February is National Heart Awareness month, with the goal to bring more awareness about the prevalence and severity of heart disease in the United States.

I would like to focus this discussion specifically on some key differences women experience when discussing cardiovascular health. Cardiovascular disease is still the leading cause of death in women, but the good news is that we have seen the overall mortality from this disease decline in the last 40 to 50 years. Much of this has been attributed to raising awareness and reducing known risk factors such as cigarette smoking and unhealthy diets. Therefore, we need to continue the national discussion on this topic and emphasize prevention of this devastating disease.

Many of the major risk factors that cause heart disease in women overlap with risk factors associated with men. These include smoking, diabetes, high blood pressure, and a family history of early heart disease

Early prevention of cardiovascular disease is focused on the early recognition of the symptoms. There are actually more similarities in the way men and women present with cardiovascular disease than there are differences. The most common symptom in men and women remains chest pain or pressure, which is typically worse with physical activities like walking up hills or climbing stairs. This symptom is typically labeled angina by your physicians, and should always be evaluated if present. Women differ from men, in that they present more often with symptoms of cardiovascular disease that is not chest pain. Other symptoms include shortness of breath, fatigue, weakness, and jaw or arm pain. Researchers believe this has more to do with the historical delay in recognition of heart disease in women, especially if it occurs at a young age when physicians are not expecting it. Physicians are trained these days to be on the lookout for atypical symptoms which may represent cardiovascular disease. Many of us will then rely on different forms of diagnostic testing to make the diagnosis. This issue highlights the importance of continued education regarding this topic.

Once the disease has been diagnosed, there are a number of important treatment strategies which are recommended for men and women. There are, however, historical prescribing practices that represent a concerning bias in the way women are medically treated compared to men. The medication group called statins is one of these medications, and it has been shown to reduce recurrent cardiovascular events. However, this medication seems to be underused by women. This issue has also been seen to a lesser degree with medications called beta blockers and anti-platelet medications, all of which have shown cardiovascular benefit for men and women. This is likely a mixture of physician and patient bias, which highlights the importance of everyone working together on these topics to break through biased thinking which could have harmful consequences.

In summary, the medical community is beginning to understand and address important clinical differences between men and women in the field of cardiovascular disease. Speaking with your physician about worrisome symptoms, medical choices and preventive strategies is always the first step.

I would like to close by highlighting one of the most important risk factor differences for women versus men — smoking. Smoking has a severe impact on a woman’s cardiovascular risk. Smoking has been associated in almost half of all coronary events in women. This risk seems to hold true even if smoking just one to two cigarettes per day. The risk of cardiovascular disease in women is threefold higher compared with nonsmokers. In men, this risk is twofold higher. The good news, however, is that the cessation of smoking decreases this risk dramatically. Therefore, it is never too late to quit smoking!

This week’s Health Talk was written by Dr. Adam T. Coleman, cardiologist, Rutland Heart Center.

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