Are women more at risk for Heart Disease than Men?
There are some risk factors specific to women in regards to heart disease.
There are steps women can do to reduce their risk.
What are some important signs of heart problems specific to women?
Dr. Rozy Dunham is here to give some great tips for diet and Heart disease prevention that women should know.
Selected Podcast
Heart Disease Prevention For Women
Featured Speaker:
Rozy Dunham, MD
Dr. Rozy Dunham is board certified in Internal Medicine, Cardiovascular Diseases and Advanced Cardiac Life Support. Transcription:
Heart Disease Prevention For Women
Melanie (Host): Heart disease is the number one killer of women causing 1 in 3 deaths each year. That's approximately one woman every minute. But, it doesn't affect all women alike and the warning signs for women aren't the same as in men. My guest today is Dr. Rosie Dunham. She's a cardiologist with Lourdes Health System. Dr. Dunham, welcome to the show. So, are women more at risk for heart disease than men?
Dr. Rosie Dunham (Guest): Women are not at increased risk for heart disease but they are at increased risk for worse outcomes. Women tend to die or have a higher mortality after their event than men do, so, although the prevalence of heart disease and the risk for heart disease is the same amongst men and women, more women tend to have worse outcomes from their heart attack than do men.
Melanie: Why is that?
Dr. Dunham: Well, I think it's multi-factorial. I think the mechanism of heart disease in women is different. I think it's under-recognized in women. I think there's a delay in treatment as a result of that. Women themselves often don't recognize the symptoms of heart disease and present for evaluation and treatment much later than men do. There's often a delay of over 6 hours before they even think to call 911 when they begin to have symptoms. I think that's definitely one of the factors. Still, despite all the education we're doing in women with heart disease, there's still a lack of recognition amongst women when they are having symptoms and a tendency to be in denial when they're having symptoms because they're just too busy taking care of others rather than themselves.
Melanie: Well, that's certainly true. We always take care of everybody else before ourselves and typically, Dr. Dunham, in the past, all the studies Framingham and such, have always been done on men. Is that changing just a little bit?
Dr. Dunham: That's changing. There's definitely a push to include more women in our clinical trials, but women are still grossly underrepresented in all the trials, across the board, with respect to heart disease. Although women represent a large percentage of people out there with heart disease, in clinical trials, they're often 20% or less of the participants in the trial. So, we definitely need to encourage women to participate in clinical trials and be involved so we have more data and more information for treatment.
Melanie: What are some risk factors that are specific to women in regards to heart disease and then, what can women do to reduce some of those controllable risk factors?
Dr. Dunham: Well, the major risk factors are the same in men as in women. Things like diabetes, smoking, hypertension, obesity--those are risk factors that are common across gender. Risk factors that are specific to women include: use of hormone replacement therapy. There are a lot of women who use hormones post-menopausally, to reduce the symptoms of menopause. There is kind of equivocal data on how hormones affect heart disease but there has been some data to support that women who use hormone replacement therapy can be at increased risk for blood clots and heart disease. Other risk factors are actually going all the way back to the pregnancy years. Women who have pregnancy-induced hypertension, gestational diabetes, eclampsia, or pre-eclampsia, we now know that these women are at higher risk later in life for cardiovascular disease as well. Certain risk factors are actually more potent in women than in men. Tobacco smoking or cigarette smoking is a much stronger risk factor in young women than it is in men. So, if you are a woman who smokes, you are at higher risk than an equivalent male of the same age who smokes, as well. Diabetes is a more potent risk factor in young women. Hypertension is a more potent risk factor in young women. So, though they're common across gender, those risk factors tend to be stronger in women in terms of predicting heart disease.
Melanie: Dr. Dunham, as you said, we don't typically recognize some of those symptoms of heart problems. Women, we get anxious and stressed out; we are so busy; we get chest pains. We get shooting chest pains. We get pains in our legs. We get all of these things all the time. How do we know what's something that would send us to see you versus something that is just anxiety, stress, overwork, whatever?
Dr. Dunham: Well, you hit the nail on the head. I think women often do chalk up their symptoms to anxiety and stress or fatigue and they don't present for evaluation soon enough. I think women should have a low threshold for presentation to a doctor. I think if they feel that something is not right, something is not typical, in terms of how they typically feel, they should have a low threshold for contacting their primary care physician and then let them decide if that thing needs further work up. I mean, we all know the typical symptoms of heart disease: chest pain, an elephant sitting on your chest, tightness in the chest, pain in the arm, the jaw or the neck, but women often have the more atypical symptoms which can be anything ranging from just unusual amounts of fatigue, shortness of breath, flu-like symptoms, dizziness, indigestion, palpitations, a feeling of anxiety, or what they call a sense of dread. All of these things can be signs of heart disease and women should have a low threshold for getting checked out. I think we tend to have a higher threshold, we tend to wait longer and we blow things off when, in fact, we should have a lower threshold and present to our doctors quicker.
Melanie: If somebody came to you and said they had a sense of dread or they get chest pains; if they get shortness of breath or any of these things you’ve mentioned, what tests do you recommend, typically, so that you can find out if they have heart disease?
Dr. Dunham: Well, at the very basic level, an EKG should be performed. A primary care physician can do that in their office and, obviously, the cardiologist, we do that in our office, as well. An EKG, in the midst of these symptoms, can instantly tell you if you're having a heart attack or are at risk for a heart attack. Beyond just a plain EKG, you might get referred to a cardiologist who would then perform a stress test. Stress testing basically uncovers blockages in the arteries. We put you on a treadmill, you exercise, and sometimes that's coupled with imaging of the heart. We can also do what’s called an echocardiogram, which an ultrasound of the heart, which can show us how the heart is pumping, how the valves are working and just let us know how the heart is functioning, in general. So, we definitely have a lot of tests in our arsenal, but at the very basic level, and EKG should be done if they're complaining of the symptoms.
Melanie: What do you like women to know about preventing heart disease? You've mentioned quit smoking. What else? Where does diet and exercise fit into this role?
Dr. Dunham: Well, diet and exercise are very important but in terms of the classic risk factors, definitely quit smoking. I mean, smoking is the most detrimental thing you can do to your health. So, quitting smoking is number one. Then, it's a matter of managing what they call your "numbers." Know your blood pressure; make sure you have a healthy blood pressure. Know you blood sugar; make sure you're not in the diabetic or pre-diabetic range. Your weight or BMI is important. Make sure you maintain a healthy weight or body mass index and that's mainly done through diet and exercise, which you mentioned. So, for women, the general recommendation is, to maintain cardiovascular health and to maintain your current weight, if you're at a healthy weight, you should be doing about 30 minutes of cardiovascular exercise most days of the week. Now, that means, 4-5 days out of the week, you're doing brisk walking or light jogging or biking or swimming; something that gets the heart rate up. If you're looking to lose weight, that time would increase to about 40 minutes to an hour most days of the week in order to lose weight or maintain a healthy weight. Diet, we all know about eating a heart-healthy diet. What that means is plenty of fruits and vegetables, whole grains, lean proteins. Avoid high fat, high cholesterol meats like beef. Avoid processed carbohydrates and try to load your plate up with fruits and vegetables as the main portion on your plate.
Melanie: Thank you so much. It's really great information. In just the last minute, tell the listeners why they should come to Lourdes Health System for their care.
Dr. Dunham: Well, we are a complete cardiac care line top to bottom. We provide every cardiac service you might ever need from electrophysiological services dealing with arrhythmias and pacemakers and such, to interventional cardiologists who are doing state-of-the-art, minimally invasive valve replacements, coronary stenting, etc. Then, we have a whole team of clinical cardiologists who can treat cardiovascular disease ranging from valvular disease to heart attack and stroke to peripheral vascular disease. So, we really are a full service cardiovascular team.
Melanie: Thank you so much. You're listening to Lourdes Health Talk. For more information, you can go to LourdesNet.org. That's LourdesNet.org. This is Melanie Cole. Thanks so much for listening.
Heart Disease Prevention For Women
Melanie (Host): Heart disease is the number one killer of women causing 1 in 3 deaths each year. That's approximately one woman every minute. But, it doesn't affect all women alike and the warning signs for women aren't the same as in men. My guest today is Dr. Rosie Dunham. She's a cardiologist with Lourdes Health System. Dr. Dunham, welcome to the show. So, are women more at risk for heart disease than men?
Dr. Rosie Dunham (Guest): Women are not at increased risk for heart disease but they are at increased risk for worse outcomes. Women tend to die or have a higher mortality after their event than men do, so, although the prevalence of heart disease and the risk for heart disease is the same amongst men and women, more women tend to have worse outcomes from their heart attack than do men.
Melanie: Why is that?
Dr. Dunham: Well, I think it's multi-factorial. I think the mechanism of heart disease in women is different. I think it's under-recognized in women. I think there's a delay in treatment as a result of that. Women themselves often don't recognize the symptoms of heart disease and present for evaluation and treatment much later than men do. There's often a delay of over 6 hours before they even think to call 911 when they begin to have symptoms. I think that's definitely one of the factors. Still, despite all the education we're doing in women with heart disease, there's still a lack of recognition amongst women when they are having symptoms and a tendency to be in denial when they're having symptoms because they're just too busy taking care of others rather than themselves.
Melanie: Well, that's certainly true. We always take care of everybody else before ourselves and typically, Dr. Dunham, in the past, all the studies Framingham and such, have always been done on men. Is that changing just a little bit?
Dr. Dunham: That's changing. There's definitely a push to include more women in our clinical trials, but women are still grossly underrepresented in all the trials, across the board, with respect to heart disease. Although women represent a large percentage of people out there with heart disease, in clinical trials, they're often 20% or less of the participants in the trial. So, we definitely need to encourage women to participate in clinical trials and be involved so we have more data and more information for treatment.
Melanie: What are some risk factors that are specific to women in regards to heart disease and then, what can women do to reduce some of those controllable risk factors?
Dr. Dunham: Well, the major risk factors are the same in men as in women. Things like diabetes, smoking, hypertension, obesity--those are risk factors that are common across gender. Risk factors that are specific to women include: use of hormone replacement therapy. There are a lot of women who use hormones post-menopausally, to reduce the symptoms of menopause. There is kind of equivocal data on how hormones affect heart disease but there has been some data to support that women who use hormone replacement therapy can be at increased risk for blood clots and heart disease. Other risk factors are actually going all the way back to the pregnancy years. Women who have pregnancy-induced hypertension, gestational diabetes, eclampsia, or pre-eclampsia, we now know that these women are at higher risk later in life for cardiovascular disease as well. Certain risk factors are actually more potent in women than in men. Tobacco smoking or cigarette smoking is a much stronger risk factor in young women than it is in men. So, if you are a woman who smokes, you are at higher risk than an equivalent male of the same age who smokes, as well. Diabetes is a more potent risk factor in young women. Hypertension is a more potent risk factor in young women. So, though they're common across gender, those risk factors tend to be stronger in women in terms of predicting heart disease.
Melanie: Dr. Dunham, as you said, we don't typically recognize some of those symptoms of heart problems. Women, we get anxious and stressed out; we are so busy; we get chest pains. We get shooting chest pains. We get pains in our legs. We get all of these things all the time. How do we know what's something that would send us to see you versus something that is just anxiety, stress, overwork, whatever?
Dr. Dunham: Well, you hit the nail on the head. I think women often do chalk up their symptoms to anxiety and stress or fatigue and they don't present for evaluation soon enough. I think women should have a low threshold for presentation to a doctor. I think if they feel that something is not right, something is not typical, in terms of how they typically feel, they should have a low threshold for contacting their primary care physician and then let them decide if that thing needs further work up. I mean, we all know the typical symptoms of heart disease: chest pain, an elephant sitting on your chest, tightness in the chest, pain in the arm, the jaw or the neck, but women often have the more atypical symptoms which can be anything ranging from just unusual amounts of fatigue, shortness of breath, flu-like symptoms, dizziness, indigestion, palpitations, a feeling of anxiety, or what they call a sense of dread. All of these things can be signs of heart disease and women should have a low threshold for getting checked out. I think we tend to have a higher threshold, we tend to wait longer and we blow things off when, in fact, we should have a lower threshold and present to our doctors quicker.
Melanie: If somebody came to you and said they had a sense of dread or they get chest pains; if they get shortness of breath or any of these things you’ve mentioned, what tests do you recommend, typically, so that you can find out if they have heart disease?
Dr. Dunham: Well, at the very basic level, an EKG should be performed. A primary care physician can do that in their office and, obviously, the cardiologist, we do that in our office, as well. An EKG, in the midst of these symptoms, can instantly tell you if you're having a heart attack or are at risk for a heart attack. Beyond just a plain EKG, you might get referred to a cardiologist who would then perform a stress test. Stress testing basically uncovers blockages in the arteries. We put you on a treadmill, you exercise, and sometimes that's coupled with imaging of the heart. We can also do what’s called an echocardiogram, which an ultrasound of the heart, which can show us how the heart is pumping, how the valves are working and just let us know how the heart is functioning, in general. So, we definitely have a lot of tests in our arsenal, but at the very basic level, and EKG should be done if they're complaining of the symptoms.
Melanie: What do you like women to know about preventing heart disease? You've mentioned quit smoking. What else? Where does diet and exercise fit into this role?
Dr. Dunham: Well, diet and exercise are very important but in terms of the classic risk factors, definitely quit smoking. I mean, smoking is the most detrimental thing you can do to your health. So, quitting smoking is number one. Then, it's a matter of managing what they call your "numbers." Know your blood pressure; make sure you have a healthy blood pressure. Know you blood sugar; make sure you're not in the diabetic or pre-diabetic range. Your weight or BMI is important. Make sure you maintain a healthy weight or body mass index and that's mainly done through diet and exercise, which you mentioned. So, for women, the general recommendation is, to maintain cardiovascular health and to maintain your current weight, if you're at a healthy weight, you should be doing about 30 minutes of cardiovascular exercise most days of the week. Now, that means, 4-5 days out of the week, you're doing brisk walking or light jogging or biking or swimming; something that gets the heart rate up. If you're looking to lose weight, that time would increase to about 40 minutes to an hour most days of the week in order to lose weight or maintain a healthy weight. Diet, we all know about eating a heart-healthy diet. What that means is plenty of fruits and vegetables, whole grains, lean proteins. Avoid high fat, high cholesterol meats like beef. Avoid processed carbohydrates and try to load your plate up with fruits and vegetables as the main portion on your plate.
Melanie: Thank you so much. It's really great information. In just the last minute, tell the listeners why they should come to Lourdes Health System for their care.
Dr. Dunham: Well, we are a complete cardiac care line top to bottom. We provide every cardiac service you might ever need from electrophysiological services dealing with arrhythmias and pacemakers and such, to interventional cardiologists who are doing state-of-the-art, minimally invasive valve replacements, coronary stenting, etc. Then, we have a whole team of clinical cardiologists who can treat cardiovascular disease ranging from valvular disease to heart attack and stroke to peripheral vascular disease. So, we really are a full service cardiovascular team.
Melanie: Thank you so much. You're listening to Lourdes Health Talk. For more information, you can go to LourdesNet.org. That's LourdesNet.org. This is Melanie Cole. Thanks so much for listening.