The latest on
why their heart attacks go undetected, how they may benefit from half doses of
cholesterol drugs, and more
by Meryl Davids Landau, AARP, February 2, 2021
Doctors have known for years that men and women experience heart
disease somewhat differently. It’s long been clear, for instance, that before
menopause, women are less likely to develop heart disease than men. This is
thanks to the protection estrogen provides, and it’s a key reason why the
average age for a heart attack is 64 for men but 72 for women. Women catch
up quickly, though, making heart disease the leading cause of death for both
sexes overall during non-pandemic times.
But new research is changing cardiologists’ understanding of
heart disease in women. Take, for instance, the symptoms of a heart attack. With women,
doctors have for some time been taught to look for “atypical” signs, including
heartburn, back pain, or pain that is burning, stabbing or resembles
indigestion. With men, they expect more “typical” symptoms, including chest,
jaw or arm pain; pain that radiates to one of the arms, neck, jaw or back; and
nausea, vomiting, sweating or palpitations. But recent research shows women are
just as likely to experience the “classic” signs as men. A study of nearly
2,000 patients published recently in the Journal of the American Heart
Association found that women’s most common symptoms were chest pain
and aches radiating down the left arm.
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This is just one of several recent findings — with more included
below — that shed light on sex-related differences in the diagnosis and
treatment of heart disease.
Younger women
are at greater risk of death
Women have fewer heart attacks than men, but they tend to fare
worse during them. To find out why, researchers at the Mayo Clinic in
Rochester, Minnesota, examined hospital data on nearly 7 million heart attack
patients. In a study published in January in Mayo Clinic
Proceedings, they showed that women who are hospitalized with a heart
attack are less likely than men to receive life-saving treatments, such as
angioplasty, in which clogged arteries are opened, and mechanical circulatory
support, in which devices are used to improve blood flow.
Lead researcher Mohamad Alkhouli, M.D., an interventional
cardiologist at the Mayo Clinic, speculates that doctors may hold back on these
treatments because they believe women won’t fare as well during such surgeries.
The researchers also discovered that women under age 65 were more likely than
men to die from a heart attack — especially when they suffer from a type in
which the coronary artery is significantly but not completely blocked.
More menopause
symptoms may mean more risk
While it’s long been known that the plummeting estrogen levels of menopause reduce the
hormone’s protection of the heart, new research shows that greater suffering from
menopause’s hot flashes or sleep disturbances may signal greater cardiovascular
risks. When researchers from medical centers across the country followed more
than 20,000 women ages 50 to 79 for a median of seven years, they found a link
between having two or more moderate or severe menopause symptoms and increased
risk of things like heart attack and stroke.
The researchers, who published their findings in the medical
journal Menopause, offer several possible explanations. For
one, severe hot flashes are associated with artery stiffness, inflammation and
vascular problems, which are linked to heart disease. In addition, bothersome
menopause symptoms may compromise women’s ability to get adequate exercise and
sleep, in turn harming heart health.
Heart risks
also increase during perimenopause
New research from the American Heart Association, published in Circulation, shows
that the hormonal shifts that occur during perimenopause — the years preceding
menopause — set the stage for heart disease. “As women transition, they
experience many changes that, when taken together, increase their risk of
cardiovascular disease,” says lead researcher Samar R. El Khoudary, Ph.D.,
associate professor of epidemiology at the University of Pittsburgh. During
this time, “bad” LDL cholesterol begins to rise; “good” HDL cholesterol may stop being protective;
body fat accumulates in the abdomen instead of the hips; and insomnia and
depression may occur, she says. El Khoudary suggests seeing perimenopause as a
critical time to start lowering heart disease risk with practices like regular
exercise and prioritized sleep.
Breast cancer’s
links to blood clots, heart failure and more
Unfortunately, breast cancer survivors over age 65 have
another health risk to worry about: heart problems. A study published in
January in the Journal of the National Comprehensive Cancer Network found
that survivors were at greater risk of life-threatening blood clots called deep
vein thrombosis, arrhythmia, heart failure, heart valve disease and sudden
cardiac arrest compared to women who had not had cancer.
In the study, while these conditions were seen most often during
the first year after diagnosis, the heightened risk remained for five years. At
highest risk were Black women and women with stage 3 and hormone receptor-negative
breast cancer. For all, ill effects of the chemotherapy drugs used to battle
cancer may partly explain the findings, the researchers say. Lifestyle
differences may also play a role, since women who smoke, are obese or have a
more sedentary lifestyle are prone to both breast cancer and heart disease.
Hector R. Villarraga, M.D., a cardiologist at the Mayo Clinic in
Rochester, Minnesota, recommends that breast cancer survivors get an
echocardiogram, which produces images of the heart, five years after their
cancer treatment ends. If you were treated with radiation, ask your doctor
about having a cardiac stress test 10 years after you’ve completed treatment,
he says.
Sussing out
“hidden” heart attacks with better imaging
Most heart attacks are caused by blockages in the large arteries
of the heart. But in up to 15 percent of cases in which people experience
symptoms such as chest pain and shortness of breath, there are no significant
blockages. These little-understood heart attacks, known as myocardial
infarction with non-obstructive coronary arteries (MINOCAs), can still cause
heart damage and are also three times more likely to occur in women.
“Sometimes women come to a hospital with heart attack symptoms
and, after they get tested, they’re told they didn’t have a heart attack,” says
Harmony Reynolds, M.D., a cardiologist and director of the Sarah Ross Soter
Center for Women’s Cardiovascular Research at NYU Langone Health in New York.
That’s because an angiogram — the test that’s used to evaluate patients with
heart attack symptoms — may not reveal the underlying cause, says Reynolds.
Without knowing what’s causing patients’ symptoms, doctors aren’t able to treat
them.
To pinpoint the causes of MINOCAs, Reynolds and researchers from
several institutions used advanced imaging tests called cardiac MRIs and
coronary optical coherence tomography (OCT). They were able to identify the
causes of these otherwise undetected heart attacks in more than 100 women, and
they published their findings in the journal Circulation. The
causes they observed included hidden plaque ruptures that, like a blockage,
stopped blood flow to the heart, and spasms in the coronary artery, which can
temporarily close the artery, cutting off blood flow.
If you experienced symptoms of a heart attack but were told you
didn’t have one, consider asking your doctor (or one affiliated with an
academic medical center) if you should have one of these advanced imaging
tests, advises Reynolds.
Drug doses
designed for men may not be best for women
Men and women with heart disease generally receive the same prescriptions. But when it comes to heart
failure — in which the heart is unable to pump enough blood to meet the body’s
needs — they probably shouldn’t, according to a new study published in The
Lancet. The researchers found that women have the lowest rates of death
and hospitalization when they are given half the standard dosages of ACE
inhibitors, angiotensin-receptor blockers (ARBs) and/or beta blockers. Men, on
the other hand, fare best with the full prescription.
The researchers speculate that weight differences may explain
these findings. Children’s drugs are typically prescribed by weight, but this
is rarely done for adults, explains Joyce Oen-Hsiao, M.D., director of clinical
cardiology at Yale Medicine, who was not involved with the study. Other possible
reasons include sex hormones and differences in the way drugs are absorbed,
metabolized and excreted.
More on Heart Health
·
Women may overlook cardiovascular risk
·
Survivors share their heart attack stories
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Cardiovascular health for people 50+
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