According to the American Heart Association, 39 percent of all female deaths in America are the result of cardiovascular disease. A study published five years ago revealed there is still a lack of understanding among women about the dangers of heart disease and stroke. Ellen Gordon, MD, cardiologist at UI Heart and Vascular Center, talks about heart disease in women:

In the introduction, we mentioned a study that suggests that women still do not fully understand the dangers of heart disease. We've been talking about heart disease in women for a number of years. What is it about the disease that women still do not understand?

We now know from that study that about 55 percent of women understand that heart disease is their number one cause of death and that it kills more women than all forms of cancer combined. The good news is that number is up from 30 percent in 1997 to 55 percent now. The bad news in that is when we turn around and ask these same women what their individual, personal, greatest health risk is, a miserable 13 percent say that it's heart disease. So there's a major disconnect here. In other words, women just don't think heart disease is going to happen to them.

Who is at risk of developing heart disease?

That's a huge number. Heart disease is now the number one cause of death in the world with possibly the exception of sub-Saharan Africa. When we talk about who is at risk, we think about two groups:

• Our high risk group is women who have some form of heart disease. We want to prevent further disease not only in the women who have heart disease but also women who have had a stroke, have blockages in arteries to their extremities—that's called peripheral artery disease—and women who have diabetes.
• With the other group, we want to prevent development of disease in women who don't have it.

The traditional risk factors would be high cholesterol, smoking, family history of early heart disease, high blood pressure, and being overweight. And obviously the traditional risk factors—the more you have the higher your risk.

Does age or race play a part in women's heart disease?

Yes it does. The good news is that women get heart disease later than men. And that can be turned into more time to prevent the disease. The bad news is once women get it, they tend to be sicker and they have a lot more problems. It's a lethal disease but it's also very disabling and people forget about that part.

The second part of your question, race; there's a lot we've learned recently in that area, but one area in particular—African-American women—have significantly increased risk. They have high blood pressure at an earlier age, they have more problems with it, and they also have a higher risk of death rate compared to the general population. It's about 23 percent higher, so they're at particular risk. Another group that is at risk is some ethnic groups that are at high risk for diabetes. That would be again, African-American women, Hispanics, Asians, Pacific Islanders, or Native Americans.

What can women do to decrease their risks of developing heart disease?

Start right now. It's never too late to decrease your risk. What we know is that most women think they don't need to start until they're about 50. We have to remember that we develop arthrosclerosis in our big arteries, our aortas, as teenagers. So it's starting way before we're starting to decrease risk. Women need to know their individual risk factors. They need to know what their numbers are, what their blood pressure is, what their LDL cholesterol is, etc. And they need to know the goal. What number do they need to get that to—and they need to get it there.

This is another place where we have major disconnect. When we survey women, they know they need to exercise, lose weight, quit smoking, and reduce cholesterol. But, when we ask how many do, for example, 56 percent of us are obese, 66 percent of us don't exercise, and 40 percent of us have high cholesterol. I could go on, but there's still a lot to be done. There's a lot more they can learn if they want to Visit Go Red for Women, which is the American Heart Association's heart disease for women site. And there's a tool http://www.goredforwomen.org/hcu/index.aspx there where they can actually assess their own individual risk and see where they need to be. 

What are the common symptoms of a heart attack?

I want to emphasize that most men and women still present with chest discomfort. That is the most common presenting symptom of a heart attack. It's typically chest discomfort that's in the center of the chest. It can last for a few minutes or go away and come back. It can feel like an uncomfortable pressure, a squeezing, a fullness, or discomfort.

It is true that more women than men don't present with chest discomfort. In a recent summary of all the studies, about 37 percent of women didn't have chest discomfort, but 27 percent of men didn't either, so it's not that it's just women who don't have chest discomfort. In those situations, women can often present with shortness of breath; they can have the discomfort in another part of the upper body. It can be in their stomach, it can be in one or both arms, their back, their neck, or their jaw. And they can also break out in a cold sweat, be nauseated, or be very, very lightheaded. So those are some of the more unusual presenting symptoms.

What are some symptoms women may experience when having a heart attack that may be considered uncommon?

Those would most likely be breaking out in a cold sweat, nausea, lightheaded, shortness of breath. I want to emphasize, chest discomfort is the number one presenting symptom, but other women—about 37 percent of women—won't have that and they'll have some of these other symptoms that we mentioned.

Why is recognizing symptoms early important?

Time equals heart muscle. Every minute you wait, heart muscle is dying and when heart muscles dies, it can't pump. And the good news about this is we have treatments that can restore blood flow to the heart muscle and actually save muscle. So the longer you wait, the more at risk, the heart muscle may die, and when it's dead there's not much we can do about it. 

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Ellen Gordon, MD

UI Heart and Vascular Center