Heart of the Matter Raising Awareness Of Coronary Disease In Women Is A Pressing Issue Nationwide

Each year on Feb. 4, thousands of women and men don their favorite red shirt, dress, tie, or another ruddy garment in order to call attention to the number one cause of death in American women.


National Wear Red Day is sponsored by the U.S. Department of Health and Human Services and the National Institutes of Health, and since its inception has garnered the support and participation of a host of notable names, including designers Tommy Hilfiger, Calvin Klein, Donna Karan, and Ralph Lauren, who design red dresses for the cause, and First Lady Laura Bush, who champions the cause across the country.

The annual awareness day is staged to draw attention to a serious problem; but area cardiologists say it’s not the designer gowns, festive events, or celebrity endorsements that matter so much as raising the country’s consciousness of heart disease in women and underscoring the importance of preventative measures.

“Heart disease in women is a real problem,” said Dr. Reed Shnider, medical director of preventative cardiology and wellness at Baystate Medical Center. “Incidences of heart disease in general are going down, but the numbers in women are increasing.”

Shnider said the numbers of reported cases could be rising because methods to detect the diseases are improving – cardiac disease has typically been harder to diagnose in women than in men – but he suspects a national failure to modify certain risk factors such as diet and frequency of physical activity could also be to blame.

“The question becomes ‘with everything else women have to worry about – from major global events to their everyday lives – should they also be concerned about heart disease?’ The answer is yes.”

Pumping Information

Shnider said women tend to be more aware of other conditions that affect women than of heart disease, even though a woman is five times more likely to die from cardiac disease than from breast cancer, for example. That lack of education regarding the disease can be attributed to a number of factors – women, for instance, are generally older than men when they develop cardiac disease, leading to the misconception that the condition is more prevalent in men.

But the numbers of men and women suffering from heart disease are about equal, Shnider said, and higher in the United States than anywhere else on the globe – probably, he said, due to diet, exercise, and other lifestyle habits that contribute to risk factors like weight gain and diabetes.

Certain risk factors have shown to be more prevalent in women than men – a fact that Shnider said many women are unaware of. Diabetes, one of the stronger risk factors for heart disease, occurs more frequently in women, as do high blood pressure and obesity, for instance.

“Smoking is also such a potent risk factor,” added Dr. Jay Markham, a cardiologist with Pioneer Valley Cardiology in Springfield. “Young people, especially women, are still smoking at outrageous rates.”

Conversely, rates of high total cholesterol tend to be higher in men; but Shnider repeated that it’s important for everyone, and in particular women, to understand that gender is not protective when it comes to heart disease – anyone can be affected.

“This disease does not discriminate between genders,” he said, “and the various risk factors are distributed pretty equally.”

“Women should recognize that preventive cardiology applies to everyone, including them,” he continued, noting that a multitude of problems face women in the detection and treatment of heart disease. “It is harder to detect coronary disease in women. There is a higher incidence of false negatives in women when testing for heart disease, and their symptoms are not typically as well defined as in men.”

Markham agreed. “There are still plenty of women out there, primarily younger women, who think they are protected simply by being female,” he said. “Men tend to develop heart disease at a younger age, but once women go through menopause, their risk increases dramatically and the numbers become equivalent very quickly.”

Markham also noted that women tend to present classic symptoms of heart disease – such as pain in the left arm – less frequently than men, making diagnosis more difficult.

“Women’s symptoms can be less defined,” he said, “and classic testing, like the standard treadmill test, can be less accurate in women the same age as men, because women typically develop heart disease later in life. There are still a lot of unknowns.”

Some of the intangibles of heart disease, such as emotional and social concerns, can also factor into the overall health of a woman with heart disease, and some of those issues are currently being studied more in depth across the country in order to better address the issue of coronary disease in women.

“Since women tend to be older when heart disease occurs, the social factor tends to play a part more so than in men,” Shnider said, adding that the ‘social factor’ means that women, especially in Western cultures, tend to be caregivers, and are used to overlooking their own ailments.

“It’s not in the plans to get sick,” he said, “so women often take longer to seek help when symptoms occur.”

Further, when women are treated for heart disease, especially with surgery, they often have a more difficult time recovering. Exactly why is still unclear, said Shnider, but there are a number of theories, including smaller arteries often found in women, hormonal factors, more advanced illness because of late detection, and depression.

“There is evidence to suggest that depression following a heart attack or surgery is disproportionately greater in women than men,” said Shnider, adding that a study of women with heart disease and depression is pending in the field of cardiology.

Red Alert

The study is just one of many that is bringing added attention to the women and heart disease in the medical world, as efforts such as ‘Wear Red Day’ and other fundraisers and awareness events work to increase education across the country.

“I think there has been a perception for a long time that women are less likely to be in danger of developing heart disease,” Markham said. “But of late, that perception is dying away very rapidly.”

“There are concerted efforts to tailor diagnoses and management of heart disease to women,” Shnider noted, “And in turn a specialty in women’s cardiac disease is emerging. Prevention, counseling, and treatment of heart disease can be successful when approached with a knowledge of both heart health and women’s health. And it’s well worth making the effort.”

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