospital comes when you tell a stranger you have chest pain. The longest delay comes when you tell your husband.

Classic risk factors can be divided into those we can’t change and those we can.

Unchangeable risks include:

  1. Age: men over age 45 and women over age 55.
  2. Family history of premature heart disease in a first degree relative (parent, sibling) in men under age 50 and women under age 60.

Risks we can address:

1. Hypertension - the new target is 130/80 regardless of sex

• A stronger predictor of heart disease in women than men
• Before menopause, risk is lower in women than men. After menopause, it’s higher.
• Risk factors include obesity, diabetes, physical inactivity, increased salt, more than two servings of alcohol each day
• Obesity has the highest negative impact on women
• Excess salt adds more risk after menopause

2. Diabetes

• Diabetes increases risk of heart attack or stroke more in women than in men
Target goal for men and women is HgA1c of less than 7.0%

3. Smoking

• Associated with ½ of all coronary events in women
Smoking in women (1 pack/day) increases risk 2-4 times over non-smokers
Increased risk even with smoking 1-4 cigarettes/day
Women who smoke have their first heart attack 19 years earlier than female non-smokers. Men who smoke have their first heart attack seven years earlier than male non-smokers.

There is hope. For those who have smoked one pack a day for 20 years; Quit for five years to lower your risk below those who still smoke; Quit for 10-15 years and your risk drops closer to that of someone who never smoked!

Risk factors specific to women:

  1. Onset of menstrual periods at an early age
  2. Hypertension which starts before or during pregnancy
  3. Gestational diabetes – present during pregnancy; gone with delivery
  4. Pre-term birth – delivery before 37 weeks; more risk if delivery before 34 weeks
  5. Fetal birthweight less than 10th percentile
  6. Miscarriages – (more than 3) may be associated with risk of heart attack. Both may be from clotting or inflammatory disorders

Is there a benefit to taking aspirin? No question – if you’ve already had a heart attack or stroke, it reduces risk of subsequent events by 25 percent. If you are otherwise healthy, there is no proven benefit and it may actually increase the risk of bleeding. Recent studies suggest medications that lower your LDL (bad cholesterol) called ‘statins’ are equally effective in men and women.

During the program, we also heard the remarkable story of Stephanie. At age 35, her heart stopped while she slept. A fortuitous phone call at 6 a.m. awakened her husband who noticed her irregular breathing. She was in cardiac arrest. His quick reflex to perform CPR gave her a second chance at life.

CPR saves lives. Visit the American Heart Association website ( and find where you can take a CPR course in your community.

Tune in to “Your Radio Doctor” on Talk Radio 1210 WPHT every Sunday morning at 10 a.m. Each week, Dr. Ritchie interviews guests, including physicians from all specialties, researchers, and other leaders in the medical community. She takes on topics like heart disease, colon cancer, neonatal care and many others.

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