The Heart of a Woman

February was national heart month and I had a chance to attend some high-level conferences in cardiology. One of the things that struck me was the double-sided sword of woman’s cardiovascular health.

If you are man reading this please don’t stop now because this is a “woman’s article”. For centuries the stereotypical female role in Western households was to take care of the man’s health along with the rest of the family. While so many other social changes have happened and recently many more have been ignited and will surely follow, the awareness of heart disease in women is not where it should be.

So here is a simple guide for you:

  1. The incidence of pre-menopausal women who suffer from heart disease is rising while the incidence of post-menopausal women with heart disease is falling somewhat.
  2. Post and peri-menopause are STILL the high-risk times when all women and the men who love them should wake up and be proactive about more aggressive testing. Stress testing in low risk people can lead to false positives but in this population, anyone can benefit from more aggressive screening.
  3. Women do not have the same symptoms for heart disease and heart attack as men do. Extreme fatigue even in the absence of exercise, nausea and vomiting and upper back pain are considered “atypical presentations” for angina and heart attack but they are far more typical in women than the stereotypical fist in front of the chest Hollywood Heart Attack that men get. This may be because women tend to clog long segments of a heart artery while men tend to have more specific localized blocks that suddenly rupture but the bottom line is there is a difference in presentation and even anatomy in women versus men heart wise.
  4. When I graduated Medical School so many decades ago my class graduated with 53% women making up the tally. This is a tendency that has continued with the average medical school class being at least 50% women. For whatever reason these women tended to wind up in primary care areas and not in specialty areas.

Only 10% of women who graduate medical school become Cardiologists. It may seem trendy to say that this represents a gender gap but in the case of heart disease it is an important one. I am sure there are many fine male cardiologists who pay attention to the differences in heart disease between men and women.

But I think the prognosis and outcome for women would be improved if more women went into Cardiology as a sub specialty.

I am surprised with all the activism there is not a large support group out there to help correct this imbalance.

Men and Women, are you listening? The same banding together for a common good of women in other areas would work here. The AAC has a women’s section, but at 10%, women could be far better represented. Maybe you can help?!

In the meantime: Ladies and gentlemen- are you taking your fish oil

Dr. Dave

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