What Women and Husbands Don't Know About Heart Attack

by Dr. W. Gifford Jones

Tuesday, September 19, 2006

"Vive la Difference!" We all know what Maurice Chevalier was thinking when he uttered these words about boys and girls. But there's a "difference" between the sexes that Chevalier wasn't referring to and that few women or their husbands know.

When heart attack is mentioned, most of us invariably think of men. Now, a report from the Cleveland Clinic in the U.S. shows that coronary attack can be an even more ominous event for women. And ignorance of the reason means the outcome can be more deadly.

Women have always appeared to be the stronger sex since they live longer and heart attack strikes them 10 years later than men. This gives them the appearance of invincibility, but in effect the coronary fuse just takes longer to burn.

I'm sure most readers know that obesity, diabetes, smoking, hypertension, taking the car to the corner store and elevated cholesterol are all risk factors for heart attack in both sexes. But Cleveland researchers have taken a closer look at these threats and found that some in particular have a greater impact on women.

For instance, it's known that cigarette use doubles the risk of heart attack in men. But Cleveland researchers were shocked to discover that women who smoke increase their risk of coronary attack two to five times more than men.

Dr. Yvonne Braver, at the Center for Women's Health at the Cleveland Clinic, reports that "Heart disease develops at a much younger age in women who smoke". Female smokers, she says, typically have heart attacks 19 years earlier than women who do not smoke. And if their systolic blood pressure (the upper number) is elevated, the risk of heart attack is greater for women.

Today, diabetes is a huge problem for both sexes. We know that 50 percent of patients with this disease die from heart attack. But for those over 60 years of age diabetes is more common in women. The Cleveland Clinic study shows women with this disease are at even greater risk of heart attack than men.

There's another less known problem called the "Metabolic Syndrome". It's a basket of troubles that includes abdominal obesity, high blood pressure, increased levels of triglycerides (a blood fat), low levels of good cholesterol HDL and a high fasting blood sugar. This combination sets the stage for heart attack in both sexes, but the study shows that women are once again affected more than men.

Symptoms of heart attack also differ in women. Rather than the crushing chest pain experienced by males, women more often complain of extreme weakness, shortness of breath, jaw pain, nausea and vomiting. And symptoms can be present for hours or days.

Because these symptoms are so vague, doctors are less likely to suspect that heart disease is present. So women are less often referred for diagnostic tests. But even if these tests are done they are less accurate and more dangerous.

Doctors often use radioactive material to scan the heart for evidence of blocked arteries, but the presence of female breast tissue decreases the quality of the image. And since a woman's heart muscle is smaller the results are less reliable. This means there's an increased chance of suspecting heart disease when it's not present.

If doctors decide on angiography to detect blocked arteries, women face another hazard. Their coronary arteries are smaller and more easily damaged when catheters are inserted into them.

But their troubles don't end here. Dr. Tirone David, an internationally known Toronto heart surgeon, says the operative mortality is higher in women due to the decreased size of coronary vessels. Surgeons must join together vessels the size of a piece of spaghetti, not an easy task.

Women who have heart attacks are also more likely than men to die within a year.

And they have an increased risk of a second attack within six years.

Since heart disease is the Number One killer, everyone should follow a healthy lifestyle to prevent this disease. But faced with these additional hazards women who are obese, smoke and have other risk factors for heart attack should make a major effort to eliminate them.

W. Gifford-Jones M.D is the pen name of Dr. Ken Walker graduate of Harvard. Dr. Walker's website is: Docgiff.com

My book, �90 + How I Got There� can be obtained by sending $19.95 to:

Giff Holdings, 525 Balliol St, Unit # 6,Toronto, Ontario, M4S 1E1

Pre-2008 articles by Gifford Jones

Canada Free Press, CFP Editor Judi McLeod