Protecting women's hearts: An interview with a Mayo Clinic specialist

When it comes to the prevention and treatment of cardiovascular disease, men have traditionally garnered more attention than women. You might think this is because men are more susceptible to cardiovascular disease than are women. But in reality, more women than men die of cardiovascular disease each year.

Cardiologist Sharonne Hayes, M.D., director of the Women's Heart Clinic at Mayo Clinic, Rochester, Minn., and chair of the scientific advisory board of WomenHeart: The National Coalition for Women with Heart Disease, shares her insights about women and heart disease.

Isn't heart disease just heart disease, whether it's in a man or a woman?

Not necessarily. We have gaps in our knowledge about the prevention and treatment of heart disease in women. For one thing, women historically haven't been included in scientific research studies to the extent men have. The danger in that is that if you have no hard evidence for women, you may undertreat or overtreat them, or simply not understand their unique risks. For instance, women may have different or more subtle symptoms of heart attacks than men, so women themselves and even health care professionals may be less likely to recognize when a woman is having a heart attack.

We also know that men and women respond differently to certain heart medications, such as clot-busting drugs (thrombolytics). If we use the same treatment in women that we use in men without understanding those differences, we may actually increase their risks of complications.

How do heart attack symptoms differ in women and men?

The most common symptom of a heart attack in both men and women is some type of pain, pressure or discomfort in the chest. But it's not always severe or even the most prominent symptom, particularly in women. Women are more likely to have signs and symptoms unrelated to chest pain, such as:

• Neck, shoulder, upper back or abdominal discomfort
• Shortness of breath
• Nausea or vomiting
• Sweating
• Lightheadedness or dizziness
• Unusual fatigue

How do women know if they're at risk of heart disease?

Women — and men — can be grouped by the risk factors they have that can estimate their likelihood of having a heart attack or dying of heart disease within 10 years. The risk levels are:

• High risk. You already have heart disease or another serious, high-risk condition, such as kidney disease or diabetes.
• Intermediate risk. You have metabolic syndrome, early signs of cardiovascular disease, multiple risk factors — such as smoking, high blood pressure or high cholesterol — or parents, siblings or children with early-onset heart disease.
• Lower risk. You may have metabolic syndrome or one or more risk factors.
• Optimal risk. You have the best possible risk profile and you live a heart-healthy lifestyle.

So, if you're at optimal risk, you don't need to worry, right?

No, that's not the case. Keep in mind that heart disease exists on a continuum, with shades of gray — it's not black-and-white. Even a marathoner may have early signs of heart disease if we look hard enough. She may not have symptoms, but it's still heart disease.

If even marathoners have signs of heart disease, it seems inevitable, so why bother trying to prevent it?

Even though the marathoner may have early signs of heart disease, she's at low risk of actually having a heart attack or dying of heart disease if she maintains her healthy lifestyle and controls her risk factors.

Many people think that heart disease is a natural part of getting older, but it isn't. It's largely preventable by making healthy lifestyle choices. In general, we just have such poor lifestyles in this country that nearly all of us put ourselves at risk. In fact, heart disease is the No. 1 killer of women.

Are most women aware that heart disease is the No. 1 killer of women?

There's good and bad news. The American Heart Association surveyed women in 1997 and 2003 and found that the percentage of women who are now aware that heart disease is the No. 1 killer of women has increased significantly — from about 33 percent then to 46 percent now.

The bad news is that there's still a disconnect. Women still don't think they personally are at risk of heart disease. On the other hand, almost every woman thinks she's going to die from breast cancer, despite the statistics.

Why do women think they're more likely to get breast cancer than heart disease?

Women identify breast cancer as a woman's disease, but they don't think the same way about heart disease — they think it's a man's disease. Or they believe heart disease is an older woman's disease, something their grandmother's going to get, not them. Even if they have risk factors for heart disease, such as smoking and being overweight, they often don't make the connection. They're also more afraid of what it means to have breast cancer.

Why does the thought of breast cancer scare women more than heart disease?

For one thing, they think the treatment for breast cancer is much more devastating — possibly with chemotherapy, radiation and mastectomy — even though treatment for heart disease is not necessarily any easier or less debilitating. Another factor is that breast cancer affects more women in the younger age group. Most women under the age of 50 are more likely to know of a woman who's had breast cancer than one who's had a heart attack.

Thanks to the myth of the Hollywood heart attack, many people think heart disease would be a "good way to go." They think they'll be walking down the street, clutch their chest, fall to the ground and have a quick and peaceful end — unlike a protracted, painful struggle with breast cancer.

What's the reality of living with heart disease?

It's not like that Hollywood heart attack at all. Heart disease can be debilitating. You may not be able to care for your home and family, go walking or play with your kids. Women with some types of heart disease have very limited energy and a very poor quality of life. But often, these scenarios can be avoided if you get treatment quickly and appropriately.

There seems to be an ethnic disparity in heart disease. Why are black and Hispanic women at higher risk of dying of this disease?

It's complicated. Some of it is socioeconomic. Some of it is also the result of medical disparities. They may get fewer health screenings, or they haven't received ethnic-specific health messages. There are genetic differences to consider, too. African-American women are more likely to have high blood pressure and diabetes, but they actually smoke less than white women do. Other ethnic traditions may put a different emphasis on diet and physical activity. Also, if appropriate health information isn't getting to these communities effectively, they may be less aware of the risks, and that translates into higher mortality.

What can women do to reduce their risk of heart disease?

As for the basics: Be active, maintain a normal weight, and don't smoke. This core advice hasn't changed in decades.

Women also need to take their prescribed medications appropriately, such as beta blockers, blood thinners and aspirin, and they need to better manage other conditions that are risk factors for heart disease, such as high blood pressure, high cholesterol and diabetes. Some women at high risk may also benefit from the use of supplements, such as omega-3 fatty acids and folic acid. These are all things you can talk to your doctor about.

What specifically counts as being active?

Well, it's not the same as being busy. I have women tell me how busy they are, that they're always running around doing stuff, and they may be tired at the end of the day, but they aren't physically fit. Being active means doing something physical, getting exercise.

In my practice, I give concrete examples of what this means. For instance, it means taking the stairs instead of the elevator, walking, riding bikes with your kids. I tell women to get a pedometer and track their steps. The goal is to log 10,000 steps a day, which is about five miles. You may work long hours, go home fatigued and think you've gotten a lot of exercise, but you haven't. You're tired because you're out of condition or mentally fatigued. That happens to me, too — I'm in my office all day, I work through lunch, and I may be tired out at the end of the day but realize I've only logged 4,000 steps. That means I'd better get moving.

Many women feel so pressed for time already, it's hard to fit in exercise.

Time is a huge issue. You may commute for 45 minutes, work eight hours, then go home and do chores, help kids with homework and fix dinner. Women really do have a time crunch, but there are creative ways around that. I know the last thing you want to do is add 15 minutes into your day to walk. In a perfect world, we'd all have an opportunity to go to the gym or work out every day. But you can do it incrementally — you don't need to fit in one long workout. You can take the stairs up to your office instead of the elevator. You can watch the news while walking on the treadmill.

Can you give an example of how someone you know made heart-healthy changes?

I know a woman who works on the 11th floor. She was overweight and very out of shape. She started exercising by walking up just a few flights of stairs each morning and then taking the elevator the rest of the way when she got tired. One day, she realized she had walked all the way up to the 14th floor without realizing it or getting winded. Now, she walks up to the 18th floor and then back down to the 11th because it feels good and is a great start to her day. I can tell patients with a completely straight face that soon you'll want to do more exercise because you'll feel better.

What's next in the effort to prevent heart disease in women?

Recent studies have helped us begin to identify gaps in our knowledge and will spur researchers to look for answers that will improve care for women. Doctors are becoming more aware of the different signs to watch for that may indicate a woman is having a heart attack — different than what men may experience.

Women and physicians also need to become better educated about heart disease in women. Knowledge helps women feel empowered to ask questions and learn more about how to prevent heart disease.

And as women become more informed about their risks they'll be better able to follow through with healthier lifestyle habits.

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