Those Fragile Hearts

By Sanjay Gupta

When I think of someone having a heart attack, the image that comes to mind is of a red-faced, overweight, middle-aged businessman. What I forget--and what I was forcefully reminded of by a survey in the current edition of Women's Health Issues--is that heart disease is also the No. 1 killer of women. In fact, more women than men die of heart disease each year, notes Dr. Sharonne Hayes, director of the Mayo Women's Heart Clinic and co-author of the study.

No wonder women with heart disease--6.4 million in the U.S. alone--are unhappy with their medical care. In the past two decades, the number of men who die each year of heart disease has fallen from 510,000 to 440,000, thanks to better diagnosis and treatment, but the number of women who die of it has increased from 490,000 to 510,000, according to the American Heart Association.

The women in Hayes' survey think they know whose fault that is: 58% of those who were dissatisfied blamed the ignorance of their doctors. And they may be right. In a 1999 Gallup poll, only 55% of physicians surveyed correctly identified heart disease as the greatest health risk for women over 50. That's better than the 8% of American women who got the answer right in an American Heart Association survey--but doctors are expected to know this kind of thing!

Patients also expect doctors to give them the treatment they need. But Hayes found that women with heart disease are less likely than men to be diagnosed correctly or treated promptly and are less likely to be sent for cardiac rehabilitation. And though they are more likely to suffer depression and anxiety, they are less likely to be referred for psychological counseling. As a result, women with heart disease tend to become socially isolated. They feel, as Hayes puts it, that "no one understands what they're experiencing."

There are, in fact, differences in how men and women experience heart disease. Premenopausal women hardly ever have heart attacks; postmenopausal women, whose hearts are no longer protected by estrogen, on the other hand, quickly become even more vulnerable than men. Smoking increases the risk of heart disease more dramatically for women. Even the signs of an incipient heart attack can be different for each sex. While some women get the classic symptoms--chest and arm pain, a squeezing sensation in the chest and shortness of breath--many others experience atypical symptoms, such as dizziness, nausea and pressure between the shoulder blades.

The good news for both men and women is that heart disease has become simpler to diagnose. Treatment is easier too, with options ranging from diet and exercise to statins and surgery. Prevention is key. Everyone should get his or her blood pressure tested and cholesterol checked at least once a year. Nobody should ever smoke, but now that women know they are especially vulnerable, they owe it to their hearts--and their loved ones--to quit. --With reporting by A. Chris Gajilan/New York

Dr. Gupta is a neurosurgeon and CNN correspondent

With reporting by A. Chris Gajilan/New York