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February 2007 Issue

Andra Blomkalns, MD, says that physicians often have difficulty identifying serious cardiac symptoms in women.
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What Every Woman Needs to Know About Heart Attacks

Published February 2007

Cardiovascular disease (CVD) is the No. 1 killer of American women, and more women have died of the disease than men since 1984.
Despite this, when women seek medical care, doctors may not always associate their symptoms with acute coronary syndrome (ACS) and do not treat them as aggressively as men.

That's what researchers from across the country, including Andra Blomkalns, MD, assistant professor and director of the UC emergency residency program, found in a review of several national studies.

"I feel that sometimes clinicians, and even patients, don't believe that women have the disease," says Blomkalns. "Coronary heart disease has been thought of as a 'man's disease' for so long that the attitudes, therapies and interventions have not been thought of as gender neutral."
Blomkalns suggests several things that women should know about coronary heart disease: 

  • Women may have different heart attack symptoms than men. Pain in the chest and arms and shortness of breath are among the "classic" symptoms many people associate with a heart attack. Gastric symptoms such as stomach pain or nausea, not the "classic" symptoms, may be experienced more by women, say Blomkalns. "Unfortunately," she says, "physicians often have greater difficulty identifying serious clinical cardiac symptoms in women, making it more difficult to administer optimal treatment."
  • Women tend to be older than men when they have their first heart attack. According to Blomkalns, in addition to being older than men by about 10 years, women often have other health complications, like diabetes and high blood pressure. These conditions can have a higher risk for death or other cardiovascular complications.
  •  Cardiac treatment is mostly based on research trials involving men. Traditionally, fewer women have been enrolled in CVD clinical trials than men. "Because the standard methods of diagnosis and treatment for heart attacks are the result of trials involving mostly men, the treatment may not be perfectly applicable to women," says Blomkalns.
  • Women are often not treated as aggressively as men. Despite the fact that women tend to have higher risk features than men, recent national research that Blomkalns was involved in shows that women who arrived at the hospital with heart attack symptoms were less likely to be treated according to the standard guidelines. "We're trying to understand the disparity so we can ensure that all patients at risk for a heart attack, female or male, receive care that has been proven to save lives." 
    Women may experience greater side effects from cardiac treatment than men. Women tend to have more complications from cardiac procedures than men, including bleeding more often after receiving antithrombotics (blood thinners) and fibrinolytics (clot busters). "Women and men are different when it comes to heart disease," Blomkalns says. "They present differently and act differently when they are treated. We have not begun to understand the implications of these differences, and more research is needed."

Regardless whether you are a man or a woman, there are several risk factors you can control or treat to reduce your chance of coronary heart disease. Blomkalns recommends the following for healthy living: 

  • Avoid tobacco smoke and excessive alcohol consumption
  • Eat food low in cholesterol and saturated fats
  •  Be physically active and maintain a healthy weight
  • Get regular medical exams. 

"Following these suggestions can improve your cardiovascular health and prevent other diseases, such as diabetes," she says.

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