Bob Roth

When I was working on my latest Aging Today column, it occurred to me that I wished I could write again about women and heart disease — that’s how important it is for women to have all the right information. The more women know, the better the chance they’ll be able to recognize it and correct it. I last wrote about the subject in January 2018, and I decided the message is so vital that I would run that same column again for Hearth Health Month 2020, dispelling the vast amount of misinformation about heart disease and its symptoms in women. 

I’ll be back next month with a new column.

Heart health and gender bias

​If my 20-year-old self could see me now — living in the Valley of the Sun, where it is bathing suit season 10 months of the year, and surrounded by women ... Wait, let me explain.

I am married to the most amazing woman with three daughters. I work in an office with all women and work in a field dominated by women. So in honor of Heart Health Month, I dedicate this discussion of women’s heart health to my Valentine sweethearts and the strong, capable women in my life and in our

community at large.

And I must give a special shout-out to Dr. Martha Gulati, the division chief of cardiology at the University of Arizona College of Medicine - Phoenix, who provided me with the facts to empower women to advocate for their own cardiac health.

In the U.S., more women than men have died from heart disease and stroke since 1985. One out every three women are at risk of developing heart disease, with the trend approaching one out of every two. Are you blown away by that statistic? Women, when you are in line at the ladies room for a concert or sporting event, either you, the person in front of you or the person behind you is at risk of developing heart disease. As our society becomes increasingly sedentary, the risk looks more like a coin toss: Heads you’re at risk, tails you’re not.

The fuel that has added to this inferno of cardiac disease in women is the lack of recognition of risk both by women themselves and by the medical community.

Heart disease will kill one in three women worldwide, yet breast cancer, with a death rate of one in 30, is more on our radar. Dr. Nanette Wenger, a pioneer of cardiac research in women, called this the “bikini” approach to women’s health, looking essentially at the breast and reproductive system to the exclusion of the rest of the body.

As the backbone of the family, women tend to address their own health last or ignore important warning signs of heart disease. Whether working outside the home or in the home, they tend to put their own health issues on the back burner. I see this often with family caregivers, especially those caring for aging parents.

Women who exhibit symptoms of a heart attack tend to underestimate the severity of their symptoms, not wanting to complain about seemingly minor aches and pains. It is not uncommon for women to minimize nagging symptoms in order not to appear “hysterical,” a tendency with a long history. In fact, the word “hysterical” comes from the Greek hysterika, meaning uterus. So it is not surprising that women would underreport symptoms to shed this negative female stereotype.

Women’s symptoms of a heart attack can be more subtle than a man’s. They don’t necessarily present as that chest-crushing pain that describes a textbook heart attack in men. And it’s no wonder — the patients described in textbooks were men! Before the early 1990s, women were routinely excluded from most major cardiology trials.

Women should be aware of the subtle signs of heart disease, such as

shortness of breath, jaw pain, back pain, nausea, vomiting, sleep disturbances or fatigue. If activities that are the normal for you suddenly become difficult, you could have heart disease and you need to see your doctor and clearly express your concerns.

Certain factors put women at greater risk of getting heart disease. There are modifiable and non-modifiable risk factors. Non-modifiable risk factors

are age, family history and race/ethnicity. We obviously can’t change those, but it is important to know about how these risks affect us. We can affect the modifiable risk factors, which include:

• Smoking

• High-blood pressure

• High cholesterol

• Diabetes

• Physical inactivity/poor fitness

• Metabolic syndrome

• Obesity

• Stress, depression, anxiety

• Sleep apnea

• Sleep deprivation

Additionally, emerging research shows that for women who develop diabetes or high-blood pressure during pregnancy, heart disease is a long-term threat. Also at higher risk: mothers whose babies were born too small or too soon. Researchers believe pregnancy can mimic the stressors of age. Pregnancy could be a woman’s first free stress test.

Even with the inclusion of women in cardiac research, heart disease is still considered a man’s disease. Heart disease usually affects women about

10 years later than men, but it hits a whole lot harder. Compared with men, more women die from the initial heart attack. For those men and women who survive the initial heart attack, more women die within one year of the heart attack. Twice as many women than men end up disabled as a result of heart disease.

Remember, heart disease is preventable. The cardiology community is still in the infancy of its campaign to really educate women. Women need to advocate for their own heart health by knowing their risks and taking charge of their destiny through action and education.

I lost my mother to heart disease. She was the matriarch of my family and the inspiration to devote my career to caring for our aging adult population. On Feb. 7, join me and wear red to support the American Heart Association’s Go Red for Women Day. I will proudly don my red on this day in memory of my beloved mother and in celebration of the amazing women in my life. JN

Bob Roth is managing partner of Cypress HomeCare Solutions.

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