A recent survey reported by the American Heart Association reveals that the majority of American women do not understand the true threat of cardiovascular disease. Despite the fact that heart disease is the leading cause of death among women, a nationwide survey revealed that only 8% of women perceive heart disease as the greatest threat to their health. More than six out of 10 women falsely believe that they are more likely to develop cancer than heart disease. This lack of public awareness is alarming physicians who insist that heart disease is becoming more preventable. Many women are also unaware that heart attack symptoms tend to be different in men and women.

The Threat of Cardiovascular Disease in Women

Coronary artery disease is the number one cause of death in the United States among both men and women. Over 500,000 (one-half million) American women die of cardiovascular disease each year. This is twice the number of deaths from all cancer combined; lung cancer, the leading cause of cancer deaths, claims approximately 65,000 deaths per year, and breast cancer kills around 40,000 women. Other statistics from the American Heart Association:

• One in five women have some form of heart or blood vessel disease.
• 38% of women who have heart attacks die within the first year compared to 25% of men.
• 35% of women have a second heart attack within six years of the first attack compared to 18% of men.
• Over 60,000 women die of stroke each year; approximately 60% of stroke deaths occur in women.

Despite these figures, the American Heart Association reported that only 34% of the 1,000 women surveyed during June/July 2000 believed that heart disease was the leading cause of death in the United States. Among young women ages 25 to 34, only 4% believed heart disease was a danger to them while 72% believed cancer was their greatest health threat.

Experts attribute these misperceptions to a number of factors, the two main ones being the medical profession and the media. In the survey, only 20% of the women reported seeing any literature on heart disease in their doctors’ offices. According to a recent editorial in Circulation by Dr. Rose Marie Robertson, President of the American Heart Association, only half of the 50 million Americans with high blood pressure are receiving treatment. Many Americans with high cholesterol do not take cholesterol-lowering drugs or make necessary exercise and dietary changes to help lose excess weight. Furthermore, a large number of Americans do not know they have diabetes, a disease that can significantly increase the risk of heart disease and stroke among other problems.

The media may also contribute to the lack of heart disease awareness. Just recently, news stories have begun to report that women are also at risk for cardiovascular problems, attempting to dispel the myth that heart disease is a man’s disease. However, the number of reports about cancer still outnumber those on heart disease and stroke despite the disproportional number of deaths from cardiovascular disease.

Another misperception about heart disease is that it is the best way to die. According to a New York Times interview with Dr. Nieca Goldberg, the Director of the Women’s Heart Program at Lenox Hill Hospital in New York, many people have a "romanticized" idea that a heart attack is a quick, less painful way to die than cancer. However, in reality, Dr. Goldberg emphasized that heart disease can cause years of disability, pain, and a decreased quality of life.

Heart Disease Differences in Women and Men

Men have a greater risk of heart attack than women and are more likely to have heart attacks earlier in life than women. However, women are also at risk for heart disease. As a woman ages, her risk of heart disease increases: 9,000 American women under age 45 have heart attacks each year versus 250,000 women over age 65. Medical experts believe the increased risk of heart disease in older women is related to the depletion of the female hormone estrogen at menopause.

While researchers are still investigating why estrogen may help prevent heart disease, they believe that blood flow through clogged arteries is different for men and women and may explain why a woman’s risk of heart disease increases dramatically as she ages. It is thought that estrogen helps a woman’s arteries to expand when they become blocked with hardened fatty build-up, allowing the blood to flow around the blockage. In men, the arteries are not as flexible. As a man’s arteries become blocked, they narrow, reducing the blood flow.

As men age and their arteries become blocked, the body develops new arteries to serve as back-up blood routes; these back-up routes are called collateral blood supplies. However, women do not develop these collateral blood supplies as they age since, with estrogen, their blood vessels can expand to accommodate blockage. Thus, the thought is that when a woman’s estrogen production decreases significantly at menopause, her arteries tend to lose their flexibility and her risk of heart disease increases significantly since no collateral blood supply is developed. This may also explain why more women are likely to die within a year of a heart attack than men.

Many of the risk factors for heart disease are the same for women and men. These risk factors include: high blood pressure, high cholesterol, diabetes, high fat diet, excessive weight, lack of physical activity, smoking, and a family history of heart disease. However, other risk factors for women include menopause (specifically, loss of estrogen at this time) and the use of oral contraceptives among smokers or those with high blood pressure.

Women also tend to have different heart attack symptoms than men. The following chart summarizes these differences:

Preventing Cardiovascular Disease

While no preventive measure can eliminate the chances of developing heart disease, the U.S. government recently issued new guidelines in an effort to aggressively treat and prevent heart disease in millions of Americans. In addition to more emphasis on low-fat diets and exercise, the guidelines call for an increase in the number of people that need to take cholesterol-lowering drugs from 13 million Americans to an estimated 36 million. According to the National Heart, Lung, and Blood Institute (NHBLI), if the new guidelines are followed, the incidence of heart disease could be reduced by as much as 30% to 40%.

The new guidelines include:

• Treating patients with at least a 20% risk of having a heart attack in 10 years as aggressively as those who already have heart disease.
• Treating high cholesterol more aggressively in people with diabetes.
• Using a lipoprotein profile as the first test for high cholesterol.
• Modifying the current HDL ("good") cholesterol level guideline to 40 mg/dL.
• Emphasizing the need for nutrition, exercise, and weight control in treating high cholesterol.
• Identifying people with "metabolic syndrome" and treating them aggressively to prevent heart attacks (a condition characterized by abdominal obesity, high triglycerides, high blood pressure, high blood-sugar levels, and low HDL ("good") cholesterol)
• Treating people with high triglyceride levels more aggressively.
• Advising to take cholesterol-lowering drugs to lower cholesterol instead of hormone replacement therapy (the American Heart Association recently endorsed this recommendation too).

 Click here to learn more about these guidelines.

Additional Resources and References

• The American Heart Association survey results concerning women and cardiovascular disease are available at http://women.americanheart.org/
• The June 24, 2001 New York Times report by Denise Grady is entitled, "A Devastating Lack of Awareness," http://www.nytimes.com
• The American Heart Association provides information on cardiovascular disease at http://www.americanheart.org/
• The May 21, 2001 Imaginis Report, "New Guidelines Emphasize Aggressive Measures to Lower Cholesterol in Millions of Americans," is available at http://www.imaginis.com/heart-disease/news/news5.21.01.asp
• The March 21, 2000 Imaginis Report, "Heart Disease in Women More Deadly Than Breast Cancer: Disease Attacks Women Differently Than Men," is available at http://www.imaginis.com/heart-disease/news/news3.21.00.asp

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