A cardiologist shares her thoughts on a new heart study.
Women are more likely to survive heart attacks if treated by female physicians in the emergency room, according to a study released this week that reviewed about half a million patients over more than 20 years.
I am a clinical cardiologist, and Director of Education and Outreach for the Perelman Heart Institute. I take care of patients, men and women -- helping them live healthy lives and caring for them when they are sick. And I work to advance the status of heart disease in women.
This work is personal to me. Eight years ago, my brother and only sibling died of sudden cardiac arrest at 50. There wasn’t even heart disease in my family. He had just spent the day coaching his son’s soccer game. He left three children. How could he die when so many who don’t take care of themselves live? I felt betrayed. For the first time in my life, it was difficult to be at work. But it was my work -- my caring for others -- that healed me. I couldn’t save him, but I can help others. With women, there is a lot more work to be done.
As a female cardiologist, I’m not surprised by the results of the study. When it comes to heart disease and heart attacks, our culture simply doesn’t consider women enough. As a result, heart disease remains the No. 1 cause of death for women -- more than all cancers combined -- and it is on the rise, especially in young women, ages 29 to 45.
There is a cascade of issues working against women: Women who think they are having a heart attack are less likely to call 9-1-1. A woman having a heart attack today will wait longer before seeking emergency treatment. She is less likely than a man to have the classic symptom of chest pain. She is less likely to have a diagnostic electrocardiogram and, not surprisingly, she is 50 percent more likely to be misdiagnosed.
Even if she is diagnosed correctly, she will be less likely to receive all the lifesaving therapies we have to treat heart attacks. And even if she does get these therapies, they will be given at a significant time delay compared to a man -- an average of 7 minutes -- which is significant. With respect to heart attacks, we have a saying, “time is muscle.” Even if you control for all of these variables, a woman is still up to three times more likely to die from heart attack, and it is the youngest women who fare the worst.
Most studies of heart disease have been designed by men and have examined men. Not surprisingly, this has greatly benefited men; women have not fared as well. Women’s heart disease remains under-researched, under-diagnosed, and under-treated. And even after being diagnosed with heart disease, women still do worse and are more likely to die than men in this country and globally.
Part of the problem is awareness. Only 27 percent of women can name a woman in their lives with heart disease, and only 11 percent can name a woman who has died of heart disease. How is this possible when it’s the leading killer of women? I will tell you: When women die of heart disease, it’s often attributed to something else. Women don’t talk about their heart disease, much in the same way women didn’t talk about breast cancer in the 1970s and 80s. Seventy-six percent say they rarely or never talk about it. They feel embarrassed, frightened, or stigmatized by it, and young women are the most likely to feel this way.
But these conversations are important, because a woman who knows another woman with heart disease is more likely to consider her own risk and bring it up with her doctor. Currently, 70 percent of women never or almost never raise the issue of their heart health with their physician. These women assume their doctor will bring it up if it’s important.
We polled physicians, too, and found that only 37 percent of primary care doctors considered heart disease to be a top-tier health concern for their female patients. If women are waiting for their doctors to bring it up, and doctors largely aren’t doing that, these conversations simply aren’t happening. Women who report having their heart checked by their doctor are twice as likely to discuss this topic with family and friends. No heart check, no conversation with loved ones, and the problem continues.
My advice to women: Understand that heart disease is your greatest health threat – even if you’re young -- and that it’s largely preventable. It’s never too early (or late) to start taking care of your heart. When it comes to health care, be your own advocate. Discuss your risk and ways to reduce it with your health care provider. If you think you are having symptoms of heart disease or a heart attack, don’t wait. Make sure you are being heard. Demand that your heart gets checked.
When you are with your primary care provider:
- Discuss your personal and family history of heart disease
- Talk about any symptoms you may be having (especially symptoms that come with emotional or physical stress that go away with rest)
- Talk about any complications you had during pregnancy (hypertension, diabetes, pre-eclampsia)
- Discuss your smoking history, diet, exercise habits, stress levels and mood
- Report any history of migraine headaches with or without aura
- Have your blood pressure and waist circumference measured
- Check blood work for lipids (cholesterol) and glucose (sugar)
For more information, watch this video courtesy of Real Women Real Stories.