Doctor’s Tip: What to know about women and heart disease |

Doctor’s Tip: What to know about women and heart disease

Dr. Greg Feinsinger
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Here’s an all-too-common true story, from the book “Beat the Heart Attack Gene” by Brad Bale, M.D. and Amy Doneen, RN, Ph.D.: A 37-year-old woman, J.T., was rushing around getting ready for work in the morning and experienced a sharp pain in her chest, radiating down her right arm, accompanied by shortness of breath.

She had no obvious risk factors for heart disease, and it didn’t occur to her that she might be having a heart attack. She then developed nausea and collapsed on the floor. Her husband drove her to the ER and, after a long wait, an EKG was done, which was normal. She was told that because she was a woman and was young, because her pain radiated down her right instead of her left arm, and because her EKG was normal, she wasn’t having a heart attack.

She was diagnosed with anxiety and bacterial pneumonia and given azithromycin, an antibiotic that has been shown to triple cardiovascular mortality.

She continued to have symptoms during the night, and the next morning her husband drove her to an urgent care center. The doctor there was skeptical of the pneumonia diagnosis and ordered a blood test for cardiac enzymes, which were very elevated, indicating damage to the myocardium (heart muscle). He wanted to call an ambulance, but J.T. was concerned about the cost, so her husband drove her to the ER, where she waited for two hours before she was evaluated.

Another EKG was normal, but her cardiac enzymes were sky high. Finally a heart attack was diagnosed, and appropriate treatment was started. She was fortunate she lived through this saga, given that in some 20 percent of heart attacks the first symptom is the last: sudden death.

Here’s what you need to know about women and heart disease:

From age 35-85, cancer is the No. 1 killer in women, with heart disease No. 3 from age 35-44, and No. 2 from 45 to 85, after which heart disease is No. 1.

Women tend to develop heart disease a decade later than men, but as with men, heart disease is the No. 1 killer in women overall.

Of the 435,000 American women who have heart attacks every year, 83,000 are younger than 65 and 35,000 are younger than 55.

In men and women, the process that results in heart disease is the same: Damage over the years to the endothelial lining of the arteries, which eventually results in plaque (hardening of the arteries). In men, heart disease usually affects the larger coronary (heart) arteries, whereas in women smaller arteries are often involved (called microvascular disease).

In men, classic heart attack symptoms are crushing chest pain often radiating to the jaw or left arm, shortness of breath, nausea, light-headedness and sweating. Women often have more subtle symptoms, including mild pain in the upper back, shoulders, neck or either arm; anxiety; and unusual fatigue.

The American Heart Association says that coronary heart disease in women “remains understudied, underdiagnosed and undertreated.” This is especially true of younger women and black women.

How do you know if you have heart disease and are therefore at risk for a heart attack (or stroke)?

Risk factors in men and women are similar: Smoking; family history; high blood pressure (greater than 120/80); high cholesterol or triglycerides; low HDL (good cholesterol); diabetes and prediabetes; obesity; lack of exercise; inflammation; stress including depression and anxiety; and sleep problems, including sleep apnea.

Heart attack prevention doctors will want to check the health of your arteries. Bale and Doneen recommend a carotid IMT for this, which can be obtained locally only at Glenwood Medical Associates, is noninvasive and involves no radiation. Another helpful test is a coronary calcium score, available at most hospitals, but this can be falsely negative in women younger than 50 or men younger than 40, because their plaque hasn’t become calcified yet.

Dr. Caldwell Esselstyn (“Forks Over Knives” documentary, “Prevent and Reverse Heart Disease” book) says that anyone on the S.A.D. (standard American diet) can be assumed to have heart disease.

Here’s the good news though: Heart disease can be prevented and even reversed with lifestyle modification, consisting of regular exercise and plant-based, no-added-oil, whole food nutrition with avoidance of salt and sugar. If you aren’t willing to make these lifestyle changes, medications such as statin drugs can be helpful, and some people need medications even if they have an optimal lifestyle (e.g. people with severe atherosclerosis or a familial hyperlipidemia with extreme cholesterol elevation).

Dr. Feinsinger, who retired from Glenwood Medical Associates after 42 years as a family physician, now has a nonprofit Center For Prevention and Treatment of Disease Through Nutrition. He is available for free consultations about heart attack prevention and any other medical concerns. Call 970-379-5718 for an appointment. For questions about his columns, email him at

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