About 40,000 women will die from breast cancer this year. As staggering as that figure may be, breast cancer is not the biggest health risk among the female population. Heart disease is, with an estimated 500,000 women dying each year from cardiovascular disease, which can lead to a heart attack, and stroke, which is a type of cardiovascular disease that occurs when blood vessels to the brain are blocked.
According to the American Heart Association, "one in 2.5 women will die of heart disease or stroke compared with one in 30 from breast cancer."
"Women's primary concern is breast cancer. They go for mammograms religiously. The fact of the matter is, more women die of heart disease," said Dr. Carol Cardinale, a cardiologist with Kaiser Permanente of the Mid-Atlantic States. "The big misconception is that heart disease is a man's disease."
CARDINALE SAID it has only been within the last five to seven years that attitudes toward women and heart disease have been changing. She said in the past, if a woman came into the emergency room complaining of chest pains, a doctor would presume the pains were masking something else. Whereas if a man complained of chest pains, it would be presumed it was a possible heart attack.
One of the reasons for the different treatment, Cardinale said, is because women often have different symptoms than men. A typical response for heart disease is chest pains or pressure in the chest that spreads to the shoulders, neck or arms. Most women, however, will experience chest discomfort, heavy fatigue, nausea, difficulty breathing, or abdominal pain.
"Women have varied complaints that could open the door to other things," Cardinale said. "We have to consider the more serious first. If a female patient sees a primary-care physician because she is getting fatigued walking up stairs, she needs to be referred to a cardiologist."
WOMEN WHO ARE at greater risk of heart disease, include those with a family history of diabetes, high blood pressure, a history of smoking regardless of whether the patient has quit, high cholesterol, obesity, post-menopausal women and someone who doesn't exercise.
"Anyone with composite risk factors, even only one, should be alerted to the possibility of the disease," Cardinale said.
She said 10 years ago, a woman who would come to see a doctor complaining of being fatigued would not have been given an exercise stress test, which is a screening tool for cardiovascular disease. Today, the stress test should be standard, and if the doctor does not recommend one, a patient with one of the risk factors, should request the test. Cardinale said it is not uncommon to have patients referred to her by their own request.
"Early signs will be vague. The symptoms don't scream out heart attack," Cardinale said. "The lay population needs to be aware. If the symptoms are persistent over time, are getting worse and are out of the ordinary for that person or are increasing in intensity, get to a doctor."
She said women also need to learn to recognize the symptoms and to seek help sooner. Typically a man experience what could be a heart attack will enter an emergency room within an hour. Women, on the other hand, will wait up to three or four hours before seeking help and by then, Cardinale said, the damage is already done.
CARDINALE ALSO CAUTIONED against self-diagnosis and self-medication.
"An aspirin a day is highly advantageous, for people at high risk for stroke or coronary disease. But, aspirin has some risks too," Cardinale said. "Don't take any supplements or over-the-counter medication without checking with your doctor first. There could be risks you don't know about."
The American Heart Association recommends women stay active and eat a balanced diet to lower the risk of heart disease. In addition, those with composite risk factors should be screened regularly; and when visiting a doctor, when asked about any medications the patient may be taking, include over-the-counter drugs and supplements.
"The ones that stay healthy are the ones that take the bull by the horns and get screenings. Women need to be more proactive," Cardinale said.