Column: Hidden heart disease

Cardiovascular diseases are the most common causes of death and disability for women in the United States. 1 in 9 women between the ages of 45 to 64 will develop symptoms of some form of cardiovascular disease. After age 65, the ratio climbs to 1 in 3 women.

There are significant differences between men and women in the symptoms, diagnosis, treatment, and prognosis of coronary heart disease. These factors need to be taken into account in the care of women with suspected or known cardiovascular disease. Furthermore, women are not referred for appropriate diagnostic and/or therapeutic procedures as often as men, despite similar clinical conditions and risk factors.

Risk factors for coronary heart disease include smoking history, diabetes, obesity, lipid (cholesterol) abnormalities, family history of premature coronary heart disease, high blood pressure, and lack of physical activity.

In a review of 3,100 patients undergoing exercise stress testing, women were less likely than men to have “typical” chest pain or angina, 28 percent versus 55 percent for men. Their chest pain was classified as more intense, described as sharp and burning. Women also had symptoms unrelated to pain such as extreme fatigue, shortness of breath, nausea, and sleep disturbance. In one study of heart attack patients, acute chest pain was absent in 43% of women. Chest pain in women often radiated to the neck, throat, jaw, or back.

Due to gender differences in the classic presentation of heart disease symptoms taught to physicians, women are less likely to have a cardiology consult, undergo an electrocardiogram—a test used to evaluate the heart—, cardiac monitoring, or cardiac enzyme testing, a test that shows enzymes that are released by the heart muscle when it is injured and can show presence or history of a heart attack. Women are also more likely to receive controlled substances or anti-anxiety medications in the emergency room, suggesting they are being treated for psychiatric or psychosomatic complaints. All of these factors can make it difficult to diagnose heart disease in women.

To reduce the risk of coronary heart disease, lifestyle modification is often the most effective treatment, more powerful than medication treatment. Smoking cessation is the best thing anyone can do to reduce the risk of cardiovascular disease. Lipid, cholesterol, weight loss also can be improved through exercise and healthy eating habits. Adult-onset or type II diabetes also is a powerful risk for cardiovascular disease. Diabetes often develops by eating a typical American diet, high in saturated fats and refined carbohydrates, as well as lack of exercise. When lifestyle modifications fail or for patients with multiple risk factors, doctors may often prescribe medications early on in treatment.

If you have any of the risk factors for cardiovascular disease, speak with your primary care physician, so you can begin reducing your risk of the leading cause of death in all Americans.

Dr. Steven Brooks is a board-certified primary care provider with Barton Primary Care at Stateline Medical Center. Talk to your primary care provider about recommended screenings. Visit BartonHealth.org/PrimaryCare for a list of Barton Health’s primary care offices.