We used to think that women were protected from heart disease — at least until they hit menopause. But Dr. Indu Poornima, cardiologist and director of the Allegheny Health Network (AHN) Women's Heart Center, is seeing younger and younger female patients with serious cardiac problems.
"The most important thing to understand is that heart disease affects women of all ages," Dr. Poornima says. "The reason we think this is happening is related to the increased prevalence of risk factors such as obesity, high blood pressure, diabetes and smoking in younger women. If, at age 25, you have diabetes or high blood pressure and you're smoking, the likelihood that you will have a heart attack — even when you're premenopausal — is quite high."
In fact, according to the Centers for Disease Control and Prevention (CDC), heart disease is the leading cause of death for women in the U.S. While we often think of heart disease in the form of an old man with intense chest pain, it strikes more women than men — and often with more subtle symptoms.
Shockingly, 64 percent of women who die suddenly from heart disease experience no symptoms. The women who do feel symptoms are more likely to have signs that don't fit our mental picture of heart disease and that unfortunately may be ignored.
As actress Elizabeth Banks demonstrates, women tend to experience these symptoms associated with heart disease:
Certain heart disease risk factors appear in both men and women, like high blood pressure, diabetes, smoking, obesity, a lack of physical activity and high cholesterol. Women need to keep all of those under control while paying attention to some gender-specific factors, too.
“We call pregnancy your first stress test,” Dr. Poornima says, “so if you start having high blood pressure or diabetes during your pregnancy, it's the first sign that you may have problems later on. It's a very good opportunity to identify patients and educate them about their future risk and what they can do to prevent it.”
Preeclampsia, a condition that can develop as a result of high blood pressure during pregnancy, is another possible warning that heart disease is in a woman's future.
“The incidence of preeclampsia seems to be on the rise, and we believe that it may be related to the rates of obesity,” Dr. Poornima says. “A woman with preeclampsia is at an increased risk for cardiovascular disease of all kinds, from hypertension to stroke, heart attack and other conditions.”
In other cases, the same risk factor that men face has a more dramatic result in women.
“For example, a woman with diabetes is at a higher risk for developing cardiac events including heart attack, heart failure and arrhythmias,” Dr. Poornima says.
Smoking is another major risk factor for heart disease.
“Taking birth control pills and smoking is a [particularly] deadly combination,” says Dr. Poornima. “The rate of smoking in young women is certainly not decreasing, and a lot of them are on birth control pills. That leads to blood clots that can go anywhere [in the body, and cause cardiac problems], so it's very common that these women end up with strokes at a young age. It's a devastating event if you end up with a stroke when you're young. It's difficult enough at any age.”
“I don't beat around the bush with my patients,” Dr. Poornima says. “Regardless of their age, I recommend getting at least a few minutes of physical activity every day. It doesn't even have to be labeled exercise. I like to offer it as a prescription; I suggest 30 minutes per day, five times a week. And that's as much a 'prescription' as taking a blood pressure pill or cholesterol pill or whatever else you take.”
“Physical activity is probably the most important thing you can do to prevent heart disease.”
While it's best to follow that physical activity prescription so you can try to avoid a cardiac event in the first place, it's never too late to make healthier choices.
“When someone has a heart attack, that's the opportune moment,” Dr. Poornima says. “Sometimes we can get caught up in the hospital taking care of the acute problem, but that's the most important time to discuss their long-term prognosis.
“Sometimes people carry a misconception that angioplasty, stents, or bypass surgery is a cure but it's not. Those are all temporary measures that we can use to prevent the damage at that point, but it certainly doesn't prevent them from having another event a few years down the line. That can only be prevented by controlling the risk factors.
“If you were smoking before your first heart attack, regardless of what we do to fix the problem at the moment, if you continue to smoke, you will continue to be at risk for another heart attack.”
Despite the efforts of a wide range of organizations, there are still challenges when it comes to women's awareness of heart disease and what they can do to lower their risks.
“We're getting the message across to some women, but not enough of them,” Dr. Poornima says. “Awareness of women's heart health has increased over the past couple of decades, and women are being a little bit more proactive about their health, but there's a lot of room to improve.”