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Women’s heart disease ‘understudied, underdiagnosed, undertreated,’ says AMA

Dr. Stacey Rosen, vice president of women's health

Dr. Stacey Rosen, vice president of women's health at Northwell Health in Lake Success, left, and Dr. Suzanne R. Steinbaum, director of women's heart health at Northwell-Lenox Hill Hospital in Manhattan applauded the association's statement. Photo Credit: Northwell Health

Women are “understudied, underdiagnosed and undertreated” when it comes to heart disease, according to a landmark statement in a major medical journal.

The American Heart Association, in its weekly journal Circulation, noted that women are more likely to die of cardiovascular disease than cancer and sought to dispel the myth that women and men experience identical heart attack symptoms.

The so-called “Hollywood heart attack” — sudden pain and pressure likened to an elephant seated on your chest — defines a male heart attack, but does not come close to the vague constellation of symptoms experienced by women, doctors said Tuesday.

Harbingers of a heart attack in women may be shortness of breath, flu-like symptoms, back pain or persistent jaw pain, nausea, vomiting and intense perspiration, they said.

The statement by a team of physicians is expected to have a broad impact throughout the medical community.

“Absolutely pleased to see it,” Dr. Stacey Rosen, vice president of women’s health at Northwell Health in Lake Success, said of the heart association’s new stance.

Some of her patients actually had sought dental treatment, Rosen said, unaware their jaw pain signaled a severely blocked coronary artery.

She noted several past studies have shown women sometimes do not get appropriate treatment in emergency rooms because their symptoms differ from the male archetype. Moreover, they are not always offered the battery of diagnostic tests provided their male counterparts.

Studies in this country and abroad have shown that women do not always receive optimum follow-up care even after treatment for a heart attack or other cardiovascular problem, Rosen said.

“Women are less likely to be recommended for cardiac rehab,” she said.

In terms of biology, Rosen pointed out that arterial plaque forms differently in men and women, a gender variation that doctors started to appreciate only in recent years.

Dr. Laxmi Mehta, lead author of the heart association’s statement, agreed that the disparity in cardiac care between the genders runs long and deep. She and her colleagues also found that women have longer hospitalizations following a heart attack and other cardiovascular problems, mainly because women are older and sicker when disorders emerge.

As a result, the statement noted, women have an enhanced likelihood of complications and a 30 percent greater chance of being rehospitalized within 30 days of discharge. Women also are more likely to die of heart disease than men, the statement said.

“Over the last 10 years or so, we’ve learned that women’s hearts are different than men’s in some significant ways, and while that’s helped reduce mortality, there’s much more to know,” said Mehta, director of the Women’s Cardiovascular Heart Program at Ohio State University’s Wexner Medical Center.

At South Nassau Communities Hospital in Oceanside, cardiologist Dr. Pilar Stevens-Cohen said she has been aware for years of cardiac differences between the genders and has told her female patients that they should not take their symptoms lightly.

“I always tell my patients that it’s not the typical man clutching his chest” that signals a heart attack in women, she said, “but the generalized fatigue and sweating.”

For these patients, Stevens-Cohen said she orders a cardiac enzyme test to check for a heart attack.

Dr. Suzanne R. Steinbaum, director of women’s heart health at Northwell-Lenox Hill Hospital in Manhattan, said she hopes the association’s statement helps erase disparities in diagnosis and treatment of heart disease in women.

“Women traditionally have been more afraid of developing cancer. Heart disease needs to be at the top of the agenda,” Steinbaum said. “Women have a 1 in 33 chance of dying of breast cancer, but a 1 in 3 chance of dying of heart disease.”

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