Preventing Heart Disease in Women

Do you understand the causes and symptoms of heart disease in women? Probably not – and what you don’t know could hurt you, says renowned cardiologist C. Noel Bairey Merz, M.D. In an exclusive Lifescript interview, she explains that because most heart research has been done on men, you could have a heart attack and not even realize it…

If you had chest pains, you’d probably guess right away you were having a heart attack. But what if your symptoms were fatigue, jaw pain or even nausea – would you know they might signal a cardiac emergency? Would your doctor?

That’s just one of the major differences in the symptoms of heart disease between men and women.

To get the facts on heart disease in women, we talked with leading cardiologist C. Noel Bairey Merz, M.D. She’s director of the Women’s Heart Center at Cedars-Sinai Medical Center in Los Angeles, which leads cutting-edge research on gender differences in cardiovascular disease.

In this exclusive Lifescript interview, Bairey Merz discusses the new realities of heart disease in women, how women’s risk factors have changed over the years, and the best ways to live a heart-healthy lifestyle.

What’s the top myth about heart disease in women?
The biggest myth is that only elderly women get heart disease, and young women are protected. In reality, heart disease kills more young women – even 20- to 25-year-olds – than breast cancer.

It’s also the leading killer of midlife women, ages 45-65, and older women too.

Why is there so much misinformation on the subject?
When heart disease was first studied in the 1950s, it was identified as something that killed middle-aged men … and it’s true that, at that time, more men died than women.
But demographic trends have changed. Now, more women die than men [because warning signs are not recognized]. Still, medical schools continue to teach that it’s predominantly a male disease.

The other problem is that women often present different heart attack symptoms. Women themselves will under-recognize signs, just like physicians, because we’re all tutored to [recognize] a male pattern.

What are the differences in symptoms of heart disease?
About two-thirds of men will present with what we call the “Hollywood heart attack” – typically, pain or pressure in the middle of the chest. It might radiate to the jaw or arm, with some shortness of breath, perhaps some nausea.

Women’s symptoms might just be jaw or elbow pain, stomach upset or indigestion. It might only be some shortness of breath or a sense of overwhelming fatigue.

[These other symptoms] can arise in women at least half the time. Even some men will present [them].

Are these intense sensations?
Not necessarily – that’s what’s unnerving.

You need to [know] what’s typical for you. If you always get heartburn and indigestion after eating Dodger Dogs, I don’t want to hear about it at 2 a.m., because it’s probably not a heart attack.

But if this isn’t typical, if you don’t have any good reason to be up at 2 a.m. but you’re having indigestion and are a little sweaty – and it doesn’t feel like the flu and you don’t have a fever – go to the emergency room. It might be a heart attack.
What does the latest research show about symptoms of heart disease in women?
We’ve uncovered something called microvascular coronary dysfunction. Women present with persistent, sometimes disabling chest discomfort. They have an abnormal stress test, but when they have an angiogram, [it shows] the arteries are open.

We really put this on the radar as something that takes lives – and it’s more prevalent in women. We’re doing studies on the best ways to diagnose and treat it.

If doctors aren’t aware of this, what should a woman do if her symptoms are being dismissed?
If a woman is told by her physician or cardiologist that it’s “all in her head” – that it must be her gallbladder or stomach, or she’s hysterical – it is possible that she has microvascular coronary dysfunction. She should seek a health-care provider who’s willing to entertain that thought, or go to a high-quality women’s heart center. [Here’s a list of Women’s Heart Centers around the country.]

What are the major causes of heart disease in women?
There are five traditional risk factors: cigarette smoking, high blood pressure, high cholesterol, diabetes and family history – that is, a close relative who had cardiovascular disease (including heart attack, stroke, angioplasty or bypass) before age 60.

How have women’s risk factors changed over the years?
In the 1950s, it was uncommon for women to smoke cigarettes – and if they did, they didn’t smoke a pack a day. Now, women smoke just as much as men and it’s just as big a risk factor. If you smoke cigarettes, expect to have a heart attack or stroke.
The other thing is the aging of America. Heart disease is a chronic disease – most of us will get it if we live long enough. And women, on average, live 6-8 years longer than men.

If women want to live a heart-healthy lifestyle, what are the most important things they can do?
Follow these guidelines:

1. Avoid smoking and breathing other people’s smoke, which are major causes of heart disease. Nobody should smoke in your home, particularly if you have children there.

2. Do some physical activity for 30 minutes a day. It doesn’t have to be a specific aerobic exercise, or huffing and puffing at the gym. You just need to move your body through space. It also doesn’t have to be done consecutively. It could be intermittent stair-climbing if you work in an office.

3. Eat a heart-healthy diet. Mediterranean-style eating works for women and men – but that doesn’t mean having huge bowls of pasta or drinking a cup of olive oil every day.

It means eating 9-10 servings of fruit or vegetables per day, even though the average American has two servings. A serving is about what you can hold in your hand.

You also want complex carbohydrates – mostly beans and legumes, along with whole grains. Potatoes are OK, occasionally.

Eat fish once or twice a week – the size of your palm or a deck of cards. When you eat [meat], it should be in condiment portions – don’t sit down and eat one of those massive chicken breasts.

At the very top of the Mediterranean food pyramid is the occasional dessert – not every day.

4. Avoid being obese, which is defined as 20% over your ideal body weight. Just being overweight doesn’t seem to count for very much [added risk], especially if you exercise every day.

5. Last – and my personal favorite – is a single serving [4-5 ounces] of alcohol with a meal. It’s associated with longevity as well as a lower risk of heart disease.

That doesn’t mean seven drinks on Saturday night, or drinking at the bar while eating nuts.

And, obviously, this isn’t a medical advisement. Check with your own health-care provider about whether it’s reasonable for you.

How much impact do these habits have on cardiovascular risk?
There’s very relevant research on humans demonstrating this is how we should conduct our lives.

Among the populations that have these five health habits – and less than 10% are Americans – there’s an 80% reduced lifetime risk of cardiovascular disease.

How protective is HDL (“good”) cholesterol against the causes of heart disease?
I often hear from patients and even primary-care physicians that women with high HDL could never have a heart attack … that they’re protected even if their [total] cholesterol is high, they smoke, they’re overweight and have high blood pressure. That’s a huge myth.

I wish I had $100 for every woman I’ve cared for with high HDL who had a heart attack.

If a woman has heart disease, what medications are most effective?
For the 6 million women in the U.S. who have the traditional obstructive coronary disease, they should follow the same risk-reduction strategies as men.
That includes low-dose aspirin, beta blockers [which diminish stress hormones and lower blood pressure], angiotensin-converting enzyme inhibitors [ACE inhibitors, which treat high blood pressure and congestive heart failure] and a statin, which lowers cholesterol.

We call these medications “the magic pills.”

Barbra Streisand has endowed a fund to help with research and education about heart disease at the Women’s Heart Center at Cedars-Sinai. How did she get involved?
She understands that the leading killer of women is cardiovascular disease, and she responded to a call to help.

She has been a magnanimous benefactor and spokesperson, and we’re incredibly grateful for her support.

She has also pledged additional funds – if you donate on the CrowdRise website, she’ll match it.