Heart Disease in Women
Lack of awareness adds to problems

Brenda Taylor (right) posed with Patti LaBelle at a recent concert. Taylor had a heart attack and open heart surgery at the age
of 43. (Photo courtesy of Brenda Taylor)

Wanda Tswago, a trained medical technologist, is a 44-year-old proud mother of two. And a heart attack survivor.

Even though her sister had her first heart attack at age 40, another at 42 and a fatal one at age 45, Tswago still didn’t see it coming. Her major health fear was acquiring breast cancer — not heart disease.

“I did not fit the profile,” she explained. “I was 31, had normal blood pressure and cholesterol and didn’t smoke.” She assumed her years as a dancer and gymnast — together with her small frame — offered her protection.

But she was wrong.

When it comes to heart disease misperceptions abound and partly explains the high death rate of heart disease in women — and particularly in younger women. Based on results from several recent studies, the majority of women are not aware of the disease and its link to other chronic illnesses. Nor do most women recognize the symptoms of a heart attack. That mistake can prove to be deadly. Heart disease is the number one killer in both men and women.

Yet, if you ask women to name the biggest killer among women, many would answer “breast cancer.”

Indeed breast cancer is the most common cancer in women and trails only lung cancer in the number of cancer deaths, but its numbers pale in comparison to heart disease. While roughly 40,000 women die of breast cancer each year, in the 2012 updates of heart disease and stroke statistics, the American Heart Association (AHA) reports that nearly 200,000 women succumb to heart disease each year.

A recent study commissioned by the AHA revealed that much work needs to be done to increase awareness of heart disease, particularly in women of color. Sixty percent of white women were aware of heart disease as the leading cause of death among women, compared to roughly 43 percent of African American and Hispanic women and one third of Asian women.

Awareness of signs of a heart attack is equally wanting. Only 56 percent of the women interviewed cited pain in the chest, neck, shoulder and arm as a warning sign. Less than one third recognized the threat of shortness of breath; 17 percent were aware of chest tightness and nausea. A scant 7 percent could cite fatigue as a factor.

In Tswago’s case, pain started in her lower back, an ache she initially blamed on the effects of an epidural she had during the delivery of her daughter two weeks earlier. “It was a dull, achy pain that did not go away,” she said.

Her home remedy of painkillers did not do the trick. Not only did the pain get worse, it began to travel. When it reached the left side of her neck she applied a heating pad to soothe the pain.

Wanda Tswago (left) did not know the severe pain in her back was a symptom of a heart attack. Tswago is pictured with her husband Gregg and daughter Alexxis. (Photo courtesy of Wanda Tswago)
At least nine hours had passed.

Later that night, “everything went south,” she said. “An uneasy feeling came over me. I felt disoriented.”

By that time the pain had spread to both arms, her chest — and intensified in her back. “It felt like someone was stabbing me in the back,” she said.

It was then her husband finally took her to the hospital.

But there she was required to wait additional time even though new symptoms — shortness of breath and nausea — emerged. The triage in the emergency room did not recognize her symptoms either.

An EKG eventually indicated that she had suffered a heart attack. A catheterization, a diagnostic test to look for clogged arteries, showed an almost complete blockage in one of the major arteries feeding the heart.

A stent to open the artery provided only a short-term remedy. A couple of weeks later stents were required for blockage in additional arteries.

Her cardiac woes did not end there. Two months after her second procedure, she was diagnosed with heart failure, or weakening of the heart, that often results after a heart attack.

That is not unusual. The event of the heart attack is bad enough. Worse are the consequences that continue for several years in women. The National Heart, Lung and Blood Institute (NHLBI), a component of the National Institutes of Health, found that more women than men die within the first year of a heart attack. Within five years, 22 percent of women and 15 percent of men will have another heart attack. The median years of survival after a first heart attack is 17 in men and 13 in women.

In spite of its prevalence and dire consequences, heart disease is largely preventable. According to a case-control study involving 52 countries (INTERHEART), control of nine easily measured and potentially modifiable risk factors could result in a 90 percent reduction in the risk of an initial heart attack. The research further concluded that this reduction was consistent in men and women and different ethnic groups.

Risk factors are classified by those one can control and those beyond a person’s control. Age, family history and race are not modifiable risk factors. Family history is especially important in women, according to Malissa Wood, co-director of the Corrigan Women’s Heart Health Program at the Massachusetts General Hospital Heart Center.

Family history is defined as heart disease or a heart attack in a first degree male relative before the age of 55 or a first degree female relative before the age of 65. A first degree relative is a parent or sibling.

Other risk factors can be prevented or controlled if diagnosed. High blood pressure and cholesterol, obesity, unhealthy diet, inactivity, diabetes and smoking are all correlated to heart disease. Even stress and emotion are considered heart risks.

Having one risk factor doubles the risk; having more increases the risk exponentially, said Wood.

A snapshot of risk factors in women indicates the gravity of the situation, especially among African Americans. Black women are more likely to have high blood pressure and diabetes and engage in very little physical activity. More than 70 percent are overweight or obese due largely to an unhealthy diet. African American women, compared to other women nationally, tend to consume a high amount of calories, fat and cholesterol per day.

Like Tswago, Brenda Taylor did not initially recognize the onset of her heart troubles. She thought that she had simply eaten something that didn’t agree with her. Already troubled with acid reflux, a condition that causes heartburn among other symptoms, Taylor sought her usual relief of medications.

But this time, according to Taylor, it was different. “I just wasn’t feeling well,” she said. “I didn’t have all my energy.”

A Conversation with Dr. Malissa J. Wood
Courtesy of Massachusetts General Hospital Heart Center

She popped antacids and sipped soda — anything to ease the discomfort. But nothing helped. Her condition worsened to the point when, finally, early the next morning she relented and went to the emergency room.

She was not prepared for what a nurse told her. After viewing the results of Taylor’s EKG, the nurse yelled “I need a doctor STAT.”

Taylor had had a heart attack.

“I did not recognize the symptoms,” she said.

But a catheterization told the tale. She had clogged arteries in her heart. The procedure to open her arteries was not successful, and she underwent a double bypass.

In hindsight Taylor realized she should have been more aware. Her father died from a massive heart attack at the age of 45, which increased her risk of heart disease.

But, according to Taylor, no one discussed this with her. She religiously attended her “well woman” exams and kept track of her numbers, but no one suggested that she could be of risk.

Taylor said she is determined that she will not be caught off guard again. “I have learned to be my own advocate,” she said. “I ask questions now and seek information regarding women and heart disease.”