Cardiology for Women
Lynne V. Perry-Bottinger, M.D., F.A.C.C.

Dr. Perry-Bottinger spoke at the Summer Solstice celebration this June. Below are her remarks.

Heart disease remains the number one killer of women and men in the United States. Heart disease refers to coronary artery disease or blockages in the blood vessels that feed the heart. Significant blockage in these arteries can cause angina or chest pain, heart attack or death of heart muscle, irregular heart rhythm, or fluid backup into the lungs.

Coronary artery disease affects 3 million women and 4.2 million men in the U.S. It is responsible for one-third of all female deaths, about 250,000 women annually. Ten times as many women die of this disease than from breast cancer. African-American women have the highest mortality rate from coronary artery disease of any demographic group. The states with the highest heart disease death rates are Mississippi, New York and West Virginia, in that order. The national death rate for black women is 553 per 100,000 compared with 388 per 100,000 for white women. In New York State, the death rate for black women is 573 per 100,000, compared with 487 per 100,000 for white women.

The major coronary artery disease factors are diabetes, hypertension, dyslipidemia or abnormal cholesterol profile, obesity, tobacco use, family history of premature coronary disease (first heart attack men under 55, and women under 65). Before menopause or change of life, women are less likely than men to have heart disease unless they have diabetes, hypertension, or family history of heart disease at a young age. After menopause (especially 10 years out), women have the similar risk of heart disease and subsequent death as men. Diabetes poses a greater risk factor for women than men irrespective of menopausal status. Elevated LDL or bad cholesterol portends a worse prognosis for women than men. Low HDL or good cholesterol is also a risk factor. Just recently elevated c-reactive protein has been found to be a strong predictor of cardiac events in women.

When they do have a heart attack, women are more likely than men to have non-chest-related symptoms such as jaw, neck, arm, or back pain, nausea, and shortness of breath. Contact your doctor immediately for any of the above, especially if associated with exercise.

Remember to control risk factors by following a low fat, low cholesterol, low salt diet, exercise at least three times a week, stop smoking, and drink alcohol in moderation.  A recent study shows food high in B vitamins such as green leafy vegetables, chicken and fish reduce heart disease risk in women.

Ask your doctor about taking aspirin, which mildly reduces heart disease risk in women. Ask about postmenopausal estrogen replacement, which reduces heart disease risk in women who have never had a heart attack and is now being studied in women after heart attacks.

Ask your doctor to check your HDL or good cholesterol, as this is better than total cholesterol in predicting heart disease risk in women.

Finally, be aware that a regular EKG stress test may not give the correct information about your heart. Further testing such as heart ultrasound or x-ray techniques may be required.