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Hidden Heart Disease

Cardiovascular diseases are the most common causes of death and disabilities in women in the United States. Between the ages of 45 to 64, 1 in 9 women 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 suspected or known cardiovascular disease. Furthermore, women are not referred as often as men, for appropriate diagnostic and/or therapeutic procedures, 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.

Women are less likely than men to have “typical” chest pain or angina, 28% versus 55%, in a review of 3,100 patients undergoing exercise stress testing. They also noted their chest pain as more intense and were more likely to describe it 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 have a cardiology consult, undergo an electrocardiogram, cardiac monitoring or cardiac enzyme testing. Women are 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. In fact, it is more powerful than pharmacologic treatment. Smoking cessation is the best thing anyone can do to reduce the risk for 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 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, I encourage you to make an appointment with your primary care physician, so you can begin reducing your risk of the leading cause of death in all Americans. 


Dr. Steven L. Brooks practices at Barton Primary Care & Rheumatology (upstairs at Stateline Medical Center). If you would like to make an appointment with Dr. Brooks, please call 775.589.8960.