Heart disease is the leading cause of death in women and a major cause of ill health and disability. Recent studies have suggested that women need to be more alert to the symptoms of heart disease and to seek treatment more promptly. Heart disease affects more women than men and more women die from heart disease than from all cancers combined.
Heart attacks are generally more severe in women than in men. In the first year after a heart attack, women are more likely to die than men are. In the first 6 years after a heart attack, women are almost twice as likely to have a second heart attack. These differences are because women tend to have heart attacks at older ages than men who have heart attacks.
When a woman experiences a panic attack, the body reacts by producing stress hormones. Symptoms such as chest pain, shortness of breath, pounding, rapid heartbeats (palpitations), sweating and a feeling of impending doom may occur. Transient burning in the chest, dizziness, weakness, nausea and severe indigestion along with a sense of panic are other common symptoms. Both panic attack and heart attack have similar symptoms because they trigger the body’s "fight or flight" response, but, if symptoms last for more than 2-3 minutes or the pain leaves and then returns, it could be a heart attack. Only by having testing can a correct diagnosis be made.
The American Heart Association has updated and sharpened its guidelines for preventing heart disease in women.
The focus now is on a woman's lifetime risk for heart disease, not just her short-term risk, as was the case in the 2004 guidelines.
The 2007 Guidelines for Preventing Cardiovascular Disease in Women are published this week in a special issue of the journal Circulation devoted to women's health.
Among other things, the guidelines refresh recommendations on aspirin use, hormone replacement therapy and vitamin and mineral supplementation.
"The new updated guidelines are extremely exciting, because they advance our science quite a bit and our ability to provide guidance to physicians and other health care providers on the best practices for prevention for women," said Dr. Lori Mosca, chair of the American Heart Association's (AHA) expert panel that devised the guidelines. She is also director of preventive cardiology at New York-Presbyterian Hospital in New York City.
Heart disease among women is practically epidemic, accounting for one in three female deaths.
When it comes to the prevention, diagnosis and treatment of cardiovascular disease, men have traditionally garnered more attention than women have. You might think this is because men are more susceptible to cardiovascular disease than are women. But in reality, more women than men die of cardiovascular disease each year. Women are six times as likely to die of heart disease as of breast cancer. Heart disease kills more women over 65 than all cancers combined.
"Cardiovascular disease is the leading cause of death among women," Mosca said. "The rate of awareness among women has increased from 30 to almost 60 percent, but we still need to work on the confusion around preventive strategies. We are very encouraged that the release of these new guidelines can help clear up some of this confusion and help our women engage in more conversations with physicians and health care providers as to what are the best strategies to reduce the burden of the number-one killer of women."
“Unfortunately the diagnosis of pulmonary hypertension is often delayed because of the nonspecific nature of the symptoms, such as shortness of breath with minimal exertion, fatigue, dizzy spells and fainting,” says Dr. Park. At the University of Maryland, patients undergo a thorough and careful evaluation to obtain accurate diagnosis and to consider all the treatment options.
Here are the high points of the new guidelines, which incorporate the latest science from recent randomized, controlled trials:
*Where once women were classified as being at high, intermediate or low (optimal) risk for heart disease, they are now considered high, at-risk or optimal (the latter group representing probably no more than 10 percent of women). The new stratification incorporates, but does not rely solely on, the conventional Framingham Score that doctors use to assess cardiovascular risk. It also takes into account lifetime risk, not just short-term risk. "We wanted to align more with clinical trial evidence and acknowledge that cardiovascular disease is so ubiquitous in women," Mosca said.
*Expanded lifestyle interventions include a continued emphasis on quitting smoking and avoiding secondhand smoke. This time, the guidelines also recommend counseling, nicotine replacement or other forms of smoking cessation therapy.
*All women are still urged to exercise a minimum of 30 minutes per day, but women who need to lose weight or maintain weight loss are now advised to engage in 60 to 90 minutes of moderate-intensity activity on most, or preferably all, days of the week.
*A heart-healthy diet should still be rich in fruits, whole grains and fiber foods with a limited intake of alcohol and sodium.
*Saturated fat should now be reduced to less than 7 percent of calories (the previous guidelines stated 10 percent).
*Women should eat oily fish, a source of omega-3 fatty acids, at least twice a week. "This is not recommended for all women but can be considered a balance of benefit and risk for women at high risk," Mosca said.
*Women at very high risk for heart disease should try to lower their LDL ("bad") cholesterol to less than 70 mg/dL. Otherwise, high-risk women are still encouraged to lower their LDL to less than 100 mg/dL.
*Women aged 65 and over should consider taking low-dose aspirin on a routine basis, regardless of their risk. Aspirin has been shown to prevent both heart attacks and stroke in this age group. Diabetes, high blood pressure, and high cholesterol are major risk factors for heart disease. The same measures that help prevent or control these conditions will also reduce your risk for heart disease. For example, medicines for blood pressure such as ACE inhibitors also reduce the workload of the heart and other organs.
*Women under 65 should not be taking aspirin routinely, as it has been shown only to have a benefit for stroke prevention.
*The upper dose of aspirin for high-risk women is now 325 mg per day, up from 162 mg.
*As stated in the previous guidelines, neither hormone replacement therapy, selective estrogen receptor modulators or antioxidant supplements such as vitamins C and E should be used to prevent heart disease.
*Folic acid should also not be used to prevent cardiovascular disease, a major change from the last set of recommendations.
The current issue of Circulation also included heart information from several other studies:
*Age, rather than health care disparities, seems to explain why more women than men die in the hospital after a heart attack. "The differences in death rates are largely due to differences in age when the heart attack occurred and not due to differences in treatment," said Dr. Alice Jacobs, professor of medicine at Boston University School of Medicine, who was also involved with the new guidelines.
*Differences in an estrogen gene (ESR1) do not appear to affect the risk of heart attack and stroke in response to hormone replacement therapy, as was previously thought. The gene may, however, be associated with an elevated risk of breast cancer.
*Some 40 percent of postmenopausal women have "pre-hypertension," associated with a 58 percent higher risk of cardiovascular death, said researchers from the Women's Health Initiative. It's unclear if intervening in this group will reduce cardiovascular problems, Jacobs said.
*Supplementation with calcium/vitamin D had no effect on heart disease and stroke risk in postmenopausal women who were generally healthy.
*Estrogen, when delivered by patch or gel, does not seem to increase the risk of blood clots in the vein (venous thromboembolism or VTE). Only estrogen taken orally seems to increase this risk.
Some women who have a heart attack do not know it. Heart attack symptoms in women may be different from those experienced by men, Every minute counts, even if the symptoms seem to dissappear! Know that not everyone gets all of these warning signs. And, sometimes these signs can go away and return. Treatments are most effective if given within one hour of when the attack begins.
Signs of a Heart Attack:
*Chest discomfort or uncomfortable pressure, fullness, squeezing or pain in the center of the chest that lasts longer than a few minutes, or comes and goes.
*Spreading pain to one or both arms, back, jaw, or stomach.
*Cold sweats and nausea.
Make sure that your provider knows about any other medicines you are taking. If you decide you need to make changes in the way you live, you probably won't be able to turn your life around all at once. Try to develop healthy habits that incorporate lifestyle goals. If you do, you will greatly decrease your chances for developing heart disease.
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