Women and Heart Disease

K. took a zig-zag course across the parking lot, stepping briskly around the
puddle rims. Fit and vigorous at 71, K. was anxious to get to work but felt
an unaccustomed chest pain upon getting indoors and needed to sit down. The
pain was dull and radiating and accompanied by a flush of heat and
perspiration. Five minutes later, the pain subsided. "Stomach trouble," K.
thought, and didn't give the matter much thought until the next morning,
when the scenario recurred. The next day, same sequence. Indigestion is
rarely so punctual. That afternoon, K. walked into a hospital emergency

If K.'s story conjures the image of a nicotine-stained, slightly paunchy
businessman suffering a heart attack, think again. The stereotyped candidate
for heart attack may be overweight, overachieving, under-exercised,
hypertensive-and resoundingly male-but the fact is coronary heart disease is
no more a "man's disease" than is the flu.

Of the one million Americans with the disease, virtually half are women. Of
the half-million fatal heart attacks in the United States every year,
247,000 occur in women. Among the fortunate survivors of heart attack is
K.--for Katherine--a Boston suburbanite now doing well after her mild heart
attack in 1993.

Coronary heart disease is the number one cause of premature death-in men and
women-in the industrialized world. Women are six times more likely to die of
a heart attack than of breast cancer. And women who have a heart attack are
twice as likely to die within a few weeks as men who experience a similar

Whence, then, the notion that coronary heart disease is a problem that only
men need worry about? Blame it partly on biology: statistics show that heart
attacks in women before the age of menopause are rare. A 40 year-old woman
has only about one-fourth the chance of dying from heart disease of a man
the same age.

But there are other reasons for the misconception. Inadvertently, perhaps,
it has been reinforced by researchers who have studied coronary artery
disease and doctors who have treated it. Until recently, nearly all
epidemiologic studies of coronary disease-what causes it, how it can be
treated, and how it can be prevented-have been performed on men. And there
is abundant evidence, some scientific, some anecdotal, that physicians have
treated coronary disease less aggressively in women than in men.

Whatever the roots of this bias, it has left many women with a false sense
of safety-one that could imperil their lives. "Traditionally, women have not
believed they would get heart disease, so they haven't sought treatment as
aggressively as men have," says Elizabeth Ross, a cardiologist and head of
the committee on women and heart disease at the Washington, D.C., chapter of
the American Heart Association (AHA). "A man may be playing racquetball and
feel a pain in his chest and think right away that it's a heart attack. A
woman may experience chest pain and dismiss it as indigestion and not seek
prompt treatment."

Such delays can be catastrophic. Modern blood-thinning drugs used to treat
heart-attack victims are most effective if administered within four hours of
the onset of symptoms. A woman who dismisses the symptoms of a heart attack
as stomach trouble, who lies down and tries to "sleep it off" before seeking
treatment can do irreparable, possibly fatal, damage to the heart.

Recently, however, women's heart disease has begun to emerge from its public
eclipse. A massive public-information campaign by the AHA has spread the
word that older women are just-or nearly-as likely to develop coronary
disease as men are. And physicians are becoming more attuned to signs of the
disease in their female patients. "There has been a definite
consciousness-raising about this issue," Ross says. "The prevalence of heart
disease in older women, combined with the fact that women tend to live
longer than men, mean that women's heart disease is going to be a public
health issue for a long time to come."

by Robert Levy

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