Women's Heart Health

Dr. Stephen Sinatra on Women, Stress, and Heart Disease

"When it comes to CAD, treating a woman requires different skills."
Stephen Sinatra, MD, is a cardiologist at the University of Connecticut School of medicine and the author of The Sinatra Solution: Metabolic Cardiology.

Q: Public health organizations have been hammering home the idea that heart disease is the number-one killer of women. Is it really possible that women still underestimate their risk?

A: I strongly believe that women underestimate their risk. Women really fear breast cancer; that's still their number-one concern. I think that fear of breast cancer is overwhelming for a woman. The problem is that women still don't get it. They feel that heart disease is a male-oriented disease.

Q: OK, coronary artery disease is the leading killer of women, but what age group are we talking about? Don't women get it much later in life than men do?

A: The earliest heart attack I have seen in a woman was in a 17-year-old. But generally women lag 10 years behind men. The average male gets it at 55 and woman at 65, but—and a big but here—a woman's instance of coronary artery disease (CAD) skyrockets after the age of 45. Once she starts developing perimenopause, her risk goes up by 400%. And 45- to 50-year-old women are at the greatest risk of heart disease.

Q: How is CAD different in women compared to men?

A: It's an anatomical issue. A woman's heart is smaller than a man's. Also her blood vessels are smaller. Women are more difficult to treat with angioplasty and bypass surgery because of the nature and smaller caliber of their vessels. There is also a muscular difference. Women get more diastolic dysfunction than men. Women with high blood pressure have far more complications than men do because of diastolic dysfunction. Even cardiologists don't understand it. It takes more energy to fill the heart with blood than to empty it. It requires more metabolic support, and the problem with women with hypertension and CAD is that they develop more stiffening of the left ventricle than men. Women and their cardiologists need to be very cognizant of this anatomical difference.

Q: CAD is the leading cause of death among women in the U.S., but it can still be hard to catch. How can women better recognize the symptoms?

A: Women practice denial almost as much as men do. They seem to think, "It can't be heart disease. I'm a woman." The most important aspect is getting treated quickly.Women need to take notice if something dreadful is going on in their body. If she has profound shortness of breath, sudden jaw pain, or a new pain in her back, she needs to rely on her instincts. She must seek medical attention.

Q: What atypical symptoms should women watch out for?

A: The typical presenting factor in men is pain underneath the breast bone. They also tend to break out in a sweat. Women can have that too, but I've seen women sitting in the emergency room for three or four hours with jaw pain, waiting to see an oral surgeon. And, for example, if a woman carrying a heavy load suddenly develops a profound weakness and shortness of breath, this could be the result of cardiac vulnerability. If it is something that is alarming or different—some sort of atypical pain—women should rely on their instincts and call their doctor.

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