Heart disease is the leading cause of death for women. The numbers are alarming: one in three women die from heart disease, according to the American Heart Association, yet it’s so commonly overlooked. That disconnect is exactly what worries Sheila Sahni, MD, interventional cardiologist and director of the Women’s Heart Program at Sahni Heart Center, Hackensack Meridian Health, with locations in Clark and Eatontown.
“There’s such a critical gap, not only in women understanding that heart disease is their number one threat, but even among physicians,” Dr. Sahni says. “Primary care physicians aren’t always understanding that women are at risk.”
That knowledge gap matters, especially because women’s heart disease often looks different than it does in men and can be easier to miss. One of the biggest reasons heart disease is missed in women is that it doesn’t always follow the pattern we imagine. Most of us picture a heart attack as sudden. That’s more typical in men. In women, it’s often more subtle and harder to recognize, Dr. Sahni says.
“Women can have more of a slow erosion of the blood vessels, and that doesn’t actually end up requiring a stent,” Dr. Sahni says. “Women have often been told, ‘Oh, you didn’t have a blockage, you’re fine.’ But the reality is, they did have a heart attack, and they’re not fine.”
Conditions like microvascular disease, more common in women, don’t always show up on standard tests the same way. But they can still cause real damage to the heart. In other words, no blockage doesn’t necessarily mean no problem.
From how symptoms show up to when to seek care from a cardiologist, here are the key takeaways Dr. Sahni shared:
Symptoms can be easy to miss and dismiss
For women carrying the mental load of juggling everything and everyone else first, it can be easy to miss symptoms that need to be addressed. While chest discomfort can happen, “it might not be the predominant symptom,” she says. Instead, women may experience shortness of breath, upper back or neck pain, jaw pain, unusual fatigue, nausea or a headache or migraine. “Unlike men where the symptoms come on more like a lightning bolt, for women it can be more like a slow burn,” she says. “The symptom could be going on for days… or even weeks.”
When it comes to spotting and managing symptoms, the most important thing she urges women to do is be in tune with any changes in their bodies. “If something is not going the way it used to… note it and act on it. Don’t wait on it.”
Understand how heart disease risk changes over the years
Women’s cardiovascular risk doesn’t stay the same over time; it shifts at key stages of life, and sometimes very rapidly. Three out of 10 heart attacks in women now occur under age 55, and heart disease is the third leading cause of death for women ages 25 to 44, according to the American Heart Association’s 2016 Scientific Statement on Acute Myocardial Infarction.
That data reflects what experts describe as a “tale of two trends.” On one hand, there’s positive progress: overall, deaths from coronary heart disease have dropped significantly, falling by 39 percent between 2001 and 2011, with total deaths down by more than 25 percent. But for women ages 35 to 54, those gains have stalled and even reversed a bit, with death rates increasing by 1.5 percent more recently. So while heart disease outcomes are improving overall, younger women are increasingly at risk.
“Pregnancy is a woman’s first stress test,” Dr. Sahni says. During that time, the body is building an entirely new vascular system, and complications like high blood pressure or gestational diabetes can reveal underlying risk, she explains.
“When we start to see high blood pressure in pregnancy, it quadruples a woman’s risk for developing high blood pressure later in life… and also quadruples their risk for heart disease… developing earlier,” she says.
For many women, menopause can be another stress test on the heart. “Think about menopause as this protective shield of estrogen being taken from you,” she says. As estrogen declines, blood vessels stiffen, blood pressure rises, and cholesterol levels can quickly shift.
“We see these major risk factors change, and it can be dramatic, sometimes overnight,” she says.
Traditional risk factors hit women harder
Most women know about risk factors like high blood pressure, diabetes and smoking, but fewer realize how much more dangerous they can be for women.
“Hypertension is especially ominous for women,” Dr. Sahni says, adding that it’s the leading cause of stroke and a major driver of heart disease.
Diabetes also elevates heart disease risk. “Diabetes carries a 3 to 7 times increased risk for cardiovascular disease for women,” she says, and smoking increases heart attack risk by 60 percent more in women than men.
Most clinical trial research has historically enrolled far more men than women, which is why there is less of an understanding of a woman’s unique heart disease risk among many physicians, Sahni says. Because heart disease risk factors affect women differently, it’s critical to see a cardiologist who understands the unique ways heart disease presents in women, she says.
Burnout and stress are important risk factors
It’s no surprise that chronic stress, burnout and emotional and physical fatigue can wreak havoc on a woman’s heart health. And while that pressure is all too often normalized, it can have serious heart health consequences.
“We have to treat burnout and exhaustion just like we do blood pressure,” she says, adding that we need to be in tune with our bodies and know when it’s time to take a pause. “I don’t have a medication for burnout. You have to slow down. You have to physically tune into what’s going on.”
That’s exactly the message she’ll share at Let’s Talk Women’s Health & Wellness’ panel From Burnout to Balance on March 14, helping women recognize that chronic stress is something that needs immediate attention and action.
Don’t wait for symptoms to see a specialist
Many women assume they only need to see a cardiologist if something is wrong. They’re often told by their primary care physicians that there is no need to see a specialist unless something is obviously amiss. Dr. Sahni strongly disagrees with this guidance, stressing the importance of seeing a cardiologist.
Even if she feels fine and has no obvious symptoms, Sahni says “any woman above the age of 50 should see a cardiologist.” She often advises starting to see a cardiologist even earlier. “Women coming in at the age of 40 is actually completely reasonable.”
Why is seeing a cardiologist earlier often a good idea? For starters, things like pregnancy history that may not come up in a routine physical can be an important piece of the puzzle when it comes to assessing heart health and getting ahead of problems before they happen. “Sometimes a primary care doctor might not even know your OB history,” she says, even though those details can significantly affect risk.
Get your bloodwork done and advocate for yourself
Make sure you stay on schedule and get your blood work done regularly. Know and share your blood pressure and cholesterol numbers with your cardiologist. “Ask directly, ‘Could this symptom be my heart?’” It’s worth repeating: If something doesn’t feel right, trust your gut. “Don’t be afraid to get a second opinion… it’s persistence that really saves lives.”
Know that small daily habits can make a big difference
Beyond staying on top of annual physicals, getting bloodwork done and seeing a cardiologist when the time is right, there are many habits you can easily adapt within your day that can go a long way towards protecting your heart.
For starters, “Twenty minutes of walking every day can significantly reduce your cardiovascular disease risk,” Dr. Sahni says.
Healthy eating is obviously also important. Dr. Sahni recommends a plant-forward approach and a simple way to think about it is: “Is it clean? Is it lean? Is it green?”
Focusing on vegetables, whole grains and fiber-rich foods can help lower cholesterol and support long-term heart health, she says.
Be wary of certain supplements
All too often, Dr. Sahni sees patients jump through hoops to avoid taking a statin. Instead, they will try a supplement to treat and lower cholesterol.
Some “supplements are extremely dangerous, particularly the supplements that will tell you they’re going to lower cholesterol,” she says.
In many instances, she has seen patients with good cholesterol levels who still have advanced heart disease because the underlying issue wasn’t treated. “The supplement lowered the number, but did not actually do anything to the plaque,” she explains.
Medications like statins, on the other hand, have been studied extensively and can stabilize plaque. Of course, every case is unique depending on a patients’ individual numbers and history, Sahni says, but it’s important to understand when statins can play an important role in lowering your heart disease risk. “Patients who are statin averse are really denying themselves a life-saving medication,” she says.
Dr. Sahni will be speaking about reclaiming your energy through preventive health and more at Let’s Talk Women’s Health & Wellness on March 14th at NJPAC in Newark. For more information about the symposium and to get tickets, click here and use promo code NJFAMILY30 for a 30 percent discount on tickets.
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