By Kristin Reynolds / Cedars-Sinai
C. Noel Bairey Merz, MD, has a pretty good idea why many women with heart disease don’t get the healthcare they need.
“Too often, when a young woman has heart disease symptoms, a physician will ignore those symptoms and tell her that she needs to lose weight,” said Bairey Merz, director of the Barbra Streisand Women’s Heart Center in the Smidt Heart Institute at Cedars-Sinai. “That’s because heart disease symptoms in women can be very different from what men experience. So it’s crucial that women know what to look for.”
Although heart disease is the leading cause of death among women in the U.S., according to the Centers for Disease Control and Prevention, most heart disease research has been conducted on men. And even though rates of heart disease and heart attacks are increasing among women 35 to 54 years old, they are less likely to receive evidence-based treatments such as statins and more likely to be told they are “too young” to have heart disease, Bairey Merz said.
“These delays and dismissals have had serious consequences,” she said. “The Women’s Ischemia Syndrome Evaluation [WISE] study that I led for the National Heart, Lung, and Blood Institute helped us better understand that heart disease doesn’t always look the same in women. That insight ultimately pushed the field to rethink and improve how we diagnose and treat it.”
Despite these advances, women with heart disease are still more likely to be misdiagnosed, underdiagnosed or undertreated—sometimes delaying care that could save their lives.
“The good news is that heart disease is largely preventable,” Bairey Merz said. “And for women in particular—who may not experience obvious symptoms or whose symptoms are subtle—knowledge is a powerful prevention tool.”
To explain what women should watch for, the Cedars-Sinai Newsroom spoke with Bairey Merz about what women can do to protect their hearts and advocate for the healthcare they need.
What are some of the biggest myths about heart disease?
Many people believe that heart disease primarily affects men, that heart attacks always involve crushing chest pain, or that cancer is the top cause of death. In reality, heart disease kills more women than all cancers combined, yet fewer than half of women recognize it as their greatest health threat.
While men tend to develop cardiovascular disease earlier, women are more likely to experience poorer outcomes.
Why are heart attack rates increasing among younger women?
For decades, heart attack death rates declined sharply, thanks to improved research, standardized treatment guidelines, and widespread use of effective medications and procedures. While heart attack deaths are still much lower than they once were, the increase in heart problems among younger adults is concerning.
Researchers are looking into exact causes for the increase, but we know that contributing factors include low levels of physical activity and prolonged sedentary behavior, rising rates of diabetes and obesity, chronic stress, and environmental exposures such as air pollution.
What does a heart attack feel like for women?
The so-called “Hollywood heart attack”—tingling in the left arm that leads to sudden, crushing chest pain—is common in men and can occur in women as well. But many women experience subtler symptoms, including shortness of breath, nausea, unusual fatigue, back or jaw pain, or chest discomfort that doesn’t feel severe or dramatic.
Because these symptoms don’t match common expectations of a heart attack, they may be overlooked or dismissed. Anyone experiencing them should seek medical care immediately.
What causes heart attacks in women?
An increasing number of heart attacks are occurring in people without significant blockages in the major coronary arteries, a pattern seen more often in women. While men’s heart disease more commonly involves blockage in large arteries, women are more likely to experience dysfunction of the heart’s smaller blood vessels. This condition—called ischemia with no obstructive coronary artery disease [INOCA]—can cause reduced blood flow to the heart even when major arteries appear clear.
Even women who are physically fit can develop INOCA. In the past, if a woman had heart attack symptoms but a “normal” angiogram showing clear major arteries, her condition might not have been recognized. Continued awareness and ongoing education around INOCA are helping clinicians better diagnose and treat these patients.
What is a normal heart rate for women?
A normal resting heart rate for most adults is between 60 and 100 beats per minute, according to the American Heart Association. Because women’s hearts are typically smaller, their resting heart rate may run slightly higher than men’s. Women should consult their doctor if their resting heart rate is below 60 or above 100 beats per minute when not exercising.
How can women protect heart health and prevent heart disease?
Heart disease develops silently over decades. While heart disease can be managed with highly effective treatments, prevention is the most powerful strategy.
An estimated 80% of heart disease cases are preventable with lifestyle modifications. These include staying current with annual screenings and knowing cholesterol, blood pressure and blood sugar levels; exercising at least 30 minutes daily; breaking up prolonged sitting because a sedentary lifestyle is considered as strong a risk factor as smoking; managing stress; getting seven to nine hours of sleep; avoiding smoking; and following a nutritious diet.
A Mediterranean-style, largely plant-based diet rich in fruits, vegetables, nuts, beans, whole grains, olive oil and lean proteins is recommended. Parents are encouraged to help ensure their children make healthy food choices, too.
Heart health isn’t about deprivation. It’s about building lifelong habits that prevent disease before it starts.
Read more on the Cedars-Sinai Blog: High Blood Pressure—What Women Need to Know
Information source; Cedars-Sinai
C. Noel Bairey Merz, MD. Image courtesy of Cedars-Sinai
