Breast cancer affects one out of every eight women in the United States. Heart disease and stroke affects one out of every two women. In 2009, breast cancer killed 40,467 women in the U.S. Heart disease killed 292,188 that same year.
Most American women can identify breast cancer as a risk to their health but few can do the same for heart disease, says Martha Gulati, MD, co-author of an article published Sunday in the journal Global Heart. And not only are women unaware of the danger, the medical community does not treat them as thoroughly or as aggressively as men, despite heart disease killing both men and women equally.
Women don’t get the same screening, preventive treatment, or life-saving medications or procedures, Gulati explains. Gulati is a cardiologist at the Ohio State University and author of the book “Saving Women’s Hearts: How You Can Prevent and Reverse Heart Disease With Natural and Conventional Strategies.”
Although the overall death rate from heart disease in the United States has dropped by 30%, rates among younger women (55 years and younger) are actually rising. Women under 50 years old who have a heart attack related to heart disease are twice as likely as men to die. Forty-two percent of older women (over 65 years) who have a heart attack will die within a year, compared with only 24% of men.
We’re still in the infancy of understanding female cardiac health, says Gulati. “It’s only in the mid-90s to the early 2000s that people actually started focusing on women’s hearts,” she adds.
Physicians used to think that women didn’t have as many risk factors, but we now know this isn’t true. A woman with diabetes has three to seven times higher than normal risk of developing heart disease, while a man with diabetes sees only an increased risk of two to three times. Obesity also has raises heart disease risk more among women (64% for women compared with 46% for men). And then there are unique risk factors for women: elevated blood pressure during pregnancy (pre-eclampsia) and diabetes during pregnancy (gestational diabetes). Women who have either of these disorders have a higher risk of developing heart disease later on in life, as can women who have fluctuating or abnormal hormones. Certain autoimmune diseases, such as lupus and rheumatoid arthritis, are also risk factors, Gulati explains. And although these illnesses affect both genders, they do affect more women.
The heart’s physical make up is important too. Women have narrower coronary arteries than men and they have more “microvascular disease,” blockages of the tiniest blood vessels. Furthermore, women have a stronger familial risk. A woman who has a parent or sibling who has heart disease has a higher risk than a man would in the same position.
Symptoms among women can be quite different from men, so it might not occur to a woman or her family members that she may have heart disease – and even her doctor may not think of it. Many women who have had heart attacks report feeling “flu-ish” or sick to their stomach, never experiencing the chest-crushing pain that we often hear about. They may have, instead, an ache in their left arm, their jaw, or in their chest going through to the back.
If a woman does go the doctor or an emergency room, her treatment is often very different than what a man might receive, says Gulati. “We’re less likely to give them the lifesaving medications that we commonly give to men. We also often won’t give some of the lifesaving therapies like a cardiac catheterization or using thrombolytics. We don’t do that as quickly or as often.” But no one knows why this is, Gulati adds. Women are less likely to undergo revascularization, where a blocked blood vessel is opened up to allow for better blood flow or get an implantable defibrillator, a device that shocks your heart back into a healthy rhythm.
The community at large needs to be more educated, says Gulati. Before she wrote her book, Gulati did a survey that proved what she already suspected. Many women between their mid-thirties to early forties didn’t know or understand their risk of heart disease. But this is the time when they can do the most to help themselves. While not all heart disease can be avoided, 80% is preventable, Gulati points out. This means women need to be aware of their risks and they must make the time and the effort to keep as healthy as possible. And we have to make the medical system more accountable and ready to treat women properly and effectively.
“We should be horrified that we, as women, don’t get the same treatment as men when we come in with a heart attack,” Gulati says. “We should be horrified that we don’t get the same life-saving therapies.”
And those women who have beaten breast cancer? Most go on to live healthy and fulfilling lives – and often end up developing heart disease themselves. “Whether the increased [heart disease] risk is due to the breast cancer therapies or to the disease itself (which is associated with some of the same risk factors for [heart disease]) remains unknown,” the article says. One disease is not more important the other. We just have to make sure that one doesn’t overshadow the other.