Knowing Your Risk Can Save Your Life
By Gina Lundberg, Illustration by Earl Keleny
During my early years in private practice, I found that women were requesting a female cardiologist, and I was getting many new referrals.
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I began to see inadequacies in the way women were treated for chest pain. I would get furious when a female patient would tell me how her doctor had dismissed her symptoms and told her she was just stressed. I heard story after story of women getting a pat on the head and being given an antidepressant or benzodiazepine for chest pain. I continued to see women get diagnosed late in their cardiac disease because their doctor did not request testing for heart disease.
Cardiovascular disease (CVD) is the single largest killer of women in the United States—one woman dies of cardiovascular disease every minute. While one in 30 women will die of breast cancer, one in three women will die of cardiovascular disease. CVD deaths in women surpass deaths from all forms of cancer, lung disease, and Alzheimer's disease combined.
African-American women are 40% more likely to die of CVD compared with white women. Yet, awareness of CVD as the No. 1 killer of women is lacking in African American and Hispanic women.
Two-thirds of women who die of heart disease have had no prior symptoms, compared with half of men having no prior symptoms. And more women than men will have a second heart attack after their first heart attack.
While deaths from heart disease in men were declining in the US between 1979 and 2003, deaths from heart disease in women remained unchanged. Only recently have we seen declines in heart disease deaths in women.
I decided to specialize in women and heart disease, with a focus on prevention, founding the first women's heart center in the state in 1998 and the first hospital-based program in 2001.
In the years since then, I have seen a 24-year-old woman who suffered an acute anterior myocardial infarction that unfortunately was misdiagnosed in the ED as gastroenteritis because she presented with nausea, vomiting, epigastric pain, and diaphoresis. Because of her age, no one ordered an EKG or cardiac enzymes. But her past medical history showed that she was a smoker on birth control pills who had low HDL cholesterol, central obesity, and elevated triglyceride levels—all known risk factors for cardiovascular disease. Sadly, her infarction progressed before I was consulted, and she now has a low ejection fraction (a measure of heart failure) and a defibrillator.
I have seen a 45-year-old woman who complained for 10 years of epigastric pain, fatigue, and shortness of breath on exertion. She finally came to me for consultation, and her EKG revealed left bundle branch block, meaning her left ventricle was contracting later than her right ventricle. Her echocardiogram confirmed dilated cardiomyopathy with an ejection fraction of 25%, when over 55% is normal. She is doing much better now with proper medical therapy and a biventricular pacemaker with resynchronization therapy.
And I've seen a 75-year-old woman with chronic angina who suffered from Parkinson's disease. Medical therapy for her angina had failed, and no one would attempt heart catheterization because she could not lie flat or stop shaking with tremor. But one of my interventional colleagues gave in to my pleading and took her to the cath lab. With sedation, she had a reduction in her tremor, and he opened her nearly totally blocked right coronary artery. She lived pain free another 10 years. She and her family were extremely grateful that we had been very driven to improve the quality and quantity of her life.
Of the more than 600 women screened at the Emory Saint Joseph's Heart Center for Women, about 40% were recommended to a cardiologist for further evaluation. Twenty percent of the screened women established care with a primary-care physician, 43% needed further evaluation for a sleep disorder, and up to 10% were recommended to follow up with a psychologist or psychiatrist for significant signs of depression. Nearly 10% were sent for further evaluation of peripheral artery disease. Using the 2011 ACC Guidelines on Prevention of Heart Disease in Women, 12% of the women screened were high risk, 43% were at risk, 43% were low risk, and less than 2% were found to be ideal risk (no risk factors.)
 Gina Price Lundberg is founder and director of the Heart Center for Women at Emory Saint Joseph's Hospital. She serves on the American College of Cardiology Foundation Prevention of Cardiovascular Disease Committee and is an American Heart Association national spokesperson. |
The Emory Women's Heart Center (EWHC) was developed in 2013, and now has six locations: Emory University Hospital, Emory East Cobb, Emory Johns Creek, Emory Midtown, Emory Decatur, and Emory Hillandale. Susmita Parashar, Ijeoma Isiadinso, Alexis Cutchins, and Farheen Shirazi are the EWHC site physicians,and four nurse practitioners provide screenings, CVD evaluation, and education of our patients.
The goals of the center are to screen and educate women on their individual risk. We also strive to educate the regional medical community about the latest information and treatment of heart disease in women. August 16, 2014, will be the eighth annual Women and Heart Disease Conference at Twelve Atlantic Station. In addition to promoting awareness and education, we encourage participation in clinical research so we will have the best evidence for treatment of heart disease in women. Women need to understand the symptoms and risk factors that can be unique to them.
The EWHC team is continuing the rich history of Emory's dedication to heart disease in women. Cardiologists Nanette Wenger, professor emeritus of medicine at Emory who received the Lifetime Achievement Award from the American College of Cardiology, and Leslee Shaw, professor of cardiology and co-director of Emory's Clinical Cardiovascular Research Institute, are pioneers and leaders in the field of heart disease in women. Both have been essential advisers to the center, and Shaw is its research director.
Most heart disease is preventable, so we want to reach women before 60 years of age, evaluate their individual risks, and educate them on risk reduction. We counsel patients on weight loss, exercise programs, diet, and other lifestyle changes, as well as help them understand how stress, obesity, depression, and menopause may impact their hearts.
I also recommend fish oil supplements to most of my patients after 50, not just for the triglyceride-lowering and cardiovascular benefits, but for the powerful antioxidant and brain-power benefits as well.
We are busy—busy at work, at home, taking care of kids and aging parents, keeping up with friends, and a million other commitments. Days and weeks fly by, without much thought to our own well-being. But your heart deserves a bit of your attention. Don't wait until it demands it.
