Carolyn Warner

(WOMENSENEWS)–Carolyn Warner nearly died of her doctors’ ignorance.

In August 1997 she was driving down the freeway when she felt tingling in her arms and shortness of breath. Gripping the wheel, she veered off the highway, pulled into a hotel and called for help. She says that when she arrived at the emergency room, doctors shrugged off her problem as mere anxiety. But when she visited a cardiologist two weeks later, she discovered she had a 98 percent blockage in her right artery–the vessel through which blood is pumped to the heart muscle–and needed immediate surgery to clear it.

“I continued having cardiac events that required emergency attention,” says Warner, a 60-year-old food industry consultant in Upland, Calif. “But three more times, medical providers failed to recognize my symptoms, which are less dramatic in women than in men.”

She says paramedics and doctors continued to tell her that she had anxiety and that eventually, she had a heart attack requiring triple-bypass surgery, in which blood vessels from other parts of the body are used to replace clogged arteries and reroute blood to the heart.

If Warner had been a man, her condition might not have been dismissed so easily. Both her father and grandfather died of heart attacks, prompting doctors to screen her brother for heart disease, though they never bothered to monitor her and her two sisters.

Stories like Warner’s are why the National Institutes of Health, based in Bethesda, Md., and the American Heart Association, based in Dallas, have made Feb. 4 “Wear Red Day.” On this day, women’s heart health advocates are crusading to raise awareness about women’s vulnerability to heart disease. They are encouraging women to don red garb and a signature “Red Dress Pin” (a symbol also garnishing heart-healthy products on grocery shelves). In synch with this campaign, February’s Wheat Chex and Multi-Bran Chex cereal boxes will feature photos of Dr. Nieca Goldberg, a spokesperson for the heart association and a leading authority in the fight against heart disease in women.

“Eighty percent of heart attacks in women can be prevented,” says Goldberg. “We need to educate women so they protect themselves by eating healthy, getting exercise and lowering their cholesterol and blood pressure. In order to save lives, we need to improve women’s heart care, conduct more studies on gender differences and enroll more women in heart research trials.”

Slowly but surely, these efforts are paying off. In a 1997 American Heart Association survey, only 30 percent of women correctly listed heart disease as women’s leading cause of death. In a 2004 follow-up survey, the number had surged to 46 percent.

Though heart disease can be prevented, it still kills more than 40 percent of American women, two-thirds of whom die with no previously recognized symptoms.

Heart disease is the number one killer of women as well as men. But women account for only 36 percent of open-heart surgeries, according to the National Coalition for Women with Heart Disease, based in Washington, D.C.

Women are more likely to die after their first heart attack or after bypass surgery. They are less likely to receive necessary medications like aspirin, beta-blockers and ACE inhibitors after a heart attack. Women account for only 25 percent of heart research subjects–and 5 percent of cardiologists.

Awareness Movement

Raising awareness about heart disease in women has been a long and uphill battle especially when it comes to educating the medical community. In the early 1990s, one Gallup poll showed 88 percent of primary doctors didn’t know that women’s heart disease symptoms differ substantially from men’s. More than a third failed to recognize that heart disease is women’s leading cause of death.

In the early 1990s, the National Institutes of Health worked to remedy this problem by launching its Women’s Health Initiative and boosting heart disease research, treatment and education. In 1998, a group of female heart attack survivors formed the nonprofit National Coalition for Women with Heart Disease and launched a coast-to-coast awareness campaign. In February 2000, representatives from the coalition and other women’s health groups met with the institutes’ authorities and urged them to step up their efforts. This led to the birth of the institutes’ Heart Truth Campaign, the heart association’s “Go Red for Women” initiative and Wear Red Day, now in its second year.

Celebrated by the coalition, the institutes, the heart association and other women’s health groups, Wear Red Day has become a major media event with a celebrity spokesperson (singer Toni Braxton), fashion show fundraisers featuring red dresses and gala events galore. On this day, the heart association also invites employees at sponsoring companies to wear red and contribute $5 each to the treatment of heart disease in women.

Same Conditions, Different Symptoms

The 8 million American women who suffer from heart disease develop the same conditions as men, including angina (chest pain), coronary artery disease (in which plaque builds up in the blood vessels), stroke (loss of brain function caused by blockage of the blood vessels) and heart failure (in which the heart can’t pump enough blood to the body). But women’s symptoms can be dramatically different.

If women have high cholesterol levels, the plaque that builds up in their arteries tends to be softer and more diffuse than that of men. If they have blockages, these obstructions tend to lie not in the major arteries but in the often-overlooked smaller branches.

Women’s heart attack symptoms are also usually more subtle. “Women tend to have less discomfort in their chest and more of the other associated symptoms like indigestion, backache, a vague feeling of malaise, unusual fatigue, dizziness and palpitations,” says Dr. Robert Bonow, chief of cardiology at Northwestern Memorial Hospital in Chicago. “Women also tend to have heart attacks in their 60s and 70s, decades later than men.”

Gains in Awareness, Treatment

Despite plenty of room left for improvement, health advocates report strides in recognition and treatment of women’s heart disease as scientists conduct more studies on women’s heart health and develop ultrasound and other imaging techniques that are better at detecting women’s more subtle warning signs.

In 2003, the heart association established new prevention guidelines for women that focus on lifestyle changes and more aggressive intervention. “Surveys show that 60 to 80 percent of physicians are now following these guidelines in better-performing hospitals,” says Dr. C. Noel Bairey-Merz, director of the Women’s Health Program at Cedars-Sinai Medical Center in Los Angeles.

While the coalition provides support groups for female patients nationwide, the heart association and the institutes are trying to spread heart-healthy recommendations to women through television, radio and printed public-service announcements.

Health authorities exhort women to quit smoking, get 30 minutes of exercise a day and load up on fruits, vegetables and whole grains while going light on red meat and cheese. Women are also advised to get their heart condition regularly evaluated starting at age 40, and to maintain healthy blood pressure, trigliceride and cholesterol levels.

Women are also warned about the factors that put them at highest risk of developing heart trouble: having diabetes, being overweight, being African American and being over the age of 65.

“For too long, we’ve lived with the stereotype that women are not at risk for heart disease,” says Nancy Loving, director of the National Coalition for Women with Heart Disease. “But women are finally beginning to take ownership of this epidemic and to claim it as their most pressing health issue.”

Molly M. Ginty is a freelance writer based in New York City.

For more information:

American Heart Association–
“Go Red for Women”:

The National Coalition for Women with Heart Disease

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