Ladies First: Recognizing the Symptoms of Acute Coronary Syndrome in Women
03/11/2004.
Heart disease is the leading cause of death among women in the United States. 43% of these deaths, nearly 500,000 annually, are caused by cardiovascular disease.
Of that 43%, roughly three quarters may be attributed to heart disease, while the remaining one quarter are a result of stroke. Furthermore, 267,000 women die each year from heart attacks, which kill six times as many women as breast cancer.
Equally surprising is the fact that coronary heart disease is as prevalent in women as it is in men. Currently 8,000,000 American women are living with heart disease – 10% of women ages 45 to 64 and 25% of women over the age 65. Today, 6,000,000 women have history of heart attack, angina or both, and nearly 13% of women age 45 and over have had a heart attack.
Unfortunately, as compared to men, the long-term outcome for women with coronary heart disease is not as favorable.
38% of women and 25% of men will die within one year of a first recognized heart attack. 35% of female heart attack survivors will have another heart attack within six years, while just 18% of male heart attack survivors (nearly half as many) will experience a second heart attack. Similarly, 46% of female heart attack survivors will be disabled with heart failure within six years, whereas only 22% of male heart attack survivors will suffer the same fate. Finally, women are almost twice as likely as men to die after bypass surgery.
This gender discrepancy in outcomes has been related to poor recognition of coronary heart disease in women and therefore less aggressive treatment. At present, women are less likely than men to receive beta-blockers, ACE inhibitors or even aspirin after a heart attack. More women than men die of heart disease each year, yet women receive only 33% of angioplasties and stents; 28% of implantable defibrillators and 36% of open-heart surgeries.
Therefore, patients and physicians cannot rely upon the symptom of chest discomfort to recognize coronary heart disease in women.
Physicians who treat women should routinely screen for and aggressively treat coronary risk factors. Additionally, these physicians should have a low threshold for screening for coronary heart disease when at-risk women present symptoms of fatigue, new-onset weakness, sleep disturbances, shortness of breath or chest discomfort.
Good websites to refer women patients to include www.womenheart.org and www.americanheart.org.
Five Facts about the Fairer Sex.
The presence of traditional risk factors for coronary heart disease such as hypertension, diabetes, obesity, sedentary life style, smoking, and dyslipidemia denote a high risk group of women.
- Women who smoke risk having a heart attack 19 years earlier than non-smoking women.
- Women with diabetes are two to three times more likely to have heart attacks.
- High blood pressure is more common in women taking oral contraceptives, especially in obese women.
- 39% of white women, 57% of black women and 57% of Hispanic women are sedentary and do not participate in any physical activity.
- 23% of white women, 38% of black women and 36% of Hispanic women are obese.
A recent study published in Circulation may explain the poor recognition of coronary heart disease in women. The most common prodromal symptoms in women before an admission for myocardial infarction or unstable angina were:
- (71%) Unusual fatigue
- (52%) New-onset weakness
- (48%) Sleep disturbances
- (42%) Shortness of breath
- (30%) Chest discomfort