Susan Matulevicius, M.D. Answers Questions On: Women’s Heart Health

Despite being viewed for many years as “a man’s disease,” heart disease kills more women than men – one in three – each year. And because cardiovascular disease can affect people of all ages, all women are at risk.

Primary prevention is about helping patients modify their risk of ever having heart disease. We can all do simple things to mitigate this risk, including making sure our blood pressure and cholesterol are controlled, exercising regularly and not smoking, and maintaining a healthy weight.

Secondary prevention is about helping patients lower their risk once they have developed heart disease. The goal is to stop heart disease from progressing and to prevent a cardiac event such as a heart attack or heart-related stroke. We work on the same issues we do with primary prevention but may be more aggressive in targeting things like cholesterol and blood pressure.

Although menopause does not cause heart disease, certain risk factors for cardiovascular disease increase around the time of menopause, including a rise in blood pressure, an increase in LDL (“bad”) cholesterol, and a decrease in estrogen.

These changes, along with the fatigue that may occur with menopause, may cause women to gain weight and exercise less, which increases the risk of heart disease. In addition, unhealthy habits such as smoking and being sedentary start to take a toll when we are in our 50s.

The best things people can do to decrease their heart disease risk are to take time for themselves throughout their lives to stay physically active, maintain a healthy weight, keep an eye on their blood pressure and cholesterol levels, never smoke, and eat a heart- healthy diet.

Women often experience cardiac pain differently than men do – symptoms can include shortness of breath, nausea, dizziness, and back or jaw pain – so they shouldn’t assume that they’re not having heart-related symptoms just because they don't have chest pain or pressure.

Although there are many other causes for these symptoms, it’s important for women not to ignore them and to consult their doctors to ensure their hearts are healthy.

The cardiac event that women tend to experience most differently from men is a heart attack. Some women feel no symptoms at all; others note shortness of breath, dizziness, lightheadedness, back pain, nausea, or vomiting. Because of these nonspecific symptoms, women frequently don't seek treatment early and are less apt to call 911.

Men and women can also experience heart palpitations and cardiac arrhythmias (abnormal heart rhythms) differently, with symptoms ranging from dizziness and fatigue or a fluttering in the chest to simply feeling anxious or unsettled. While many palpitations and arrhythmias are not causes for concern, some do require treatment, and patients should discuss them with their doctors.

Women are also more likely than men to develop diastolic heart failure (caused by stiffening of the heart muscle) versus systolic heart failure (inefficient pumping), primarily because their hearts tend to be smaller than men’s. Both types can cause swelling in the legs, shortness of breath – especially when lying flat – and breathlessness with normal activities.