Women and Heart Disease

K. took a zig-zag course across the parking lot, stepping briskly around the puddle rims. Fit and vigorous at 71, K. was anxious to get to work but felt an unaccustomed chest pain upon getting indoors and needed to sit down. The pain was dull and radiating and accompanied by a flush of heat and perspiration. Five minutes later, the pain subsided. "Stomach trouble," K. thought, and didn't give the matter much thought until the next morning,when the scenario recurred. The next day, same sequence. Indigestion is rarely so punctual. That afternoon, K. walked into a hospital emergency room.

If K.'s story conjures the image of a nicotine-stained, slightly paunchy businessman suffering a heart attack, think again. The stereotyped candidate for heart attack may be overweight, overachieving, under-exercised,hypertensive-and resoundingly male-but the fact is coronary heart disease is no more a "man's disease" than is the flu.

Of the one million Americans with the disease, virtually half are women. Of the half-million fatal heart attacks in the United States every year,247,000 occur in women. Among the fortunate survivors of heart attack is K.--for Katherine--a Boston suburbanite now doing well after her mild heart attack in 1993.

Coronary heart disease is the number one cause of premature death-in men and women-in the industrialized world. Women are six times more likely to die of a heart attack than of breast cancer. And women who have a heart attack are twice as likely to die within a few weeks as men who experience a similar attack.

Whence, then, the notion that coronary heart disease is a problem that only men need worry about? Blame it partly on biology: statistics show that heart attacks in women before the age of menopause are rare. A 40 year-old woman has only about one-fourth the chance of dying from heart disease of a man the same age.

But there are other reasons for the misconception. Inadvertently, perhaps, it has been reinforced by researchers who have studied coronary artery disease and doctors who have treated it. Until recently, nearly all epidemiologic studies of coronary disease-what causes it, how it can be treated, and how it can be prevented-have been performed on men. And there is abundant evidence, some scientific, some anecdotal, that physicians have treated coronary disease less aggressively in women than in men.

Whatever the roots of this bias, it has left many women with a false sense of safety-one that could imperil their lives. "Traditionally, women have not believed they would get heart disease, so they haven't sought treatment as aggressively as men have," says Elizabeth Ross, a cardiologist and head of the committee on women and heart disease at the Washington, D.C., chapter of the American Heart Association (AHA). "A man may be playing racquetball and feel a pain in his chest and think right away that it's a heart attack. A woman may experience chest pain and dismiss it as indigestion and not seek prompt treatment."

Such delays can be catastrophic. Modern blood-thinning drugs used to treat heart-attack victims are most effective if administered within four hours of the onset of symptoms. A woman who dismisses the symptoms of a heart attack as stomach trouble, who lies down and tries to "sleep it off" before seeking treatment can do irreparable, possibly fatal, damage to the heart.

Recently, however, women's heart disease has begun to emerge from its public eclipse. A massive public-information campaign by the AHA has spread the word that older women are just-or nearly-as likely to develop coronary disease as men are. And physicians are becoming more attuned to signs of the disease in their female patients. "There has been a definite consciousness-raising about this issue," Ross says. "The prevalence of heart disease in older women, combined with the fact that women tend to live longer than men, mean that women's heart disease is going to be a public health issue for a long time to come."

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