PUBLISHED: 4:57 PM on Wednesday, February 20, 2008
Women's heart health
You see three women sitting together. Consider this: one will die of coronary heart disease.

"I usually start my talks off by asking every woman to look at the women sitting to either side of her. I tell everyone that you, or one of the people next to you, will die of heart disease," says health educator Justine Muench, RN, who works at Bartlett Regional Hospital's Education Services Department.

Courtesy Photo
  Cardiac rehap specialist Bob Chatfiled, RN, right demonstrates heart strengthening exercises.
Cardiovascular disease - heart disease, stroke, and other cardiovascular ailments - kill more women in Alaska than any other disease. Every day in Alaska a woman will die of heart disease or stroke. According to Alaskan statistics, women are more likely to die within a year of a first heart attack than men (38% compared to 25%).

The reasons women are experiencing more coronary disease than men are complex, and in some ways deeply ironic. Women famously insist that the men in their lives pay attention to health, urging their husbands/sons/brothers to not ignore symptoms. Usually it is the woman who makes the doctor's appointment for the man.

"Women will seek medical attention for themselves," Muench observes, "but in a delayed fashion. They will first make sure their families are taken care of and then make sure their work is covered. After all is in order, then they seek attention."

Delay, however, can be fatal. Usually, the most critical time of a heart attack is within the first hour of symptoms.

Much of the initial attention that gave focus to heart disease was propelled by alarming statistics, which revealed men were dropping dead of heart attack at relatively early ages. "It was considered a young men's disease and very tragic. Men were dying at ages 40 to 50," says Bartlett's cardiac rehab specialist, Bob Chatfield, RN.

Men got with the program and began to follow all the good advice - to lower their blood pressure and cholesterol numbers, to eat healthier and get more exercise. The medical establishment also got much better at diagnosing and treating men. As the incidence of heart disease among men fell, it was rising for women.

Chatfield doesn't mince words. "The reason men are doing better with heart disease than women is that they are doing something about it."

Chatfield says that even though women are more likely to suffer from heart disease than men, far fewer women than men seek cardiac rehabilitation services. He speculates that women may be put off by the thought of being forced to exercise. "Usually, they are fine once they get here, when they find I don't ask them to do activities beyond their capacity," he says.

A big problem with coronary disease is that, for women, the symptoms are often much more subtle than for men. "Women usually don't feel the severe, concentrated pain that usually propels men to seek treatment," says Muench. "Women have more nebulous type symptoms."

The reason the symptoms are nebulous has everything to do with the gender-specific morphology of the disease.

Men have larger vessels and tend to get big plaque build-ups. Women have smaller vessels and a much slower progression of plaque deposits - the result is women do not often experience the intense chest pain that sends a man to his doctor, and the problems are not as obvious as men's in CT scans.

Tragically, even well-trained doctors can easily fail to diagnose the disease in women, especially young women. Stories by women, in their 30s and younger, who had been misdiagnosed, can be found at:

These stories emphasize how difficult it is for people to get their heads around the idea that women, especially young women, are at risk of heart disease.

How to lower your risk of heart attack? More on this next week, but until then, if you smoke, quit. Smoking, more than any other lifestyle issue, elevates a woman's (or man's) risk of developing coronary disease.

"People talk themselves out of quitting because they think the damage is irreversible," says Chatfield. "This is not true for blood vessels. In a year, your vessels will not know you have ever smoked. It is the only risk factor for heart and stroke that can be completely eliminated."