Heart Attacks Hit Middle-Aged Women |
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Heart attack risk is rising in U.S. women -- decades earlier than you might expect. Find out why, and what women can do about it.
"I never thought it could happen to me." That's how Rose Rench reacted when doctors told her she was having a heart attack. At age 46, Rench was bewildered when she suddenly couldn't catch her breath while out for a walk on a sunny spring day. "I was young, I was 130 pounds, and I'd quit smoking a month before. I was healthy. But I couldn't breathe." Rench tells WebMD that she somehow drove herself home, but couldn't rest; her mind raced as she tried to gasp for breath. "I thought maybe I was having an asthma attack, though I’d never had asthma before. But I never thought of a heart attack," she says. Rench drove herself to the emergency room, where tests showed an 80% blockage in two of the arteries bringing blood and nutrients to her heart. She immediately underwent a procedure to open those clogged arteries and keep them open with stents, which are tiny mesh tubes used to treat blockages. Rench's story isn't as rare as you might think. A recent study shows that heart attacks are rising among middle-aged women, who have long been thought to be protected against heart disease -- at least until they reach menopause and lose the protective effect of the hormone estrogen. What's behind that alarming trend -- and what can women do to protect themselves from having a heart attack in middle age? The answers, heart experts tell WebMD, are all about raising awareness and taking action. Heart Attacks Rising in Middle-Aged WomenHere's a quick look at the rising heart attack rate among middle-aged U.S. women. That trend, reported in 2009, is based on more than 8,000 U.S. men and women aged 35-54 studied between 1988-1994 and 1999-2004. During both time periods, heart attacks were more common among men than women. But men's heart attack rate dropped from 2.5% to 2.2%, while women's heart attack rate rose from 0.7% to 1%. In short, heart attack rates headed down for men, and up for women. Why? Men had a few things going for them. Their blood pressure dropped, their HDL ("good") cholesterol improved, and they were less likely than women to smoke. "The lower rates of smoking, improved blood pressure levels, and improved HDL among men suggest that educational campaigns aimed at men are working," says researcher Amytis Towfighi, MD, of the University of Southern California. But women showed only one positive trend: an improvement in their HDL cholesterol level. They also had two major drawbacks: a higher rate of smoking and an uptick in diabetes, most likely because of obesity. Heart Attack Hazard: ObesityAbout 35% of U.S. women are obese, according to the CDC. And those extra pounds pack a cardiovascular threat. "We used to think obesity was a risk factor simply because it is associated with established risk factors such as high blood pressure and diabetes and high cholesterol levels. But now we recognize that by itself, it increases risk," says Martha L. Daviglus, MD, PhD, professor of preventive medicine and medicine at Northwestern University's Feinberg School of Medicine in Chicago and spokeswoman for the American Heart Association. Heart Attack Hazard: Missed DiagnosisThe rise in heart attacks among middle-aged women may be partly due to the fact that doctors are getting better at diagnosing them. In 2003, a study published in Circulation showed that female heart attack patients may not suffer the typical symptom of acute chest pain. Instead, they were more likely to have weakness, breathlessness, and fatigue. Nausea, dizziness, feelings of indigestion, and back pain were also linked to women's heart attacks. Doctors and heart organizations got the message out that women's heart attack symptoms can differ from men's heart attack symptoms. Then in 2009, a Canadian study of 305 men and women showed that both sexes were equally likely to report chest discomfort and other typical heart attack symptoms. The issue still isn't settled. "But we’re pretty much coming around to realizing the symptoms can be similar," Rita Redberg, MD, MSc, director of women's cardiovascular services at the University of California, San Francisco, tells WebMD. The bottom line, experts say, is that women should tell doctors about all of their symptoms. A bigger problem is that women are less likely to think they're having a heart attack and seek care, Redberg says. Take Rench, now 52, for example. Since her first heart attack, she has had two others, yet still failed to recognize the symptoms when they first struck. "I was doing aerobics when I felt a pain in my chest and thought I had just pulled a muscle," she says of her second attack. When she had her third heart attack, which occurred in 2009, "I was cleaning house and I felt butterflies in my stomach, flutters in my chest. But I continued cleaning for hours," she says. It wasn't until that night, around 9 p.m., that Rench finally went to the emergency room. If you think you may be having a heart attack, act right away, Daviglus says. "If you have pain, breathlessness, or other symptoms, call 911," she says. "Women tend to dismiss pain, saying, 'This will pass. It's probably nothing."' And although Rench drove herself to the hospital when she had her first heart attack, don't do that yourself. Call 911 instead; this is no time to get behind the wheel. Heart Attack Hazard: StressStress may also be driving up the heart attack rate in middle-aged women. But maybe not in the way you think. Think of stress as a tipping point -- one that tilts away from healthy self-care. "Stress is the last drop that fills the glass of water," Daviglus says. "By itself, I don't believe stress can cause a heart attack, but it does mean self-care goes to the bottom of the list. Trips to the gym, and healthy, home-cooked meals take backstage. And women may not take the time to get regular checkups" if they're too stressed to tend to themselves, she says. A stress-free life isn't realistic. But your response to stress may matter more than the stress itself. "It's not so much stress but how you deal with it. If you eat or drink too much to deal with stress, that is going to increase your risk," Redberg says. "But if you walk, take Pilates, do deep breathing, or have other positive coping mechanisms," you'll be helping your heart health, she says. Build your stress management skills, because you probably won't be able to get rid of all your stressors. Heart Attack Hazard: Unrecognized RisksAnother threat to middle-aged women's hearts is a gender gap in recognizing and addressing risk factors that can be prevented -- such as high blood pressure, high cholesterol, obesity, and smoking. Rench had a risk factor she couldn't help: Her family history of heart disease. She says that before her first heart attack, she told her doctor that her parents and two brothers had died of heart disease and asked if there were steps she should take to prevent having a heart attack herself. Her doctor replied, "'Women do not have heart attacks before age 50.' End of discussion," recalls Rench, who switched doctors after that. "We need to do better at recognizing and treating risk factors in women," says Erin Donnelly Michos, MD, MHS, assistant professor of medicine in the cardiology division of Johns Hopkins School of Medicine in Baltimore. Consider this: Studies have shown that men have their cholesterol checked more frequently and treated more aggressively than women. Men are also more likely to control their high blood pressure, and to get aspirin, beta blockers, and cholesterol-lowering statin drugs if they have a heart attack. So far, data don't show that women are at greater risk than men for heart disease. "But if we don't take care of the problem, women will be showing up with higher blood pressure and higher cholesterol levels -- and higher heart attacks rates -- than men," Daviglus says. If that frightening prospect sounds familiar, it's because we’ve seen it before -- with lung cancer. For years, lung cancer was more common in men than in women. But as more women started smoking, their lung cancer rates rose, narrowing that gap. Delete Your Heart Attack HazardsHere are five things women can do to avoid a middle-aged heart attack: 1. Recognize your risk. Heart disease is the No. 1 cause of death among U.S. women. Awareness about heart disease in women is rising, but still has a ways to go. "As with any educational process, we have to keep reminding women -- and doctors -- over and over," Redberg says. 2. Know your numbers. "You should know your BMI, waist circumference, blood pressure, total cholesterol, LDL cholesterol, HDL cholesterol, and triglyceride levels, as well as your family history," Michos says. "And know the target levels for women your age." Michos says she's had patients who were shocked to learn their blood pressure and cholesterol numbers were off target, often because they had no idea what their optimal levels were. "They just assumed they were not at risk. You need to know the target. If you’re not on target level, make an appointment with your doctor and go over each risk factor," Michos says. 3. Consider getting an ECG. Daviglus suggests that people with one or more heart disease risk factors -- such as family history of heart disease, hypertension, diabetes, abnormal cholesterol readings, tobacco use, excess weight, poor diet, and physical inactivity -- get an electrocardiogram (ECG) in their 40s. "If it’s normal, you don't have to have one every year. But that gives doctors a baseline to compare to in the future -- much like your first mammogram," she says. 4. Upgrade your health habits. You've heard it before: Eat right, exercise regularly, and don't smoke. Some tips:
5. Take a holistic approach. Not all causes of heart disease have been defined. Stress, poor sleep, and periodontal disease, for example, are increasingly being recognized as contributors. Attending to your health in general is a good bet all around. |
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