By: Leah Golbert, SWHR Communications Intern
In the United States, a person dies every 33 seconds from cardiovascular disease (CVD), the leading cause of death for women and men across the country. CVD is a general term for disorders impacting the heart and blood vessels. A diagnosis of CVD can refer to a number of different conditions, including heart disease, heart attack, stroke, heart failure, arrhythmia, heart valve problems and more. Many cardiovascular diseases present with a wide range of symptoms, particularly for women, sometimes resulting in missed or delayed diagnoses. Understanding women’s CVD risk and prioritizing early diagnoses are crucial for healthy aging and better patient outcomes.
Cardiovascular Disease in Women
The most common types of CVD in women are heart failure, ischemic heart disease (IHD), and arrhythmia. IHD, also known as coronary heart disease, is the most common heart disease in women and the leading cause of death in women. There are several risk factors for CVD that are specific to women, including an early age of their first period; being post-menopausal; having had a hysterectomy, breast cancer, and complications during pregnancy; as well as having an autoimmune disease. Eighty percent of women ages 40 to 60 have one or more risk factors for IHD.
Among the challenges women face when it comes to CVD is that women tend to present with different symptoms than men. Because heart attack symptoms have been studied mostly in men, it has led to improper education and awareness about heart attack presentation in women. The most common heart attack symptoms for men and women are chest pain, discomfort, and shortness of breath. However, cold sweat outbreaks, nausea, dizziness, vomiting, heart palpitations, and unexplained fatigue are more common heart attack symptoms in women. Women are also more likely to report mild symptoms or symptoms without chest pain related to a heart attack, which often leads to missed or delayed diagnoses. This gender difference demonstrates the significance of improving education and awareness among physicians and the public regarding women’s heart health diagnoses.
Diagnostic Tests
Stephanie Coulter, MD, FACC, FASE, of The Texas Heart Institute explained in a webinar hosted by the Society for Women’s Health Research this spring that one’s risk group for heart disease can largely determine how a patient is treated when seeking care. Factors contributing to an individual’s risk group for CVD can include age, menopausal status, smoking status, family history, exercise level, and obesity status, among other factors.
She shared that when a patient—regardless of risk group—comes into the emergency room with chest pain, providers should always perform an electrocardiogram (ECO or EKG). EKGs record the electrical signals of the heart to check for irregular heartbeats and can be used as both screening tests and diagnostic tests; many providers are generally trained in the basics of reading EKGs, and the test is readily available in many emergency rooms across the country. “Even if you are low-risk, demand that you [still] get an EKG,” said Dr. Coulter. She explained that there are rare cases where low risk individuals, especially young females, can develop serious conditions such as heart attacks, strokes, and IHD. While the technology is basic, an EKG can give answers quickly.
An EKG can also provide imaging of the heart. This test uses ultrasound waves to determine the heart’s structure and show how the blood is moving through the heart. It can highlight problems with heart valves, the outer lining of the heart (pericardium), blood clots, holes between the heart chambers, the heart’s pumping strength, and more. This test can be a valuable early detection method for CVD.
Blood tests are another important diagnostic tool to measure one’s risk for developing CVD, since having high cholesterol increases the risk of having heart disease and a heart attack. Lipid panel tests measure lipids, lipoprotein A, C-reactive protein, and homocysteine levels, which show the levels of fats and cholesterol in the blood. Lipid panel testing is typically be done every four to six years but may be required more frequently based on age, family history, and patient risk factors, such as gestational diabetes, PCOS, preeclampsia, or an autoimmune disease.
Check out the Read My Lip campaign to learn more about how cholesterol impacts heart health and when to request a lipid test from your provider.
Another diagnostic tool that can be used for understanding one’s heart health is imaging. Common types of imaging to detect CVD include chest x-rays, CT scans, angiograms, and MRI scans. Imaging scans can provide views of the heart, lungs, chest, and blood vessels and can be used to detect heart disease and arrythmia early or to determine the extent of cardiac damage from a heart attack.
To gauge one’s overall heart health, there are also exercise tests or stress tests, which monitor how the heart reacts to physical activity. These are typically used to diagnose IHD, determine safe levels of exercise for patients, and predict the risk of heart attack. During these tests, the patient is hooked up to heart monitoring leads (cables) and will walk on a treadmill or use a stationary bike, increasing their exertion over time. The test measures blood pressure, heart rate, breathing, electrical activity, and perceived exertion. Stress test results will show any reductions in blood supply to arteries supplying the heart during exercise, which could be evidence of heart attack or coronary artery disease.
Lastly, the cardiac catheterization procedure uses a catheter and dye to highlight blockages in the coronary arteries. Physicians can gain insight into chamber pressures, strength, and blood oxygen content using this procedure, which can allow for a clearer diagnosis of ischemic heart disease, congenital heart disease, or heart failure.
These are just a handful of the screening and diagnostic tests available to gain greater insight into one’s heart health. There are several other tests that provide more nuanced views of the heart, such as cardiac positron emission tomography (PET) and single-photon emission computerized tomography (SPECT) scans. Patients should always consult their provider and discuss all their heart health risk factors before selecting the tests that may be right for them.
Addressing Barriers to Care
Diagnostic tests must be easily accessible for women to truly improve their cardiovascular outcomes. Care access and uptake can be improved by increasing public awareness of these tests through federal education and awareness campaigns. In addition, improving medical school education about sex and gender differences in cardiovascular risk can have positive impacts on women’s cardiovascular health outcomes when they go in for other doctors visits.
Working to reduce disparities is another critical step in closing heart health gaps for women of color. In 2019, African Americans were 30% more likely to die from heart disease than non-Hispanic whites. Black women have more risk factors and higher mortality rates for CVD and develop disease earlier than white women. Black women also experience higher rates of diabetes and obesity, increasing their risk for heart disease and high blood pressure.
Early diagnosis through risk factor assessment and diagnostic testing for CVD are crucial in promoting healthy aging for all women. Educating physicians on the differing presentations in women and diagnostic process for CVD is crucial, as is increasing public awareness of cardiovascular risk factors among women. More heart health education across the health care ecosystem will improve outcomes for women across the country. As the leading cause of death for women – and men – in the United States, cardiovascular disease must be recognized as a priority by both patients and physicians now.