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Heart disease is the leading cause of death in women. So where’s the research?

Dr. David Wolinsky, medical director of cardiac rehabilitation at Cleveland Clinic, consults with his patient Kathleen Slater. The Coral Springs mother of two had atrial fibrilation four years ago and through diet, exercise, medication and checkups, has maintained good health.
Dr. David Wolinsky, medical director of cardiac rehabilitation at Cleveland Clinic, consults with his patient Kathleen Slater. The Coral Springs mother of two had atrial fibrilation four years ago and through diet, exercise, medication and checkups, has maintained good health. Courtesy Cleveland Clinic

Barbra Streisand is fed up with men getting treated better than women.

What has raised her ire? Male mice.

For years, the National Institutes of Health, which provides most of the money for medical research, has used male mice to study heart disease. Why? Men were the primary research subjects.

Women have heart disease, too. In fact, heart disease is the No. 1 killer of American women (and men). Yet heart disease death rates in the United States have declined steadily for men over the last quarter century. Not so much for women.

“I have always been extremely exasperated by gender discrimination,” said Streisand, who has launched a campaign to educate women about heart disease.

“Even in the labs, they didn’t use female mice,” she added. “More women die of heart disease than all cancers combined. That’s hard to believe, but that’s the truth. Every 80 seconds a woman dies of heart disease.”

Heart disease, which killed “Star Wars” actress Carrie Fisher two days after Christmas last year at only 60, is the leading cause of death in both men and women, according to the American Heart Association. Some 43 million women are living with cardiovascular disease and might not even be aware. Streisand’s figures are backed by the association and experts like Dr. David Wolinsky, medical director of cardiac rehab at Cleveland Clinic Florida in Weston.

Different symptoms

Men and women are quite different when it comes to recognizing the symptoms of heart attack.

“There has been a history of paying less attention to women’s symptoms, and when we use guidelines for testing — pre-test likelihood of disease when we look for risk factors like age, typically — women come out at a lower risk,” Wolinsky said. “The guidelines we have now are applicable to people with a higher risk, and women don’t fall into these guidelines. So, women don’t qualify for these tests or get approved for these tests.”

Adds Dr. David Ancona, a cardiologist at Memorial Hospital West in Pembroke Pines, “Textbooks have been filled with how men present, but we have unfortunately been burned too many times, and females have suffered because of the dismissal of benign-appearing symptoms.”

Both men and women having a heart attack can experience chest pressure that feels like a heavy, overwhelming weight sitting on the chest. Men’s pain can radiate down the left arm. Women’s chest pain, however, can feel more like a sharp, burning or stabbing sensation.

For women, pain can be felt in either arm, the back, neck or jaw. Other signs in women can include fatigue, shortness of breath, atypical chest pain brought on during rest rather than activity or triggered by emotional stress. Cold sweats or sweating that doesn’t occur as a result of exercise or heat should also be reported to a medical professional.

“Back when I was in my early practice, if the ER called about a young person, say 40, and described some of the symptoms and said she was a woman, we often dismissed the chest symptoms. ‘Well, she’s a woman. Probably doesn’t mean coronary heart disease.’ Fact of the matter, coronary heart disease is the No. 1 killer of women, more than all cancers put together,” said Ancona, former chief of staff at Memorial West.

In fact, about 64 percent of women who die suddenly of coronary heart disease have no previous symptoms prior to the fatal attack, according to the Centers for Disease Control and Prevention.

Types of heart disease

Coronary heart disease, the most common type of heart disease, happens when plaque forms on the inner lining of the coronary arteries and reduces the flow of oxygen-rich blood to the heart. In the United States, one in four women die from heart disease, and more women die from coronary heart disease than from all cancers, chronic respiratory disease, Alzheimer’s and accidents combined.

Coronary heart disease death rates in women aged 35 to 54 years are increasing, possibly because of the obesity epidemic, the misguided notion that women are “protected” before menopause — after menopause they rapidly catch up to men — and the lack of awareness, research and tests to detect heart disease in women. Inflammatory diseases like lupus and rheumatoid arthritis, pregnancy complications and inadequate sleep can also elevate a woman’s risk for heart attack.

Lack of awareness

Many still believe heart disease is primarily a man’s problem. According to a recent American Heart Association study, the number of women aware that heart disease is the leading cause of death has increased in the last 15 years — but this knowledge is still lacking in minorities and younger women.

Awareness of coronary heart disease among U.S. women increased from 30 percent in 1997 to slightly more than half, 56 percent, in 2012, the study found. Among black and Hispanic women, only 36 percent were aware in 2012. Most thought cancer was the leading killer.

The first women-specific clinical recommendations for coronary heart disease prevention were published by the American Heart Association in 1999.

“The approach to women and heart disease has changed significantly in the last five years, but it still remains difficult to determine the best tests at a given time for people, and we learn all of this as we put the papers together,” Wolinsky said. “But we don’t have all the answers yet. I’d love to see this promoted more, quite frankly. The Cancer Society seems to engage patients in the community very effectively. People are afraid of cancer.”

Wolinsky points to former vice president Joe Biden’s efforts with his Cancer Moonshot funding initiative to advance research for the National Cancer Institute. “We need the same advocate for heart disease.”

Streisand, for instance. Her Barbra Streisand Women’s Heart Center at Cedars-Sinai in Los Angeles has taken a leading role in research focused on women. On her recent concert tour, which played to sold-out houses in Miami and Sunrise in December, Streisand used her stage to push for more awareness of women’s heart disease and for more appropriate research.

New tests

Wolinsky applauds the effort. “There are new tests that seem to work well in women, of which Cedars-Sinai has the best where Streisand is — and that’s probably thanks to her,” he said. Wolinsky cited current tests, like magnetic resonance imaging to assess the function the heart, the size of the ventricles and atria chambers of the heart and valve function, and magnetic resonance angiography, which looks at coronary arteries.

These tests are available locally, including at Cleveland Clinic, Memorial West, Baptist Hospital, Mount Sinai Medical Center and University of Miami Hospital.

These medical institutions are also working with the Positron Emission Tomography (PET) scan of the heart, a noninvasive nuclear imaging test that produces pictures of the heart. From these scans, doctors can better diagnose coronary artery disease and assess its damage due to a heart attack.

Take control yourself

“You know what’s interesting? Even about men, they say, ‘This guy died of natural causes.’ There’s nothing natural about dying of a heart attack. You can prevent it,” Streisand said.

“I was at her concert and she was talking about this and people didn’t know what she was saying,” Wolinsky said. “We think it’s common knowledge, but it’s not.”

Patients, men and women, need to know their blood pressure, their cholesterol and triglyceride numbers and the difference between good and bad cholesterol levels. Regular daily exercise and proper diet are musts to strengthen the heart, Ancona said.

“I say daily, because then it becomes normal part of a routine, not an exception to the day,” the cardiologist said. “Never teach yourself how to quit.”

Kathleen Slater, 58, is a Coral Springs mother of two and grandmother of three. There was a history of heart problems on her mother’s side. Four years ago, a routine test before a surgical procedure detected an extra heartbeat. Slater thought the sensation was anxiety. After testing, she was diagnosed with atrial fibrillation. Medication, along with diet, exercise and self-monitoring of her blood pressure, has kept her healthy.

Slater’s message: “Be aware of your body.” She lost two friends, ages 53 and 54, to heart disease. “It’s really sad. Both of them could have been fixed. They were playing around with blood pressure. It would go up and down and up and down. One had a mini stroke. You can’t ignore your body. You are given one life to live. Live it to the fullest.”

Equal time for female mice

Despite the advancements, and the attention after Fisher’s death, there is still much to be done.

“We don’t have enough money given to us by the NIH and the government to do the research, and we need to do it because women are different than men,” Streisand said. “They have different size hearts. Different size arteries. And the research has to be done on women in the labs on female mice. When I said, ‘How come you don’t use female mice?’ They said, ‘They are more expensive.’

“Why are they more expensive? Because they are more complex. They have different hormones. Duh! You can’t do research on women’s heart disease on male mice or on males — and in the last 50 years it has been on males. Can you imagine? We are physiologically different. We have different plumbing. We have babies. We nurture. We feed babies. We are different.”

Howard Cohen: 305-376-3619, @HowardCohen

Symptoms of heart attack in women

▪ Unusual fatigue unrelated to illness or emotional stress or exertion.

▪ Atypical chest symptoms, such as a stabbing sensation, discomfort or more classic pressure-like symptoms that can feel like a tightening vise. Pain can be anywhere in the chest, not just on the heart’s left side.

▪ Discomfort or pain in either arm; also, back, neck or jaw.

▪  Heart palpitations.

▪ An episode of unexplained sweating.

▪ Stomach pain. Sometimes mistaken for heartburn, flu or stomach ulcer. Can feel like someone heavy is sitting on your stomach.

▪ Nausea.

▪ Shortness of breath or lightheadedness for no apparent reason, or combined with other symptoms.

Tips for a Healthy Heart

1. Physical activity is an important way to prevent heart disease — the nation’s No. 1 killer — and stroke, the nation’s No. 5 killer. Aim for at least 30 minutes a day, five days a week to improve your cardiovascular health. Moderate activity gets your heart beating faster. You should be able to talk while exercising to maximize aerobic benefit. The simplest change you can make to improve your heart health is to start walking.

2. Eat fresh foods. Avoid processed foods — that includes sugar.

3. Get a good night’s sleep.

For more, and to download a treatment guide, go to https://health.clevelandclinic.org/2016/02/love-your-heart-16/

Sources: Dr. David Ancona, cardiologist, Memorial Hospital West; Dr. David Wolinsky, medical director of cardiac rehab at Cleveland Clinic; and WebMD.

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