@1900 words, 8 pages including cover sheet and sources. Written for Pathophysiology, April, 2011.

1. 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

2. 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, and
determine how the incidence of heart disease among women can be lowered. This topic is being
considered because heart disease is a serious yet seriously misunderstood disease especially in
the female community of the United States, and thorough examination of this topic is key to
interpreting 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 of
men 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 “…true
pandemic that respects no borders.” (WHO, Deaths from, 2010). The Centers for Disease
Control (CDC) has stated (Brownstein, 2008, page 1) that cardiovascular disease is the foremost
cause of death in the United States. Experts warn us that heart disease is not just a problem for
men as was once supposed. Heart disease is the leading cause of death of women. According to
the WHO (WHO, 2009), though cardiovascular disease is generally considered to be a disease
reserved only for men, it is the number one killer of women across the globe. 45% of deaths in
women over the age of 60 come about because of chronic conditions including cardiovascular
disease. The fact is that not only are many women dying of heart disease, but many women are
living with heart disease as well. Texas Health Resources (Texas Health Resources, 2011) tells
us that one in 3 adult women has some form of heart or vascular disease, and these numbers are
expected 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

3. Heart disease among women 3
number of admissions to hospitals for heart related illness tripled between 1979 and 2004. Rates
of mortality are improving, but they are not improving across gender lines. The National Heart
Lung and Blood Institute (NHBLI) (NHLBI, 2009) states that though mortality rates from heart
attacks have improved significantly in the past 30 years, the results are not as positive for women
as they are for men.
The symptoms and signs of heart disease are not always the same with women as they are
in men. Because women experience symptoms and signs differently than men do, it is important
to note the similarities and differences if change is to be made. Men generally suffer from the
more widely recognized, tradition signs of heart disease. As stated by the NIH (NHBLI, What
are, N.D.), men report feeling a pressure or squeezing in the chest that may extend to one or both
arms. This pain, called angina, tends to worsen with physical exertion. It also eases with rest or
sleep. Signs of heart disease in women may differ greatly from men. Women do experience
chest pain, but the pain is sharp and may radiate into the neck, jaw, throat or upper back, and
women 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. A
woman may also experience heartburn or indigestion, nausea, vomiting and fatigue. She might
feel a fluttering in the chest caused by heart palpitations, and experience swelling of the lower
body and extremities. Some women may have no signs or symptoms at all until they have a
heart attack. Although symptoms and signs certainly may vary by individual, women far more
likely 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 the
traditional symptoms and signs of heart disease, they are more likely to experience vague

4. Heart disease among women 4
symptoms such as fatigue or lack of stamina, vague discomfort or pain, or simply a general sense
of discomfort.
Heart disease in women is not always diagnosed as it should be. Women can be under
diagnosed when it comes to heart disease. According to WHO (WHO, 2009), because the
symptoms of cardiovascular disease are not the same in women as they are in men, women are
often under diagnosed. Because symptoms of heart disease are atypical in women, they are more
likely to be diagnosed with a condition other than heart disease. According to
TheHeartDisease.net (HerbalBloom, 2008), because women experience nausea and vomiting as
signs 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 has
said (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 no
signs or symptoms at all. As a result, these women are not diagnosed with heart disease until
they experience a heart attack, heart failure or irregular heartbeat. TheHeartDisease.net goes
further to say (HerbalBloom, 2008) that women wait on average 25 minutes longer than men to
receive treatments to break up clots. This treatment when given in a timely manner can stop a
heart 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 for
women are largely the same as they are for men. The American Heart Association’s (AHA) Go
Red for Women campaign (AHA, n.d.) lists major risk factors as high cholesterol, high blood
pressure, smoking, physical inactivity, obesity, diabetes, stress, the use of birth control pills, and
alcohol and illegal drug use as major etiologies in the progression of heart disease. The NIH

5. Heart disease among women 5
(NHLBI, What causes, N.D.) adds low estrogen levels and high levels of stress hormones to this
list, and the CDC (CDC, 2011) includes poor diet. Risk factors that a patient has no control over
are 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 for
the occurrence of heart disease in both men and women. There are, however some significant
differences when it comes to the development of heart disease. One significant difference, as
noted by the NIH (NHLBI, 2009), is that women tend to suffer from heart disease about 10 years
later in life than do men. As a result the mortality rate is higher because of the likelihood that
she 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 viable
option only if women become aware of it. The WHO has stated (WHO, Prevention, 2010) that
key 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 and
help in the reduction of the risk of developing this disease. Prevention is very important because
as 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 in
Harvard Health Publications (Harvard, 2010-2011), about half of women in the United States
knew 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 of
a 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 the
WHO iterates, although genetics do play a small role in the development of the disease, in cases
of mortality 80%-90% of the people who died had at least one, but often more than one, major

6. Heart disease among women 6
risk 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 disease
in at risk population, including women. WHO studies have revealed that the death rate of heart
disease patients is declining, and they attribute this decrease to increased prevention diagnosis
and treatment. Awareness has led to a lower number of smokers, and lower blood pressure and
blood 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 teach
healthy habits to at risk populations not only supports healthy lifestyles but also prevents
cardiovascular diseases.
As the preceding research has shown, heart disease is not a disease reserved solely for
men. Heart disease is a condition that spans all people, including women. It has been proven
that 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, the
symptoms and signs of heart disease do vary greatly between men and women. Knowing these
differences, as stated above, can vastly improve the outcome of heart episodes. Research has
proven that heart disease can be prevented through lifestyle change, and that by increasing
awareness of these facts and encouraging prevention of the disease through the control of risk
factors the incidence of heart disease in women can indeed be reduced.

7. Heart disease among women 7
References
AHA GoRed for Women. (N.D.). Understand your risks. Retrieved from:
http://www.goredforwomen.org/understand_your_risks.aspx
Brownstein, 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.pdf
CDC. (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.htm
HerbalBloom. (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.html
NHLBI (N.D.). What causes heart disease? Retrieved from:
http://www.nhlbi.nih.gov/health/dci/Diseases/hdw/hdw_causes.html
NHLBI. (November, 2009). What is heart disease? Retrieved from:
http://www.nhlbi.nih.gov/health/dci/Diseases/hdw/hdw_whatis.html
NIH. (n.d.). Heart disease in women. Retrieved from:
http://www.nlm.nih.gov/medlineplus/heartdiseaseinwomen.html
Sutter Health. (2008-2011). Heart attacks in women: can you spot one months ahead? Retrieved
from https://mylifestages.org/featuredarticle/heart/system1_trouble.page

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Texas Health Resources. (2011). Women and heart disease. Retrieved from:
http://www.texashealth.org/heartV_template_secondary.cfm?id=4038
WHO. (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.pdf
WHO. (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.pdf
WHO. (November 2009). Women’s health fact sheet. Retrieved from:
http://www.who.int/mediacentre/factsheets/fs334/en/index.html