Heart disease among women 1 How can the incidence of heart disease among women be lowered? Prepared for: S Williams Pathophysiology SPRA11 Section G Prepared by: Mary Strube April 8, 2011
Heart disease among women 2 How can the incidence of heart disease among women be lowered? The purpose of this paper is to explore the common beliefs of people about heart disease,investigate the signs, symptoms, risk factors and preventative strategies of heart disease, anddetermine how the incidence of heart disease among women can be lowered. This topic is beingconsidered because heart disease is a serious yet seriously misunderstood disease especially inthe female community of the United States, and thorough examination of this topic is key tointerpreting why it is misunderstood and what can be done to change that. Heart disease is not just a man’s disease. It is the number one leading cause of death ofmen and women both in America and worldwide. According to the World Health Organization(WHO), there are more people worldwide who have died from coronary heart disease (CHD)since 1990 than from any other cause. The WHO has said that heart disease is a “…truepandemic that respects no borders.” (WHO, Deaths from, 2010). The Centers for DiseaseControl (CDC) has stated (Brownstein, 2008, page 1) that cardiovascular disease is the foremostcause of death in the United States. Experts warn us that heart disease is not just a problem formen as was once supposed. Heart disease is the leading cause of death of women. According tothe WHO (WHO, 2009), though cardiovascular disease is generally considered to be a diseasereserved only for men, it is the number one killer of women across the globe. 45% of deaths inwomen over the age of 60 come about because of chronic conditions including cardiovasculardisease. The fact is that not only are many women dying of heart disease, but many women areliving with heart disease as well. Texas Health Resources (Texas Health Resources, 2011) tellsus that one in 3 adult women has some form of heart or vascular disease, and these numbers areexpected to only get worse. The instance of heart disease is escalating in both men and women.According to an article published in the National Institute of Health (NIH) (Fang, 2008), the
Heart disease among women 3number of admissions to hospitals for heart related illness tripled between 1979 and 2004. Ratesof mortality are improving, but they are not improving across gender lines. The National HeartLung and Blood Institute (NHBLI) (NHLBI, 2009) states that though mortality rates from heartattacks have improved significantly in the past 30 years, the results are not as positive for womenas they are for men. The symptoms and signs of heart disease are not always the same with women as they arein men. Because women experience symptoms and signs differently than men do, it is importantto note the similarities and differences if change is to be made. Men generally suffer from themore widely recognized, tradition signs of heart disease. As stated by the NIH (NHBLI, Whatare, N.D.), men report feeling a pressure or squeezing in the chest that may extend to one or botharms. This pain, called angina, tends to worsen with physical exertion. It also eases with rest orsleep. Signs of heart disease in women may differ greatly from men. Women do experiencechest pain, but the pain is sharp and may radiate into the neck, jaw, throat or upper back, andwomen are more likely to have angina while resting, sleeping or doing routine activities.Additionally, women are more likely to experience angina as a response to mental stress. Awoman may also experience heartburn or indigestion, nausea, vomiting and fatigue. She mightfeel a fluttering in the chest caused by heart palpitations, and experience swelling of the lowerbody and extremities. Some women may have no signs or symptoms at all until they have aheart attack. Although symptoms and signs certainly may vary by individual, women far morelikely than men to present with atypical signs. Sutter Health Cardiologist Zi-Jian Xu, M.D.,FACC, Ph.D has stated (Sutter Health, 2011) that while women do experience many of thetraditional symptoms and signs of heart disease, they are more likely to experience vague
Heart disease among women 4symptoms such as fatigue or lack of stamina, vague discomfort or pain, or simply a general senseof discomfort. Heart disease in women is not always diagnosed as it should be. Women can be underdiagnosed when it comes to heart disease. According to WHO (WHO, 2009), because thesymptoms of cardiovascular disease are not the same in women as they are in men, women areoften under diagnosed. Because symptoms of heart disease are atypical in women, they are morelikely to be diagnosed with a condition other than heart disease. According toTheHeartDisease.net (HerbalBloom, 2008), because women experience nausea and vomiting assigns of disease, doctors often diagnose a gastrointestinal problem rather than a cardiac one.Women are also likely to receive delayed diagnosis when it comes to heart disease. The NIH hassaid (NHLBI, What are, N.D.) that the signs of a CHD may differ between men and women.Some women suffer from silent CHD, which is a condition of having CHD but exhibiting nosigns or symptoms at all. As a result, these women are not diagnosed with heart disease untilthey experience a heart attack, heart failure or irregular heartbeat. TheHeartDisease.net goesfurther to say (HerbalBloom, 2008) that women wait on average 25 minutes longer than men toreceive treatments to break up clots. This treatment when given in a timely manner can stop aheart attack. Failure to receive this treatment leads to increased risk of stroke and death. Though symptoms and signs of heart disease may vary greatly between men and women,many of the risk factors are the same, with only a few exceptions. Controllable risk factors forwomen are largely the same as they are for men. The American Heart Association’s (AHA) GoRed for Women campaign (AHA, n.d.) lists major risk factors as high cholesterol, high bloodpressure, smoking, physical inactivity, obesity, diabetes, stress, the use of birth control pills, andalcohol and illegal drug use as major etiologies in the progression of heart disease. The NIH
Heart disease among women 5(NHLBI, What causes, N.D.) adds low estrogen levels and high levels of stress hormones to thislist, and the CDC (CDC, 2011) includes poor diet. Risk factors that a patient has no control overare also similar between men and women. According to the AHA (AHA, N.D.), family history,race, increasing age, gender, and previous instance of heart attack or stroke are all risk factors forthe occurrence of heart disease in both men and women. There are, however some significantdifferences when it comes to the development of heart disease. One significant difference, asnoted by the NIH (NHLBI, 2009), is that women tend to suffer from heart disease about 10 yearslater in life than do men. As a result the mortality rate is higher because of the likelihood thatshe will have other serious health problems that likely will impede her recovery. The incidence of heart disease can be reduced through prevention, but this is a viableoption only if women become aware of it. The WHO has stated (WHO, Prevention, 2010) thatkey factors in reducing the risk of heart disease are having good control of blood pressure,cholesterol and blood glucose, and that personal behavior and lifestyle can make a difference andhelp in the reduction of the risk of developing this disease. Prevention is very important becauseas the NIH tells us two thirds of women who have a heart attack never fully recover. (NIH, n.d.)Few women know their risk of developing heart disease. According to a study published inHarvard Health Publications (Harvard, 2010-2011), about half of women in the United Statesknew that heart disease is the number one killer of women, but only 13% felt a personal risk.The WHO asserts than 2/3 of patients who die within 28 days of first experiencing symptoms ofa heart attack die on the way to the hospital, highlighting the need for awareness and prevention.Further, many women are not aware of the importance of controlling their risk factors. As theWHO iterates, although genetics do play a small role in the development of the disease, in casesof mortality 80%-90% of the people who died had at least one, but often more than one, major
Heart disease among women 6risk factors that were influenced by choices in the patient’s life. (WHO, Deaths, 2010)Awareness campaigns have proven to be a reliable way to reduce the incidence of heart diseasein at risk population, including women. WHO studies have revealed that the death rate of heartdisease patients is declining, and they attribute this decrease to increased prevention diagnosisand treatment. Awareness has led to a lower number of smokers, and lower blood pressure andblood cholesterol levels across the world, contributing to the better figures. (WHO, Deaths,2010) The CDC has found (Brownstein, 2008, page 2) that counseling programs which teachhealthy habits to at risk populations not only supports healthy lifestyles but also preventscardiovascular diseases. As the preceding research has shown, heart disease is not a disease reserved solely formen. Heart disease is a condition that spans all people, including women. It has been proventhat heart disease affects 1 of every 3 women not only in the United States, but worldwide.Studies have shown that although risk factors for the disease affect everyone similarly, thesymptoms and signs of heart disease do vary greatly between men and women. Knowing thesedifferences, as stated above, can vastly improve the outcome of heart episodes. Research hasproven that heart disease can be prevented through lifestyle change, and that by increasingawareness of these facts and encouraging prevention of the disease through the control of riskfactors the incidence of heart disease in women can indeed be reduced.
Heart disease among women 7ReferencesAHA GoRed for Women. (N.D.). Understand your risks. Retrieved from: http://www.goredforwomen.org/understand_your_risks.aspxBrownstein, J. Nell. (April, 2008). Addressing heart disease and stroke prevention through comprehensive population-level approaches. Preventing Chronic Disease, Vol. 5 (No. 2). Retrieved from: http://www.cdc.gov/pcd/issues/2008/apr/pdf/07_0251.pdfCDC. (February, 2011). Women and heart disease prevention. Retrieved from: http://www.cdc.gov/women/heart/Fang J., Mensah G.A., Croft J.B., Keenan N.L. (August, 2008). Heart Failure-Related Hospitalization in the U.S., 1979 to 2004 [Abstract]. Journal of the American College of Cardiology, 52 (6), pp. 428-434. Retrieved from: http://www.ncbi.nlm.nih.gov/sites/entrez?orig_db=PubMed&db=pubmed&cmd=Search &term=428[page]%20AND%20Fang%20J[author]Harvard Medical School. (2010-2011). Gender matters: heart disease risk in women. Retrieved from: http://www.health.harvard.edu/newsweek/Gender_matters_Heart_disease_risk_in_wome n.htmHerbalBloom. (February, 2008). Failure to diagnose heart attacks most common medical malpractice. Retrieved from: http://www.theheartdisease.net/573/failure-to-diagnose- heart-attacks-most-common-medical-malpractice/NHLBI. (N.D.). What are the signs and symptoms of heart disease? Retrieved from: http://www.nhlbi.nih.gov/health/dci/Diseases/hdw/hdw_signsandsymptoms.htmlNHLBI (N.D.). What causes heart disease? Retrieved from: http://www.nhlbi.nih.gov/health/dci/Diseases/hdw/hdw_causes.htmlNHLBI. (November, 2009). What is heart disease? Retrieved from: http://www.nhlbi.nih.gov/health/dci/Diseases/hdw/hdw_whatis.htmlNIH. (n.d.). Heart disease in women. Retrieved from: http://www.nlm.nih.gov/medlineplus/heartdiseaseinwomen.htmlSutter Health. (2008-2011). Heart attacks in women: can you spot one months ahead? Retrieved from https://mylifestages.org/featuredarticle/heart/system1_trouble.page
Heart disease among women 8Texas Health Resources. (2011). Women and heart disease. Retrieved from: http://www.texashealth.org/heartV_template_secondary.cfm?id=4038WHO. (December, 2010). Deaths from coronary heart disease. The atlas of heart disease and stroke. Retrieved from: http://www.who.int/cardiovascular_diseases/en/cvd_atlas_14_deathHD.pdfWHO. (December, 2010). Prevention: personal choices and actions. The atlas of heart disease and stroke. Retrieved from: http://www.who.int/cardiovascular_diseases/en/cvd_atlas_20_personal_choices.pdfWHO. (November 2009). Women’s health fact sheet. Retrieved from: http://www.who.int/mediacentre/factsheets/fs334/en/index.html