Many doctors still don't understand how heart disease can look in women, which in part explains why more women than men are now dying of heart disease, according to new findings. Women are dying unnecessarily, says C. Noel Bairey Merz, M.D., the director of the Women's Heart Center at Cedars-Sinai Medical Center in Los Angeles, because doctors are not recognizing the disease and are therefore failing to prescribe the medications that would save lives.
Bairey Merz says doctors need to learn about how heart disease affects women, and she notes that women increasingly are dying of the disease at younger ages. She presented her findings Oct. 14 at an American Physiological Society conference in Jackson, Miss.
The most recent figures from the American Heart Association show 422,000 women died of cardiovascular disease in 2007, compared with 392,000 men. Although these numbers are down from 490,000 for both sexes in 1984, heart disease remains the leading cause of death for both women and men in the United States.
Before the routine use of the angiogram — a type of x-ray that provides images of any blockages to the blood flow in the coronary arteries — essentially all men and women with chest pressure, shortness of breath and other heart attack symptoms were given heart medications, Bairey Merz says.
But it is possible to be on the verge of a heart attack and still have clear coronary arteries, Bairey Merz says. In 10 to 30 percent of women, and a much smaller percentage of men, the disease involves the small arteries failing to dilate and constrict properly to ensure enough blood and oxygen reach the heart.
Less than 25 percent of these patients will receive any treatment, because the angiogram showed their larger heart arteries were clear, Bairey Merz says, explaining: "The angiogram trumps all other thinking." She says her conclusions are based on 16 years as chair of an ongoing National Heart, Lung and Blood Institute study, in which researchers followed 936 women experiencing chest pain or a suspected heart attack from 1996 to 2000.
Nisha Chandra-Strobos, M.D., chair of cardiology at Johns Hopkins Bayview Medical Center, agrees that physicians "need to be alert to the fact that a middle-aged, overweight woman with shortness of breath could just as easily have heart disease rather than [simply be] ... out of shape."
And yet, while the small vessel condition is a concern and "warrants further study," Chandra-Strobos says, coronary artery disease is still by far the biggest killer of both men and women. Genetics contribute to heart disease, she says, but men and women can reduce their risk by avoiding tobacco, exercising, maintaining a healthy weight and recognizing the symptoms.
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Jennifer Anderson is a health and science writer.