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>Heart Disease: What Women and Doctors Overlook

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Women Are Not Small Men
The following comes from Nica Goldberg, MD, a cardiologist and former chief of women’s cardiac care at Lenox Hill Hospital in New York City. She is assistant clinical professor at New York University School of Medicine, and author of Women Are Not Small Men: Life Saving Strategies in Preventing and Treating Heart Disease in Women (Ballintine) and The Women’s Healthy Heart Program (Random House). www.totalheartcare.com

Most women now know that heart disease is their single greatest health risk–geater than stroke and all cancers, including breast malignancies, combined.

However, many doctors still associate heart disease with men–and overlook it in women. That’s partially because a woman’s symptoms of heart disease or heart attack are different from symptoms in men–but no less dangerous.

Consider these facts:

  • A woman has a one in two lifetime risk of dying of heart attack. Her lifetime risk of dying of breast cancer is only one in 25.
  • Women are twice as likely to die in the first few weeks following heart attack. Fortunately, recent research has revealed ways to help protect women.

Delayed Onset:
Heart disease in women tends to become apparent about 10 years later than it does in men. The same risk factors that excuse men to have heart attacks in middle age are initially masked in women by the protective effects of estrogen, the hormone that is associated with healthy cholesterol levels. After menopause, sharp declines in estrogen dramatically increase a woman’s risk for heart attack.

Different Symptoms:
The classic heart attack symptoms, such as crushing chest pain or pain that radiates down an arm can affect women, but are more common in men. Women have their own classic types of symptoms, which doctors often fail to recognize. They include:

  • unusual fatigue
  • heart palpitations
  • pressure or pain in the upper addomen
  • back pain, or symptoms resembling indigestion


Angina, mild to severe chest pain caused by insufficient blood to the heart and often the initial symptoms of a heart attack, occurs less often in women than in men. Women are less likely than men to suffer an angina-equivalent symptoms–shortness of breath, tightness or tingling in the arm and/or lower chest.

Doctors who don’t recognize heart attack symptoms in women may delay life-saving treatments –and women may not go to the hospital because they do not understand the significance of the symptoms.

Missed Risk Factors:
About 80% of women who die suddenly of a heart attack have modifiable risk factors, such as obesity or a history of smoking, but women are less likely to receive adequate counseling regarding preventive strategies.

Important: Because heart disease is strongly associated with lifestyle issues, women must begin addressing key risk factors, such as weight, exercise levels, diabetes and smoking, years before monopause.

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