It is well known that men are at greater risk than women for heart disease, however, the warning signs for women aren’t the same in men. There are many misconceptions about heart disease in women, and they could be putting you at risk.
In this podcast Jack Tighe, MD, discusses heart disease symptoms in women, red flags to pay attention to and how you can reduce your risk by knowing your numbers and making healthy lifestyle choices.
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How the Warning Signs of Heart Disease are Different in Women than in Men
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Learn more about Jack Tighe, MD
Jack Tighe, MD
Dr. Tighe received his bachelor's degree from the University of Michigan and his medical degree from Loyola University- Stritch School of Medicine. He completed a residency in internal medicine at the Walter Reed Army Medical Center in Washington, D.C., where he also completed fellowship training in cardiovascular disease. During his training at Walter Reed Medical Center he received the outstanding resident award, the outstanding fellow award and was inducted into the alpha omega alpha medical honor society. Dr. Tighe has presented at national and international conferences including the American Heart Association and the American College of Cardiology. Dr. Tighe has also co- authored numerous studies that have been published in peer reviewed journals including the New England Journal of Medicine. Dr. Tighe is a member of the American College of Cardiology, American Society of Echocardiography and the Society for Cardiovascular Computed Tomography. Dr. Tighe is also the Director of the Cardiovascular Institute at St. Luke's Cornwall Hospital.Learn more about Jack Tighe, MD
Transcription:
How the Warning Signs of Heart Disease are Different in Women than in Men
Melanie Cole (Host): Did you know that heart disease is the number one killer of women and is more deadly than all forms of cancer combined. That’s really quite a statement to make, but the warning signs for women are not the same as men. My guest today is Dr. Jack Tighe. He’s the medical director of St. Luke’s Cornwall Hospital’s Cardiovascular Institute. Welcome to the show Dr. Tighe. How prevalent is cardiovascular disease in women?
Dr. Jack Tighe, MD (Guest): Well thanks Melanie for having me here today. Heart disease in women is very prevalent and this is a well-timed session here now at the end of heart month for women. It’s the number one cause as you pointed out in your introduction of mortality among women and it’s about six times more likely to cause mortality than breast cancer which is something that for many women is in the fore – or one of their major concerns about health. Heart disease is quite a bit more common.
Melanie: So, what are the – you know we have heard about these warning signs and heart attack warning signs the chest clutching, the left arm, you know we have seen that on TV and all those studies back in the day, Dr. Tighe were done, Framingham and all that were done on men. What is different for women? What might we notice that would say you know this could be one of those symptoms that they talk about?
Dr. Tighe: Right, well there is a combination of things. First of all, I mean the symptoms of – the classical symptoms that people were described in Framingham and in studies of men can still be present in women too, so you know those same symptoms may be identical, but women there’s a combination of things. I mean they may -the symptoms may be a little bit more protean, they may just feel uncomfortable or winded or like they are running out of energy. Not necessarily have typical chest discomfort. They may just be breathless and as we all do, you know you tend to minimize symptoms when people feel something, they may just say well I didn’t sleep well, I don’t feel well, my stomach is acting up. They may be dismissive, and that dismissiveness can sometimes leads to harm. So, listening to yourself and looking at also at the risk factors that you have. If you are a woman, if you are over 60, where women likelihood of having heart disease is equivalent to men. If you are a smoker or have other risk factors, diabetes, high blood pressure, high cholesterol. Certainly, a change in the way you are feeling, a change in energy, even if it is a subtle change. It might be an important change to discuss with your doctor.
Melanie: All good points and the fact is Dr. Tighe, women, we are the caregivers of society and they always say put your own mask on before you put the mask of your loved ones on but, as you say, we don’t always pay attention to those. We are stressed out. We are multitasking. We are busy doing other things. Some of these symptoms you mentioned could be a symptom of stress. That’s why so many of us just sort of pass it off and say oh you know. We hesitate to go to a doctor because we don’t want to be you know told oh, it’s really, it’s nothing, it’s just stress.
Dr. Tighe: Sure, and nobody wants to be – to jump the gun or to cry wolf or go to their doctor with complaints that they are worried about and turn out to be told that well it’s stress or it’s your stomach or nothing to worry about. But by the same token, you hate to be wrong. So, I think if you are having symptoms that are new, symptoms that you don’t understand, symptoms that you are worried about and you have risk factors, you know you are an older person over 60. Women have the same risk of having heart disease over 60 that men do in terms of frequency. If you’re diabetic, if you are a smoker, if you have high blood pressure, or family history then you have to take these symptoms seriously. And it is better to be – to seek attention and be wrong than to not seek attention and find out that you have a heart problem after all.
Melanie: If we were to ask you what screening tests should we have. If we want to know, obviously we know if we have those risk factors smoker, obesity, diabetes, family history any of those; but if we want to get screened to see if there is plaques in our arteries or if pains that we experience might be related to heart disease, what do you recommend to women as some screening tools that you would say you know what, it’s not a bad idea if you have this?
Dr. Tighe: Well I think screening breaks into three different parts. Screening is looking at your risk factors, we talked about the Framingham study, the Framingham risk index. It’s a nice way to screen your risk factors. It looks at your blood pressure, it looks at your cholesterol, it looks at whether you are diabetic, and it looks at your blood pressure and sort of – it’s a clinical way of getting an idea of what your likelihood of having a heart event in the next ten years is. So, if you want to know based on my risk factors, is there an increased chance of me having heart disease as I get older, that’s a nice way to start. A calcium score – we had a discussion about calcium scores a few weeks back. A calcium score is a perfect test in this situation. A person with no symptoms, has some risk factors, may be not a lot of risk factors, maybe only a couple, a calcium score is a test where we can do a non-contrast CT scan of the chest that allows us to look at the coronary arteries and see if calcium is depositing on the coronaries which is the diagnosis of coronary disease. That is atherosclerosis, so it makes the call. If you had symptoms, problems in the chest, trouble breathing, changes in energy, and you have risk factors, then this is a good reason to think about a screening stress test. Stress testing in people without symptoms is debatable as to whether that is helpful or not. But definitely if you have symptoms and you have an intermediate risk of having heart problems, then it’s worthwhile to do that to assess for the presence of heart muscles that may be in jeopardy.
Melanie: And what about things like stress, high blood pressure, how much do they contribute to heart disease and what do you tell women and men about dealing with those kinds of inflammatory things like stress and high blood pressure?
Dr. Tighe: Well high blood pressure is a medical illness and needs treatment just like any other medical illness does. It’s a chronic condition. It requires treatment and as just does diabetes, or high cholesterol in certain people require treatment, blood pressure control is really a critical thing. Stress be it is situational or emotional or just the usual sort of multiple stressors from living in an active and demanding lifestyle that many of us do, is tough. That’s a harder one to manage because a lot of those stressors we are obliged to own them. So, it is finding a way to sublimate some of that stress, regular exercise is a nice one. I think that that’s a healthy way to deal with stress. Being able to delegate and take the assistance of others, taking time for yourself to recreate, these are all important things to do. And as we get older and as we get more burdened with things, you can’t forget yourself. You pointed out that women bear a lot of weight in terms of the demands of their family, the demands of their careers, the demands of their children, you do have to – we sometimes put ourselves last in that equation, but you do have to take a little bit of time for yourself as well too.
Melanie: Dr. Tighe, we hear a lot in the media about meds and reducing our risks, and we have heard about aspirin taking a baby aspirin every day. When does a person a woman or a man know that this is the right thing to do to take a baby aspirin every day?
Dr. Tighe: Well this is a question that has been well-researched, and it depends on gender. In men, it has been well-demonstrated that even with one risk factor above age 40 that there is a pretty good indication particularly in folks with diabetes or in multiplicity of cardiovascular risk factors like smoking and high blood pressure that they would benefit from a daily low dose aspirin as primary prevention for a coronary event. That meaning they don’t have any coronary disease that we know of but that low dose aspirin will reduce the chance of a first event like a heart attack or a stroke. Less clear in women. A large study that looked at this, the Women’s Health Initiative looked at this back a number of years ago and they found that actually in women who were treated with low dose aspirin for primary prevention, no known disease, will aspirin help. It turned out that they were more like to have GI complications than they were to prevent a heart attack or a stroke. That’s not true if they have coronary disease. So, any gender independent men and women, both benefit from low dose aspirin if they have coronary disease. So, if you have a positive calcium score, if you have a stent, if you have diabetes which is so closely related to heart disease that they are almost the same thing; then low dose aspirin men and women benefit.
Melanie: Absolutely and great points all. So, wrap it up for us Dr. Tighe with your best information, best advice about heart disease and women and what you want us to know about hopefully preventing it in the first place and those risk factors that we can control, doing something about them.
Dr. Tighe: Well, I think the important thing for women to recognize is that heart disease is very prevalent. It will likely be the reason that most of us will die. That includes men and women. Although women’s onset of heart disease is a little bit later in life, into their 60s as opposed to into their 40s as men typically have their onset of heart disease. It nonetheless, reaches the same frequency as men in their 60s, so, it’s very prevalent. There are risk factors that are well-recognized including high blood pressure, smoking, high cholesterol, diabetes, overweight, inactivity, and family history and if you have one or more of those cardiovascular risk factors, it is worth seeing your doctor and sitting down and looking at your risk factor profile, getting a clinical gestalt of what your risk is by the Framingham index, thinking about a calcium score if you have more than one of these risk factors, it may be a way of confirming or refuting the presence of coronary disease. Also by all means seeing a doctor and being referred for some type of functional testing to see whether or not there is a heart muscle that is having a problem with impaired blood flow.
Melanie: Thank you so much Dr. Tighe, it’s really such important information and not only this time of year but really all year round for women to hear and take care of themselves. This is Doc Talk presented by St. Luke’s Cornwall Hospital. For more information, please visit www.stlukescornwallhospital.org that’s www.stlukescornwallhospital.org . I’m Melanie Cole. Thanks for tuning in.
How the Warning Signs of Heart Disease are Different in Women than in Men
Melanie Cole (Host): Did you know that heart disease is the number one killer of women and is more deadly than all forms of cancer combined. That’s really quite a statement to make, but the warning signs for women are not the same as men. My guest today is Dr. Jack Tighe. He’s the medical director of St. Luke’s Cornwall Hospital’s Cardiovascular Institute. Welcome to the show Dr. Tighe. How prevalent is cardiovascular disease in women?
Dr. Jack Tighe, MD (Guest): Well thanks Melanie for having me here today. Heart disease in women is very prevalent and this is a well-timed session here now at the end of heart month for women. It’s the number one cause as you pointed out in your introduction of mortality among women and it’s about six times more likely to cause mortality than breast cancer which is something that for many women is in the fore – or one of their major concerns about health. Heart disease is quite a bit more common.
Melanie: So, what are the – you know we have heard about these warning signs and heart attack warning signs the chest clutching, the left arm, you know we have seen that on TV and all those studies back in the day, Dr. Tighe were done, Framingham and all that were done on men. What is different for women? What might we notice that would say you know this could be one of those symptoms that they talk about?
Dr. Tighe: Right, well there is a combination of things. First of all, I mean the symptoms of – the classical symptoms that people were described in Framingham and in studies of men can still be present in women too, so you know those same symptoms may be identical, but women there’s a combination of things. I mean they may -the symptoms may be a little bit more protean, they may just feel uncomfortable or winded or like they are running out of energy. Not necessarily have typical chest discomfort. They may just be breathless and as we all do, you know you tend to minimize symptoms when people feel something, they may just say well I didn’t sleep well, I don’t feel well, my stomach is acting up. They may be dismissive, and that dismissiveness can sometimes leads to harm. So, listening to yourself and looking at also at the risk factors that you have. If you are a woman, if you are over 60, where women likelihood of having heart disease is equivalent to men. If you are a smoker or have other risk factors, diabetes, high blood pressure, high cholesterol. Certainly, a change in the way you are feeling, a change in energy, even if it is a subtle change. It might be an important change to discuss with your doctor.
Melanie: All good points and the fact is Dr. Tighe, women, we are the caregivers of society and they always say put your own mask on before you put the mask of your loved ones on but, as you say, we don’t always pay attention to those. We are stressed out. We are multitasking. We are busy doing other things. Some of these symptoms you mentioned could be a symptom of stress. That’s why so many of us just sort of pass it off and say oh you know. We hesitate to go to a doctor because we don’t want to be you know told oh, it’s really, it’s nothing, it’s just stress.
Dr. Tighe: Sure, and nobody wants to be – to jump the gun or to cry wolf or go to their doctor with complaints that they are worried about and turn out to be told that well it’s stress or it’s your stomach or nothing to worry about. But by the same token, you hate to be wrong. So, I think if you are having symptoms that are new, symptoms that you don’t understand, symptoms that you are worried about and you have risk factors, you know you are an older person over 60. Women have the same risk of having heart disease over 60 that men do in terms of frequency. If you’re diabetic, if you are a smoker, if you have high blood pressure, or family history then you have to take these symptoms seriously. And it is better to be – to seek attention and be wrong than to not seek attention and find out that you have a heart problem after all.
Melanie: If we were to ask you what screening tests should we have. If we want to know, obviously we know if we have those risk factors smoker, obesity, diabetes, family history any of those; but if we want to get screened to see if there is plaques in our arteries or if pains that we experience might be related to heart disease, what do you recommend to women as some screening tools that you would say you know what, it’s not a bad idea if you have this?
Dr. Tighe: Well I think screening breaks into three different parts. Screening is looking at your risk factors, we talked about the Framingham study, the Framingham risk index. It’s a nice way to screen your risk factors. It looks at your blood pressure, it looks at your cholesterol, it looks at whether you are diabetic, and it looks at your blood pressure and sort of – it’s a clinical way of getting an idea of what your likelihood of having a heart event in the next ten years is. So, if you want to know based on my risk factors, is there an increased chance of me having heart disease as I get older, that’s a nice way to start. A calcium score – we had a discussion about calcium scores a few weeks back. A calcium score is a perfect test in this situation. A person with no symptoms, has some risk factors, may be not a lot of risk factors, maybe only a couple, a calcium score is a test where we can do a non-contrast CT scan of the chest that allows us to look at the coronary arteries and see if calcium is depositing on the coronaries which is the diagnosis of coronary disease. That is atherosclerosis, so it makes the call. If you had symptoms, problems in the chest, trouble breathing, changes in energy, and you have risk factors, then this is a good reason to think about a screening stress test. Stress testing in people without symptoms is debatable as to whether that is helpful or not. But definitely if you have symptoms and you have an intermediate risk of having heart problems, then it’s worthwhile to do that to assess for the presence of heart muscles that may be in jeopardy.
Melanie: And what about things like stress, high blood pressure, how much do they contribute to heart disease and what do you tell women and men about dealing with those kinds of inflammatory things like stress and high blood pressure?
Dr. Tighe: Well high blood pressure is a medical illness and needs treatment just like any other medical illness does. It’s a chronic condition. It requires treatment and as just does diabetes, or high cholesterol in certain people require treatment, blood pressure control is really a critical thing. Stress be it is situational or emotional or just the usual sort of multiple stressors from living in an active and demanding lifestyle that many of us do, is tough. That’s a harder one to manage because a lot of those stressors we are obliged to own them. So, it is finding a way to sublimate some of that stress, regular exercise is a nice one. I think that that’s a healthy way to deal with stress. Being able to delegate and take the assistance of others, taking time for yourself to recreate, these are all important things to do. And as we get older and as we get more burdened with things, you can’t forget yourself. You pointed out that women bear a lot of weight in terms of the demands of their family, the demands of their careers, the demands of their children, you do have to – we sometimes put ourselves last in that equation, but you do have to take a little bit of time for yourself as well too.
Melanie: Dr. Tighe, we hear a lot in the media about meds and reducing our risks, and we have heard about aspirin taking a baby aspirin every day. When does a person a woman or a man know that this is the right thing to do to take a baby aspirin every day?
Dr. Tighe: Well this is a question that has been well-researched, and it depends on gender. In men, it has been well-demonstrated that even with one risk factor above age 40 that there is a pretty good indication particularly in folks with diabetes or in multiplicity of cardiovascular risk factors like smoking and high blood pressure that they would benefit from a daily low dose aspirin as primary prevention for a coronary event. That meaning they don’t have any coronary disease that we know of but that low dose aspirin will reduce the chance of a first event like a heart attack or a stroke. Less clear in women. A large study that looked at this, the Women’s Health Initiative looked at this back a number of years ago and they found that actually in women who were treated with low dose aspirin for primary prevention, no known disease, will aspirin help. It turned out that they were more like to have GI complications than they were to prevent a heart attack or a stroke. That’s not true if they have coronary disease. So, any gender independent men and women, both benefit from low dose aspirin if they have coronary disease. So, if you have a positive calcium score, if you have a stent, if you have diabetes which is so closely related to heart disease that they are almost the same thing; then low dose aspirin men and women benefit.
Melanie: Absolutely and great points all. So, wrap it up for us Dr. Tighe with your best information, best advice about heart disease and women and what you want us to know about hopefully preventing it in the first place and those risk factors that we can control, doing something about them.
Dr. Tighe: Well, I think the important thing for women to recognize is that heart disease is very prevalent. It will likely be the reason that most of us will die. That includes men and women. Although women’s onset of heart disease is a little bit later in life, into their 60s as opposed to into their 40s as men typically have their onset of heart disease. It nonetheless, reaches the same frequency as men in their 60s, so, it’s very prevalent. There are risk factors that are well-recognized including high blood pressure, smoking, high cholesterol, diabetes, overweight, inactivity, and family history and if you have one or more of those cardiovascular risk factors, it is worth seeing your doctor and sitting down and looking at your risk factor profile, getting a clinical gestalt of what your risk is by the Framingham index, thinking about a calcium score if you have more than one of these risk factors, it may be a way of confirming or refuting the presence of coronary disease. Also by all means seeing a doctor and being referred for some type of functional testing to see whether or not there is a heart muscle that is having a problem with impaired blood flow.
Melanie: Thank you so much Dr. Tighe, it’s really such important information and not only this time of year but really all year round for women to hear and take care of themselves. This is Doc Talk presented by St. Luke’s Cornwall Hospital. For more information, please visit www.stlukescornwallhospital.org that’s www.stlukescornwallhospital.org . I’m Melanie Cole. Thanks for tuning in.