Watertown Daily Times, N.Y., Bare Bones Health column

April 16--Tweet

More often than not, when Americans think of heart attacks, we picture stout older men clutching their chests at the dinner table, the downfall of a diet rich in red meat and beer.

Yet despite misconceptions, heart disease is the No. 1 killer of women in New York and the United States, outstripping diseases more often associated with "women's health," like breast cancer and Alzheimer's.

In fact, as many women die from heart attacks as men each year. According to the Centers for Disease Control and Prevention, heart disease killed 289,758 women in 2013 and was responsible for one in four female deaths.

If these statistics catch you by surprise, you're far from alone. The Centers for Disease Control found that only 54 percent of women recognize heart disease as their leading cause of death. For decades the focus on the heart disease has been on men, due in part to women historically having been excluded from clinical research.

They may not know it, but for many women the symptoms of a heart attack are much different from the standard indicators set by studying men.

Many women may well experience the traditional male symptoms, including dull, heavy or squeezing chest pain which radiates down one or both arms, cold sweats and symptoms that worsen with physical activity. Others, however, may instead experience sharp or burning chest pain, pain in the neck, jaw, abdomen or back, indigestion, nausea or have no noticeable symptoms at all.

Women are more likely than men to report heartburn, vomiting, extreme fatigue, difficulty breathing, light-headedness and dizziness. Women's heart attack symptoms are also more likely to occur while resting or sleeping than in men and can even be triggered by emotional stress.

Women are also far more likely than men to have their symptoms misdiagnosed as a result of mental anguish or trauma. Yet in recent years, stress has been found to be the cause of very real heart problems such as stress-induced cardiomyopathy, reductively named Broken Heart Syndrome, in which a terrible emotional blow causes heart muscle failure.

Doctors are more likely to miss or misattribute heart attack symptoms in women in general. So culturally ingrained as "male" is this disease that even when the doctors themselves are women, the likelihood of misdiagnosis remains higher for their fellow female patients.

Geetanjali Sangwan is a cardiologist and director of cardiology at the Claxton-Hepburn Medical Center in Ogdensburg. Earlier this year, Dr. Sangwan explained that heart symptoms are more often missed and more mistakes are made when women have cardiac emergencies.

The outcome of a heart attack is more likely to be severe, even fatal, in women, she said.

Women with atypical symptoms have been diagnosed with everything from indigestion to "hysteria" and panic attacks, said Dr. Sangwan, and these misdiagnoses of cardiological events increase the risk that they will be ultimately fatal.

"The general impression of my female patients is that it's a male-dominated disease," Dr. Sangwan said. "They are more likely to ignore it as muscle pain, especially when they are younger."

On average, she said, women wait four hours longer than men to seek medical attention for their symptoms.

Gender discrepancies are not only seen in how heart disease is treated, but in the field of cardiology itself. As of 2013, only 13 percent of cardiologists were women.

According to a study recently published in the Journal of the American College of Cardiology, women in cardiology were three times more likely than men to experience discrimination based on gender and being a parent.

It found that while male cardiologists reported more "family barriers" in recent years than they had in the past, they remain much more likely to be married and have children in addition to their careers than women cardiologists.

Dr. Sangwan herself was one of only two women in her prestigious cardiology fellowship in Brooklyn, with only one woman having come before her some years prior.

"We had to prove ourselves, but we opened doors in many ways," Dr. Sangwan said. When she first began in the demanding field, Dr. Sangwan noted that the salary difference between her and her male peers was "huge."

According to authors of the study in the Journal of the American College of Cardiology, "Discrimination continues to be an issue reported by a clear majority of female cardiologists. Addressing the changing demographics and practice settings of the workforce, increasing diversity, and achieving parity in race and sex continue to be important goals for the cardiology community."

While the perception of heart disease as a "male" issue influences doctors regardless of gender, having more female specialists could increase visibility and improve treatment for heart disease in women.

In Jefferson, Lewis and St. Lawrence counties, on average, even more women than men visit the ER or are hospitalized due to hypertension (dangerously high blood pressure.)

It's important to keep in mind that one's risk for heart disease can be raised by many factors. Being overweight, poor diet, lack of exercise, stress, smoking and excessive drinking are some lifestyle risk factors.

Diabetes, high cholesterol and blood pressure, metabolic syndromes, family history, depression, anemia, sleep apnea, menopause and taking birth control pills can all also increase the likeliness of heart disease.

But don't despair just yet -- for every risk, there are preventions, mitigations and ways to screen. Especially as women get older, we can be aware of our risks, make lifestyle changes and find a general practitioner or specialist who knows what to look for and how to listen.

Heart disease doesn't need to be the No. 1 killer forever as women and their doctors become more attuned to its signs and symptoms. In the end, knowledge is power, so know your risks, listen to your body and, when in doubt, don't wait -- get medical help.

Jen Jackson is the medical reporter at the Watertown Daily Times. Email her at jjackson@wdt.net.

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