Answers about heart disease in women, with Dr. Gerrie Gardner

March 6, 2017 Gerrie Gardner

By Providence Medical Group with Gerrie Gardner, DO

Cardiovascular disease accounts for nearly 1 of every 3 deaths in the United States, at an average rate of 1 death every 40 seconds. Despite these startling statistics, too many people take a passive attitude about their heart. They don’t take steps to protect their heart health until a problem occurs. Why? Simply, many people are unaware of the reality of heart disease – especially women.

There is no denying a major gender gap when it comes to heart disease. Despite considerable advances in the past few years, heart disease has killed more women than men each year since 1984 and continues to be underappreciated as the No.1 killer of women. Part of the problem is that men and women perceive their risk for heart disease differently.

We sat down with Gerrie Gardner, DO, lead cardiologist at Providence Medical Group, Everett, Wash., to discuss how heart disease affects women. We dove into female risk factors, aging and menopause, preventive measures, and what symptoms women experience during a heart attack. Her perspectives are interesting and applicable to everyday life.

How is the female heart different from the male heart?

Male and female hearts have all the same structures. The only real difference is the size of a male heart versus a female heart. “The typical heart in anyone’s body will be about the size of their two hands clasped together,” says Dr. Gardner. “It’s relative to body size. A woman’s heart arteries are typically smaller than a man’s heart arteries.”

Do women’s risks for heart disease change as they get older and reach menopause?

It is a known fact that women’s risk for heart disease increases after age 65 and postmenopause. According to the American Heart Association, the hormone estrogen has a positive effect on the inner layer of the artery wall, keeping blood vessels flexible. But the topic of hormones and how it relates to heart disease is controversial. “Declining estrogen levels may play a role in an increased risk of heart disease for postmenopausal women, although, that is by no means the only reason women are at higher risk of a cardiovascular event. These risks include aging, family history, diabetes, hypertension and lack of exercise.” says Dr. Gardner.

At what age should women worry about heart disease?

Younger women should pay attention to the risk factors that could indicate cardiovascular risk later in life. These risk factors include: gestational diabetes, gestational hypertension, general uncontrolled hypertension, diabetes, obesity and high cholesterol. The most important risk factors are family history and dependence on tobacco/nicotine products.

“The only thing we really cannot control is family history. The truth is, if your parents had early heart disease, then you are at risk for early heart disease,” says Dr. Gardner.

“Although this is an extreme example, it can happen. I had a 33-year-old patient who had a miscarriage, and then she started having chest pains which were in fact, a heart attack. She required a stent, and then six months later she had bypass surgery.

“Why did this happen to someone so young? Her father had early heart disease and had bypass surgery at the age of 35 years. She had diabetes, and she smoked prior to her pregnancy. So she had several risk factors to contend with besides family history.

“Everyone should investigate whether heart disease runs in their family, and if it does, they need to tell their doctor.”

Cardiovascular disease typically occurs 7-10 years later in woman than in men. It is the major cause of death for women 65 years or older. For men, the major risk starts at 55. Women generally feel like they’re protected against cardiovascular disease. But over time, if they have not controlled their risk factors and they’re over the age of 65, they’re at risk of a heart condition or death.

What can women do to protect themselves?

First and foremost, women need to address their risk factors, like high blood pressure, cholesterol, smoking, obesity and diabetes. “It’s important to avoid tobacco and nicotine products. That’s the most important thing you can do to protect your heart,” says Dr. Gardner.

“If a woman and a man of the same age both smoked 10 cigarettes a day, it would have a worse effect on the woman.”

The second most important thing women can do to protect their heart is manage high blood pressure. “Hypertension is a silent killer. Women and men can have chronically high blood pressure values with no associated symptoms,” she says.

“To lower blood pressure without medications, women can try exercise, weight loss, meditation and a low-salt diet.”

Cardiologists are always going to recommend a low-fat diet with limited portions of red meat. Dr. Gardner is specifically a fan of the heart-healthy Mediterranean diet, which is abundant in poultry, fish, vegetables, fruits and grains, but low in red meat, fat and sodium.

Why do more women die from heart attacks than men?

When a woman has a heart attack, she has a worse prognosis after a heart attack compared to a man her same age. “The major differences are that women present later, they are typically older when a heart attack occurs, and their vessels are smaller than men’s, which means more risk for complications,” says Dr. Gardner.

“Women go to the hospital later than men when they’re experiencing a heart attack. A study in Scotland showed the average time for a man to go the hospital after a heart attack is 30 minutes. The average time for a woman is 180 minutes.”

During a heart attack, the heart muscle cells die. If more muscle cells die, the patient is at increased risk for heart failure.

What heart attack symptoms do women experience?

One of the usual descriptions of a heart attack is “an elephant sitting on the chest.” Although women can experience these typical symptoms, they often experience atypical symptoms. Dr. Gardner breaks down the seven symptoms of a woman’s heart attack:

  1. Pain in arms, neck, jaw, and upper back
  2. Upper stomach pain
  3. Abdominal pressure that feels like “elephant sitting on stomach”
  4. Nausea, shortness of breath, lightheadedness
  5. Sweating, nervous cold sweat
  6. Severe fatigue, “tiredness in chest”
  7. Feeling of doom, something bad is happening 

Women can experience one or more of these symptoms during a heart attack. The best choice is to seek treatment at the emergency room. It’s okay to call 911.

What is your universal advice to all women in regards to their heart health?

Know your numbers! It’s so important to be aware of your body and always manage your blood pressure, your cholesterol values and your weight,” says Dr. Gardner.

“I would also recommend that everyone have a cholesterol panel done starting at age 20 to use as a baseline.”

If you or a loved one is concerned with heart health, contact your primary physician today.

Thank you, Dr. Gardner, for your insights.

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