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Dr. Annabelle Volgman Heart disease is the number one cause of death in women. Typically the problem arises from blockages that impede blood flow in the arteries, sometimes leading to a heart attack. Men and women share the same risk factors for heart disease: age, family history, high blood pressure, high cholesterol, diabetes, smoking, physical inactivity, obesity. But women’s arteries are smaller than men’s, and younger women tend to get dangerous blockages in their tiny arteries. “I equate that to a tree,” says Dr. Vera Rigolin, a cardiologist at Northwestern University’s Feinberg School of Medicine. Younger women more often get their arterial clogs out in the little twigs. Unfortunately, “most tests are designed to look for blockages in the big arteries, like the trunks [where the problem tends to occur in men]. We’re not very good at looking at the teeny tiny blood vessels,” says Rigolin. “If you don’t diagnose the problem, you don’t treat it.”
Symptoms can differ between men and women, too. Typically when people experience angina (chest pain that occurs when part of the heart is deprived of oxygen), they feel pressure that radiates to the left arm or to the neck. Women are much more likely than men to feel atypical symptoms, such as fatigue and shortness of breath. Because of these vague signs, sometimes women and their doctors don’t recognize the trouble. “I always tell patients the most important thing is: Does something feel different to you?” says Dr. Rupa Mehta, the medical director for the cardiac rehabilitation program at the University of Chicago Medical Center.
As women age, their coronary problems come to more closely resemble those of men. That’s partly because after menopause (12 consecutive months without a menstrual period, which a typical American experiences at age 52), women lose estrogen and their blood vessels become less elastic and don’t accommodate the surge of blood as well. “Estrogen does nice things for vasculature, makes it more supple,” says Dr. Elizabeth McNally, the director of the University of Chicago’s Institute for Cardiovascular Research. Also, cholesterol—particularly “bad” LDL cholesterol—rises in older women. Weight gain and physical inactivity can play a significant role, too, says Rigolin.
As a general rule, women fare worse when it comes to surgery to treat blockages in arteries. One reason is that they tend to be older when they get the operation; another is that their arteries—always smaller than men’s—are trickier to work with.
Some of the new findings are particularly, well, disheartening. In the past decade, the number of men with diabetes who die of heart disease has started to decline. But the number of women has not. “We usually say if somebody has diabetes that they basically have heart disease. The risk of a heart attack is the same,” says Dr. Annabelle Volgman, the medical director of the Rush Heart Center for Women. She talks to her female patients about losing weight—and about being careful to take calcium (which women often use for bone health) only with vitamin D. “If you take calcium without vitamin D, you have a 30 percent more increased risk of heart attack,” she says. One theory holds that calcium, like plaque, may build up in the arteries, and vitamin D apparently reduces the risk.
Today doctors are still trying to figure out how best to help women. For the past 15 years, Dr. Mary McGrae McDermott and her colleagues at the Feinberg School have followed men and women with peripheral arterial disease (PAD)—a condition in which cholesterol-caused plaque blocks arteries in the lower extremities. PAD patients also tend to have blockages in heart and cerebral arteries. Because of the blocked leg arteries, victims experience trouble walking even before they’ve had a heart attack. The doctors’ new data show that the mobility of female PAD patients declines faster than that of male PAD patients. This means it’s important for women to exercise and do strength training, says McDermott. “Women live longer than men, and, probably for this reason, they live longer with chronic diseases than men.”
The best preventive advice: “Stay as slim as possible,” says Volgman.
HEART DISEASE | FERTILITY | PREGNANCY | BREAST AND OVARIAN CANCER
CERVICAL AND ENDOMETRIAL CANCER | OSTEOPOROSIS
HEADACHES, MULTIPLE SCLEROSIS, AND OTHER NEUROLOGIC DISORDERS | DEPRESSION
EATING DISORDERS | INCONTINENCE | IMMUNE DISORDERS | SLEEP DISORDERS
Photograph: Taylor Castle Assistant: Ace Ujimori Hair and Makeup: Morgan Blaul