Listen to your heart

Cardiovascular disease is the leading cause of death among women, so it's important to know and recognize the risk factors

April 16, 2003|By Leslie Goldman, Special to the Tribune.

Myra Kirchberg thought she was in labor when the pain began. For Debbie Slater, it was surely indigestion. But Marilynn Johnston knew. On Feb. 1, when a squeezing pressure started to spread across her chest, the 63-year-old from Northfield found herself taking a detour from her regular walking workout to the hospital. Her next surprise: She was one of five females receiving an angiogram that day.

"I found it shocking," Johnston said, "that I was in the company of all women."

The facts, however, give weight to her experience. Cardiovascular disease, which includes heart disease and stroke, is the leading cause of death for U.S. women, according to the American Heart Association. Experts estimate that 1 in 2 women will die of cardiovascular disease.

In 2000, heart disease claimed the lives of 254,630 women. Compare that with the 41,872 women who died from breast cancer in the same year, and the diagnosis is clear: Heart disease is not just a man's illness.

Despite such grim statistics, few women identify heart disease as their most menacing health threat. In a recent National Council of the Aging survey, only 9 percent of women ages 45-64 named heart disease as their most feared condition (61 percent said breast cancer).

As Dr. Sara Mobasseri, a preventive cardiologist at Evanston Northwestern Healthcare, asked, "It's fine to get a Pap smear every year or a mammogram, but who ever says `Let's get a lipid profile or a cholesterol screening'?"

When it comes to the subject of heart disease and women, misconceptions abound, primarily because symptoms can differ between genders (see list). For example, said Dr. Barbara Alving, deputy director of the National Heart, Lung and Blood Institute in Bethesda, Md., "Women might say `I've had a lot of heartburn lately,' or `I've really been tired.' They tend to downplay their symptoms because they don't really believe they can have heart disease."

That's precisely what Kirchberg, 34, of Crystal Lake thought two years ago when, 35 weeks pregnant with twins, she had a heart attack in the shower. Though this fit runner's symptoms were classic--left arm pain radiating into her jaw, shortness of breath, sweating--she misattributed them to labor. So did the paramedics, who she said sat calmly with her in her living room, discussing her pregnancy and medical history. When an EKG revealed a heart attack, she thought, "`This is crazy! Of course it's not a heart attack.' At age 32, that was literally the last thing on my mind."

Slater, 52, of Miami, thought the pressure in her chest that ominous day in 1986 was indigestion.

"At 35, you don't think `Something's wrong with my heart.' I thought I ate something," bad, she said.

A hospital stay and EKG ruled out a heart attack, and she said she was told "If you were a man, we would keep you here overnight, but you're a female, your results were negative. It must be something else."

A trim non-smoker, Slater's main risk factor was family history. She returned home but the pain continued. A week later she returned, with a heart attack.

Despite the statistics, experts say heart disease in women is often missed--or even ignored. In Slater's hospital room, medical students streamed in to see "the woman with the heart attack." She was even asked if cocaine use might have prompted her cardiac arrest. (It didn't).

According to the first-ever national survey of female heart patients, conducted by WomenHeart: The National Coalition for Women with Heart Disease and released this year, more than half report dissatisfaction with some aspect of their health care. Women are underrepresented professionally in cardiac care, too. Mobasseri, for example, is her hospital's first female cardiologist.

Less emphasis on the disease

The dearth in public awareness, Alving said, can be attributed to the fact that women don't make the connection between risk factors such as high blood pressure, smoking and high blood cholesterol and their own risk of developing heart disease. Plus, vigorous public awareness campaigns surrounding other issues like breast cancer have resulted in women putting less emphasis on heart disease. As a result, women do not take their risk of heart disease seriously or personally, Alving said.

In February, the heart, lung and blood institute kicked off the Heart Truth Campaign and Red Dress Project to raise awareness. Its goal is to make the red dress, like AIDS' red ribbon, the national symbol for women and heart disease.

Experts agree that assessing and taking charge of one's risk factors for heart disease is crucial. While some risk factors, like family history and age, are uncontrollable, many can be modified. Smoking is a prime example: Tobacco use doubles a woman's risk of heart disease, Mobasseri said, making it the most preventable risk factor. Physical inactivity and obesity are also perpetrators, paving the way for heart disease, high blood pressure and type 2 diabetes.