For Women: A Heart-To-Heart Talk
Knowledge about gender differences in heart disease can help you protect your health

When you think about the steps that women can take to safeguard their health, which ones come to mind? Mammograms? Pap smears?
As important as those tests are, thinking about your ticker is just as crucial. “It’s a common misconception that cancer is the most serious problem for women to worry about, but heart disease is the No. 1 killer in America,” says cardiologist Peter Hui, M.D., director of the Coronary Care Unit at California Pacific Medical Center and a Brown & Toland physician with the California Pacific Cardiovascular Medical Group.

Doctors are trying to get the word out, but there’s a new wrinkle: Most heart disease research involves men, and we’re now learning that various aspects of the disease — from symptoms to how it manifests — can be very different in women. “When we started studying cardiovascular disease in the late 1940s, the focus was on middle-aged men because they had a fairly high incidence of heart disease, and medical science just continued to study men,” said Jennifer Tremmel, M.D., clinical director of Women’s Heart Health at Stanford Hospital and Clinics.
That’s changing. About 15 years ago, the National Institutes of Health made a big push to include women and to investigate differences between the sexes. “Unfortunately,” observes Dr. Hui, “the proportion of research patients who are women is still quite low — about 25 to 30 percent.”

Still, some new insights are bubbling to the surface. While women share the same risk factors as men, for example, some factors such as diabetes seem to confer more risk to women. Also, having low HDL (“good” cholesterol) and high triglycerides (a type of fat in the body) may be somewhat more dangerous for women.
Symptoms of cardiovascular trouble may also differ. “Men seem more likely to report chest pain than women do,” Dr. Tremmel says. “Also, women tend to report several more symptoms during a heart attack — maybe chest pressure, pain in their belly, shortness of breath, a headache — and that often makes it more difficult for the physician to realize what’s going on.”

Clear and specific communication with the doctor can help. Be as detailed as possible, specifically when reporting discomfort in the chest area. Try to articulate whether your pain is sharp or dull, and if you feel pressure, Dr. Tremmel says.

Even the root of chest pain may differ depending on your gender, according to some research. A recent study reviewed nearly 25,000 cases of angina (chest pain caused by lack of oxygen to the heart) in 31 countries. “Anginal rates were higher in women than men in most countries,” Dr. Tremmel says. “This was fascinating, given that we find obstructive disease in the heart arteries that would be a cause of this angina less often in women. Data shows that angina may be coming not from an anatomical obstruction but from a functional problem in the heart arteries. And there may be differences in these functional problems between women and men.”

What’s key is having a healthcare provider who’s conscious of potential differences in heart disease in women versus men.
Drug treatment may need to be modified for women. “Medication dosages might be less for women because of body size differences,” Dr. Hui says.

While medical science sorts out all the gender issues, women need to be vigilant about their own cardiovascular health and realize that their symptoms and care may differ from those of men. Adds Dr. Hui, “Talk to your doctor so you understand your risk factors.”

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