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Heart Attacks: women versus men

December is heart attack season: especially for women

Unfortunately with all the joy and fun that comes with the Christmas season, there is a tremendous amount of stress. The stress of missing loved ones that have passed away, the stress of family dinners with estranged relatives, the stress of gift-buying and the stress of over-eating and exercise programs abandoned for the month.
This time of year it is the women who do most of the work, the shopping, the cooking, the gift-buying and the decorating. During all this hard work they may suffer a number of physical symptoms such as chest pain, nausea, sweating, pain radiating down the left arm.
The problem is that these symptoms are associated with hard work and long hours spent on Christmas activities. Women are much tougher than men and work through their symptoms a lot better. They will dismiss the pain in the arm feeling it was caused by too much lifting of the grandchildren. They will dismiss the nausea and sweating and ill-feeling as a temporary condition maybe caused by their menopause. They will never think that they are having a heart attack because we have all watched people have them in the movies. The problem is that the traditional heart attack with the chest pain, severe pressure on the chest, shortness of breath and eventually passing out are strictly male symptoms. Men and women are totally different in the way they show heart attack symptoms. The women with these symptoms are having a heart attack.
In men, arterial plaque breaks off, causing a clot and when this clot gets stuck in an artery and blocks off the blood supply they get crushing chest pain, a Hollywood-style chest-clutching heart attack. In women, plaque tends to erode gradually blocking the artery, so they suffer fatigue, pain around the shoulders, back and arm.
But even when women are smart enough to go to emergency with their symptoms, they are often misdiagnosed between 26 and 54 per cent of the time according to the latest published research.
In 2012, the most recent year for which detailed data are available, 66,178 Canadians died of cardiovascular disease, 33,196 women, and 32,982 men.
Just in case you missed it, that’s more women than men. In fact cardiovascular disease is the top cause of death, disability and hospitalization for women over the age of 35. Also, for some strange reason, the survival rate from your first heart attack is greater for men than for women.
Yet most health practitioners labour under the false belief that heart disease is a man’s disease and cancer is a women’s disease. Even in our fund-raising there is a great emphasis on breast cancer and ovarian cancer and smaller amount on prostate cancer for men. Heart-disease fund-raising is more geared to men.
Finally there is growing recognition that cardiovascular disease needs to be treated differently in women. That is the motivation for the creation of the new Canadian Women’s Heart Health Centre, the first of its kind in Canada, at the University of Ottawa Heart Institute.
The reason why heart attacks of men and women are so different has to do with the basic biological differences between males and females. In the first place women develop cardiovascular disease, on average, seven to ten years later than men. They also have specific risks relating to pregnancy: Woman who suffer pre-eclampsia or gestational diabetes have significantly higher risks of heart disease later in life. It is also well documented that a women’s risk of heart attack or stroke soars after menopause, because blood pressure, cholesterol and diabetes rates all increase.
In the end most of the risk factors are common to both sexes. However, the main reason women with heart disease have worse outcomes is not physically because of gender, but because prevention is lacking and treatment is delayed.
The new centre in Ottawa will focus on prevention and providing strategies and resources. Health providers still do not consider this an issue and tend to be very dismissive with regard to women’s symptoms, sending them home from the ER with possibly a prescription for acid reflux or nausea or assuming they have the flu or some virus. Until a generation ago, cardiovascular research focussed exclusively on men and most of our physicians are elderly and were taught that in school.
Despite efforts to raise awareness, the treatment gap remains huge. Women get fewer angiograms, less surgery (either revascularization or bypass) and fewer stents. They are less like to be prescribed daily aspirin and ace inhibitors, beta blockers and statins for heart disease. It wasn’t until 2004 that the first gender-specific treatment guidelines for cardiovascular disease were published.
Because of this lack of treatment and misdiagnoses of symptoms, it is not surprising that women have higher death rates; 38 per cent of women die within a year of having a heart attack, compared with 25 per cent of men.
And while heart-related deaths are falling overall, due largely to the decrease in smoking rates, they are falling much more quickly for men than for women. In the past 35 years, cardiovascular mortality has dropped 17 per cent in men, but just 2 per cent in women.
So this Christmas season if you are a women suffering from fatigue,
pain, nausea, sweats or just feeling ill, do not attribute it to menopause, the food you ate or the stress of the season. If these symptoms persist, you must see your physician or go to Emergency. Your life may depend upon it. Print This Article Print This Article

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