Thank goodness there is a lot more recognition of heart disease in women now. Appropriately, the emphasis on the topic of heart disease in the same month as Valentine’s Day helps both women and men focus on the number one killer of women after menopause.
When I was a medical student and for most of my career, the conventional thinking was that heart disease just wasn’t much of a problem in women. Estrogen was acknowledged to have a protective effect on the heart and blood vessels until menopause and after that -- well, there was no after that unless you wanted to prescribe an estrogen preparation. Estrogen supplementation is a whole different topic for another time.
My initiation into the world of hospital medicine was with a hard-driving, chain cigarette smoking (yes, inside the hospital), loud but brilliant male internist – may he rest in peace. He was often heard to say that women “will double cross you” on heart exams such as treadmill stress tests, because the results were not the same as those seen in men with heart disease. And some of those same women had the nerve to have a heart attack anyway.
Recognition of heart disease on older women was long in coming and recognition of heart disease in pre-menopausal women is still not on the radar screen for many health practitioners. Very few women internists go on to seek cardiology training. In 2002 about 10% of cardiology trainees were women and only about 6% of practicing cardiologists were women.
When I was growing up there weren’t very many women in the workforce and those that were working tended to be in “women’s jobs” such as nursing, teaching, secretarial work or service positions such as waiting tables. It was an assumption of the day that men’s work was harder and more stressful than women’s work and that the housewives who were in charge of raising children and managing a household were just doing what came naturally. Therefore it couldn’t be that stressful.
If you happened to be one of the working women during that period AND you were also raising children and managing a household, that was just your choice and you shouldn’t expect any assistance from your spouse regarding domestic duties. Also, in that era the harmful effects of cigarette smoking were not recognized as any more than an annoyance to those who didn’t smoke. Stress was believed to be the main cause of heart problems, so naturally, men would be the logical ones to be affected. We now know of many other risk factors that cause heart disease
Fortunately, a lot of those stereotypes no longer hold sway but there is still a long way to go in addressing the cause and prevention of heart disease in women. Women’s symptoms of heart disease are still described as “atypical”, harkening back to the belief that men’s symptoms are typical. But wait – aren’t we 51% of the population? Maybe it’s the other way around.
What did I mean earlier when I said that estrogen has a protective effect on the heart and blood vessels? It is believed that estrogen acts as an anti-oxidant and has a beneficial effect on blood lipids (fats) such as cholesterol and triglycerides and on blood sugar. You still produce some estrogen after menopause but in a much smaller amount and with a different chemical structure than during menstruation. In essence you lose whatever beneficial effect estrogen had on your cardiovascular system with the appearance of menopause.
Those other risk factors I mentioned are family history, high cholesterol, cigarette smoking, diabetes, high blood pressure, being overweight, having a sedentary lifestyle AND being under a lot of stress. Chronic stress from sheer exhaustion, from chronic depression or from constantly being the family referee leads to inflammation in the blood vessels and puts an extra burden on the heart.
Even in younger women, estrogen can only go so far and can’t reverse the negative effects of being an overweight, cigarette smoking, poorly controlled diabetic with high blood pressure who is trying to work full time, raise children and keep house. Nor can estrogen supplementation in older women override the stressful effects of being a full time caregiver for someone with a debilitating illness and has little to no social support, has her own health problems and who never has the opportunity or inclination to get any exercise.
Let’s move past our estrogen fixation and get down to the HEART of the matter. Symptoms of heart disease in women include chest pain/pressure, pain in the left arm or jaw, boring pain into the left back, shortness of breath with exertion, swelling in the feet and legs, poor exercise tolerance and nausea that can be mistaken for stomach upset. You may have other symptoms such as rapid pulse, irregular heartbeats, dizziness or fainting. And remember not all heart disease results in a heart attack. You may have developed other, chronic heart conditions such as atrial fibrillation, congestive heart failure or heart valve problems that need medical management before they lead to a stroke or other physical debility.
Visit Go Red for Women for more detailed information with hints and tips on how to prevent or manage your heart so you can keep on giving it to those you love.
