Going red: raising awareness of heart disease in women
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February 6th is National Wear Red Day.
Historically, heart disease and heart attacks have typically been associated with men. Consequently, most research in this area has focused on men, and as a result, a distorted picture of heart disease and risk has formed, with women's needs being ignored and awareness of their risk suffering.
In an interview with abc2, Dr. Suzanne Steinbaum, cardiologist and spokesperson for the American Heart Association (AHA), described how women's perceptions of heart disease are slowly changing:
"When I go out and say heart disease is your number one killer more than all cancers combined, I remember 10 years ago, I remember 5 years ago everyone saying 'Really? Are you sure?' Isn't it breast cancer?' And I see now they're saying, 'yeah, we've heard of that.'"
One factor in this shift in attitudes is Go Red For Women. Set up in 2004 by the AHA, Go Red For Women is an initiative designed to raise awareness of heart disease among women, dispelling myths and empowering women to take control of their health.
Heart disease: the facts
According to the Centers for Disease Control and Prevention (CDC), around 600,000 people die of heart disease in the US every year, a total representing 1 in 4 deaths. The most common form of heart disease is coronary heart disease, responsible for around 380,000 deaths each year and costing the US $108.9 billion annually.Coronary heart disease occurs when a substance called plaque, made up of cholesterol deposits, builds up in the arteries, restricting the flow of blood and narrowing the arteries. Narrow arteries are more susceptible to being blocked by blood clots. A common symptom of coronary heart disease is angina.
Heart attacks are another aspect of heart disease. Also referred to as a myocardial infarction, a heart attack occurs when part of the heart muscle either dies or is damaged due to a reduction in blood supply. Around 720,000 Americans have heart attacks each year, with 515,000 of these people experiencing them for the first time.
While heart disease is typically seen as a male health problem, it kills similar amounts of men and women. The Mayo Clinic state that more women than men die of heart disease each year.
Women experience different challenges to men when it comes to heart disease, and this could be where part of the misconception stems from. While similar numbers of men and women die of heart disease, heart attack diagnosis is much more common in men than women. Are enough people aware of the different ways in which women experience heart disease?
Unique problems faced by women
The most well-known symptom of a heart attack is chest pain or discomfort, but women are more likely than men to experience heart attacks differently. Dr. Nieca Goldberg, a volunteer with the AHA, explains:"Although men and women can experience chest pressure that feels like an elephant sitting across the chest, women can experience a heart attack without chest pressure. Instead, they may experience shortness of breath, pressure or pain in the lower chest or upper abdomen, dizziness, lightheadedness or fainting, upper back pressure or extreme fatigue."The symptoms listed by Dr. Goldberg are common to many other conditions and are not typically associated with a heart attack. This can lead to some women downplaying the severity of these symptoms when they occur.
Some of these symptoms can also be associated with conditions that only affect women - pregnancy and menopause. In fact, both pregnancy and menopause can increase the risk of heart disease in women; reduced levels of estrogen are a risk factor for cardiovascular disease in small blood vessels, and there is an increased risk of both high blood pressure and diabetes when pregnant.
"We are just at the beginning of understanding the differences between the sexes when it comes to heart disease," says Dr. C. Noel Bairey Merz, director of the Women's Heart Center at the Cedars-Sinai Heart Institute.
She believes that the heart disease experienced by each gender should have its own name.
"The more we find out, the more it becomes clear that men and women can experience different diseases and the medical names for those diseases should reflect the differences. There is enough research to conclude that women and men can experience different types of heart disease," she explains.
Dr. Bairey Merz suggests that women's heart disease should be referred to as ischemic heart disease, indicating its primary cause being a lack of blood flow and oxygen to the heart. The form of heart disease that typically affects men should still be referred to as coronary heart disease, as men are more likely to have plaque build-up in the large arteries surrounding the heart.
'Medicine favoring men'
It is not just different symptoms that affect rates of heart disease diagnosis between men and women. The methods employed to make diagnoses are also a factor.
As heart disease has traditionally been associated with men, research has tended to focus on them, reducing awareness of women's risks.
The authors suggest that using different criteria for men and women in a diagnostic blood test could improve diagnosis rates. In heart attack diagnosis, blood tests are commonly used to measure levels of troponin, a protein released by the heart during an attack.
Traditionally, a single diagnostic threshold for both men and women is used. However, previous research has identified that troponin levels can be twice as high in men than in women. Using gender-specific diagnostic thresholds led to improved heart diagnosis rates in the study.
"If these results are confirmed in the much larger clinical trial we're funding, these results suggest that using a high sensitivity troponin test, with a threshold specific to each gender, could save many more women's lives by identifying them earlier to take steps to prevent them dying or having another, bigger heart attack," stated Prof. Peter Weissberg, medical director of the British Heart Foundation in the UK.
There are many examples of ongoing research where the goal is to improve the way in which heart disease in women is diagnosed and treated. But while doctors, scientists and researchers are working toward this, what can the general public do? This is where Go Red For Women come in.
National Wear Red Day
Heart disease is a deadly health condition, but a great many of deaths caused by it are considered to be avoidable. A CDC report in 2010 stated that an estimated 200,070 avoidable deaths from heart disease, stroke and hypertensive disease occurred in the US.This fact emphasizes the importance of raising awareness of heart disease, because a real difference can be made and lives can be saved. Go Red For Women report 80% of heart disease and stroke cases in women are preventable.
Through education and lifestyle changes, the risk of heart disease can be reduced, and this is the focus of the Go Red For Women campaign. Go Red For Women explain what it means to "Go Red" with the following acronym:
- Get your numbers - check your blood pressure, cholesterol and glucose levels with a doctor
- Own your lifestyle - live healthily by regularly exercising, eating a balanced diet and quitting smoking
- Raise your voice - support the call for more research and education focusing on women
- Educate your family - promote healthy living among those closest to you
- Donate - support the cause by donating your own time or money.
Across the US on February 6th, thousands of people will be donning red clothing in order to show support and to raise awareness. Many will also use this moment as a springboard for making lifestyle changes to reduce their personal risk. The Mayo Clinic recommend the following changes to help people "own their lifestyle:"
- Maintain a healthy weight
- Exercise 30-60 minutes most days of the week, or 60-90 minutes if weight loss is needed
- Follow a diet that is low in salt, saturated fat and cholesterol
- Do not smoke
- Follow the advice of doctors and take medications precisely as prescribed.
Amanda Gonzalez was only 18 when she was given an implanted cardioverter defibrillator to treat an irregular heart rhythm. She told Go Red For Women she wants women to know that heart disease is not limited to those over 65:
"People would always tell me, 'You're too young to have heart disease,' but it can affect you at any age, especially if it's in your family history. One year prior to my cardiac event, my grandfather died of a heart attack in my home. Heart disease snuck up on me during the best time of my life. It's never too early to check your heart health, so don't wait until it's too late!"Go Red For Women has made a difference. More than 900,000 women have joined Go Red For Women. This group have been found to live healthily, talk about heart health with others and are more likely to visit their doctors - 91% visited their doctor in the past 12 months, compared with 73% of all US women.
Lifestyle changes and education are the simplest ways that heart disease rates will fall. As we put on our red t-shirts today, we hope that Go Red For Women and the AHA continue to have success in the future.
Written by James McIntosh
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