By Blithe Wiley

Although many women will say that their number one health concern is cancer, heart disease is actually the number one killer for women. In fact, heart disease accounts for one in every three female deaths in the United States each year, whereas one in 31 American women dies from breast cancer annually.

What exactly is heart or cardiovascular disease?

Cardiovascular disease generally refers to conditions that involve narrowed or blocked blood vessels that can lead to a heart attack, chest pain (angina), or stroke. Other heart conditions, such as those that affect the heart’s muscle, valves, or rhythm, also are considered forms of heart disease.

There are several notable differences in cardiovascular disease in women and men. First, men tend to develop cardiovascular disease at younger ages than women, primarily due to estrogen’s beneficial effect on women. Therefore, when women present with a similar cardiovascular condition, they are often older and will have more health problems.

Another key difference is that women often do not have the “typical” symptoms that alert them to the warning signs. For men, heart attack symptoms often include chest pressure and pain, shortness of breath, and nausea or vomiting. Women can often experience symptoms that are much more vague, including weakness, fatigue, and indigestion.

These vague symptoms may cause a woman to delay seeking diagnosis and treatment. What’s more, by the time a woman is evaluated by a cardiovascular specialist, pursuing more aggressive measures such as high-risk surgical procedures may pose a greater risk.

According to Sonja Brune, Acute/Critical Care Clinical Nurse Specialist and Advanced Practice Provider with the UT Health San Antonio Cardiology Heart Failure Program, it is of utmost importance that women play an advocacy role in their prevention and treatment of heart disease. First and foremost, she says she cannot stress enough the importance of every woman having a primary care provider.

“Women should see their primary care provider annually, beginning in their twenties,” Brune explained. “Even if a woman has no medical conditions, an annual visit with her PCP will evaluate risk factors and pick up diseases early on to be treated before any symptoms exist.”

Women need to make being their own heart health advocate a priority because, for so many women, their health care needs come last.

“Women are instinctively caregivers”, said Brune. “At an early age, little girls intuitively begin caring for their baby dolls and stuffed animals. As they grow older, many start helping to care for younger siblings or become babysitters. Adult women often designate themselves as the health advocate for their husbands, scheduling their check-ups, etc. They often find themselves caring for aging parents and sometimes take on raising grandchildren.”

In her 30-plus years in healthcare, Brune says that she has seen women as being the self-sacrificing force behind caring for others time and again.

“Not a week goes by that I do not tell at least one of my female patients that she will not be there to care for others if she does not start taking care of herself. Sadly, that is sometimes the main reason why they will begin devoting more attention to their own wellbeing.”

Brune recommends that women know their health history, including family history. She also suggests they keep detailed listings of their medications (including over-the-counter), any allergies they have, prior hospitalizations and surgeries, and their previous and current healthcare providers.

She notes that women also need to be aware of heart disease risk factors and which ones can be modified. Some risk factors cannot be changed, such as age and genetics. The modifiable risk factors that affect both men and women are tobacco use, physical inactivity, poor nutrition, overweight and obesity, high cholesterol, high blood pressure, diabetes, kidney disease, and sleep apnea. Furthermore, women-specific factors that can increase the risk of developing cardiovascular disease include polycystic ovarian syndrome, pregnancy-induced hypertension, preeclampsia, and gestational diabetes.

What are some of the lifestyle changes women can make to address the modifiable risk factors?

Brune notes a number of key lifestyle changes that can help reduce the risk of heart disease.

“In addition to making lifestyle changes, such as avoiding tobacco and vaping, exercising daily, eating a heart-healthy diet and maintaining a healthy weight, women should know the health conditions that can increase the risk of developing cardiovascular disease and work with their healthcare provider to keep these controlled,” Brune said.

These health conditions include:

· High cholesterol and/or triglycerides
· High blood pressure
· Diabetes mellitus
· Metabolic syndrome
· Kidney disease
· Sleep apnea

“The key here is that you NEED to know your health status,” said Brune. “None of the conditions above are associated with any significant symptoms, so you must be evaluated. In fact, it is not uncommon for someone to find out that she has high blood pressure or diabetes AFTER she has been diagnosed with cardiovascular disease.”