Heart disease is No. 1 killer of American women, but it’s often misdiagnosed. Here’s why

For decades heart disease was considered a man’s disease. Women were not part of clinical trials and their atypical symptoms were not duly recognized when they sought help. That has changed slowly.

However, alarming death statistics underscore the fact that women’s tickers (and the vascular system that supports their function) aren’t as healthy as they should be. Heart disease remains the number one killer of American women, causing about one in every five deaths, according to the Centers for Disease Control and Prevention.

In fact, more women die of heart disease than all forms of cancer combined. More worrisome: An online study of 300 randomly selected physicians (mostly primary care and obstetricians/gynecologists) found that these doctors were less attentive to women’s risk factors for both heart and cardiovascular conditions. (Cardiovascular disease includes both heart and blood vessel conditions.)

“Part of the problem is that it [cardiovascular disease] goes undiagnosed more in women,” says Dr. Mistyann-Blue Miller, an interventional cardiologist with Cleveland Clinic’s Indian River Hospital. . “They don’t present with the expected symptoms, and it’s not uncommon for those symptoms to be attributed to something else.”

Different symptoms for women

Men, for example, tend to suffer pain or pressure in the chest during a heart attack. With women, not so much. On the other hand, women may display symptoms of dizziness, nausea, fatigue and shortness of breath. But this absence of pain can result in a late diagnosis — and devastating consequences.

Dr. Marie Delgado-Lelievre, a cardiologist at the University of Miami Miller School of Medicine, remembers a woman in her 50s who came to her because of high blood pressure. On the surface, this seemed to be her only symptom. During the consultation, the physician discovered that the patient had also been suffering from shortness of breath and occasional chest pains.

Alarmed by these telltale signs, Delgado-Lelievre ordered a stress test and cardiac catheterization procedure. Ultimately the patient underwent open-heart surgery.

“This happens more frequently than we think,” the UM cardiologist acknowledges.

Time is of the essence in the case of a heart attack or stroke, cardiologists point out, and they urge women — and their physicians — to act quickly at the first sign of a potential CVD event. Prompt care stops further damage.

Unfortunately, women often put their own health on the back burner. “Some women patients neglect their own health,” says Dr. Andrea Vitello, cardiologist at Baptist Health’s Miami Cardiac & Vascular Institute. “They’re always doing for others.”

Educating women, doctors on risk factors

Vitello and her colleagues at Baptist are developing a new cardiovascular program aimed at educating both women and physicians on female risk factors, proper treatment and prevention. She is particularly eager to raise awareness among younger women who often shrug off the silent but dangerous symptoms of certain kinds of CVD.

The most common type is coronary artery disease, a condition in which plaque blocks the arteries in your heart. This leads to narrowing of those heart vessels, thus diminishing the blood flow the heart needs. CAD has a strong genetic component, yet young women with a family history of the condition may not recognize the danger it poses. Over time it can weaken the heart muscle, leading to heart failure.

“They’re not aware they have certain risk factors,” says Dr. Lucia Blanchard, a cardiologist with Broward Health. “So, they can’t take the steps early on to limit the damage.”

Dissimilar cardiovascular symptoms are not the only thing that differentiates women from their male counterparts. Even when controlling for certain risk factors, health outcomes may be worse for women than for men. Women with diabetes fare worse than men if they’ve already had a heart attack. Female smokers are also more likely to have a heart attack than men who smoke.

And menopause proves a particularly fraught stage in women’s heart health. After 55, they are more likely to get heart disease, in part before of the drop in estrogen. This hormone serves as a protecting factor because it helps decrease LDL (bad) cholesterol while also increasing HDL (good) cholesterol.

High-blood pressure during pregnancy

But cardiovascular issues aren’t necessarily restricted to an older demographic. The factors that result in cardiovascular disease can, and do, affect younger women.

High blood pressure during pregnancy is particularly problematic — and fatal. A recent study found that the number of mothers who died of high blood pressure during pregnancy shot up 15-fold between 1979 and 2018. Researchers concluded that about 75% of these maternal deaths were preventable.

Even among those who survive, gestational hypertension foreshadows serious health issues down the road. Some women have been found to develop chronic hypertension as early as three years after pregnancy.

High blood pressure remains one of the most common risk factors of heart disease, says Delgado-Lelievre. Known as “the silent killer,” it is especially dangerous because people who suffer from it don’t always display obvious symptoms. She helped found the University of Miami Comprehensive Hypertension Center to care for people with complex or difficult-to-treat hypertension. It was recently awarded the American Heart Association’s Comprehensive Hypertension Center Certification, the only center in Florida to earn that distinction.

Though the center treats both men and women, focused attention will be especially helpful for the latter. Studies have shown that only 1 in 4 women with hypertension are adequately treated. That needs to change if women and their healthcare advocates want to lower fatalities caused by chronic, and often undetected, cardiovascular disease.

“The message here is that you need to take care of yourself at an early age,” Delgado-Lelievre concludes. “You need to be aware of risk factors. You need to be talking to your doctor about your family history. Don’t wait until you’re 50 to do that.”

This story was originally published February 19, 2022 at 7:00 AM.