Written By: KW Hillis

With hands clutched to their chest and a face filled with pain, someone slowly sinks to the ground. Classic signs of a heart attack — but not in women.

February is American Heart Month, but it is also Women’s Heart Awareness month because “cardiovascular disease is the No. 1 killer of women over the age of 20 … and heart disease looks very different in women than men,” said Dr. Christine Rattin, cardiologist on Southwestern Medical Center’s staff with the Oklahoma Heart Hospital Physicians Lawton Clinic, in a phone interview. “I often have people ask me ‘Why do we even need a women’s heart awareness month? Women don’t have heart problems. Women get breast cancer.’”

This common misconception can actually increase the rate death and the incidence of the disease, because women don’t see themselves suffering from cardiovascular disease. Statistics are startling and Rattin hopes that her information “scares” women into taking the disease seriously.

Rattin will be giving a series of four talks in February at SWMC (see box) focused on women and their hearts. Reservations are needed due to limited seating.

“Cardiovascular disease is responsible for the deaths of one out of every 2.5 women in America, while one in 30 women will die from breast cancer,” she said. “This kills more than the next seven most common causes of death combined … This means you may never actually know someone that has died from breast cancer but you will know and probably will be related to a woman that dies from cardiovascular disease.”

The stark reality of those numbers is that “cardiovascular disease causes one death per minute among females in the United States.”

Women’s symptoms   

Instead of the crushing chest pain that is seen in men, women’s symptoms are more subtle.    Women’s symptoms include “shortness of breath, fatigue, pressure in the chest, arms, jaw or back, which is often accompanied by nausea and or dizziness,” she said.

Rattin sees both male and female patients with the disease, but she said that many factors lead to women not doing as well as men.

Those factors include the fact that women tend to wait longer than men to seek treatment, “women do not do as well as men do in regards to heart failure (and) women are twice as likely as men to have a second heart attack within a year of the first heart attack.

“A lot of women are fabulous at being the support person. But when I bring out a stress test, they are scared to death. They say, ‘No way I’m taking off my clothes and running on a tread mill.’ But we have other ways of testing.”

Rattin will explain those methods at the heart health talks this month. There is one very scary statistic — “64 percent of women who die suddenly from cardiovascular disease had no previous symptoms,” Rattin added.    Science doesn’t know exactly why a heart attack manifests itself differently in men and women and why women don’t do as well with cardiovascular disease, but there are some clues.

“Pain tolerance is significantly higher in women than men,” Rattin said, explaining that women may dismiss symptoms and may not take time to focus on themselves whereas men will usually speak up about any changes in how they feel. Another difference is that women respond differently to aspirin and other medications then men do.

Although the presence of estrogen before menopause does help protect women, even younger women are having problems with heart disease, she said, explaining that women’s arteries are smaller and they don’t get as aggressive a treatment for high cholesterol and other risk factors as men do.

Up until about 12 years ago, most cardiovascular disease studies involved groups of men. That changed when Bernadine Healy became the director of the National Heart, Lung and Blood Institute. Those studies and NASA studies involving female astronauts have added a lot to the understanding of how diseases and medicine affect males and females — sometimes differently, Rattin said.

Since the studies are fairly new, one problem in diagnosing heart disease in a woman can be a doctor’s preconceived notions.

“There are still doctors saying it’s anxiety when a woman comes in with symptoms,” she said.

What are the risks?  

There are many things that can lead to cardiovascular disease, especially in Oklahoma.

“Oklahoma is typically at the top in the nation in regard to heart disease in both men and women,” Rattin said, explaining that risk factors for developing cardiovascular disease include diabetes, smoking, obesity, sleep apnea, high blood pressure, high cholesterol and lack of leisure time or “unplugging.”    In Oklahoma, the diagnosis of diabetes has increased 40 percent in the past 10 years. More then one in four of the state’s residents smoke and about one-third are considered obese.

Insufficient sleep and sleep apnea, or abnormal pauses in breathing, have been linked to “a number of chronic diseases and conditions, including diabetes, cardiovascular disease, obesity, and depression,” according to the Centers for Disease Control and Prevention.

“Persons with sleep apnea have been found to be at increased risk for a number of cardiovascular diseases. Notably, hypertension, stroke, coronary heart disease and irregular heartbeats … have been found to be more common among those with disordered sleep.”

In Oklahoma, one in five people have high blood pressure and high cholesterol.

The lack of leisure time is one surprising risk factor. Oklahoma ranks as the third worst state in the U.S. for the states that reported, she said, explaining that leisure time makes a difference in how a person’s body deals with stress.    “Leisure or extra time is when you do things for yourself, like exercise. … There isn’t a lot of unplugging here.”    T

Take control of health   

“Women must take control of their own heart health by knowing their symptoms and their risk factors such as family history, smoking, obesity, diabetes, high blood pressure and high cholesterol. Oklahoman women can’t afford to not pay attention,” Rattin said.

Many of the risk factors can be avoided if a women knows what they need to do.

One of the risk factors — smoking — is dangerous for a person’s heart whether they smoke or are just around smoke.

“For two hours after each cigarette is smoked the lining of the arteries change … (causing) any fats or cholesterol to stick to the arteries,” Rattin said, adding that this also applies to breathing in secondhand smoke.

Recent statistics show that “women’s heart disease is on the rise and men’s have leveled off,” Rattin said.    To learn more about heart health, women are invited to attend Rattin’s talks at SWMC this month.

To reserve a seat at one or more of the talks, call 531-6483. For more information about heart disease in women, visit www.nhibi.nih.gov. orwww.heart.org.

Southwestern Medical Center Women’s Heart Health Talks

 SPEAKER: Dr. Christine Rattin, cardiologist on SWMC’s staff with the Oklahoma Heart Hospital Physicians Lawton Clinic. WHEN: Series of four talks: q 5:30 p.m. Thursday, “Women’s Hearts are from Venus, Men’s Heart’s are from Mars.” q 2 p.m. Feb. 11, “I Can’t Sleep. Women and Heart Disease.” q 5:30 p.m. Feb. 21, “Women and their Broken Hearts.” q 2 p.m. Feb. 25, “I Have Chest Pain. Now What?” WHERE: SWMC, 5602 SW Lee Blvd. INFORMATION: Reservations suggested due to limited seating. Call 531-6483 as soon as possible for reservations to attend one or more of the talks.

 Heart attacks – signs and symptoms in women
  • Center of chest: Uncomfortable pressure, fullness, squeezing or pain which lasts more than a few minutes or goes away and comes back again
  • Pain or discomfort in one or both arms, the back, neck, jaw or stomach
  • Shortness of breath, with or without chest discomfort
  • Nausea or vomiting, dizziness or fainting, breaking out in a cold sweat.

If experiencing any of these symptoms: Call 9-1-1 and get to the hospital. Minutes count.

Source: American Heart Association, www.heart.org.