Not all hearts are created equal. And that means the diseases that affect the heart aren’t, either.
For women, that’s a problem. Heart disease is the No. 1 killer of American women, more lethal than all forms of cancer combined, including breast cancer. But the nature of cardiovascular diseases in women, along with the treatments for those diseases, have been woefully understudied.
“The concept of women and heart disease is a really new concept; research has only included women to even a mildly significant degree since about 2000,” says Dr. Deirdre Mattina, director of the Henry Ford Women’s Heart Center. “We have very little data, really, to show which medications are equally effective in women and men. Even today, most trials only have about 20-25 percent women in the trial.”
A fair bit of press has been given to the fact that women experiencing a heart attack may have different symptoms than those commonly associated with men. Typically, women are less likely than men to go from feeling fine one minute to clutching their chest and collapsing the next.
But Mattina notes that people report a broad array of symptoms that can be linked to heart disease, from tingling in their shoulder to an all-over feeling of being unwell.
Instead, she says, the real gender difference is in cardiovascular anatomy and physiology.
Women are much less likely than men to have macrovascular disease — problems with the large blood vessels in the body, including those that supply the heart. Artery blockages can be ameliorated through bypass surgery or the insertion of a stent, which creates space in the artery for improved blood flow. Women, on the other hand, are much more likely to have microvascular issues: blockages in the tiny vessels.
“This becomes a problem, because they have the same symptoms, and outcomes are very similar for men and women who have big-vessel disease and small-vessel disease,” Mattina says. “However, there is a therapy for big-vessel disease, which is stents. But small vessels are very hard to even see with heart catheterization, and you can’t bypass them. So we’re really struggling with how to treat it in women.”
In addition, says Dr. Pamela Marcovitz, director of Beaumont Health System’s Ministrelli Women’s Heart Center, “women are more likely to have an unusual heart attack.” The most common mechanism for heart attack is rupture of an existing plaque. Women are more likely to have plaque erosion, which is a more gradual process — and which could be why women sometimes have different symptoms.
The Experience of Emotions
Another manifestation of heart trouble that primarily affects women is stress-induced cardiomyopathy — more commonly known as Broken Heart Syndrome. Occurring most often in postmenopausal women, the syndrome typically occurs after acute emotional distress, which can set off a physiological reaction that causes the heart’s pumping action to slow severely. The syndrome’s symptoms mimic a heart attack, so its sufferers are often sent for an angiogram, only to discover they have little or no heart disease.
“One of the things we know now is that the experience of emotions — it’s not just ‘in your head,’ ” says Ethan Kross, a professor of psychology at the University of Michigan who has studied the similarities between people’s experience of emotional and physical pain. “You can see how these emotions play out in your brain and how they play out physically as well. We shouldn’t ignore feelings of emotional distress just because people can’t point to a black-and-blue mark.
“We know that stress doesn’t just feel bad,” he adds. “We know what it does to your blood pressure, for example, quite directly. It can have implications for stress-hormone release, cellular aging — literally how your body is functioning.”
Fortunately, nearly all people with Broken Heart Syndrome recover completely, and rarely suffer it twice. For those with the syndrome, stress reduction is critically important, Marcovitz says.
Always the Caretakers
Elvira O’Bryan, 74, says she noticed nothing in particular before she developed serious cardiac issues.
“I’m not one that really pays much attention,” she says. “Women are like that; we’re busy being caretakers.”
The Troy resident had a strong family history of coronary heart disease — her mother had died at age 45 from heart failure — but regular stress tests had turned up nothing for years, so she eventually stopped getting them.
Then, one evening last May, O’Bryan’s chest started to hurt. She took several baby aspirin, felt better, and went to bed. The next day, she called the Ministrelli Women’s Heart Center, where she had been a regular patient for years. After performing an EKG, her doctor told her to high-tail it to the hospital. But O’Bryan needed to make arrangements for her puppy — she raised canines for Leader Dogs for the Blind — so she went the next day instead. She ended up needing a quadruple bypass.
Today, she says, “I feel great — I even moved the fridge and cleaned behind it.” Looking back, she says she doesn’t see any particular warning signs: “I didn’t realize I wasn’t feeling well. My tiredness, my lack of energy — I thought it was just aging. Seventy-four is no spring chicken. But now I’m going like I’m in my 40s.”
O’Bryan’s disregard for her fatigue isn’t unusual in women.
“Women are, in the majority of households, the primary caregivers,” Mattina says. “They’re busy taking care of everyone else and really don’t prioritize their own health in the equation.”
As a result, women can miss subtle symptoms of serious disease.
At Henry Ford Health System, an online quiz and screening are designed to help women (and men) tune into those symptoms and get the care they need.
The Heart Disease HealthRisk Assessment was rolled out on the health system’s website and social media about a year ago, says Ruth Fisher, the health system’s vice president of heart and vascular services.
The assessment takes 10-15 minutes and stratifies a respondent’s risk; those who are high-risk are contacted to see if they’d like to make an appointment or obtain a list of their local health care providers. Patients can submit comments and questions through the assessment and receive a response from staff.
Henry Ford also offers a $99 screening program that comprises seven tests with same-day results and a consultation with a physician. (Insurance companies often won’t pay for screening.)
“Before you leave, you know your risk and now you’re well informed,” Fisher says. “You can do more advanced testing or see your own physician.
“Often times you don’t know you have heart disease because you don’t feel it,” Fisher says. “So how do you know you have risk?”
Staving Off Heart Disease
The bad news is the medical establishment doesn’t know a lot about how to treat heart disease in women. The good news is that we know a lot about how to prevent it.
“Heart disease is on the decline for women, but not as much for men,” says Dr. Pamela Marcovitz, director of Beaumont Health System’s Ministrelli Women’s Heart Center. “The striking thing to me is that, in the case of coronary heart disease, we’re talking about a disease that is 80 percent preventable.
“No matter when you start changing, it’s never too late to improve your prognosis.”
How to keep your ticker tip-top
• If you smoke, stop. There is no single bigger behavioral risk factor for heart disease.
• Get moving. Aim for 150 minutes of aerobic exercise a week. Tackle that in whatever sized chunks you want, and don’t worry about getting to the gym — you can go for a brisk walk or explore short interval workouts at home.
• If you have a sedentary job, no matter how fit you are, get up and walk around for a few minutes every hour. “Sitting is the new smoking,” Marcovitz says. “The stats on it are alarming — the average adult sits for nine hours a day.”
• Eat whole grains, lean protein, legumes, and plant-based foods; this nutrition switch should be viewed as a long-term lifestyle change, not a short-term fix.
• Find ways to alleviate chronic stress. You may not have the time or money for regular yoga, but meditative breathing is free and helps in just a few minutes (find books and videos at your local library). In any case, deal with what ails your mind as well as your body.
• If you’re on medication designed to keep your cardiovascular system healthy, like a statin, keep taking it. That it’s working is not a sign that you no longer need it.