Women's Heart Advisor January 2017 Issue

10 Things Women Need to Know About Coronary Artery Disease

It’s the same disease men have, but there are some key differences.

Coronary artery disease (CAD) is a very real threat to women, particularly after menopause. While many women are most frightened by breast cancer, more women die from heart disease every year than from all forms of cancer combined.

Fatty plaques that grow in the arteries are responsible for these deaths. The way these plaques grow, rupture and cause heart attacks is the same in women as in men. However, women tend to experience different symptoms and may need different diagnostic tests. The impact of a heart attack can be different for a woman than a man. Unfortunately, women don’t always receive recommended treatments and, as a result, often have poorer outcomes.

Doctor consultation

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Regular checkups allow your doctor to identify heart disease problems early, so you can begin taking action to up your odds of a good outcome.

Here’s what you need to know about this type of heart disease:

1. Women have the same risk factors as men.

If you smoke, are overweight, have high blood pressure, high blood sugar levels or high cholesterol, you are at increased risk for developing CAD and having a heart attack or stroke. A shocking 90 percent of U.S. women have one or more of these risk factors. Your risk will continue to increase, if the risk factor is not addressed.

A family history of heart disease is especially concerning. If your father or brother was diagnosed with CAD before age 55, or your mother or sister before age 65, then your risk is especially high.

2. Women have additional CAD risk factors men don’t have.

Certain diseases increase the risk of CAD. These include gestational diabetes, gestational hypertension, polycystic ovary disease and endometriosis. Endometriosis may raise the risk of developing CAD up to 400 percent, likely through chronic inflammation, which contributes to both diseases.

3. The symptoms of a heart attack may be hard to recognize.

Women may experience the typical chest pain associated with heart attack, but are more likely to have subtle symptoms that are easily mistaken for a less-serious condition. These include:

- Upper back or shoulder pain
- Jaw pain or pain that radiates to the jaw
- Pain that radiates to the arm
- Pressure in the center of the chest
- Nausea and indigestion
- Shortness of breath or feeling “winded”
- Unusual fatigue for several days
- Lightheadedness
- A feeling of impending doom

4. Standard tests don’t always show the cause of chest pain in women.

A moving X-ray taken during a cardiac catheterization (angiogram) reveals narrowed areas in large arteries. But in women, CAD often affects the smaller arteries, which cannot be seen on angiography. For this reason, women who continue to have chest pain should see a cardiologist specializing in women with heart disease.

5. Your first heart attack may be deadly.

The average age of a first heart attack in women is 70. A woman is more likely than a man to die from her first heart attack. About 64 percent of women who die suddenly from a heart attack had no symptoms.

6. You may not receive proper medications after a heart attack.

After being rushed to the hospital during a heart attack, women are more likely than men to develop blood clots. Unfortunately, they are less likely than men to be given a drug to prevent blood clots, such as prasugrel (Effient®).

7. You may develop heart failure without having a heart attack.

Damage to the heart muscle can prevent the heart from pumping normally (heart failure). In men, heart failure is generally the result of damage from a heart attack that prevents the muscle from squeezing forcefully (systolic heart failure). Women are more likely to have heart damage from high blood pressure or a condition that prevents their heart muscle from relaxing properly between beats (diastolic heart failure).

8. You may live a long time with heart failure.

Women with diastolic heart failure generally live longer than men with heart failure. However, they tend to need frequent hospitalizations and have more shortness of breath.

9. Revascularization is effective in women.

Restoring blood flow by rerouting blood around the blockages (coronary artery bypass grafting) or opening them with a balloon and inserting a stent (percutaneous coronary angiography) work well in women.

10. Most heart attacks can be prevented.

Most adults in the developed world have some degree of CAD, but it doesn’t have to culminate in a heart attack or stroke. Most heart attacks could be preventing by adopting these healthy lifestyle habits: quitting smoking, exercising, eating a heart-healthy diet, controlling your weight, and having annual blood pressure checks, physicals, and blood work to check on cholesterol and blood sugar. “It’s never too late to lead a healthy lifestyle. Learning to eat right, exercise more and quitting smoking can add years to your life,” says Leslie Cho, MD, director of Cleveland Clinic’s Women’s Cardiovascular Center.

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