Heart Attack Prevention--Are You Getting Adequate Care?

By Lynnette Horn

A recent medical study, published in the Annals of Internal Medicine,found doctors often fail to prescribe proven preventative treatments for women already suffering from heart disease.

The researchers used data from a nationwide study originally designed to investigate the effects hormone replacement therapy (HRT) had on the heart of postmenopausal women. They found that half or fewer of the women studied (all of whom had known heart disease) were taking drugs that help prevent future heart attacks, such as beta-blockers and cholesterol lowering agents. And only 83% were on a daily aspirin regimen.

Although the study doesn't address why women are under-treated, Dr. Stephen Phlaum, a SLU Care cardiologist, believes it's because historically heart disease was considered a man's disease. "Early indications from the 50s and 60s were that it killed men, not women," he said. Since the disease in women doesn't necessarily display the same classic symptoms as in men, it often went unrecognized and untreated.

Today, even though much more is known about heart disease in women, the misperception still persists among medical professionals and the general public, alike. As an example, Dr. Phlaum pointed out that a woman is far more likely to die of heart disease than breast cancer, yet the latter receives most of the media coverage. "When something becomes the favored disease in the media it gets the research money, as well," he added.

In reality, heart disease is the leading cause of death in women. According to national disease control statistics 500,000 women in the U.S. died of it in 1997, while only 42,000 died of breast cancer. One step further, that same year, the number of women who died from all other major diseases including breast cancer, totaled only 250,000. Heart disease killed twice as many women than all other diseases combined.

"Yet, we don't think of it as a woman's disease," Dr. Phlaum said. It's true that women before menopause have fewer incidences of heart attack. But once they reach menopause, they have a greater risk of heart attack than men.

What can you do to ensure adequate care?

The American Heart Association, in a study of physician and patient perceptions, asked doctors (both men and women) if they discussed risk factors for heart disease with their women patients. The study found 70% of the doctors never discussed risk factors. On the other hand, 77% of the women said they wanted their doctors to discuss risk factors with them.

The patient, Dr. Phlaum said, has the responsibility to ask for information and to follow through. Doctors have so many responsibilities outside of medicine that eat into the time they spend with their patients, he explained, that it is often left to the woman to be assertive in getting the information they need. He encourages all women to become proactive in their wellness care, to learn of risk factors and know the signs of heart disease.

What are the risk factors?

While there are a number of minor factors, such as obesity and ethnicity, that have a role in heart disease when combined with other factors, Dr. Phlaum was quick to point out that they alone do not increase risk. The ones to be concerned with are the following major risk factors for women:

- Age over 55 - Diabetes - A family member (male or female) who has had a heart attack before the age of 55 - High cholesterol--as determined by LDL levels, and relative to other risk factors- - Previous heart attac

What are the symptoms?

Women may or may not experience the classic symptoms of heart attack, which include: - Pain, pressure, a squeezing sensation or stabbing pain in the chest - Pain radiating to shoulder, neck, back, arm or jaw - Pounding heart or change in heart rhythm - Difficulty breathing - Nausea, vomiting, abdominal pain - Cold seats or clammy skin - Dizziness - A feeling of anxiety, panic or doom - Heartburn More typically in women: - Sudden onset of weakness, body aches, overall feeling of illness - A burning sensation in the chest, often mistaken for heartburn - An unusual feeling of mild discomfort in the chest or bac

First Published in Progressive Woman Magazine, 2003