Heart disease in women

In every year since 1984, cardiovascular disease has claimed the lives of m ore females than males. More than 450,000 women succumb to heart disease an nually, and 250,000 die of coronary artery disease. Despite the proportions , most women believe they will die of breast cancer. The perception that he art disease is a man's disease and that women are more likely to die of bre ast cancer is alarming. Although women develop heart disease about 10 years later than men, they ar e likely to fare worse after a heart attack. The poorer outcomes are due, i n part, to the failure to identify heart attack symptoms. Approximately 35% of heart attacks in women are believed to go unnoticed or unreported. Howe ver, because of increased age, women are more likely to have co-morbid dise ases such as diabetes and hypertension. In women, not only is "tightness" o r discomfort in the chest a warning sign, but in addition, nausea and dizzi ness are common indicators of myocardial ischemia. Other symptoms include b reathlessness, perspiration, a sensation of fluttering in the heart, and fu llness in the chest. In comparison to men, women are less likely to undergo tertiary care interventions such as cardiac catheterization, angioplasty, thrombolytic therapy, and bypass surgery; to participate in cardiac rehabil itation; and to return to work full-time after myocardial infarction. In the past, most research about treatments for heart disease focused on me n, and gender differences have been ignored. Recent studies are enrolling e nough women to test if there are differences between men and women in outco mes. One of the major areas of research relates to estrogen and hormonal re placement therapy to reduce the relative risk of heart attack and stroke. T he Women's Health Initiative is a major NIH-sponsored trial that addresses the issue of primary prevention of cardiac disease by hormonal replacement therapy. The results will be available in 2004. The Heart Estrogen/Progesti n Replacement Study (HERS), disappointingly, did not show a significant red uction of coronary events in women taking hormonal replacement therapy, nor did the Estrogen Replacement and Atherosclerosis (ERA) trial of 309 postme nopausal women who underwent coronary angiography. New insight into the role of vitamins, phytoestrogens and other natural sou rces,and selective estrogen receptor modulators may provide other options f or management. Until then, modification of risk factors and healthy life st yle choices are recommended for reducing the risk of cardiac disease. In fa ct, the key to a healthy heart in the year 2000 appears closely tied to lif e style choices. Prevention of disease is the key and current recommendatio ns are simply to stop smoking, or do not start; treat and control blood pre ssure >140/90 mm Hg; manage elevated lipids by diet, exercise, and choleste rol-lowering medications (if necessary); treat diabetes; lose weight so tha t BMI is <25; walk for 20-30 minutes at least three times a week; and take an aspirin tablet daily.