There is an accidental conspiracy going on to not diagnose heart disease in young women. This starts with the notion by both patient and doctor that heart disease is not a problem in females.
That is dead wrong. More women die of cardiovascular disease than men. Furthermore, more women die of cardiovascular disease than all cancer deaths combined, including breast cancer. Women typically tend to get cardiovascular disease about 10 years later than men.
It is harder for doctors to diagnose the disease in women. They don’t often have classic textbook symptoms, such as the crushing sub-sternal chest pain found in the sweaty, middle-aged man. A woman may not experience chest pain, but instead complain of indigestion, back or neck pain. The pain may be less acute and far less alarming. That makes finding the disease and ordering the correct tests all the more challenging.
And for a lot of reasons, women do not have a sense of urgency to get potential cardiac symptoms checked out. One in three women who believe they are having a heart attack talk themselves out of calling 911. That means when women finally do get into the medical system, the heart damage is more severe, and we have lost the option for quickly reestablishing blood flow.
Silent heart disease is common in women. In fact, 60% of heart attacks occurring in women have no preceding history of commonly recognized heart symptoms. The heart attack “is out of the blue.”
Even medical research has traditionally short-changed women. Research is done overwhelmingly on men. The reason for this disparity is the concern for unexpected pregnancy to either cause a complication, or drop the subject from the study. That results in data derived from men being used in the treatment of a disease that occurs in both sexes. And, surprise – that doesn’t always work out.
But heart disease prevention is not sexist. Long-term observational studies on huge population groups, like Framingham or the Nurses Study, show prevention works in both sexes. That means staying far away from cigarette smoking, keeping blood pressure and weight under control, and eating sensibly.
Exercise, red wine and some dark chocolate are all things that are both pleasurable, and good for your heart. Mental health also affects your chance of getting heart disease, and men don’t own the market on overworked job craziness.
Cardiovascular disease is nondiscriminatory. Both doctors and patients need to open their eyes to this disease burden we share. Prevention is way easier than fixing it.
Donald Bucklin, MD (Dr. B) is a Regional Medical Director for U.S. HealthWorks and has been practicing clinical occupational medicine for more than 25 years. Dr. B. works in our Scottsdale, Arizona clinic.
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