Many women worry when the number on their bathroom scale inches up or their favorite pair of jeans no longer fit. But, while most women may consider weight gain a top concern, they may be overlooking a larger danger to their health.
Cardiovascular disease (CVD), which includes coronary heart disease, heart attacks, heart failure, and stroke, is the number one cause of death in women. In 2016, it killed almost 400,000 women in America-more than breast cancer and every other type of cancer combined. Experts say that one in three women in this country will ultimately lose their lives to heart disease.
Yet nearly half of all women don’t realize the seriousness of this threat, according to a survey published in the June 2017 issue of the Journal of the American College of Cardiology. The study also finds that doctors often don’t ask the right questions to assess their female patients’ heart risks.
The gender disparity
Many women think that CVD is a man’s disease-and early in life men are more likely to have heart issues. But after menopause, the gender gap disappears. When a woman’s cardioprotective estrogen declines, her risk rises to rival that of a man.
Women face significant disadvantages when it comes to identifying and stopping heart disease. While men develop blockages in major coronary arteries, women tend to have narrowing of smaller blood vessels, which aren’t as visible on diagnostic tests. Since their symptoms are subtler than men’s, women often wait longer to seek medical attention. These combined factors often lead to delayed or missed diagnoses.
Women also tend to be treated less aggressively than men-even though research finds they would benefit just as much from such treatment. Women with high blood pressure or cholesterol often don’t get the drug therapy they need to bring their numbers into a healthy range. Those with existing heart disease are less likely than men to get treatments that could save their lives-like an implantable cardioverter-defibrillator to correct an abnormal heart rhythm, a stent to open blocked blood vessels, or cardiac rehabilitation to improve their overall heart health.
Complicating matters is that most studies done to evaluate new tests and treatments for CVD are conducted in men. That gender inequality makes it hard for doctors to know how safe or effective any intervention might be in women.
For all these reasons, women are at a disadvantage when it comes to surviving CVD. Although the death rate from heart disease has declined overall, the drop-off has been slower in women. And among women ages 35 to 54, CVD death rates have increased.
Nearly 75 percent of CVD in women is preventable with lifestyle modifications like getting exercise, eating a healthy diet, and quitting smoking. The trouble is, many women don’t implement these changes to protect their hearts because they’re unaware of their risks.
Lack of awareness
The Women’s Heart Alliance (a collaboration between Cedars-Sinai Heart Institute and New York-Presbyterian Hospital/Weill Cornell Medical Center) surveyed 1,011 women ages 25 to 60 and 200 primary care doctors, including ob/gyns, and 100 cardiologists. They found that 45 percent of the women didn’t know heart disease is the number one cause of death among their gender. Broken down by race, 73 percent of Hispanic women, 55 percent of African-American women, and 34 percent of white women were unaware that heart disease is the leading killer of women.
Almost 71 percent said they’d never brought up the issue of heart health during their checkups because they assumed their doctor would lead the discussion if there were a problem. Even women who thought they might already have a heart condition stayed silent. Only one-third of them sought medical attention.
The stigma of heart disease
One reason women may not be getting assessed properly for heart disease risks is the stigma that surrounds the disease. Most women surveyed knew that being overweight puts their heart at risk, but 45 percent canceled or postponed doctor visits until they had lost a few pounds-likely because they were embarrassed by the possibility that their doctor might call them out for being overweight. In fact, most women responded that they’d rather do their taxes than visit their doctor.
More than a quarter of the respondents said heart disease was embarrassing because “people just assume you are not eating right or exercising.” Overall, 57 percent knew they should be doing more to protect their heart health, but they found the effort sometimes overwhelming.
Don’t ask, don’t tell
The survey found that doctors might also bear some responsibility for women’s lack of heart disease knowledge and preemptive action. Only 16 percent of the women surveyed said their doctors had informed them of their risks-even though most respondents had at least one CVD risk factor.
Only 7 percent of doctors said they discussed heart disease at every visit-often because their patients had more pressing health issues or didn’t report heart-related symptoms. In fact, the most common advice doctors imparted to their female patients was-as many had feared-to lose weight. And just 16 percent of primary care doctors and 22 percent of cardiologists performed all eight of the American Heart Association’s (AHA’s) recommended heart disease risk assessments, which include evaluating personal and family medical history; heart disease symptoms; depression; and smoking, diet, and physical activity habits as well as measuring cholesterol, triglycerides, and blood sugar levels.
The lack of attention to women’s risks suggests that some doctors may not be prioritizing heart disease prevention by encouraging patients to control risk factors or consider low-dose aspirin or statin therapy if warranted. Still, most cardiologists (82 percent) and primary care doctors (64 percent) felt extremely or very well prepared to assess women’s heart health.
Know your risks
Because your doctor might not bring up heart disease during your visits, it’s up to you to broach the subject and ask about your risks.
You’re more likely to develop heart disease if you:
- Have diabetes
- Are overweight or obese
- Are physically inactive
- Have high blood pressure
- Have high cholesterol
- Have a history of pregnancy complications like a premature delivery, high blood pressure, or gestational diabetes
- Have an autoimmune disease, such as rheumatoid arthritis or lupus
- Have a history of breast cancer
- Suffer from depression
Finally, take preemptive action. Early intervention to control your risks can help you avoid a heart disease diagnosis and potentially avert a heart attack or stroke down the road. One way to lower your heart disease risk is by implementing the AHA’s “Life’s Simple 7”:
1. Manage blood pressure
2. Control cholesterol
3. Reduce blood sugar
4. Get active
5. Eat better
6. Lose weight
7. Stop smoking
These seven strategies can improve your heart health, as well as your overall health. Discuss them with your doctor at each visit.