How's your heart?
Coronary disease attacks men and women in different ways. Whether
you're in tip-top health, at risk, or even showing symptoms, Alison
Motluk tells how cutting-edge diagnostic tests can end up prolonging
your life and ensuring that the beat goes on.
O, The Oprah Magazine, May 2007
BY NOW WE ALL KNOW THAT THE symptoms of heart disease
are--dangerously--far more subtle in women than in men. Instead of the
crushing chest pain and cold sweat that would make a man grasp for the
phone, women might notice simply indigestion or fatigue. For about two
out of five of us who have heart disease, "the first symptom is death,"
says Lori Mosca, MD, PhD, director of preventive cardiology at New
Medicine is only just learning that
the difference in symptoms reflects differences in the disease itself.
For example, men tend to form big, easily observed clumps of plaque
(the buildup of cholesterol, calcium, and other deposits that narrows
blood vessels and causes clots). But as many as three million women
have a condition called microvascular disease, in which the plaque
spreads evenly throughout the artery walls and accumulates in the tiny
tributaries--often making them rigid--at the end of the stream of
arteries feeding the heart, where it's frequently not picked up by
traditional angiograms, according to WISE (Women's Ischemia Syndrome
Evaluation), an ongoing study launched by the National Institutes of
Health in 1996. This is partly why the gold standards for catching
heart disease in men--like the angiogram and the treadmill stress
test--just don't work as well in women.
insights are leading to better high-tech scans for us. One thing about
heart disease that's the same for both sexes: It's the number one cause
of death. So here's what you need to know if:You're Perfectly Healthy ...
For women age 20 and over, the American Heart Association recommends the following:
- At least every two years, measure blood pressure, pulse, waist size, and body mass index.
You Feel Fine but Have Risk Factors ...
least every five years, get both your blood sugar and fasting blood
lipids (total cholesterol, HDL, LDL, and triglycerides) tested.
helps protect the heart during childbearing years, giving women a
definite advantage over men before menopause, says Robert Bonow, MD,
chief of the division of cardiology at Northwestern Memorial Hospital
in Chicago--an edge that can be erased by risk factors including:
blood pressure, abnormal cholesterol levels, diabetes, a waist larger
than 35 inches, a BMI of 25 or greater, or inactivity.
- Smoking--it cranks up risk as much as an extra 92 pounds would, according to the WISE study.
- Family history of stroke or heart disease, especially in a father or brother before age 55 or mother or sister before age 65.
you have any of these risk factors, you may want to talk to your doctor
about getting one of the relatively new blood or imaging tests that can
offer a clearer picture of your heart health--and whether you should
start taking drugs or make lifestyle changes. Keep in mind that at this
point, the tests are more suggestive than definitive.
tests: C-reactive protein (CRP) is the most established of the blood
tests and the one you should probably get if you're not showing any
symptoms yet. It can pick up problems even in women with low levels of
LDL, or "bad," cholesterol (up to half of all heart attacks occur in
people with normal LDL levels).
- Imaging tests: A
new technique called a CT angiogram (or cardiac CT) is another test you
might consider, says Mehmet Oz, MD, director of the Cardiovascular
Institute at Columbia University Medical Center in New York City,
especially if you have risk factors--like smoking or obesity--that
you're willing to change. An image constructed from 64 pictures, or
slices, presents a fairly precise idea of how blood is flowing through
the arteries and whether calcified or soft plaque is causing
Other imaging tests that may be offered at
this stage are an ultrasound of the carotid artery or electron beam
computed tomography (EBCT), an X-ray procedure that scans for calcium
in the heart's vessels. Oz believes the CT angiogram is superior to
both, pointing out that another difference between the sexes is that
unlike men, women tend not to deposit calcium in their plaque (which
actually makes it more likely to rupture)--so the danger for us would
be less visible on an EBCT. A recent review in the Journal of the
American Medical Association found scant evidence that this scan leads
to better outcomes.You Have Symptoms ...
carrying groceries up one flight of stairs prompts out-of-the-ordinary
breathlessness or a burning pain anywhere, front or back, between your
belly button and chin, you may be noticing signs of heart disease.
Other symptoms include unusual fatigue, dizziness, nausea, or a
tightness in the chest.
For women, cardiologists are turning to
a new generation of diagnostic techniques. You should always start with
either an echocardiogram or nuclear stress test, says Oz.
- Echocardiogram: This is basically an ultrasound of the heart, usually conducted by passing a wand across your chest.
stress test (also called cardiac or myocardial perfusion imaging or
SPECT): With a small amount of an injected radioactive substance, a
camera shows if the heart is receiving adequate blood supply when
you're both at rest and at peak exercise on a treadmill or bicycle. The
beauty of this test is that it can pick up evidence of small vessel
- CT angiogram: This test is becoming
increasingly useful at the symptom stage as well, says Jennifer Mieres,
MD, director of nuclear cardiology at New York University School of
Medicine and chair of the American Heart Association's Cardiac Imaging
committee. "The CT angiogram is especially good for looking at hidden
plaque without calcium," adds Oz.
- Cardiac MRI:
Another promising up-and-comer that uses a strong magnetic field and
radio waves to create images of your heart. It's mostly available at
big academic centers and may prove especially helpful in younger,
perimenopausal women, says Mieres.
tests are not going to save your life," says Mosca. "You are going to
save your life, because you are going to be committed to a
heart-healthy lifestyle." While a recent national survey pointed out
that a mere 3 percent of American adults fully follow heart-healthy
habits, we all know the drill. Give up smoking. Choose foods wisely.
Stay at a healthy weight. And be active for at least 30 minutes on most
days. Says Mieres: "Small steps make a difference."
persistent symptoms go undiagnosed, don't give up. "Everybody's looking
for the magic test, and we don't have that," says Nieca Goldberg, MD,
chief of women's cardiac care at New York's Lenox Hill Hospital. "Find
a doctor who's listening."