Preventing Heart Attacks in Women A Top Cardiologist Explains How to Avoid Heart Problems

Many of us still believe the myth that heart attacks are mostly a male problem. But every year, 435,000 American women have heart attacks, and 267,000 die as a result. Cardiologist Jennifer Mieres, M.D., explains how women’s symptoms differ from men’s and how to protect yourself... Not all doctors are up to date when it comes to heart attacks in women. “I still hear complaints from women who had classic heart attack symptoms, and their doctors paid no attention,” says Jennifer Mieres, M.D., a cardiologist at the North Shore-Long Island Jewish Health System in Manhasset, N.Y., and spokesperson for the American Heart Association. “Sometimes you need to get a second opinion or another doctor.” Besides finding the right doctor, there’s a lot women can do to protect themselves from heart problems, she says. In this exclusive Lifescript interview, Mieres shares important facts about heart attacks in women. What occurs during a heart attack? A heart attack happens when blood flow to the heart muscle is interrupted or stopped. [It typically occurs] when there’s a buildup of fatty plaque in the arteries, causing a blood vessel rupture, which then forms a clot that can block off the artery. If blood isn’t flowing to the heart as it should, the heart is starved of oxygen. What are signs of a heart attack in women? How are they different from men’s? Many women have the same symptoms men do – chest pain or pressure that can extend to the neck and down the left arm. But women are more likely to experience pain in the jaw and upper-left back, shortness of breath, nausea or dizziness, and unusual fatigue. During a heart attack, women also are more likely to have feelings of doom and gloom, an unexpected panic attack or cold sweats. If these symptoms don’t go away for 15 minutes, call 911. If they ease but persist for a half hour, you should still call 911. What are the most effective ways to prevent heart attacks in women? Find out if you have [heart attack] risk factors like high cholesterol, high blood sugar or high blood pressure by getting regular checkups. You may need to make changes in your diet and exercise more. Or if that doesn’t work, talk to your doctor about medications that can help in conjunction with lifestyle changes. Don’t smoke. If you do smoke, quit. Try to avoid secondhand smoke too, since it is just as likely to contribute to heart attacks. Exercise briskly for a half hour most days – it can be broken down into 10 minutes, three times a day – and if you’re overweight, bring your weight down to a normal range. Finally, get enough sleep. Why would lack of sleep set the stage for heart attacks in women? Getting less than six hours of sleep a night increases a woman’s heart attack risk. Lack of sleep raises blood pressure and stress hormones. It also causes inflammation of the arteries, which plays a role in the buildup of plaque that can trigger heart attacks. If an immediate family member has suffered a heart attack, does that increase a woman’s heart attack risk Family history is important. If your mom had a heart attack by her 50s or your dad in his 40s, you’re more likely to develop heart disease. If a sibling had a heart attack at a young age, there’s an even stronger link. Trouble isn’t inevitable, but you need to closely track your [heart attack risk] factors and do everything you can to prevent problems. Can aspirin or supplements – for example, vitamins C or E or omega-3 – help ward off heart problems? Aspirin helps prevent men’s heart attacks, but the evidence isn’t as clear for women. If you have many [heart attack] risk factors, though, taking a baby aspirin every day is recommended for women of any age – with their doctor’s OK. Women in their 60s are advised to take aspirin because it prevents stroke, which has many of the same risk factors as heart attacks. Studies haven’t found that vitamins C and E help the heart. On the other hand, omega-3 may be worth taking if you’re not getting it from fatty fish twice a week. Omega-3 can reduce inflammation in the arteries and blood-clotting that causes heart attacks. Does red wine really help? There’s some benefit in women drinking 4-6 ounces – that’s one glass – of red wine a day. And some evidence suggests other kinds of alcohol are protective too. But if you’re not a drinker, don’t start, because there are better ways of protecting your heart, with no downside, such as a low-fat diet, 30 minutes of brisk exercise most days, and not smoking. Does having diabetes affect a woman’s heart attack risk? Women with diabetes are 3-7 times more likely to have heart attacks than women without diabetes. We think that’s because diabetic women have a greater plaque buildup and it’s more widely deposited across the arteries. But that underscores the value of not being overweight, which raises your risk for type 2 diabetes. Does it matter where a woman carries the extra pounds? For example, if it’s mostly in her thighs and hips rather than the tummy, is she as likely to have a heart attack? If you carry the weight around your waistline, studies suggest there’s a stronger link to heart disease. But being overweight, wherever you carry the pounds, makes you more vulnerable to heart attacks. If you’re overweight – even if you’re fit aerobically – you’re still more likely to have a heart attack than a fit woman of normal weight. Is hormone replacement therapy safe for women’s hearts? The bottom line is that it’s safe to use combined hormones – estrogen and progesterone – for a few years at menopause. But they don’t prevent heart attacks [in women]. What’s the relationship between stress and heart attacks in women? Stress drives up blood pressure and stress hormones that hurt the heart. Women need to learn to relieve their stress. Try to put things in perspective: Control what you can and let the rest go. Take a stroll or meditate in the middle of a stressful day. Even a 10-minute break to listen to your favorite music can help. A circle of supportive friends really helps too. Besides checking cholesterol, sugar levels and blood pressure yearly, what other screening tests should women have? Even if you have no [heart attack] risk factors, get a baseline EKG [electrocardiogram] in your 40s. After age 45, if you have no symptoms of [heart problems] but have risk factors such as hypertension or diabetes, get a yearly EKG because it can detect “silent heart disease” that produces no symptoms. If you don’t have any symptoms or risk factors, consult your doctor on how often to get an EKG – it’s a judgment call. There are no clear-cut scientific guidelines on how frequently women need them. Should women get high-tech scans for coronary calcium that indicates heart disease? Even with the radiation concerns? State-of-the-art scanners have radiation levels similar to standard X-rays, and you’re more likely to find these better machines at academic centers. Still, it’s radiation. You and your doctor have to balance the risks and benefits – don’t just do it without consulting your doctor. If you have a strong family history of heart disease but no risk factors, it might be worthwhile to get a scan in your 40s to see if you’re developing heart disease. A scan can also help if you have borderline high cholesterol but you’re not sure whether to go on medication. If you’re taken to the ER with possible heart attack symptoms, what should happen upon arrival? First, immediately tell the doctors that you think you’re having a heart attack, so you’re not left unattended. You’ll get an EKG. Then, even if you’re not having a heart attack, you’re likely to get either a stress echocardiogram with ultrasound while you’re on a treadmill or a stress nuclear cardiology test. Both show blood flow to the heart at rest, and if there are blockages with exercise. If you're having a heart attack, and especially if you’re at a hospital without equipment to do angiograms, you should get clot-dissolving medication within an hour of your arrival. The sooner, the better, because that limits damage to the heart. In many cases, especially if there’s a big blockage and angiogram equipment is available, patients with abnormal stress tests are given an angiogram immediately. For an angiogram, a small catheter is inserted in a leg or wrist artery, and threaded up to the heart. A dye is injected, enabling the doctor to see exactly where blockages are on an X-ray. Then, the patient gets angioplasty – a tiny balloon is expanded at that clogged point to widen the artery. Lastly, a stent – a small wire-mesh tube – is wedged in to help keep the artery open. Why do some women have bypass surgery instead? Is there a difference in recovery depending on how they’re treated? There's no single best treatment for all women having heart attacks. Different factors come into play according to your condition. [For example,] diabetics do better with bypass, as do patients with lots of blockages. Ask your doctor questions to find out your options. There should be a discussion. At age 45 or older, about one out of four American women who have a first heart attack die within a year, compared to one out of five men. And within 5 years of a first heart attack, roughly a third of men and half of women are dead. Why do heart attacks seem to kill more women? Men show up at the ER earlier, so they’re treated sooner with lifesaving strategies that prevent heart damage. Also, women typically have more advanced heart disease by the time they come to the ER with a heart attack, so there’s already been more cardiac damage. Women are also about 10 years older than men by the time they have a first heart attack, so they often have other medical problems too. And women are less likely than men to go for cardiac rehab after a heart attack. Rehab gets you into a monitored exercise program. You’ll receive good diet information and benefit from a support group. Why are women less likely to get cardiac rehab? Sometimes women don’t want to go to cardiac rehab – they’re worried about the household activities and caring for everyone else – and their own health is last on the agenda. Medical teams should spend time to educate women about cardiac rehab and stress its importance. There is also still a need to remind and educate some doctors about the benefits of cardiac rehab in women. And women need to be proactive, to ensure that they get the rehab they need for better recovery after heart attacks. To learn more, visit our Heart and Heart Attack Health Centers. Are You on the Road to a Heart Attack? Every 20 seconds, a heart attack occurs somewhere in the United States. Coronary heart disease, the leading cause of death in this country, contributes to the 1.5 million heart attacks that occur each year.