Originally published in The Ottawa Citizen March 18, 2003
Original Title: The Truth About Women’s Hearts

Perception is everything. Not only does it apply to the political arena but to the public’s perception of health risks.

A survey by the American Heart Association done in 2000 asked women what disease they thought was the major threat to their lives. Eight per cent said heart disease compared to 50 per cent citing cancer. The reality is altogether different. Cardiovascular disease kills more women than the next 14 causes of death combined.

A woman’s lifetime risk of dying from breast cancer is one in 28 whereas one in two will die of cardiovascular disease.

This perception rings true in the office setting. It is uncommon for women to experience a heart attack at 40 or 50 years of age, but many know of someone suffering with breast cancer at this young age. This close-to-home event scares many women. Understandably, breast cancer prevention becomes a primary concern.

This skewing of risk perception leads to the difficult task of focusing preventive health and education on diseases that occur later in one’s life, such as cardiovascular disease. A woman’s risk of death from a heart attack occurs about 10 years later compared to men. Yet more women than men die from heart attack each year.

Studies done in the early ’90s indicate that women with the appearance of heart disease symptoms are less likely to be referred for evaluation and treatment. Further, sex-specific risk-factor differences exist for women. These include elevated cholesterol, high blood pressure (hypertension), diabetes, smoking and premature menopause.

For example, a low good-cholesterol level (HDL-cholesterol) below 1.05 millimoles per litre is more predictive of fatal heart disease for women over the age of 65 compared to men with the same level. In 1998, the U.S. National Health and Nutrition Examination Survey reported that more women than men had cholesterol levels above the desirable range.

Fifty-two per cent of women over the age of 45 have hypertension increasing the risk of heart disease and stroke.

Compared to a non-diabetic woman, a woman with diabetes has a threefold to sevenfold greater risk of heart disease. Compare this to a twofold to threefold greater risk for diabetic men.

More women than men smoke. Smoking rates among teenage girls exceeds those of boys. Smoking accounts for over 50 per cent of heart attack in middle-aged women and will likely increase given the smoking trends.

What can you do to prevent cardiovascular disease? The Web site familydoctor.org provides helpful information (http://familydoctor.org/handouts/667.html).

Consult your family doctor for a thorough medical examination. This includes a detailed family history (heart disease, diabetes, stroke and hypertension) and a personal medical history that reviews previous illnesses, alcohol and drug use, cigarette smoking, and diet.

Your doctor will order blood tests to check for diabetes and elevated cholesterol levels, among others. If the results are abnormal, he or she may order additional tests and offer treatment options.

Lifestyle modifications are the first treatment choice when cholesterol levels are elevated. Women should stop smoking and alter their diet to limit fat intake. Your doctor’s office should have many handouts of sample diets prepared by the Canadian Diabetes Association or log on to the Heart and Stroke Foundation of Canada Web page at http://ww2.heartandstroke.ca/Page.asp?PageID=1559&SubCategoryID=195&Src=&Type=Article.

Weight loss and exercise (30 minutes of moderate intensity exercise three to four times per week) are crucial to reduce the risk of heart disease. These components will increase the HDL-cholesterol, reduce blood pressure and decrease the risk of type 2 diabetes.

If six to 12 weeks of lifestyle changes do not sufficiently reduce cholesterol levels, medical therapy is the next step. The Heart Protection Study demonstrated a dramatic reduction in fatal heart disease and stroke risk equally in men and women using a cholesterol-lowering statin medication.

These medications (Zocor, Lipitor, Mevacor, Lescol, Pravachol) reduce the risk of coronary artery blockage caused by small clots or plaques that accumulate on the arterial walls.

Estrogen replacement therapy, once considered to reduce the risk of heart disease, is no longer a recommendation. The recent Heart and Estrogen/ progestin Replacement Study (HERS) did not show any reduction of fatal or nonfatal heart attack risk in women who had coronary heart disease.

If you have not had a recent heart disease risk assessment, book an appointment with your doctor. There is sufficient evidence-based information available to accurately assess your 10-year risk of heart disease. Women, justifiably vigilant about breast cancer, should be more so for heart disease.

Early intervention can save your life.

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© Dr. Barry Dworkin 2002