Got high blood pressure? Cholesterol? Diabetes? Obesity? Inflammation? If so, they can increase your risk for the deadly duo: heart disease and stroke. Both involve blood flow dysfunctions and both are more devastating and less understood when they strike female victims.
In a two-part series, we examine these twin threats, starting with heart disease.
When Carolyn Thomas went to the emergency room with chest pains, she was sent home with antacids and a scolding. Weeks later, she returned – with a heart attack.
Unusual? Hardly. Like many women, Thomas suffered from a heart condition that’s believed to be far more common among women than men; microvascular disease. Because its symptoms deviate from the majority of ‘garden-variety’ cardiovascular disease (read that: male heart issues), the condition did – and still does – confound many medical practitioners.
Coronary Artery Disease = Ischemia
Coronary artery disease, also known as ischemia, occurs when blood flow to the heart is interrupted, causing tissue death. Men frequently seek medical help when they have major blockages that narrow the main arteries to the heart; obstructions clearly visible on common tests. But many women face subtler problems, from ongoing chest discomfort to vague upper body pains, crushing fatigue, and spells of dizziness. These symptoms can occur when small blood vessels surrounding and feeding the heart, part of the microvascular system, inappropriately constrict causing relentless angina, chest pains that seem to come from nowhere.
Some researchers blame anatomical sex differences – smaller vessels and thinner heart muscle in women – while others point to the loss of estrogen’s blood-vessel-relaxing effects after menopause. But the exact reasons behind this ‘women’s heart disease’ aren’t completely clear. Yet. What is known is that women have been historically excluded from major cardiac research, leaving doctors without proper diagnostic and treatment guidelines that apply specifically to them.“Men and women both get heart disease,” explains Cardiologist Sharonne N. Hayes, a professor of cardiovascular medicine and women’s heart disease expert at the Mayo Clinic, “but it’s been said that men with the disease often ‘explode’ while women ‘implode’.”
Without the massive blockages or substantial arterial plaque, many women with microvascular symptoms are sent home with an all-clear. And that can leave them without the vital preventive strategies that could potentially prevent or slow future damage. Delays in that kind of care can have dire consequences.
Heart disease remains the leading cause of death and illness among women, claiming 400,000 lives annually in the US. A recent WISE Study (Women’s Ischemia Syndrome Evaluation) found one in three deaths occurred among women with no obvious obstructive coronary disease. At the same time, women who survive face a poor prognosis. When compared to men, women have more inpatient complications, heart failure, and heart attacks.
To remedy that, a nationwide, Warrior Project– Women’s Ischemia Trial to Reduce Events in Non-Obstructive Coronary Artery Disease – is exploring potential treatments options with studies underway at multiple medical centers around the country. “This will,” opines Eileen M. Handberg, Ph.D., ARNP-BC, FACC, a researcher at the University of Florida WARRIOR site, help “all the women caught in the middle.”
Pregnancy and hearts
Meanwhile, stubborn problems persist. Eleven years after her initial foray into a hostile emergency room, Thomas, now a top blogger on women and heart disease, regularly hears from readers who encounter doubtful doctors. The 69-year-old Canadian wants more women to learn about a surprising fact she discovered far too late; that common pregnancy complications can predict subsequent heart issues.“Pregnancy can serve as an early stress test that unmasks an unhealthy cardiovascular system,” says Dr. Hayes, “so all women should not only know their cholesterol and blood pressure numbers, but their pregnancy histories.” Specifically, women should share that medical information if they developed:
- Diabetes: high blood glucose or blood sugar can predispose a woman to Type 2 Diabetes and heart disease
- High blood pressure; often resulting in the preeclampsia, this dangerous blood-pressure-related illness threatens mother and child
- Low birthweight babies; babies born weighing under 5 lb. 8 oz. may indicate that blood flow to the fetus was inadequate
- Premature delivery: roughly10 percent of births as of 2017 occurred before full gestation, possibly due to inflammatory and other processes.
Cardiologist Janet Wei of Cedars Sinai hospital in Los Angeles, another WARRIOR researcher, is confident that more medical professionals will take “women’s heart disease” seriously once researchers complete the $14.9 million, three-year WARRIOR project. “We’re hoping to spread awareness of this condition to all providers,” she says. But until then, experts on women’s heart disease advise their patients to be proactive and aware, by understanding that:
- Angina alone– the chest pain or discomfort – is a risk factor for serious heart problems, even without any obstructive disease
- Pregnancy complications, again, should always be discussed with doctors
- Testing options(and the nearest major testing sites) should be familiar to heart patients
- Heart attack symptoms in women should be immediately responded to. They include shortness of breath, nausea or vomiting, extreme fatigue, chest or upper-body discomfort, unusual jaw or arm pain, dizziness, and fainting.
The bottom line, says Thomas – who suffered from preeclampsia during her pregnancy decades earlier – is to know your body and demand treatment if something doesn’t feel right. “I have one message and I keep repeating it,” says Thomas. “Don’t be like me and stay away from the emergency room because you’re too embarrassed to go back. Insist on being treated, demand tests. You are the best judge of your own health.”