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Matters of the heart

More women than men die of heart disease, yet a woman's symptoms are more likely to be overlooked by health providers. Here's how to recognize the warning signs.

By Dennis Cheek, Ph.D., RN, FAHA
Abell-Hanger Professor of Gerontological Nursing

Excerpted from "Preventing and treating heart disease in women."

Cardiovascular disease is the leading cause of death in both women and men in the United States. Although many women believe that they’re more likely to be diagnosed with breast cancer, their risk of cardiovascular disease is significantly greater. In fact, heart disease-related deaths outnumber the next seven causes of death combined, including cancer.

One in three U.S. women eventually succumbs to heart disease, according to the American Heart Association. And while the rates for men are declining, the rates for women are rising steadily. Many of these deaths result from high blood pressure, stroke and coronary heart diseases.

Many health care providers fail to discuss heart disease or its risk factors with female patients because they think of heart disease as primarily belonging to men. This leads to less aggressive treatment, or even no treatment at all. In fact, women are more likely than men to die after their first cardiac event.

So what are the risk factors?

Diabetes. A Nurse’s Health Study showed a seven-fold increase in cardiovascular events for women with diabetes, and about half of all women with diabetes die of heart disease.
Hypertension. Women with hypertension have a much greater risk of cardiovascular disease than normotensive women or men, and this increases even more significantly if she’s premenopausal.

Ethnic group. African-American women are more likely to have hypertension than other groups, and Hispanic and African-American women share high death rates from diabetes.
Smoking. A woman who has smoked her entire adult life has a risk of cardiovascular disease that is even higher than that for men. Even a few cigarettes a day caused a higher risk.

Obesity. Sedentary lifestyles and poor diet contribute to obesity and high blood pressure. Central obesity is especially dangerous: The waist-hip circumference confers a greater risk than body mass index, so women should strive to maintain a waist circumference of less than 35 inches.

Lack of exercise. Exercise may decrease a woman’s risk for heart disease by half, and post-menopausal women who have experienced an myocardial infarction (MI) can significantly decrease their risk of a second MI by beginning an exercise program. Women can benefit from simply walking or doing light to moderate activity for 30 minutes most days of the week.

Stress. Women experiencing “high stress, low control” situations anywhere in their lives have a much greater risk of developing disease and having poorer outcomes.
Depression. Women who are also depressed may have more cardiac events or may be less likely to seek diagnosis, treatment, or rehabilitation.

All women should be counseled about the dangers of heart disease, the importance of prevention, and the variability of symptoms. At-risk women need to be identified, diagnosed, and treated, and referred to a cardiac rehabilitation program if appropriate.

Dennis Cheek is the director of the Harris School of Nursing Research Laboratory and studies cardiovascular disease and the effects of aging in women.

Contact Dennis Cheek at
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