A recent study shows that when it comes to matters of the heart, there are indeed differences between the sexes.
Researchers combed through a database of more than 1 million heart attack cases and discovered that women, especially those under the age of 45, didn’t always present signs of chest pain and discomfort — the hallmark symptoms of a heart attack.
The study, published in the Journal of the American Medical Assn. in February, found that 42% of women entered the hospital without chest pain, compared to 31% of men. Women who didn't show signs of chest pain also died at a higher rate than men who didn't show symptoms, 14% vs. 10%.
“When you don’t present with typical symptoms, there’s a delay in treatments,” said Dr. Shaista Malik, a preventive cardiologist at the UC Irvine Medical Center. “The longer it takes to get treated — which means a cardiologist unblocks the artery — the more muscle damage there is to the heart. And the more muscle damage, the higher your chance of dying.”
The study shows that patients and providers need to be on the lookout for other cues, including shortness of breath, cold sweats, nausea, pain in the jaw or back, and fatigue.
"When women come to the hospital with these symptoms, doctors don't think about checking [the heart]," Malik said, "and I think there needs to be awareness for doctors and patients to check that off the list."
Much of the research on heart attacks has been focused on men who have symptoms of central chest pain, "which is why we know less about women's symptoms," Malik said.
'A loaded gun'
For men and women, heart disease is the leading cause of death worldwide. In the U.S. alone, 1.5 million heart attacks occur each year, with 500,000 deaths.
"Cardiovascular disease is like a gun that is loaded by genetic factors but triggered by major risk factors, including hypertension, high cholesterol and obesity," said Dr. Bahram Eslami, chief of cardiovascular services at Hoag Hospital in Irvine.
Although more people die of heart disease than all cancers combined, most heart attacks can be prevented.
"The first step in being heart healthy is to know whether you're at risk or not," Malik said.
American Heart Assn. recommends having your numbers checked — blood pressure, cholesterol and blood sugars levels — starting at the age of 20 and every five years after that. Good Samaritan Hospital in Los Angeles offers myriad diagnostic services for assessing a patient’s risk for heart disease, including cardiac-computed tomography, angiography, echocardiography, EKG and treadmill testing.
Kicking the habit
Malik advises patients who find themselves at risk for heart disease to start with modifying their lifestyle choices — and the sooner, the better.
"Usually the younger you are the easier it is to change your habits," she said, adding that exercising and eating a heart-healthy diet with attention to portion size is the best place to start.
"Doctors will tell you to eat healthy, but most of us don't know how to translate that," she said.
Eslami advises a Mediterranean diet full of fish, nuts, vegetables and fruits, as well as cooking with canola and olive oils. "It has been proven for many years that this is the best diet to reduce cardiovascular events by 72% and to reduce incidents of cancer by 61%," he said.
The American Heart Assn.'s heart-healthy diet tips include limiting saturated fat, trans fat and sodium; adding low-fat proteins and dairy products, like chicken and egg whites; and eating plenty of whole grains and fruits and vegetables.
"Even if someone adds one serving of green vegetables once a day, you can reduce the incident of cardiovascular disease by 23%," Eslami said.
Consulting a dietitian or a nutritionist can help patients personalize their diets. "We don't eat all the same thing, so these [experts] can spend an hour with you going over what you eat and what changes to make," Malik said. "Finding the correct portion size can be enlightening."
The Mayo Clinic recommends sleeping at least eight hours a night and adding at least 10 minutes of moderately intense physical activity every day, like a brisk walk. An hour to 90 minutes of exercise a week, even spread out over several days, can cut your risk of heart disease in half.
"I believe everyone who's given enough education and support can make lifestyle changes," Malik said, adding that patients at UC Irvine making behavior modifications are often evaluated every two weeks for three months. "Medicare is starting to see the value in this and will reimburse for weekly dietary visits."