Maxine Levy’s family history included both breast cancer and heart disease. “I was concerned about breast cancer, but the fact that I had a family history of heart disease didn’t concern me. The doctor gave me a pill, but he didn’t say, `You’re at risk; you need to take this seriously.’”
Levy did know that her aunt had had a heart attack, even though her symptoms—nausea and vomiting—weren’t those often cited as typical warning signs. One evening Levy woke up with those same symptoms, flashed back to her aunt’s experience, and knew she was having a heart attack. Her husband was doubtful, citing the corned beef sandwich she had eaten earlier in the evening. But she trusted her instincts and insisted he call 911. That move probably saved her life. She was only forty-one years old.
Levy is part of the volunteer group, WomenHeart Champions, who go around the country sharing their stories with others. Heart disease is the number one killer of women, but still does not get the attention afforded other so-called “bikini diseases,” those affecting the breast and reproductive organs. “If we paid one-half the attention to heart disease that we do to breast cancer, we could have a huge impact,” said Dr. Sharonne Hayes, director of the Mayo Clinic, Women’s Heart Clinic.
Health professionals are working hard to raise awareness. February is Heart Health Month, and on February 8, the Mayo Clinic sponsored In the Prime of Her Life—An Update on Women and Cardiovascular Disease, held at the Paley Center for Media. “Heart failure is the inability of the heart to pump enough blood to meet the needs of the rest of the body,” explained Dr. Ileana Pina, professor of epidemiology/biostatistics, Case Western Reserve University, Cleveland. Many factors can interfere with the heart’s ability to do its job well, including smoking, high blood pressure, obesity, and, of course, family genetics.
“Much is preventable with better diet and exercise,” said Dr. Susan Shurin, acting director, National Heart, Lung, and Blood Institute. “You can reduce the risk of heart disease by 82 percent with how you manage your life.” And that prevention and healthy lifestyle should start at a young age.
Many young women are conscientious about having a yearly mammogram, yet only discover they have a heart problem after becoming pregnant. “Heart disease affects one to two percent of pregnant women, 40,000, each year,” according to Dr. Heidi Connolly, director, Mayo Clinic Congenital Heart Center. While some of these problems may be minor—an extra heart beat, for example—others can be very serious and can even cause death during pregnancy. The presence of heart disease doesn’t mean that a woman shouldn’t become pregnant, but she will probably need to be monitored. Of course, women with a congenital heart problem should see a doctor before becoming pregnant. “The risk of dying from a heart attack [during pregnancy] is higher than if you present at any other time,” said Dr. Connolly.
Pregnancy may also induce other health problems that can affect the heart—gestational diabetes and preeclampsia or toxemia. For the well-being of the pregnant woman and her baby, all of her doctors should have access to all of her medical information. “There are good treatments available to us now not to harm the fetus,” said Dr. Elizabeth Ofili, chief of cardiology at the Morehouse School of Medicine in Atlanta.
Because pregnancy often brings about many changes in a woman’s body, she is more likely to blame something else, heartburn, for example, rather than heart disease as a reason for her discomfort. In fact, most women, not only those who are pregnant, are too eager to discount early warning signs. And because women still carry primary responsibility for child care and elder care, finding time for a doctor visit can be difficult. Enlisting support from family and friends is critical.
Doctors, too, need to be educated. “In women, symptoms are not recognized by doctors,” said Dr. Pina. Shortness of breath, fatigue, nausea, stomach pain, sweating, lightheadedness, may be attributed to overwork or stress, common factors in most women’s lives. “A woman will tell a doctor, `I can’t lie flat at night, but the kids gave me a hard time today,’” she said, noting that doctors need to filter out all the editorializing and focus on a woman’s symptoms. “We have to train doctors to listen carefully, to be culturally sensitive listeners.”
Two-thirds of men will have a Hollywood style heart attack—the classic scene shown again and again in films, with a man clutching his chest and collapsing. Yet most women and one-third of men are less apt to display such dramatic symptoms when in cardiac distress. “If we do a better job of taking female patterns of the disease seriously, we’ll do a better job of taking care of everyone,” said Dr. C. Noel Bairey Merz, director, Women’s Heart Center, Cedars-Sinai Medical Center, Los Angeles.
Diane McDaniel, one of the WomenHeart Champions, said she never had any symptoms. “During pregnancy, I would get shortness of breath and feel fatigued,” she explained. “One night, I couldn’t catch my breath.” Even though she was in distress, she waited until the next morning to go to the doctors. After medical tests, McDaniel found that a childhood bout of rheumatic fever had scarred a valve in her heart. In the fourth month of her pregnancy, she suffered congestive heart failure. Ordered on bed rest, she delivered a healthy baby girl and has been able to live a good life. “I watch what my weight, eat right, and scream every now and then,” she said.
While there was bad news—“One woman dies [from heart disease] for every minute we’ve been sitting here,” said Ofili—the good news is that women can do a lot to combat heart disease.
“No pill or procedure is a substitute for healthy habits,” said Patrice Desvigne-Nickens, program director, Division of Cardiovascular Diseases, National Heart, Lung, and Blood Institute, Bethesda. “The earlier you do it, the better. But it’s never too late.”
