Heart Disease

It's the leading killer of women. Are you at risk?

May 22, 2000 -- Betty White isn't one to let colds, aches, or fatigue get in her way. In fact, the active 74-year-old from Tampa, Fla., says she has "never been sick a day in her life." But on a vacation to Oklahoma City last August, sudden pains in her ear, neck, shoulders, and back became so severe that she stopped at an outpatient clinic for a checkup.

The clinic's doctor ordered a few blood tests and told White she was probably just getting a virus. White was advised to see her family doctor for another checkup when she arrived back home. But, as she found out a week-and-a-half after her first symptoms, her pains amounted to more than just the flu: She had experienced a major heart attack.

When White visited her own doctor the day after flying home from Oklahoma to Florida, he again told her it was probably the flu and sent her home. But as the days passed, she became weaker and weaker. When she could hardly breathe and couldn't get out of bed, she was rushed to the emergency room and finally diagnosed. By this time, 50% of her heart was no longer functioning.

Coronary heart disease, which can eventually lead to a heart attack, is alarmingly common in women. According to the American Heart Association (AHA), it claims the lives of a half million U.S. women every year -- making it the number one killer of women in this country. In fact, despite the perception that heart disease is a man's illness, it has killed more women than men every year since 1984, says the AHA.

With heart disease and heart attacks so common in women, you'd think doctors would be on the alert for their symptoms. But experts say that many women, like Betty White, aren't being diagnosed and treated as quickly as men with the same conditions.

A February 2000 study published in the Journal of the American Medical Association and conducted by Mayo Clinic researchers showed that women who went to the emergency room with unstable angina (chest pain) were 24% less likely than men to be tested for heart attacks or heart disease. Another study published in the November 1999 issue of the American Journal of Cardiology again showed that women at emergency rooms were less likely to be tested for a heart attack or heart disease. What's more, the second study found that women were also less likely than men to receive lifesaving medication or surgery after being diagnosed.

These studies both send the same chilling message: because women are less likely to be tested for heart disease, they are then less likely to be diagnosed with it. As a result, treatment is likely to be either delayed or less aggressive than it should be, says Nieca Goldberg, MD, a spokesperson for the AHA and chief of the women's heart program at Lenox Hill Hospital in New York City.

"Unfortunately, this kind of thing happens more often than we would like because sometimes the symptoms of a heart attack in women aren't as obvious," Goldberg says. "Even though I know better, when I think of what a heart attack looks like, I think of the picture they showed us in medical school: a middle-aged businessman in a suit, clutching at his heart."

The reality is that women having heart attacks often experience different symptoms than men. Instead of the traditional pain in the center of the chest, women may feel pain in the lower portion of the abdomen, back, jaw, or neck.

Because they may not perceive their pain as a heart attack, women often don't get to the hospital in time. Or they may describe their pain as a backache or stomachache, potentially leading the diagnosis in another direction, Goldberg says.

One solution may be to raise women's awareness that they, like men, are at risk for heart disease, including heart attacks. "The AHA is trying to get that message out there to both women and doctors," Goldberg says.

Lack of awareness is one reason White and her doctors didn't immediately recognize her heart attack. It's especially important for a heart attack to be diagnosed early, as the consequences of a delayed diagnosis can be serious. "Sometimes with a heart attack, all the damage that is going to be done is done within four to six hours. In other cases, there may be ongoing damage," says David Herrington, MD, associate professor of medicine and cardiology at Wake Forest University School of Medicine in Winston-Salem, N.C. "In either case, we do know early treatment can help prevent some of the damage."

If a heart attack is diagnosed within the first few hours, blood clot-busting medications and artery-opening surgical procedures can restore blood flow to damaged heart tissue, Goldberg says. How can women make sure they get this treatment? By not being timid. Describe your symptoms clearly, ask for testing if it isn't offered, and be sure you understand all your treatment options, she says.

After Betty White was finally diagnosed with a heart attack, her doctors put a stent (a small, wire-mesh tube) into an artery supplying her heart. The stent holds the damaged artery open, so as to save as much of the remaining live heart tissue as possible. "It's been a long haul since then," White says. She doesn't have the get up and go she once did, perhaps because of the reduced amount of oxygen-rich blood traveling through her body, says Goldberg.

But White hopes her story will help other women be on the lookout for heart attacks and have the courage to speak up when they feel something has been missed. "I have the feeling there are other women just like me all over the country," she says. "Sadly, a lot of them didn't live to tell the tale. So I'm speaking for all of us: This just has to stop."